Cables lying on the floor favor the risk of a machine tipover when suddenly mobilized. Problems occur when each of these small difficulties is added to each other.
Whole body ultrasonography in the critically ill
Each probe provides fractional data abdominal probe for pleural-alveolar characterization, cardiac probe for posterior analysis in challenging patients, vascular probe if others cannot show lung-sliding, abdominal again for assessment of artifacts length, etc. Most microconvex probes found in laptop machines do not have the resolution or range of ours.
Machines with lag between real-time and M-mode can confuse young or stressed users. Physicians also should check that their cardiac probes are able to document lung sliding in all conditions skinny patients, dyspnea, etc. This section was an opportunity to emphasize the interest of our universal probe among others [ 56 ]. We think each user, even expert, should try similar systems, at least once. A perspective is holistic when the relevance of each of its multiple element can be understood only if integrated with the others.
Lung ultrasound makes ultrasound a holistic discipline, as partially seen in the previous section. Lung ultrasound can be used without complex adaptation from the intensivist to anesthesiologists, pediatricians, neonatal intensivists, emergency physicians, and others cardiologists, pulmonologists, nephrologists, etc. The lung is a common target in these disciplines. The signs assessed using CT in adults are found without difference in critically ill neonates [ 58 , 59 ].
Whole Body Ultrasonography in the Critically Ill / Edition 1
The unit is easily affordable, generating huge cost-cutting [ 39 ]. These potentials are applicable from sophisticated ICUs to more basic settings on Earth. Lung ultrasound complements poor cardiac windows: B-profile shows pulmonary edema, A-profile hypovolemia, schematically. Painful blood gas analyses become less relevant. Lung ultrasound is not really ultrasound i. Just two signs are sufficient to define the normality lung-sliding, A-lines.
Lichtenstein, Daniel A.
This potential allows us to reconsider usual priorities. Once the physicians operational for life-saving protocols BLUE-protocol, FALLS-protocol , they can quietly learn comprehensive echocardiography during as long time as necessary. All intensivists prefer the least invasive tool, all else being equal. CT has a high accuracy but severe drawbacks: cost a real problem for most patients on Earth , transportation of critically ill patients, delay between CT and the resulting therapy, renal issues, anaphylactic shock, mainly high irradiation [ 64 , 65 ].
Ultrasound has quite similar performances to CT [ 12 , 17 , 20 , 30 , 37 ], being on occasion superior: better detection of pleural septations, necrotic areas [ 66 ], real-time measurement allowing assessment of dynamic signs: lung-sliding, air bronchogram [ 67 ], diaphragm [ 68 , 69 ].
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Pleural effusions can be quantified [ 14 , 70 - 72 ]. Lung consolidation can be monitored, which is useful for those who want to increase end-expiratory pressure [ 73 ]. The volume and progression of a pneumothorax are monitored using the lung-point location [ 34 , 37 , 38 ].
Lung ultrasound will favor programs allowing decrease in bedside radiographs and CTs in the next decades. Dressings and subcutaneous emphysema make unsuperable limitations. Exceptional cases provide difficult interpretation, even for experts. Is lung ultrasound easy? Some experiences show high interobserver agreement [ 13 ]. A burgeoning literature, up to a consensus conference [ 74 - 88 ], seems to confirm this accessibility.
A scientific assessment of the learning curve remains to be done, not in volunteers creating a selection bias , but in unselected physicians. Care should be taken to confide training to experts choosing simplicity, although one can practice lung ultrasound with any machine, any probe, any teaching approach. Our work was mainly to provide standardized signs, a major advantage of lung ultrasound, because the risk of wrong interpretations is highly decreased.
Lung ultrasound allows fast, accurate, bedside examinations of most acute respiratory disorders. It enables a pathophysiological approach to circulatory failure. Simplicity is providentially found at this vital organ. The versatility of lung ultrasound heralds a kind of visual medicine, a priority in intensive care as well as many other disciplines and settings [ 89 ]. National Center for Biotechnology Information , U. Journal List Ann Intensive Care v. Ann Intensive Care. Published online Jan 9. Daniel A Lichtenstein 1. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Daniel A Lichtenstein: rf. Received Jul 4; Accepted Nov This article has been cited by other articles in PMC. Abstract Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. Keywords: Lung ultrasound, Acute respiratory failure, Acute circulatory failure, Pulmonary oedema, Pulmonary embolism, Pneumonia, Pneumothorax, Interstitial syndrome, Fluid therapy, Haemodynamic assessment, Intensive care unit. Lung ultrasound in the critically ill The possibility of exploring the lung using ultrasound, at the bedside and noninvasively, is gaining popularity among intensivists.
Seven principles of lung ultrasound 1 Lung and critical ultrasound is performed at best using simple equipment. Ten signs The Japanese microconvex probe we use is directly applied to the intercostal space. Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Clinical applications of lung ultrasound in the critically ill How can lung ultrasound become a daily tool for the intensivist?
The approach to acute respiratory failure: the BLUE-protocol Acute respiratory failure is a life-threatening condition whose cause is sometimes difficult to recognize immediately. Figure 8. Hemodynamic assessment of circulatory failure using lung ultrasound: FALLS-protocol Acute circulatory failure is associated with high mortality.
Cardiac arrest: the opportunity for technical considerations Ultrasound plays a major role when showing reversible causes. Lung ultrasound: a holistic discipline A perspective is holistic when the relevance of each of its multiple element can be understood only if integrated with the others. Multifaceted tool Lung ultrasound can be used without complex adaptation from the intensivist to anesthesiologists, pediatricians, neonatal intensivists, emergency physicians, and others cardiologists, pulmonologists, nephrologists, etc.
Attractive tool Lung ultrasound is not really ultrasound i. Solution to the issue of growing irradiation All intensivists prefer the least invasive tool, all else being equal. Limitations Dressings and subcutaneous emphysema make unsuperable limitations. Review, conclusions Lung ultrasound allows fast, accurate, bedside examinations of most acute respiratory disorders. Competing interest The author declares that he has no competing interests. Influence of positive end-expiratory pressure on left ventricle performance. New Engl J Med.
Les ultrasons, leur application au diagnostic. Presse Med. Value of portable real-time ultrasound in the intensive care unit.
Crit Care Med. New York: McGraw-Hill; Diagnostic procedures in respiratory diseases; pp. Lung imaging in the adult respiratory distress syndrome: current practice and new insights. Intensive Care Med. Intensive use of general ultrasound in the intensive care unit a prospective study of consecutive patients Intensive Care Med. Paris: Springer; Crit Ultrasound J. Whole body ultrasonography in the critically ill. Whole Body Ultrasonography in the Critically Ill. Classification of artifacts; pp. Reflected ultrasound in the detection and localisation of pleural effusion.
Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Comparative diagnostic performances of auscultation, chest radiography and lung ultrasonography in ARDS. Pleural effusion volume; pp. The air bronchogram: sonographic demonstration. Am J Rontgenol. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis. Ultrasound diagnosis of alveolar consolidation in the critically ill.
Lung consolidation; pp. Rev Im Med. The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Radiology in heart disease. Br Med J. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. The comet-tail artifact, an ultrasound sign ruling out pneumothorax. Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. J Ultrasound Med. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water.
Am J Cardiol. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Diseases of the thorax. Vet Clin North Am. A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding.
Thoracic ultrasound diagnosis of pneumothorax. J Trauma.
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Diaphragm; pp. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department.
The lung point: an ultrasound sign specific to pneumothorax. Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-protocol. Ultrasound diagnosis of occult pneumothorax. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation. A comparison with CT scanning.
The lung pulse: an early ultrasound sign of complete atelectasis. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. BLUE-protocol; pp. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill.
Pulmonary edema. Over the past two decades it has been increasingly recognized that whole-body ultrasound is an invaluable tool in the critically ill. In addition to offering rapid whole-body assessment, it has the advantage of being a bedside approach that is available at all times and can be repeated at will.
Accordingly, it permits the immediate institution of appropriate therapeutic management. Whole-Body Ultrasound in the Critically Ill is the sequel to the author's previous books on the subject, which were first published in French in and and in English in This new volume reflects the latest state of knowledge by including a variety of improvements, revised definitions, and updated algorithms.
Findings in respect of individual organs are clearly presented, and a particular feature is the in-depth coverage of the lungs, traditionally regarded as an area unsuitable for ultrasound. Throughout, the emphasis is on the practical therapeutic impact of the technique. Its value in a variety of settings, including unexplained shock, management of hemodynamic instability, acute respiratory failure the BLUE protocol , and the critically ill neonate, is carefully explained. Interventional ultrasound and less widely recognized applications, such as mesenteric infarction, pneumoperitoneum, and intracranial hypertension, are also described.
Pitfalls of the technique receive due attention. Today, whole-body ultrasound touches upon every area of critical care. This book, from the chief pioneer in the field, shows that the technique enables critical care physicians to detect therapeutically relevant signs easily and quickly.
It will serve as an invaluable guide to the practice of a form of visual medicine. Its value in a variety of settings, including unexplained shock, management of hemodynamic instability, acute respiratory failure the BLUE protocol , and the critically ill neonate, is carefully explained.
Interventional ultrasound and less widely recognized applications, such as mesenteric infarction, pneumoperitoneum, and intracranial hypertension, are also described. Pitfalls of the technique receive due attention. Today, whole-body ultrasound touches upon every area of critical care. This book, from the chief pioneer in the field, shows that the technique enables critical care physicians to detect therapeutically relevant signs easily and quickly.
It will serve as an invaluable guide to the practice of a form of visual medicine.
- Wiener Blut (Vienna Blood), Op. 354 (Cello Part) - - Op. 354.
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