Role of ultrasound in ICU


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Role of ultrasound in ICU

  1. 1. Role of ultrasound in ICU Ashraf Nasief, MD.
  2. 2. Ultrasound in the field of critical care • The use of ultrasound has expanded enormously over the last two decades in critical care research and practice. Despite the fact that the method is operator dependent . It has many advantages, it enables clinicians for rapid, by-the-bed, relatively inexpensive, can be repeated, and save diagnostic evaluation of unstable patients.
  3. 3. Types of probes
  4. 4. B-mode VS m-mode • B-mode or 2D mode (brightness mode): a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. • M-mode (motion mode): pulses are emitted in quick succession – each time B-mode image is taken. Over time, this is analogous to recording a video in ultrasound. As the organ boundaries that produce reflections move relative to the probe, this can be used to determine the velocity of specific organ structures.
  5. 5. Examples 0f use of US in ICU • 1- Assessment of volume status • 2- US of the lung • 2- Diagnosis of pneonumothorax, hemothorax and pleural effusion. • 3- Vascular access • 4- proper endotracheal intubation • 5 – prediction of post-extubation stridor • 6- Assessment of the diaphragm. • 7 differential diagnosis of shock
  6. 6. Assessment of volume status • The 2008 ACEP Policy Statement on Emergency Ultrasound Guidelines includes the evaluation of intravascular volume status and estimation of central venous pressure (CVP) based on sonographic examination of the inferior vena cava (IVC). • ACEP Policy Statement on Emergency Ultrasound Guidelines. Ann. Emerg. Med. 2009;53:550-70.
  7. 7. Can US give us a rapid answer to this question Does this patient need fluid??
  8. 8. How to examine?
  9. 9. Cross section appearance
  10. 10. Normal IVC
  11. 11. Total collapse of IVC
  12. 12. Using the M-mode
  13. 13. Normal M-mode
  14. 14. Caval index • IVC expiratory diameter - IVC inspiratory diameter /IVC expiratory diameter × 100 = caval index (%). • 0%________________________________ 100% Volume Volume overload depletion
  15. 15. The aorta in a 8 yrs child
  16. 16. Caval /aorta index
  17. 17. Different values Measuring the IVC/Ao irrespective to the respiratory cycle has made the study simpler and patient specific, and does not necessitate looking at reference values for each age group. The mean IVC/Ao in patients euvolemic is 1.2 ± 0.12 SD, hypovolemic is 0.7 ± 0.09 SD, and volume overloaded is 1.6 ± 0.05 SD, respectively.
  18. 18. Pneumo and hemothrax Ouellet J-F et al., The sonographic diagnosis of pneumothorax. J Emerg Trauma Shock. 2011 Stone MB et al., The heart point sign: description of a new ultrasound finding suggesting pneumothorax. Acad Emerg Med. 2010 seahore- sign stratosphere- sign M- mode, sliding lung sign comet- trail- artifacts reverberations B- mode
  19. 19. How to examine
  20. 20. Ultrasound areas.
  21. 21. Normal lung
  22. 22. Normal lung
  23. 23. pneumothorax
  24. 24. Seashore apperance
  25. 25. M-mode in normal and pneumothorax Seashore Stratosphere
  26. 26. How to examine
  27. 27. Hemothorax
  28. 28. Rt pleural effusion
  29. 29. RT pleural effusion
  30. 30. Lt pleural effusion
  31. 31. The problem of pediatrics • There are no established age-wise norms for diaphragmatic excursions. Diaphragmatic excursion less than 4 mm, paradoxical movement, and difference of more than 50% between excursions of the hemidiaphragms at M-mode US are diagnostic of unilateral paralysis.
  32. 32. Diaphragmatic paralysis in a 7-month- old child
  33. 33. An advice of 2 steps 1- When I was a child I talked like a child I thought like a child I reasoned like a child When I became a man I put childish ways behind me 2- Now I see but a poor reflection . Then I shall see face to face Now I know in part Then I shall know fully.
  34. 34. Summary • Ultrasound is a very useful tool in the field of ICU and critical care medicine. • Ultrasound machine should be available in every ICU and emergency department. • We should encourage ICU and critical care physicians for the use of US by adequate training.
  35. 35. Thank you