Ultrasound in the Critically Ill: A Practical Guide

327 Pages·2022·12.549 MB·English

by  Andrew Walden, Andrew Campbell, Ashley Miller, Matthew Wise

Ultrasound in the
Critically Ill
A Practical Guide
Andrew Walden
Andrew Campbell
Ashley Miller
Matthew Wise
Editors
123
Ultrasound in the Critically Ill
Andrew Walden Andrew Campbell
(cid:129) (cid:129)
Ashley Miller Matthew Wise
(cid:129)
Editors
Ultrasound in the Critically
Ill
A Practical Guide
123
Editors
AndrewWalden AndrewCampbell
Intensive CareUnit Department ofCritical Care Medicine
RoyalBerkshire Hospital WrexhamMaelor Hospital
Reading, Berkshire, UK Wrexham, UK
AshleyMiller MatthewWise
Department ofAnaesthetics AdultCritical Care
Shrewsbury andTelford University Hospital of Wales
Hospital NHSTrust Cardiff, UK
Shrewsbury, UK
ISBN978-3-030-71740-7 ISBN978-3-030-71742-1 (eBook)
https://doi.org/10.1007/978-3-030-71742-1
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Preface
Historically, ultrasound has been delivered as a department-based diagnostic
intervention within the radiology, cardiology and obstetric departments. As
machines were often large and cumbersome, patients had to attend those depart-
ments for the examination to be performed. Rigorous training and governance
structures developed to ensure a thorough and consistent approach among radiog-
raphers, obstetric sonographers and cardiac technicians. This system is very good
forambulatorypatientsinwhichacomprehensiveassessmentisrequired;however,
for acutely unwell patients who may require intensive monitoring, oxygen therapy
or organ support, this is not such a practical approach.
With the increased portability and usability of ultrasound machines, a new
approach has developed where the machine comes to the patient rather than the
other way round. This Point of Care approach to ultrasound has led to whole new
areas of ultrasound examination and clinical decision-making. The time constraint
on a clinician caring for a sick patient means that the comprehensive departmental
use of ultrasound is replaced by a more abbreviated technique designed to answer
specific questions, often in a dichotomous way and as an extension of clinical
assessment and examination. Ruling in or ruling out certain pathologies can be
invaluable in the deciding of patient triage, further investigations and the need for
intervention or surgery.
Another advantage of point of care ultrasound over departmental ultrasound is
the ability to look at dynamic changes in physiology following interventions. For
instance,theeffectofafluidbolusoncardiacoutputorhowarecruitmentmaneuver
in a mechanically ventilated patient leads to improved lung aeration.
The use of point of care ultrasound has undoubtedly led to reduced morbidity
around interventional procedures such as paracentesis, central venous cannulation
and thoracocentesis.
One counterpoint to this flourishing of point of care ultrasound is the issue of
training and competence. Sonographers and radiographers have to spend a long
timetrainingtoensuretheyseetherangeofpathologytobeabletosafelydiagnose
certain pathologies. Cognisant of this, clinicians have developed training curricu-
lums with theoretical and practical modules to allow accreditation in a particular
v
vi Preface
area of point of care ultrasound. Notably, within the United Kingdom, the Royal
College of Radiologists has developed guidelines for non-radiology specialties
(https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr173_
ultrasound_training_med_surg.pdf). In addition, several professional bodies
have also developed similar guidelines and curriculums, e.g. Focused Acute
Medicine Ultrasound (http://famus.org.uk/) and
Focused Ultrasound in Intensive Care (https://www.ics.ac.uk/ICS/FUSIC/ICS/
FUSIC/FUSIC_Accreditation.aspx?hkey=c88fa5cd-5c3f-4c22-b007-53e01a523ce8).
Thisbookisaimedatallfrontlinestaffwhoarelookingtouseultrasoundintheir
clinical practice totrytoimprovethecare ofacutelyandcritically illpatients. The
bookislaidoutintwosections.Thefirstsectionattemptstotakeacomprehensive
approachtospecificsystemsofexaminationtakinganorgan-focusedapproach.The
second part of the book attempts to pull those chapters together by looking at
specific clinical scenarios.
Wehopethereaderofthisbookendsupwiththesamedegreeofenthusiasmthat
eachoftheeditorshaswithrespecttopointofcareultrasoundandhowitimproves
the care of our patients.
Reading, UK Andrew Walden
[email protected]
Wrexham, UK Andrew Campbell
Shrewsbury, UK Ashley Miller
Cardiff, UK Matthew Wise
Contents
1 Physics of Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Martin R. Dachsel
2 Preparation and Image Optimisation . . . . . . . . . . . . . . . . . . . . . . . 15
Martin R. Dachsel
3 Clinical Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Sonya Daniel and Tom Holmes
4 Airway Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Michael S. Kristensen and Wendy H. Teoh
5 Basic Lung Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Luna Gargani
6 Advanced Lung Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Giovanni Volpicelli, Annia Schreiber, and Enrico Boero
7 Focused Transthoracic Echocardiography . . . . . . . . . . . . . . . . . . . 67
Thomas Clark
8 Advanced Transthoracic Echocardiography . . . . . . . . . . . . . . . . . . 75
Susanna Price
9 Transoesophageal Echocardiography . . . . . . . . . . . . . . . . . . . . . . . 95
Farhan T. Husain and Maria-Magdalena Gurzun
10 FAST Scanning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Jane Brenchley
11 Renal Tract Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Hefin Jones
12 Abdominal Ultrasound—Liver, Spleen and Biliary Tree. . . . . . . . . 159
James M. Pilcher and Pawan Patel
vii
viii Contents
13 Abdominal Ultrasound—Bowel and Peritoneum. . . . . . . . . . . . . . . 209
James M. Pilcher and Pawan Patel
14 Vascular Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Manik Chandra and Andrew Bodenham
15 Venous Sonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Eugene Tabiowo
16 Neuro-ophthalmic Ultrasound. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Claire Shevlin
17 Cranial Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Claire Shevlin
18 Musculoskeletal Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Kausik Mukherjee
19 The Haemodynamically Unstable Patient . . . . . . . . . . . . . . . . . . . . 279
Ashley Miller
20 The Polytrauma Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Liza Keating
21 The Patient with Acute Breathlessness . . . . . . . . . . . . . . . . . . . . . . 299
Thomas Clark
22 The Patient Difficult to Wean from Mechanical Ventilation . . . . . . 305
Andrew Walden and Karim Fouad Alber
23 The Patient with Acute Kidney Injury . . . . . . . . . . . . . . . . . . . . . . 315
James H. Briggs
24 The Patient with Acute Abdominal Pain. . . . . . . . . . . . . . . . . . . . . 321
Andrew Campbell and Poonam Mohan Shenoy
Contributors
Karim Fouad Alber Royal Berkshire Hospital, Reading, UK
Andrew Bodenham Department of Anaesthesia, Leeds Teaching Hospitals NHS
Trust, Leeds, West Yorkshire, UK
EnricoBoero AnesthesiologyandIntensiveCare,SchoolofMedicine,University
of Torino, Torino, Italy
Jane Brenchley Department of Emergency Medicine, Royal Berkshire Hospital,
Reading, Berkshire, England
James H. Briggs Royal Berkshire Hospital, Reading, Berkshire, UK
Andrew Campbell Department of Critical Care Medicine, Wrexham Maelor
Hospital, Wrexham, UK
Manik Chandra Department of Anaesthesia, Leeds Teaching Hospitals NHS
Trust, Leeds, West Yorkshire, UK
Thomas Clark Department of Critical Care, Torbay and South Devon NHS
Foundation Trust, Torquay, UK
Martin R. Dachsel Acute Medicine, East Surrey Hospital, Redhill, Surrey, UK
Sonya Daniel University Hospital of Wales, Cardiff, UK
Luna Gargani Cardiologist, Senior Researcher of the Institute of Clinical
Physiology - National Research Council, Pisa, Italy
Maria-Magdalena Gurzun Department of Anaesthesia, Swansea, West
Glamorgan, UK
Tom Holmes University Hospital of Wales, Cardiff, UK
Farhan T. Husain Department of Anaesthesia, Swansea, West Glamorgan, UK
ix
x Contributors
Hefin Jones Consultant in Radiology, University Hospitals of North Midlands,
Stoke-on-Trent, Staffordshire, UK
Liza Keating Intensive Care Unit, Royal Berkshire Hospital, Reading, UK
Michael S. Kristensen Rigshospitalet, Copenhagen Ø, Denmark
AshleyMiller DepartmentofAnaesthetics,ShrewsburyandTelfordHospitalsNHS
Trust, Shrewsbury, UK
Kausik Mukherjee Department of Radiology, University Hospital of Wales,
Wales, UK
Pawan Patel Locum Consultant, Consultant Radiologist, St George’s University
Hospitals NHS Foundation Trust, Tooting, London, UK
JamesM.Pilcher ConsultantRadiologist,StGeorge’sUniversityHospitalsNHS
Foundation Trust, Tooting, London, UK
Susanna Price Cardiologist & Intensivist, Royal Brompton Hospital, London,
UK;
National Heart & Lung Institute, Imperial College, London, UK
AnniaSchreiber RespiratoryIntensiveCareUnit,SalvatoreMaugeriFoundation,
Pavia, Italy
Poonam Mohan Shenoy Department of Radiology, Wrexham Maelor Hospital,
Wrexham, UK
Claire Shevlin Intensive Care Unit, Craigavon Area Hospital, Portadown,
Northern Ireland, UK
Eugene Tabiowo Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, Wales,
UK
Wendy H. Teoh Private Anaesthesia Practice, Wendy Teoh Pte. Ltd., Singapore,
Singapore
Giovanni Volpicelli Department of Emergency Medicine, San Luigi Gonzaga
University Hospital, Torino, Italy
Andrew Walden Royal Berkshire Hospital, Reading, UK