Category Archives: Ultrasound

Consolidation on Lung Ultrasound

The 7 principles of Lung Ultrasound in the Critically Ill LUCI and echographic diagnosis of lung consolidation in this LIVES2019 infographic!

1 – a simple equipment is the best

2 – thorax is a mingling of air (gas) and water (fluids)

3 – lung is the most voluminous organ: here some advices on where to apply the probe?

4 – all arises from pleural line

5 – LUCI is the science of artifacts

6 – Lung: is a vital organ

7 – Most life-threatening disorders reach the wall and and have usually extensive surface

Why and how looking for consolidation?? here the Blue protocol with its profiles and some notes on the Pink protocol. How to distinguish between translobar and non translobar consolidation? Do we have an obstructive atelectasis or it’s just compression? take a look…

graphics by Marta Velia Antonini @FOAMecmo

content based on Daniel Lichtenstein masterclass at #LIVES2019

 

Renske chats with Jim Watchorn and Sam Hutchings about the kidney! At #LIVES2019

 

ABSTRACT

All adult intubated patients in critical care were eligible for inclusion using an emergency waiver of consent. A minimum of four standardized video clips were taken by an investigator using an incident dark field (IDF) video-microscope (Cytocam, Braedius Medical, NL) who subsequently calculated a POEM score and recorded the time taken. On completion a second investigator blinded to the results of the first repeated this process. At a later stage (>1 month) investigators re-scored their own and their co-investigators images. Scores were analysed using Cohens weighted Kappa score to provide intra-user, inter-user and test-retest reliability. A kappa statistic was also calculated for test-retest reliability for POEM score 1-3 against POEM score 4-5 which is the threshold for fluid administration used in an ongoing interventional study (Clinical Trials.gov  ID).

Advanced Critical Care Echocardiography Course- Day 1

Introduction (De Backer)

Consensus statement on training in 2014 https://www.ncbi.nlm.nih.gov/pubmed/24615559  – this is the basis of the ESICM’s European Diploma in advanced critical care EchoCardiography (EDEC) https://www.esicm.org/education/edec-2/

CICM Levels of training https://onlinelibrary.wiley.com/doi/full/10.1002/ajum.12127

So what does advanced CCE measure compared to basic?

-Colour doppler looking at flow patterns and valvular lesions,

-spectral doppler for quantifying valvular abnormalities, measuring cardiac output and measuring intracardiac pressures

-Heart lung interactions

TEE is recommended as essential in EDEC

 

TOE Views (Vieilland- Baron)

http://www.echo-rea.uvsq.fr/echocardiographie-en-reanimation/langue-en/open-educational-resources/the-most-common-echocardiographic-views/03-transesophageal-echocardiography-the-most-common-views-248923.kjsp?RH=1354638851042

Practice online with the Toronto Virtual TEE simulator http://pie.med.utoronto.ca/tee/

LV Systolic function- Vieillard-Baron

-LV Dilation suggests a chronic injury

-LV Systolic dysfunction does not mean cardiogenic pulmonary oedema

-LV systolic function is a combination of contractility and afterload

-RWMA is ischaemia until proven otherwise

LV Systolic Function- Vignon

At the advanced level we are going way beyond “eyeballing” ejection fraction…

 

LV Systolic function- Dessap

Assess in all views:

Visual impression
LV EF (Ideally Simpson’s method of discs)
LV FAC

Don’t forget the importance of afterload!
Good images can be obtained with TTE 90% of the time.

If you are still struggling, strain is becoming more widely available…

LV Diastolic function- McLean

This is an area without much evidence in the critically ill…

ASE recommendations for LV diastolic dysfunction https://asecho.org/wp-content/uploads/2016/03/2016_LVDiastolicFunction.pdf

Applications of diastolic dysfunction guidelines in sepsis https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-017-0342-x

How to measure Diastolic function- Slama

This is really hard!

Problem with these tools is that mitral flow/pulmonary venous flow/Propagation velocity are all rather load dependent
Ea (e’) is probably least of these

EDEC Accreditation structure (De Backer)

Register here https://www.esicm.org/education/edec-2/

Pericardial disease and echo (Paul Mayo)

Twitter thread here https://twitter.com/iceman_ex/status/1177950552526864384

Whatever you do don’t forget that tamponade is a CLINICAL diagnosis!!

Many thanks to all the amazing speakers for sharing their knowledge.

Diagnosing pneumothorax and lung effusion on Lung Ultrasound

Here a couple of infographics on bedside lung ultrasound…                                                                  first one refers to diagnosing pneumothorax, with an introduction of basic definitions on lung ultrasound (ie pleural line, pleural sliding, A/B lines, lung pulse):

1  suspecting pneumothorax in the absence of lung sliding

2 signs which confirm or rule out PTX diagnosis

3 how to look for lung point

Second infographics relates to pleural effusion:

1 diagnosing effusion on 2D and M-mode lung ultrasound

2 localize effusion & define its expected nature

3 easily & quickly quantify pleural effusion to understand if it has to be evacuated

4 if drainage is needed, POCUS could assist or guide chest tube insertion, and support continuous monitoring of the effusion, to evaluate drain effectiveness.

At the end, some tips to choose the right probe for LU & some suggested readings, enjoy!

graphics by Marta Velia Antonini @FOAMecmo                                                                                    content based on Belaïd Bouhemad masterclass at #LIVES2019