Category Archives: Ultrasound

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

Basic Echocardiography Masterclass at LIVES2019

Basic Echocardiography Masterclass at LIVES3019

Here an infographic with some tips about running a (basic) point-of-care cardiac ultrasound study in the critical care patient. The 5 main views:

parasternal long axis – PLAX

parasternal short axis – PSAX (mitral valve, papillary muscles, apex & great vessels level)

apical 4 chambers – A4C

apical 2 chambers – A2C

subcostal (4 chambers and vena cava views)

are summarised with advices in probe positioning in order to find the acoustic window, and some notes about the data potentially achievable, regarding LV, RV, pericardial fluid, volume status & others. Enjoy and follow #LIVES2019 hashtag on twitter for full virtual access to the annual ESICM congress.

graphics Marta Velia Antonini @FOAMecmo
echocardiographic scans Jonny Wilkinson @Wilkinsonjonny criticalcarenorthampton.com
content based on A. McLean & Y. Beaulieu class at #LIVES2019

ESICM Webinar – FOCUS on #POCUS

*This webinar was kindly sponsored by GE*

We would love to hear from you and any feedback/questions would be welcomed. OR if you want to find out more about #POCUS fellowships……

The presentation….

https://www.icloud.com/keynote/0TjTY6dm-GTqkL_YCFewLu4kA#ESICM_webinar

Reference list

What is #POCUS

Lichtenstein D, van Hooland S, Elbers P et al. Ten good reasons to practice ultrasound in critical care. 

Lichtenstein D and Mezière G (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-protocol. 

Perera P, Mailhot T, Riley D et al. The RUSH exam: Rapid ultrasound in shock in the evaluation of the critically ill. 

Lichtenstein D.A. Lung Ultrasound as the First Step of Management of a Cardiac Arrest: The SESAME-Protocol. In: Lung Ultrasound in the Critically Ill. Springer, 2016 Cham

Training in #POCUS

Malbrain MLNG, De Tavernier B, Haverals S et al. Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU). 

Mayo P, Beaulieu Y, Doelken P et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. 

Expert Round Table on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. 

Wong A, Galarza L and Duska F. Critical Care Ultrasound: A systematic review of international training competencies and program. 

Galarza L, Wong A and Malbrain M. The state of critical care ultrasound training in Europe: A survey of trainers and a comparison of available accreditation programmes. 

Future of #POCUS

Robba C, Goffi A, Geeraerts T et al. Brain ultrasonography: methodology, basic and advanced principles and clinical application. A narrative review. 

Aitkinson P, Beckett N, French N et al. Does point-of-care ultrasound use impact resuscitation length, rates of intervention and clinical outcomes during cardiac arrest? A study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. 

Feng M, McSparron JI, Kien Dt et al. Transthoraccic echocardiography and mortality in sepsis: analysis of MIMIC-III database.

If you are REALLY interested in pushing the limits of ultrasonography in critical care … https://thinkingcriticalcare.com/

Recommended textbooks