The use of ultrasound in the critically ill patient

Czech version

Authors: M. Balík
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny VFN, Praha
Published in: Anest. intenziv. Med., 19, 2008, č. 1, s. 54-61
Category: Intensive Medicine

Overview

The availability of an ultrasound device in the critical care setting significantly enhances the diagnostic options and makes the management of critically ill patients more effective. A growing number of papers confirm that qualified intensivists can provide accurate, safe and extensive diagnosis of the haemodynamic system with the aid of echocardiography. An examination of the lungs and pleural space and a quantification of the pleural fluid and eventual exclusion of an anterior pneumothorax should be an integral part of the transthoracic echocardiographic examination. Interrogation of the abdomen in sepsis of unknown origin, acute abdominal syndrome or in acute renal failure may direct further diagnostic and therapeutic steps in the critically ill patient. The time factor is particularly important during the admission of severe trauma and multiple trauma where the patient´s survival depends on a correctly launched diagnostic algorithm. Ultrasound plays a key role here. Interrogation with a linear probe helps before performing a percutanneous dilatational tracheostomy. The same technique may locate a central vein before the puncture in high risk patients and avoid potential complications and unnecessary transfusions of platelets. A high frequency linear probe helps significantly with neural blockade in regional anaesthesia. Ultrasound has an established role in the exploration of the venous system in suspected deep venous thrombosis. Transcranial Doppler is an important aid in the diagnostics of cerebral blood flow particularly in subarachnoid bleeding and intracranial hypertension. The cost of a multimodal ultrasonic device is substantial, however the device in the hands of a skilled intensivist may save the life of a patient and save time, complications and money for the department.

Keywords:
ultrasonography – echocardiography – chest ultrasonography – sepsis – trauma – transcranial Doppler

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