Ultrasound at #SMARTmi2019 #POCUS

By | 10/05/2019

Multiorgan ultrasound assessment in the ED (@giovolpicelli)

Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension.

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

A controversial view perhaps??

Echography is mandatory for the initial management of critically ill patients: no

Septic shock: from pathophysiology to treatment (Tavazzi)

Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database.

Sepsis and cardiac dysfunction is common

Diastolic dysfunction is under-recognised

Strain echocardiography is useful BUT not very feasible as it is challenging to get good quality views

Strain echocardiography in septic shock – a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome

Elastase measurement in sepsis gives an idea of ventriculoarterial coupling and is easy to perform (apparently)

It allows differentiation of volume responders vs norepinephrine responders

Lung ultrasound for septic patients with acute respiratory failure (Mongodi)

https://www.ncbi.nlm.nih.gov/pubmed/30372119

Lung ultrasound as a diagnostic tool for consolidations in patients under mechanical ventilation is sensitive (91.7-93%) but poor specificity (0-63.2%)

Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. AUC ROC 0.83 – link

Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome.

Spleen and kidney: a mirror to organ perfusion (Corradi)

Renal Resistive Index: not only kidney

Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography.

Ultrasound to open a window in the brain (@fabio_taccone)

Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review.

https://www.ncbi.nlm.nih.gov/pubmed/30280261
Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients

Using contrast-enhanced ultrasound to study kidney perfusion – Acute kidney injury is associated with a decrease in cortical renal perfusion during septic shock

Setting up the ventilator using ultrasound (Golligher)

Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity.

My personal opinion is that there are high inter- and intra- observer variation in measurements of diaphragm thickness.

Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure.
Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort

Is there an ideal amount of ‘effort’ diaphragm thickening that impacts outcomes? If so, could you design a treatment pathway?