Chest Ultrasonography in the ICU.pdf

Chest Ultrasonography in the ICU Greta Gardelli MD, Francesco Feletti MD, Andrea Nanni MD, Maurizio Mughetti MD, Antonella Piraccini MD, and Maurizio Zompatori MD Introduction Equipment and Examination Techniques Normal Findings Pneumothorax Pleural Effusion Parenchymal Consolidation Alveolar-Interstitial Pathology Differential Diagnosis in Respiratory Insufficiency Recruitment The Role of Ultrasound in Central Venous Catheter Placement and Arterial Catheterization Limitations Summary Chest diagnostic imaging is essential when dealing with a critically ill patient. At present, direct visualization of the lung parenchyma is performed with a chest x-ray and computed tomography with the patient in the supine position. The relative ease of bedside ultrasound examination and the availability of user-friendly, inexpensive, portable equipment have made chest ultrasonography an interesting and alternative method in various situations, because it offers accurate information that is of therapeutic and diagnostic relevance. We describe equipment and examination technique, normal findings, and chest ultrasonography signs detected in some pathological situations, such as pneumothorax, consolidations, pleural effusions, ARDS, and pulmonary edema. Key words: ultra- sonography; chest; intensive care. [Respir Care 2012;57(5):773–781. ? 2012 Daedalus Enterprises] Introduction Chest diagnostic imaging is essential when dealing with a critically ill patient. At present, direct visualization of the lung parenchyma is performed with a chest x-ray (CXR) and computed tomography (CT), with the patient in the supine position. In the ICU, CXRs are only performed on patients in the supine position. The x-ray beam is posi- tioned directly onto the chest at a distance that is less than satisfactory. In fact, when the x-ray beam does not focus tangentially on the diaphragm dome and the mediastinal structures, a correct diagnosis of the “silhouette sign” may Drs Gardelli and Mughetti are affiliate