Head to toe ultrasound: Current opinion on its role in hemodynamic instability, hypoxemia, oligoanuria and the patient with altered neurological status
Bedside ultrasound is now more commonly used in anesthesiology and critical care. There are numerous applications beyond its role in regional anesthesia and vascular access.
To describe how bedside ultrasound can be integrated to current clinical management is dealingwith hemodynamicallyunstable, hypoxemic, oligoanuric patient and in the patient with altered neurological status.
Material and methods:
Essay article describing a synthesis of the current literature, expert opinion, currentpracticeand recentclinicaltrials in the developmentofproposed algorithm dealing with the use of bedside ultrasound in the management hemodynamic instability and hypoxemia.
Three algorithms currently used in the hemodynamically unstable and the hypox-emic patient and the patient are described. In addition, a simple bedside ultrasound approach to oligoanuria and altered neurological status is proposed.
Further studies incorporating head-to-toe bedside ultrasound by trained clinicians will need to be validated but are likely to demonstrate the significant advantages of incorporating bedside ultrasound in the practice of anesthesiology and critical care.
2. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl JMed. 2003;348:1123-33.
3. Rothschild JM. Ultrasound guidance of central vein catheterization. Making health care safer: a critical analysis of patient safety practices. AHRQ Publication 01-E058; 2010. Available from: www.ahrq.gov/clinic/ptsafety/chap21.htm [20.07.01].
4. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society ofEchocardiography and the Society ofCardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011;24:1291-318.
5. Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015;95:1-80.
6. Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132 Suppl 2:S315-67.
7. Barbosa RR, Rowell SE, Fox EE, Holcomb JB, Bulger EM, Phelan HA, et al. Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy. J Trauma Acute Care Surg. 2013;75 Suppl 1:S48-52.
8. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589-96.
9. Denault A, Vegas A, Royse C. Bedside clinical and ultrasound-based approaches to the management of hemodynamic instability?Part I: focus on the clinical approach: continuing professional development. Can J Anaesth. 2014;61:843-64.
10. Vegas A, Denault A, Royse C. A bedside clinical and ultrasound-based approach to hemodynamic instability -Part II: bedside ultrasound in hemodynamic shock: continuing professional development. Can J Anaesth. 2014;61:1008-27.
11. Denault AY, Couture P, Lamarche Y, Tardif JC, Vegas A. Basic transesophageal and critical care ultrasonography. London: CRC Press; 2017.
12. Tang WH, Kitai T. Intrarenal venous flow: a window into the congestive kidney failure phenotype of heart failure? JACC Heart Fail. 2016;4:683-6.
13. Iida N, Seo Y, Sai S, Machino-Ohtsuka T, Yamamoto M, Ishizu T, et al. Clinical implications of intrarenal hemodynamic evaluation by Doppler ultrasonography in heart failure. JACC Heart Fail. 2016;4:674-82.
14. Rochon AG, L'Allier PL, Denault AY. Always consider left ventricular outflow tract obstruction in hemodynamically unstable patients. Can J Anaesth. 2009;56:962-8.
15. Denault AY, Chaput M, Couture P, Hebert Y, Haddad F, Tardif JC. Dynamic right ventricular outflow tract obstruction in cardiac surgery. J Thorac Cardiovasc Surg. 2006;132:43-9.
16. Hulin J, Aslanian P, Desjardins G, Belaidi M, Denault A. The critical importance of hepatic venous blood flow Doppler assessment for patients in shock. A & A Case Rep. 2016;6:114-20.
17. Denault AY, Couture P, Vegas A, Buithieu J, Tardif JC. Transesophageal echocardiography multimedia manual. Second edition: a perioperative transdisciplinary approach. New York: Informa Healthcare; 2011.
18. Denault AY, Couture P. Practical diastology. World J Anesthesiol. 2014;3:96-104.
19. Hunter JD, Doddi M. Sepsis and the heart. Br J Anaesth. 2010;104:3-11.
20. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007;11:274-81.
21. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117-25.
22. Sukernik MR, Mets B, Bennett-Guerrero E. Patent foramen ovale and its significance in the perioperative period. Anesth Analg. 2001;93:1137-46.
23. Haddad F, Elmi-Sarabi M, Fadel E, Mercier O, Denault AY. Pearls and pitfalls in managing right heart failure in cardiac surgery. Curr Opin Anaesthesiol. 2016;29:68-79.
24. Denault AY, Haddad F, Jacobsohn E, Deschamps A. Perioperative right ventricular dysfunction. Curr Opin Anaesthesiol. 2013;26:71-81.
25. Amsallem M, Kuznetsova T, Hanneman K, Denault A, Haddad F. Right heart imaging in patients with heart failure: a tale of two ventricles. Curr Opin Cardiol. 2016;31:469-82.
26. Duerinckx AJ, Grant EG, Perrella RR, Szeto A, Tessler FN. The pulsatile portal vein in cases of congestive heart failure: correlation of duplex Doppler findings with right atrial pressures. Radiology. 1990;176:655-8.
27. Abu-Yousef MM. Duplex Doppler sonography of the hepatic vein in tricuspid regurgitation. AJR Am J Roentgenol. 1991;156:79-83.
28. Styczynski G, Milewska A, Marczewska M, Sobieraj P, Sobczynska M, Dabrowski M, et al. Echocardiographic correlates of abnormal liver tests in patients with exacerbation of chronic heart failure. J Am Soc Echocardiogr. 2016;29:132-9.
29. Denault AY, Beaubien-Souligny W, Elmi-Serabi M, Eljaiek R, El-Hamamsy I, Lamarche Y, et al. Clinical significance of portal hypertension diagnosed after cardiac surgery. Anesth Analg. 2017;124:1109-15.
30. Tremblay JA, Beaubien-Souligny W, Elmi-Sarabi M, Desjardins G, Denault AY. Point-of-care ultrasonography to assess portal vein pulsatility and the effect of inhaled milrinone and epoprostenol in severe right ventricular failure: a report of 2 cases. A & A Case Rep. 2017, http://dx.doi.org/10.1213/XAA.0000000000000572 [Epub ahead of print].
31. Denault A, Deschamps A. Abnormal aortic-to-radial arterial pressure gradients resulting in misdiagnosis of hemodynamic instability. Can J Anaesth. 2009;56:534-6.
32. Fuda G, Denault A, Deschamps A, Bouchard D, Fortier A, Lambert J, et al. Risk factors involved in central-to-radial arterial pressure gradient during cardiac surgery. Anesth Analg. 2016;122:624-32.
33. Denault A, Lamarche Y, Rochon A, Cogan J, Liszkowski M, Lebon JS, et al. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol. 2014;30 Suppl:S459-77.
34. Cherpanath TG, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, et al. Predicting fluid responsiveness by passive leg raising: a systematic review and meta-analysis of 23 clinical trials. Crit Care Med. 2016;44:981-91.
35. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362:779-89.
36. Piette E, Daoust R, Denault A. Basic concepts in the use of thoracic and lung ultrasound. Curr Opin Anaesthesiol. 2013;26:20-30.
37. Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15:201-4.
38. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011;37:1059-68.
39. Denault AY. Difficult separation from cardiopulmonary bypass: importance, mechanism and prevention. Université, de Montréal; 2010.
40. Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, et al. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135:1050-60.
41. Arntfield R, Millington S, Ainsworth C, Arora R, Boyd J, Finlayson G, et al. Canadian recommendations for critical care ultrasound training and competency. Can Respir J. 2014;21:341-5.
42. Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg. 2012;115:1007-28.
43. Ferrada P, Evans D, Wolfe L, Anand RJ, Vanguri P, Mayglothling J, et al. Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay. J Trauma Acute Care Surg. 2014;76:31-7, discussion 7-8.
44. Kanji HD, McCallum J, Sirounis D, MacRedmond R, Moss R, Boyd JH. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 2014;29:700-5.
45. Laursen CB, Sloth E, Lassen AT, Christensen R, Lambrechtsen J, Madsen PH, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med. 2014;2: 638-46.
46. Zanobetti M, Scorpiniti M, Gigli C, Nazerian P, Vanni S, Innocenti F, et al. Point-of-care ultrasonography forevaluation of acute dyspnea in the ED. Chest. 2017;151:1295-301.
47. Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, et al. Special article: basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg. 2013;117:543-58.
The Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) is the owner of all copyrights to any articles published in the journal. Published manuscripts become the permanent property of S.C.A.R.E. and may not be published elsewhere without written permission. S.C.A.R.E. keeps the right to use these manuscripts in any form, including print, video, audio and digital.
Creative Commons License
Open-access articles can be read, downloaded and shared on a free basis upon publication. The Journal publishes all articles under the CCBY- NC-ND license. Attribution-NonCommercial-NoDerivs: CC BY- NC-ND. Of the six main licenses, this is the most restrictive because it only allows others to download and share articles as long as they give credit to the author, but they cannot in any way change the paper or use it commercially.