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McLean B, Thompson D. MRI and the Critical Care Patient: Clinical, Operational, and Financial Challenges. Crit Care Res Pract 2023; 2023:2772181. [PMID: 37325272 PMCID: PMC10264715 DOI: 10.1155/2023/2772181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today's intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient's condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient's condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient's stay in the ICU. The delay in obtaining imaging can negatively impact the patient's treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.
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Affiliation(s)
- Barbara McLean
- Division of Emergency Services and Critical Care, Grady Health System, Atlanta, GA, USA
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Abstract
The current SARS-CoV-2 outbreak leads to a growing need of point-of-care thoracic imaging that is compatible with isolation settings and infection prevention precautions. We retrospectively reviewed 17 COVID-19 patients who received point-of-care lung ultrasound imaging in our isolation unit. Lung ultrasound was able to detect interstitial lung disease effectively; severe cases showed bilaterally distributed B-Lines with or without consolidations; one case showed bilateral pleural plaques. Corresponding to CT scans, interstitial involvement is accurately depicted as B-Lines on lung ultrasound. Lung ultrasound might be suitable for detecting interstitial involvement in a bedside setting under high security isolation precautions.
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Hendin A, Koenig S, Millington SJ. Better With Ultrasound: Thoracic Ultrasound. Chest 2020; 158:2082-2089. [PMID: 32422131 DOI: 10.1016/j.chest.2020.04.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
Ultrasound examination of the thorax is superior to chest radiograph or physical examination for diagnosing common conditions such as pneumonia, pulmonary edema, pleural effusion, and pneumothorax. The basic skill set is straightforward to learn, quick to perform, repeatable, and does not involve patient transport, harmful ionizing radiation, or waiting time. This paper outlines the basic building blocks that makeup a thoracic ultrasound examination, regardless of which specific scanning protocol is performed. Narrative videos and illustrative figures demonstrating these techniques are included.
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Affiliation(s)
- Ariel Hendin
- University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada
| | - Seth Koenig
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
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Wallbridge P, Steinfort D, Tay TR, Irving L, Hew M. Diagnostic chest ultrasound for acute respiratory failure. Respir Med 2018; 141:26-36. [PMID: 30053969 DOI: 10.1016/j.rmed.2018.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/19/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
Acute respiratory failure (ARF) is a common life-threatening medical condition, with multiple underlying aetiologies. Diagnostic chest ultrasound provides accurate diagnosis of conditions that commonly cause ARF, and may improve overall diagnostic accuracy in critical care settings as compared to standard diagnostic approaches. Respiratory physicians are becoming increasingly familiar with ultrasound as a part of routine clinical practice, although the majority of data to date has focused on the emergency and intensive care settings. This review will examine the evidence for the use of diagnostic chest ultrasound, focusing on different levels of imaging efficacy; specifically ultrasound test attributes, impacts on clinician behaviour and impact on health outcomes. The evidence behind use of multi-modality ultrasound examinations in ARF will be reviewed. It is hoped that readers will become familiar with the advantages and potential issues with chest ultrasound, as well as evidence gaps in the field.
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Affiliation(s)
- Peter Wallbridge
- Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
| | - Daniel Steinfort
- Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Louis Irving
- Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Mark Hew
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Touw HR, Parlevliet KL, Beerepoot M, Schober P, Vonk A, Twisk JW, Elbers PW, Boer C, Tuinman PR. Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia 2018. [PMID: 29529332 PMCID: PMC6099367 DOI: 10.1111/anae.14243] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Postoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X-rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X-ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single-centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X-ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X-ray. We compared lung ultrasound with chest X-ray for the detection of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications. We also assessed inter-observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically-relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X-ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X-ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7 out of 17 patients (41%) with clinically-relevant postoperative pulmonary complications (p < 0.001). The clinically-relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X-ray (p = 0.024). Overall inter-observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications than chest X-ray, and at an earlier time-point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making.
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Affiliation(s)
- H R Touw
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands.,Department of Anaesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - K L Parlevliet
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - M Beerepoot
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - P Schober
- Department of Anaesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - A Vonk
- Department of Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - J W Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - P W Elbers
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - C Boer
- Department of Anaesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
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Brogi E, Bignami E, Sidoti A, Shawar M, Gargani L, Vetrugno L, Volpicelli G, Forfori F. Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit? Cardiovasc Ultrasound 2017; 15:23. [PMID: 28903756 PMCID: PMC5597991 DOI: 10.1186/s12947-017-0113-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure. Methods Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU. Results A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed. Conclusions Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome.
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Affiliation(s)
- Etrusca Brogi
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Elena Bignami
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Anna Sidoti
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Mohammed Shawar
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - National Research Council, Pisa, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Francesco Forfori
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
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Can Sarcopenia Quantified by Ultrasound of the Rectus Femoris Muscle Predict Adverse Outcome of Surgical Intensive Care Unit Patients as well as Frailty? A Prospective, Observational Cohort Study. Ann Surg 2017; 264:1116-1124. [PMID: 26655919 DOI: 10.1097/sla.0000000000001546] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare sarcopenia and frailty for outcome prediction in surgical intensive care unit (SICU) patients. BACKGROUND Frailty has been associated with adverse outcomes and describes a status of muscle weakness and decreased physiological reserve leading to increased vulnerability to stressors. However, frailty assessment depends on patient cooperation. Sarcopenia can be quantified by ultrasound and the predictive value of sarcopenia at SICU admission for adverse outcome has not been defined. METHODS We conducted a prospective, observational study of SICU patients. Sarcopenia was diagnosed by ultrasound measurement of rectus femoris cross-sectional area. Frailty was diagnosed by the Frailty Index Questionnaire based on 50 variables. Relationship between variables and outcomes was assessed by multivariable regression analysis NCT02270502. RESULTS Sarcopenia and frailty were quantified in 102 patients and observed in 43.1% and 38.2%, respectively. Sarcopenia predicted adverse discharge disposition (discharge to nursing facility or in-hospital mortality, odds ratio 7.49; 95% confidence interval 1.47-38.24; P = 0.015) independent of important clinical covariates, as did frailty (odds ratio 8.01; 95% confidence interval 1.82-35.27; P = 0.006); predictive ability did not differ between sarcopenia and frailty prediction model, reflected by χ values of 21.74 versus 23.44, respectively, and a net reclassification improvement (NRI) of -0.02 (P = 0.87). Sarcopenia and frailty predicted hospital length of stay and the frailty model had a moderately better predictive accuracy for this outcome. CONCLUSIONS Bedside diagnosis of sarcopenia by ultrasound predicts adverse discharge disposition in SICU patients equally well as frailty. Sarcopenia assessed by ultrasound may be utilized as rapid beside modality for risk stratification of critically ill patients.
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Slovis BH, Shah KH, Yeh DD, Seethala R, Kaafarani HMA, Eikermann M, Raja AS, Lee J. Significant but reasonable radiation exposure from computed tomography-related medical imaging in the ICU. Emerg Radiol 2016; 23:141-6. [PMID: 26738733 DOI: 10.1007/s10140-015-1373-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/21/2015] [Indexed: 12/19/2022]
Abstract
Admission to an intensive care unit (ICU) is associated with increased medical imaging and radiation exposure, yet few studies have estimated the risk of cancer associated with these examinations. The purpose of this study was to review computed tomography (CT) scans performed on patients admitted to two urban academic ICUs, predict their radiation exposure, and calculate their estimated lifetime attributable risk of cancer (LAR). An electronic chart review was performed on all CT scans performed between January 2007 and December 2011. The estimated effective dose of radiation was calculated for each CT, and the LAR for each patient was predicted. Mean radiation exposure was 22.2 ± 25.0 mSv with a mean LAR of 0.1 ± 0.2 % and a median of 0.6 % with a range of <0.001 to 3.4 %. Our cohort received radiation doses higher than recommended by guidelines; however, the critical nature of their admission may have warranted these imaging studies. Estimated risk of cancer in this population was overall low.
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Affiliation(s)
- Benjamin H Slovis
- Department of Emergency Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kaushal H Shah
- Department of Emergency Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raghu Seethala
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Division of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jarone Lee
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- , 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
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Biasucci DG, Cutuli SL, Pizza A, Cavaliere F. Clinically integrated ultrasound for decreasing the number of chest x-rays in the intensive care unit: It is high time to move forward a "global" use of ultrasound. J Crit Care 2015; 30:1137-8. [PMID: 26027779 DOI: 10.1016/j.jcrc.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Daniele Guerino Biasucci
- Institute of Intensive Care Medicine and Anesthesiology, "Agostino Gemelli" Teaching Hospital, Catholic University of the Sacred Heart, 00168, Rome, Italy.
| | - Salvatore Lucio Cutuli
- Institute of Intensive Care Medicine and Anesthesiology, "Agostino Gemelli" Teaching Hospital, Catholic University of the Sacred Heart, 00168, Rome, Italy.
| | - Alessandro Pizza
- Institute of Intensive Care Medicine and Anesthesiology, "Agostino Gemelli" Teaching Hospital, Catholic University of the Sacred Heart, 00168, Rome, Italy.
| | - Franco Cavaliere
- Institute of Intensive Care Medicine and Anesthesiology, "Agostino Gemelli" Teaching Hospital, Catholic University of the Sacred Heart, 00168, Rome, Italy.
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