A comprehensive review of vascular ultrasound for intensivists

Surgical critical care: from old boundaries to new frontiers

The surgical specialty of critical care has evolved into a field where the surgeon manages complex medical and surgical problems in critically ill patients. As a specialty, surgical critical care began when acutely ill surgical patients were placed in a designated area within a hospital to facilitate the delivery of medical care. As technology evolved to allow for development of increasingly intricate and sophisticated adjuncts to care, there has been recognition of the importance of physician availability and continuity of care as key factors in improving patient outcomes. Guidelines and protocols have been established to ensure quality improvement and are essential to licensing by state and national agencies. The modern ICU team provides continuous daily care to the patient in close communication with the primary operating physician. While the ultimate responsibility befalls the primary physician who performed the preoperative evaluation and operative procedure, the intensivist is expected to establish and enforce protocols, guidelines and patient care pathways for the critical care unit. It is difficult to imagine modern surgical ICU care without the surgical critical care specialist at the helm.

Validation of an inexpensive B-mode ultrasound device for detection of deep vein thrombosis

OBJECTIVE

To validate a portable, inexpensive, real-time, B-mode ultrasound device compared with duplex ultrasound in the detection of proximal lower extremity deep vein thrombosis in hospitalized patients clinically suspected of having deep vein thrombosis.

DESIGN

Prospective cohort study.

SETTING

Tertiary care community teaching hospital.

PATIENTS

Medical-surgical hospitalized patients undergoing duplex ultrasonography for clinically suspected lower extremity deep vein thrombosis.

INTERVENTIONS

Hospitalized patients who underwent duplex ultrasound examinations were enrolled in the study. Blinded from the duplex ultrasound results, the investigators utilized the study ultrasound device to perform compression ultrasonography of the common femoral, superficial femoral, and popliteal veins within 48 h of the duplex examinations. The results of the study ultrasound device were recorded as normal (compressible) or abnormal (noncompressible).

RESULTS

Of the 198 lower limbs evaluated, duplex ultrasonography documented 34 proximal lower extremity deep vein thrombi. The study ultrasound device detected 32 of the 34 proximal thrombi detected by duplex ultrasonography. One false-positive result of an examination occurred with the study ultrasound device. Compared with duplex ultrasonography, the study ultrasound device had a sensitivity of 94%, specificity of 99%, positive predictive value of 97%, and negative predictive value of 98%.

CONCLUSIONS

The results of this investigation document that the study ultrasound device has an acceptable sensitivity, specificity, and diagnostic accuracy for clinical use in detection of proximal lower extremity deep vein thrombosis. Further evaluation and validation of this ultrasound device are warranted.