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Semin Respir Crit Care Med 2015; 36(06): 878-889
DOI: 10.1055/s-0035-1564873
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bedside Ultrasound in the Intensive Care Unit: Where Is the Evidence?

Samuel M. Brown
1   Department of Pulmonary and Critical Care Medicine, University of Utah School of Medicine and Intermountain Medical Center, Salt Lake City, Utah
2   Critical Care Echocardiography Service, Intermountain Medical Center, Murray, Utah
,
Jan Kasal
3   Department of Critical Care Medicine, Saint Louis University and Mercy Hospital Saint Louis, Saint Louis, Missouri
› Author Affiliations
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Publication History

Publication Date:
23 November 2015 (online)

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Abstract

Interest in bedside ultrasound in the intensive care unit and emergency department has exploded in recent years. This interest is driven in part by the utility of ultrasound for procedural guidance. In most cases, enthusiasm outstrips current evidence. While ultrasound is often felt to be risk-free, the important risk of ultrasound is the chance of false diagnosis. The vividness of visual images may make practitioners especially prone to cognitive errors in interpretation. Possible applications of ultrasound include management of shock and respiratory failure, two complex syndromes with multiple aspects. Reasonable evidence supports use of ultrasound to guide volume expansion, although its value remains to be demonstrated in an explicit protocol. Other possibilities include ventilator titration and guidance of diuresis. While the literature is more complicated, there is some early evidence that lung ultrasound may improve the diagnosis of dyspnea, although these results have not been well validated. Centers should avoid premature loss of equipoise and participate in studies of explicit protocols that incorporate ultrasound.

Keywords

sepsis - acute respiratory distress syndrome - echocardiography - lung ultrasound - hemodynamic management - shock
 

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