A pictorial essay on the potential use of the transhepatic subcostal ultrasound view for the evaluation of lower lung lobe pathology.

Lung ultrasound has become indispensable in managing critically ill patients, offering bedside evaluation capabilities for intensive care unit physicians without ionizing radiation. This noninvasive technique demonstrates high sensitivity and specificity in diagnosing various lung pathologies, including pleural effusion and consolidation syndrome. A novel trans-hepatic subcostal approach enhances visualization of the lower right lung lobe, revealing the diaphragm dome and inferior lobe through oblique coronal sections.

Diagnosis of Lung Abscess and Pancreatic Collection Using Transesophageal and Transgastric Point-of-Care Ultrasound in a Critically Ill Patient.

Effectively managing critically ill septic patients requires careful utilization of imaging techniques. While point-of-care ultrasound (POCUS) is invaluable in the ICU, it faces challenges with conventional transcutaneous ultrasound, especially in obese patients. A 22-year-old obese female presented with abdominal pain and renal dysfunction.

Correlation between corrected carotid flow time and left ventricular outflow tract velocity-time integral using a novel technique.

Background: Transthoracic echocardiography (TTE) is widely used for assessing patients in the intensive care unit, with cardiac output measurement being crucial for hemodynamic monitoring. This is achieved by measuring the velocity-time integral (VTI) of the left ventricular outflow tract (LVOT), which serves as a surrogate of stroke volume. However, conducting TTE in the critical care setting presents several challenges.

Assessment of Cheyne-Stokes respiration using diaphragmatic ultrasonography.

This case explores Cheyne-Stokes respiration (CSR), a breathing pattern common in heart failure and brain injury patients. Using diaphragmatic ultrasound, the study assesses a 74-year-old patient with heart failure exhibiting CSR during sleep. Diaphragmatic excursion patterns reveal the characteristic crescendo-decrescendo pattern of CSR.

Exploring diaphragmatic response to high-flow nasal cannula in patients with COVID-19 pneumonia using ultrasound: a proof of concept study.

Background: Recent studies have highlighted the recognition of diaphragmatic dysfunction as a significant factor contributing to respiratory disturbances in severely ill COVID-19 patients. In the field of noninvasive respiratory support, high-flow nasal cannula (HFNC) has shown effectiveness in relieving diaphragm dysfunction. This study aims to investigate the diaphragmatic response to HFNC in patients with COVID-19 pneumonia by utilizing ultrasound.

The role of different ultrasound modes in hepatic portal venous gas diagnosis, including a novel method using color M-mode.

Hepatic portal venous gas (HPVG) indicates an abnormal gas buildup within the portal venous system, associated with severe medical conditions. Causes include heightened intraluminal pressure, bowel wall disruption, bowel necrosis, and pathogenic bacteria. Previously considered indicative of extensive bowel necrosis requiring surgery, HPVG is now recognized in non-surgical conditions, posing diagnostic challenges.

Incidental Diagnosis of Left Pneumothorax Using a New Variant of the Lung Point Sign During Cardiac Ultrasound.

Background: Pneumothorax is a common issue in the intensive care unit and emergency department, often diagnosed using lung ultrasound. The absence of lung sliding and the presence of the lung point sign are characteristic findings for pneumothorax. We describe a case of left pneumothorax diagnosed incidentally while performing a cardiac ultrasound through a new variant of the lung point sign.

Non-invasive diagnosis of diaphragmatic paralysis in botulism using ultrasound.

This case study explores foodborne botulism, a severe illness caused by botulinum neurotoxin-contaminated food. It leads to bilateral descending paralysis, involving the diaphragm. We highlight diaphragmatic ultrasound as a non-invasive diagnostic tool.

Predicting mortality in severe Covid-19 Pneumonia: the role of right ventricular dysfunction.

Purpose: There is evidence that COVID-19 can have a clinically significant effect on the right ventricle (RV). Our objective was to enhance the efficiency of assessing RV dilation for diagnosing ACP by utilizing both linear measurements and qualitative assessment and its usefulness as an independent predictor of mortality.

Methods: This is an observational, retrospective and single-center study of the Intensive Care Unit of the Sanatorio de Los Arcos in Buenos Aires, Argentina from March 2020 to January 2022.

Passive leg raising test using the carotid flow velocity-time integral to predict fluid responsiveness.

Purpose: The passive leg raising test (PLR) is a noninvasive method widely adopted to assess fluid responsiveness. We propose to explore if changes in the carotid flow assessed by echo-Doppler can predict fluid responsiveness after a PLR.

Methods: We conducted a performance diagnostic study in two intensive care units from Argentina between February and April 2022.

The value of speckle tracking echocardiography in diagnosing minoxidil-induced cardiotoxicity: a case report.

Minoxidil is a drug designed for the treatment of arterial hypotension. Due to its secondary effect of hypertrichosis, it is also used for alopecia treatment. We present a case of a 50-year-old female patient who was orally consuming Minoxidil for medical reasons.

Evaluating the Utility of Portal Vein Pulsatility Index for Detecting Fluid Unresponsiveness in the Intensive Care Unit.

Objective: The primary aim of the authors' study was to evaluate the capacity of the portal vein pulsatility index (PVP) to detect fluid unresponsiveness in patients admitted to intensive care.

Design: This was a retrospective, diagnostic accuracy study SETTING: At a tertiary medical-surgical intensive care unit in Buenos Aires, Argentina.

Participants: Patients were included during usual care in the intensive care unit, who were evaluated by ultrasonography for the flow of the portal vein, calculating their PVP prior to fluid expansion.

Short Axis In-Plane Ultrasound-Guided Technique for Internal Jugular Vein Cannulation.

Background: Real-time ultrasound (US)-guided venipuncture has become the standard of care due to its reduced complications and higher success rate. There are various techniques for US-guided cannulation of the internal jugular vein (IJV); the transversal and longitudinal views are the most widely used. There is a less commonly used technique that combines the benefits of both methods.

Utility of transcranial color-coded duplex sonography in diagnosis and monitoring of PICA aneurysm in subarachnoid hemorrhage.

This case describes the successful use of transcranial color-coded duplex sonography (TCCD) to diagnose a posterior circulation aneurysm in a patient with subarachnoid hemorrhage. A 33-year-old, was admitted to the ICU after a brain CT scan showed peritroncal subarachnoid hemorrhage. TCCD revealed a rounded image with color Doppler near the P1 portion of the right posterior cerebral artery, which was later confirmed to be a 4 mm aneurysm at the right posterior inferior cerebellar artery (PICA).

Ultrasound-guided cerebral resuscitation in patients with severe traumatic brain Injury.

Traumatic brain injury (TBI) is a worldwide public health concern given its significant morbidity and mortality, years of potential life lost, reduced quality of life and elevated healthcare costs. The primary injury occurs at the moment of impact, but secondary injuries might develop as a result of brain hemodynamic abnormalities, hypoxia, and hypotension. The cerebral edema and hemorrhage of the injured tissues causes a decrease in cerebral perfusion pressure (CPP), which leads to higher risk of cerebral ischemia, herniation and death.

Transthoracic echocardiography of patients in prone position ventilation during the COVID-19 pandemic: an observational and retrospective study.

Mechanical ventilation in prone position is a strategy that increases oxygenation and reduces mortality in severe ARDS. The hemodynamic and cardiovascular assessment of these patients is essential. Transthoracic echocardiography (TTE) is a widely used tool to assess hemodynamics in critical care, but the prone position is thought to limit adequate TTE views and goal-oriented measurements.

Cerebral circulatory arrest diagnosed with transoral Doppler ultrasonography.

We describe the case of a patient with malignant stroke in whom brain death was diagnosed by evaluating the neck vessels by transoral ultrasonography.

Carotid flow as a surrogate of the left ventricular stroke volume.

Transthoracic echocardiography (TTE) is a fundamental tool for hemodynamic monitoring in critical patients. It allows evaluating the left ventricle's stroke volume based on the measurement of the velocity-time integral (VTI) of the left ventricle outflow tract (LVOT). However, in the intensive care unit obtaining adequate echocardiographic views may present a challenge.

Effect of prone position on right ventricular dysfunction due to pulmonary embolism assessed by speckle tracking echocardiography.

Prone position has shown beneficial hemodynamic effects in patients with right ventricular dysfunction associated with acute respiratory distress syndrome decreasing the right ventricle afterload. We describe the case of a 57-year-old man with right ventricular dysfunction associated with pulmonary thromboembolism with severe hypoxemia that required mechanical ventilation in prone position. With this maneuver, we verified an improvement not only in his oxygenation, but also in his right ventricular function assessed with speckle tracking echocardiography.

Passive leg raising test to predict fluid responsiveness using the right ventricle outflow tract velocity-time integral through a subcostal view.

Purpose: The passive leg raising test (PLR) produces a reversible increase in venous return and, if the patient's ventricles are preload dependent, in the cardiac output. As this effect occurs in seconds, the transthoracic echocardiography is optimal for its real time assessment. The utility of the PLR for monitoring fluid responsiveness through the measurement of the left ventricle outflow tract velocity-time integral (LVOT VTI) in an apical 5-chamber view is well stablished.

Tips for carotid ultrasound in the intensive care unit.

The ultrasonography of carotid arteries plays a key role in evaluating cerebrovascular disease. There are some useful considerations to perform it correctly in the intensive care unit, such as using different kind of transducer, Doppler mode optimization, and the correct interpretation of the findings.