Bedside Endoscopic Ultrasound in Critically Ill patients

Mehdi Mohamadnejad,John M Dewitt,Mohammad Al-Haddad,Stuart Sherman,Gregory A Cote,Julia K Leblanc,Lee Mchenry

doi:10.1155/2011/529791

Abstract

Background. The aim of this study was to evaluate the role and impact of EUS in the management of critically ill patients. Methods. We retrospectively identified all patients at our institution over a 68-month period in whom bedside inpatient EUS was performed. EUS was considered to have a significant impact if a new diagnosis was established and/or the findings altered subsequent clinical management. Results. Fifteen patients (9 male; mean age 58 ± 15 years) underwent bedside EUS without complications. EUS-FNA (median 4 passes; range 2–7) performed in 12 (80%) demonstrated a malignant mediastinal mass/lymph node (5), pancreatic abscess (1), excluded a pelvic abscess (1), established enlarged gastric folds as benign (1) and excluded malignancy in enlarged mediastinal (1) and porta hepatis adenopathy (1). In two patients, EUS-FNA failed to diagnose mediastinal histoplasmosis (1) and a hemorrhagic pancreatic pseudocyst (1). In three diagnostic exams without FNA, EUS correctly excluded choledocholithaisis (n = 1) and cholangiocarcinoma (1), and found gastric varices successfully thrombosed after previous cyanoacrylate injection (1). EUS was considered to have an impact in 13/15 (87%) patients. Conclusions. In this series, bedside EUS in critically ill patients was technically feasible, safe and had a major impact on the majority of patients.

Highlights

Endoscopic ultrasonography (EUS) is an established modality for the diagnosis of esophagogastric, mediastinal, pancreatobiliary, and pelvic lesions
We retrospectively identified all patients at our institution over a 68-month period in whom bedside inpatient EUS was performed
EUS was considered to have a significant impact if a new diagnosis was established and/or the findings altered subsequent clinical management

Summary

Introduction

Endoscopic ultrasonography (EUS) is an established modality for the diagnosis of esophagogastric, mediastinal, pancreatobiliary, and pelvic lesions. It is mainly used for elective procedures in outpatients and occasionally inpatients who are at low risk for complications from moderate or deep sedation. We report a single center experience of the indications and impact of bedside EUS on the care of ICU patients. The aim of this study was to evaluate the role and impact of EUS in the management of critically ill patients. In this series, bedside EUS in critically ill patients was technically feasible, safe and had a major impact on the majority of patients

Objectives

Methods

Conclusion