Critical Care Ultrasound

Abstract

Critical Care Ultrasound is an electronic and print textbook that presents the use of ultrasound in intensive care. Although thorough enough for an in-depth understanding of critical care ultrasound, the concise text and excellent visuals allow this book to be used as a quick reference as well. The authors write the book with a concept they call “The Holistic Approach” to an ultrasound examination. This defines the critical care ultrasound as the part of a patient examination, which visualizes anatomic structures and function “in their live, interconnected state.” Therefore, rather than merely describe a specific ultrasound modality, the authors write each chapter within the context of the physiology, pathophysiology, and anatomy. Section I outlines the fundamental concepts of ultrasound, including a review of physics, imaging modes, image optimization, and common artifacts encountered during an examination. The section closes with a comprehensive visual review of ultrasound anatomy and pathology. Systems reviewed include head and neck, chest, abdominal, and musculoskeletal. Section II details the use of ultrasound in neurocritical care. The section opens with a chapter on transcranial Doppler. The authors describe its multiple applications, including vasospasm monitoring after aneurysmal subarachnoid hemorrhage, ischemic stroke evaluation, diagnosis of cerebral circulatory arrest, and assessment of autoregulation. Included in this section is a description of optic nerve sheath diameter as a surrogate for intracranial pressure. The text progresses to Section III: Vascular Ultrasound, beginning with an overview of arterial and venous system anatomy and pathophysiology. The deep venous thrombosis chapter describes both the basic and advanced ultrasound diagnostic techniques and strategies for a successful examination. The central venous and arterial access chapters go beyond basic ultrasound-guided technique. The text details advanced knowledge of catheterization including ultrasound-guided subclavian access, evaluation of traumatic hematoma after line placement, and criteria for choosing the appropriate vein for cannulation. The book transitions to the general chest ultrasound and echocardiography sections. The chest section describes the ultrasound as an adjuvant in diagnosing common lung pathologies including pneumothorax, pleural effusion, and pneumonia. The section includes the use of ultrasound in trauma, acute dyspnea, acute respiratory distress syndrome, and the difficult to wean mechanically ventilated patient. The echocardiography chapters describe the use of echocardiography in the evaluation of circulatory failure, septic shock, pulmonary embolism, and cardiac arrest. The hemodynamic monitoring section first presents general concepts, such as static-based parameters, dynamic arterial waveform analysis, and passive leg raising. The authors tie the use of ultrasound to these basic concepts. They describe measuring fluid responsiveness by both static and dynamic ultrasound measurements. These include measurement of inferior vena cava diameter, mitral valve inflow patterns, and respiratory variations in both aortic and inferior vena cava flow patterns. A highlight of the section is a well-organized flow chart describing the use of ultrasound as a guide in the evaluation of circulatory failure. The book transitions to abdominal and emergency ultrasound. This includes chapters on the extended FAST examination and ultrasound evaluation of abdominal compartment syndrome. There is an excellent online video, which demonstrates a FAST examination being performed on a sample patient. The final clinical section discusses soft tissue and miscellaneous uses of ultrasound. These chapters include details on evaluating musculoskeletal injury and masses. In addition, there is a chapter on ultrasound-guided percutaneous tracheostomy, which highlights the use of ultrasound in determining stoma site selection and tracheostomy size. The electronic version of the textbook is available in 3 formats: an online version through Expert Consult, as a PDF, and as an ePub book. The Expert Consult version of the book is simple and navigable. There are videos and pictures, which are organized as both a list and embedded in the chapters. This organization allows the reader to either quickly select a video for quick review or view the content within the chapter for more detail. In addition, each online chapter includes a detailed set of references if further information on a topic is desired. Unfortunately, the PDF version of the book does not provide the same seamless integration. The links provided in the PDF documents are irregular and do not always link to the referenced material. In conclusion, Critical Care Ultrasound is an excellent handbook for the intensivist or anesthesiologist. The greatest strength of the book, however, is its greatest weakness. At times, because the chapters are so brief, there are details that are omitted. Furthermore, the text does not transition well to the PDF format. Regardless of the few weaknesses, Critical Care Ultrasound is an excellent addition to the library of any intensivist or anesthesiologist. Anthony F. Dempsey, MDJudson Mehl, DODepartment of AnesthesiologyUniversity of Kentucky College of MedicineLexington, Kentucky[email protected]