Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients: Part I
Publication Date: November 1, 2015
Last Updated: March 14, 2022
Recommendations
NONCARDIAC THORACIC IMAGING
Pleural Effusion
We recommend that ultrasound should be used to complement physical examination and conventional chest radiography to diagnose and localize a pleural effusion. (1A)
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We recommend that ultrasound guidance should be used to assist in drainage (including needle guidance), particularly of small or loculated effusions compared with landmark technique. (1B)
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We have no recommendation regarding the preference to use of either static or dynamic technique to do so. ()
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Pneumothorax
We recommend that ultrasound should be used to complement or replace conventional chest radiography to diagnose a pneumothorax, depending on the clinical setting and need for rapid results. (1A)
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Interstitial and Parenchymal Lung Pathology
We suggest that a systematic approach incorporating bedside ultrasound may be a primary diagnostic modality for the ICU patient with respiratory failure. (2B)
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ABDOMINAL IMAGING
Ascites (Nontrauma Setting)
We recommend that ultrasound guidance (instead of the landmark technique), whether real-time or preprocedure, should be used to determine the optimal location for performance of paracentesis. (1B)
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Acalculous Cholecystitis
We suggest that bedside ultrasonography may be used to provide additional valuable information to the clinical presentation to establish the diagnosis of acalculous cholecystitis. (2C)
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We suggest that intensivists/critical care providers should not personally perform ultrasound primarily for the diagnosis of acute cholecystitis. (2B)
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Mechanical Causes of Anuria/Oliguria
We suggest that ultrasonography may be used to exclude mechanical causes of acute renal failure in the ICU. (2C)
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We have no recommendations regarding this issue due to the paucity of data.
VASCULAR IMAGING
Deep Venous Thrombosis (DVT)
We recommend that a focused ultrasound technique using gray scale imaging to evaluate vein compression at the common femoral and popliteal veins should be used to diagnose most proximal DVTs (compared with contrast venography). (1B)
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We recommend that intensivists can reliably perform a focused screening examination by ultrasound to diagnose lower extremity proximal DVT. (1B)
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Imaging to Assist Intravascular Catheter Insertion
We recommend that ultrasound guidance of vessel cannulation (compared with landmark technique) should be used to improve the success rate, shorten procedure time and reduce the risk of procedure-related complications such as pneumothorax. (1B)
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We recommend that in most patients, the use of real-time ultrasound is preferred over static, preprocedure marking. (1B)
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Although there are benefits to visualizing the vasculature in both short- and long-axis images by ultrasound, we recommend that the short-axis view be used during insertion to improve success rate. (1B)
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We recommend that one- (rather than two-) person technique is sufficient for ultrasound-guided vascular cannulation. (1C)
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We suggest that conventional B-mode imaging to assist in vessel cannulation should be used compared with using audible Doppler only with no imaging. (2B)
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We have no recommendation regarding routine use of a device placed on the ultrasound transducer to guide needle placement. This should be left to provider discretion. ()
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We suggest that a detailed postcannulation ultrasound examination may be used (instead of conventional chest radiography) to confirm catheter location and exclude a pneumothorax in adult patients. (2B)
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We recommend that dynamic ultrasound-guided IJ venous cannulation should be used (instead of landmark technique) to improve success rate, shorten procedure time and reduce the risk of procedure-related complications in adult patients. (1A)
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We suggest that ultrasound dynamic guidance is of limited value for most operators to guide subclavian vein catheterization in adult patients (and that landmark technique is used instead). (2C)
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We recommend that ultrasound dynamic guidance (instead of the landmark technique) should be used to improve the success rate and reduce complications for femoral venous cannulation although this benefit is mostly realized by novice operators in adult patients. (1A)
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We suggest that the use of ultrasound dynamic guidance (instead of the landmark technique) may improve the success rate and diminish complications during peripheral venous (adults and children) and arterial cannulation (adults).
- for venous catheterization
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- for arterial catheterization.
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Recommendation Grading
Overview
Title
Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients: Part I
Authoring Organization
Society of Critical Care Medicine
Publication Month/Year
November 1, 2015
Last Updated Month/Year
January 10, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
To establish evidence-based guidelines for the use of bedside ultrasound by intensivists and specialists in the ICU and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck, and extremities.
Target Patient Population
Patients in the ICU
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management
Diseases/Conditions (MeSH)
D014463 - Ultrasonography, D003422 - Critical Care, D016638 - Critical Illness, D007362 - Intensive Care Units, D018608 - Ultrasonography, Doppler
Keywords
critical care, ultrasound, intensive care unit, ultrasonography
Source Citation
Critical Care Medicine: November 2015 - Volume 43 - Issue 11 - p 2479-2502
doi: 10.1097/CCM.0000000000001216