Ultrasonography for Procedural Guidance

Ultrasound has transformed itself from a rarely used diagnostic tool to be part of the everyday intensivist armamentarium. Nowadays, ultrasound machines are ubiquitous in intensive care units throughout the world; this has led to their implementation on most interventions that get carried out in the intensive care unit, becoming for some of these the standard of care. In the past, interventions using ultrasound were focused on evaluating cardiac function and vascular access; presently, this has widened into evaluating the lung parenchyma and airways, abdominal and pelvic contents, and assessment of extracorporeal support that takes place in tertiary and quaternary centers. The modern intensivist should be well-versed in the scope of the art and science of ultrasonography, permitting prompt and adequate interventions. Through this chapter, the reader shall encounter different scenarios and images depicting the most common procedures for which ultrasound is used in a critical care unit, and other novel uses that he may face in the future. Most importantly, this chapter discusses basic concepts such as normal and abnormal anatomy, differentiation between arterial and venous structures, interpretation of common and novel images obtained during sonographic evaluation, and assessment of therapeutic interventions adequacy. Using these concepts to establish a link to our daily clinical practice will come in handy when rounding on our critically ill patients and hopefully improve their outcomes while avoiding complications.