Chacko Jose, Brar Gagan
Multidisciplinary Intensive Care Unit, Manipal Hospital, Bengaluru, Karnataka, India.
Indian J Crit Care Med. 2014 Jun;18(6):376-81. doi: 10.4103/0972-5229.133897.
Point of care ultrasonography, performed by acute care physicians, has developed into an invaluable bedside tool providing important clinical information with a major impact on patient care. In Part II of this narrative review, we describe ultrasound guided central venous cannulation, which has become standard of care with internal jugular vein cannulation. Besides improving success rates, real-time guidance also significantly reduces the incidence of complications. We also discuss compression ultrasonography - a quick and effective bedside screening tool for deep vein thrombosis of the lower extremity. Abdominal ultrasound offers vital clues in the emergency setting; in the unstable trauma victim, a focused examination may provide immediate answers and has largely superseded diagnostic peritoneal lavage in diagnosing intraperitoneal bleed. From estimation of intracranial pressure to transcranial Doppler studies, ultrasound is becoming increasingly relevant to neurocritical care. Ultrasound may also help with airway management in several situations, including percutaneous tracheostomy. Clearly, bedside ultrasonography has become an indispensable part of intensive care practice - in the rapid assessment of critically ill-patients as well as in enhancing the safety of invasive procedures.
由急症科医生进行的床旁超声检查，已发展成为一种极具价值的床边工具，能提供重要的临床信息，对患者护理产生重大影响。在本叙述性综述的第二部分，我们描述了超声引导下的中心静脉置管术，它已成为颈内静脉置管护理的标准方法。除了提高成功率外，实时引导还能显著降低并发症的发生率。我们还讨论了压迫超声检查——一种用于下肢深静脉血栓形成的快速有效的床边筛查工具。腹部超声在急诊情况下提供重要线索；对于不稳定的创伤患者，重点检查可能会立即给出答案，并且在诊断腹腔内出血方面已在很大程度上取代了诊断性腹腔灌洗。从颅内压评估到经颅多普勒研究，超声在神经重症监护中的作用越来越大。超声在包括经皮气管切开术在内的多种情况下也有助于气道管理。显然，床旁超声检查已成为重症监护实践中不可或缺的一部分——无论是在对危重症患者的快速评估中，还是在提高侵入性操作的安全性方面。
