General Critical Care

Normal Hepatopetal flow of the portal vein without fluctuation or retrograde flow (i.e blood flow towards the liver. from the portal hepatis to the liver periphery).

Reversal of the S wave on the hepatic vein Doppler in a patient with alcoholic cardiomyopathy!

Same patient with dilated IVC without respiratory variation:

Lung consolidation, dynamic airbronchgram, and pleural effusion!.

Plethoric IVC with not much variation between inspiration and expiration indicating venous congestion.

Dynamic Air Bronchogram on Lung Ultrasound

Definition:

A dynamic air bronchogram refers to the movement of air within the bronchi that is visible on ultrasound. It typically appears as hyperechoic (bright) lines or dots that move within a hypoechoic (dark) background representing consolidated lung tissue.

Clinical Significance:

- **Pneumonia:** Dynamic air bronchograms are most commonly associated with pneumonia. They indicate that there is still air movement within the bronchi, despite the surrounding lung tissue being consolidated (filled with fluid, inflammatory cells, or pus). This finding supports the diagnosis of an infectious process rather than atelectasis.

Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis | Medical Devices and Equipment | JAMA Internal Medicine | JAMA Network

Researchers conducted a systematic review and meta-analysis of 130 observational and randomized studies spanning from 2015 to 2023 to estimate the complication rate associated with central venous catheters (CVCs) in adult inpatients. The study excluded peripherally inserted central venous catheters, dialysis catheters, long-term tunneled catheters, and catheters placed by radiologists.

The analysis revealed that the three most common complications related to CVC insertions were placement failure (20.4 events per 1000 catheters placed), arterial puncture (16.2 events per 1000 catheters placed), and pneumothorax (4.4 events per 1000 catheters placed). The composite outcome of four serious complications (arterial cannulation, pneumothorax, infection, and deep venous thrombosis) from a CVC placed for 3 days was estimated to occur at a rate of 30 events per 1000 catheters placed, translating to approximately…

Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized control trial

In a clinical trial with 100 intubated critically ill patients, using a videolaryngoscope for transesophageal echocardiogram probe insertion resulted in a higher first-attempt success rate (90% vs. 58%) and overall success rate (100% vs. 72%) compared to conventional techniques. It also reduced pharyngeal complications (14% vs. 52%).

https://www.sciencedirect.com/science/article/abs/pii/S2352556824000043

Cerebral ultrasound is a developing point of care tool for intensivists and emergency physicians, with an important role in the diagnosis of acute intracranial pathology, such as the assessment of cerebrovascular diseases and in the noninvasive

intracranial pressure measurement both in the acute clinical settings and in intensive care unit (ICU).

This paper is very good on how to use cerebral ultrasound in the icu:

https://www.minervamedica.it/en/getfreepdf/MW5aWks3Rk93dHh2Y2JJeENQbDZ0Y1JpNUxYblJpM0E3b1BZSGZsZzhNVkdsYXZIcUZPVnNpWUlPVjR3NCtiSw%253D%253D/R02Y2020N03A0327.pdf

Bedside ultrasound of the lung in a supine position for a mechanically ventilated patient.

What is the estimated pleural effusion volume?

It gets easier as you practice more, I do this almost on every patient post resuscitation. Variability or pulsatility of lesss than 30% indicates no venous congestion.

Hypovolemia with IVC collapsibility index >75%, not on the ventilator