Why ICU Sonology?

Sonography has evolved to become one of the most versatile modalities for diagnosing and guiding treatment of critically ill patients. It consists of both cardiac (Echocardiography) and non-cardiac (lung, abdominal and vascular) ultrasound.

It can be used for the following in the ICU:

  • Hemodynamics
    • Non-invasive assessment of cardiac output
    • Assessing myocardial contractility and regional wall motion abnormalities
    • Volume status assessment
    • Predicting volume responsiveness
    • Diagnosing diastolic ventricular dysfunction and estimating filling pressures non-invasively
    • Assessing right heart function and diagnosing acute cor pulmonale in ARDS and pulmonary embolism
    • Detecting pericardial effusion and tamponade
  • Pulmonary
    • Detecting pleural effusion
    • Rapid diagnosis of pneumothorax
    • Differentiating consolidation, alveolar-interstitial syndrome, pulmonary embolism and pneumothorax using the BLUE protocol
  • Vascular
    • Diagnosing deep venous thrombosis
  • Abdomen
    • Detecting ascites and collections
    • Diagnosing urinary bladder distension and hydronephrosis
    • Studying renal arterial resistivity indices as an indicator of renal blood flow
  • Neuro
    • Detecting raised ICP using optic nerve sheath diameter
    • Detecting midline shift
    • Assessing adequacy of cerebral blood flow in patients with traumatic and non-traumatic brain injury
    • Diagnosing cerebral circulatory arrest
    • Assessing pupils in patients whose eyelids cannot be opened
  • Resuscitation
    • Differentiating fine ventricular fibrillation from true asytole
    • Diagnosing potentially reversible causes of PEA or asystole such as pericardial tamponade, myocardial infarction, severe hypovolemia, pulmonary embolism or tension pneumothorax – the Focussed Echocardiographic Evaluation in Resuscitation (FEER)
    • Asessing for cardiac standstill to help with prognostication during resuscitation
  • Other diagnostic uses
    • Detect fluid in pericardial, perisplenic, perihepatic aand pelvic areas in trauma – the Focussed Assessment with Sonography for Trauma (FAST)
    • Diagnosing sinusitis in intubated patients
  • Therapeutic
    • Guided arterial and central vascular access
    • For guided thoracocentesis and abdominal paracentesis
    • Pericardiocentesis
    • Bedside Percutaneous nephrostomy
    • Guided drainage of collections

The ability to assess myocardial function and cardiac output non-invasively is immensely useful in the management of the complicated or mixed shock states. This along with the ability to assess volume status has made it an essential hemodynamic monitoring tool in the ICU.

While echocardiography and sonology may be thought to be the forte of cardiologists and radiologists, it is crucial to recognise that critical care sonology has a different focus and uses different techniques to look at different aspects from traditional cardiology echocardiography. It complements rather than replaces traditional sonology.

This modality is likely to be particularly useful in resource challenged countries as it is non-invasive, economical, repeatable and can be performed at the bedside. Add to this the rapid growth of intensive care units and intensivists, and one realizes the need for a structured program to train intensivists in critical care sonology. There are, however no such training programs in place in India, and very few outside the country. That is where this website plans to step in as a starting point to a more advanced and detailed critical care sonology training and certification program.