ATS Reading List

Ultrasound in the ICU

ATS Seminars: Intensive Care Ultrasound

A series of six articles with accompanying images and video clips illustrating the most common applications of intensive care ultrasound.

Introduction to ATS Seminars: Intensive Care Ultrasound

Intensive Care Ultrasound: I. Physics, Equipment, and Image Quality

Intensive Care Ultrasound: II. Central Vascular Access and Venous Diagnostic Ultrasound

Intensive Care Ultrasound: III. Lung and Pleural Ultrasound for the Intensivist

Intensive Care Ultrasound: IV. Abdominal Ultrasound in Critical Care

Intensive Care Ultrasound: V. Goal-directed Echocardiography

Intensive Care Ultrasound: VI. Fluid Responsiveness and Shock Assessment

Thoracic Ultrasound

Wernecke K, Galanski M, Peters PE, et al. Pneumothorax: Evaluation by ultrasound — Preliminary results. J Thorac Imaging. 1987; 2:76–8.  This is the first description of using ultrasound to diagnose pneumothorax. The authors performed pleural ultrasound on 8 patients with pneumothorax and 20 healthy controls. They found respiratory excursions of the pleura in all 20 healthy patients but none in the patients with pneumothorax, thus describing the "sliding sign" that is now a key component of bedside ultrasound. They also discuss the potential for using ultrasound in patients where radiography is less sensitive for pneumothorax, such as in the supine trauma or critically ill patient.

PMID: 3298684

DA Lichtenstein, GA Mezièere. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008; 134:117–125. This observational study of 301 consecutive ICU patients compared a focused lung ultrasound protocol (BLUE) with the discharge diagnosis based on the medical record. They describe mostly favorable sensitivity and specificity, particularly for pulmonary edema (SN 97%, SP 95%), and pneumothorax (SN 88%, 100%). US was performed by highly experienced providers, and the protocol requires familiarity with BLUE-specific nomenclature, raising concerns about generalizability to other settings. The authors emphasize that US can be used rapidly at the bedside, and is useful not in isolation but as an adjunct to current diagnostic strategies.
PMID: 18403664
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Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011; 17:859–866. This meta-analysis of 20 studies assessing CXR vs US for diagnosis of pneumothorax described a pooled sensitivity and specificity of 0.89 and 0.99 for ultrasonography by non-radiologists, compared to 0.52 and 1.00 for CXR. They also found that US operator experience was strongly associated with accuracy. Weaknesses of this study include the heterogeneity of the included trials and potential for publication bias. Authors highlight the utility of US as an adjunct to diagnosis specifically in ventilated and polytrauma patients.
PMID: 21546439

Last Reviewed: June 2017