Ultrasonography is essential in intensive care units for rapid, real-time assessment and management of various organ systems, particularly for patients with mechanical circulatory support (MCS) devices. It aids in the di...Ultrasonography is essential in intensive care units for rapid, real-time assessment and management of various organ systems, particularly for patients with mechanical circulatory support (MCS) devices. It aids in the diagnosis, safe placement, and monitoring of MCS devices such as extracorporeal membrane oxygenation, Impella, and implantable left ventricular assist devices, used for conditions like cardiogenic shock and severe respiratory failure. Ultrasonography ensures precise device positioning, identifies complications, and facilitates weaning. Future advancements in AI, portable devices, and advanced imaging techniques will enhance diagnostic accuracy and patient care.
The use of point-of-care ultrasound (POCUS) has become a well-versed tool in both the assessment and management of critically ill and injured patients. POCUS is noninvasive, readily accessible, and can be repeatedly used...The use of point-of-care ultrasound (POCUS) has become a well-versed tool in both the assessment and management of critically ill and injured patients. POCUS is noninvasive, readily accessible, and can be repeatedly used without the risks associated with radiation, making it ideal for continuous monitoring. In the context of mechanical ventilation, POCUS can be instrumental in diagnosing and monitoring a variety of pulmonary and cardiac conditions. This article describes the utilization of POCUS through each phase of mechanical ventilation including its use before intubation, at the time of intubation, during mechanical ventilation, and up to the liberation of invasive ventilation.
Elevated intracranial pressure (ICP) is a critical condition that requires rapid diagnosis and intervention to prevent severe neurologic damage and mortality. While invasive ICP monitoring remains the gold standard, it c...Elevated intracranial pressure (ICP) is a critical condition that requires rapid diagnosis and intervention to prevent severe neurologic damage and mortality. While invasive ICP monitoring remains the gold standard, it carries significant risks in cases of coagulopathy, bleeding diathesis, or in unstable patients. Additionally, there is a risk of infection, particularly in immunocompromised patients. Transcranial ultrasonography offers a valuable, non-invasive bedside tool for indirectly assessing elevated ICP in critical care settings. There are 3 primary modes of detecting elevated ICP using bedside ultrasound: transcranial Doppler ultrasonography, transcranial color Doppler, and optic nerve sheath diameter.
The abdomen is a fixed space that functions at a normal physiologic pressure. Abdominal compartment syndrome (ACS) can arise from elevations in intra-abdominal pressure (IAP). Rising IAP has direct effects on the organs...The abdomen is a fixed space that functions at a normal physiologic pressure. Abdominal compartment syndrome (ACS) can arise from elevations in intra-abdominal pressure (IAP). Rising IAP has direct effects on the organs both within and outside the abdomen. These effects can be targeted using ultrasound for noninvasive and rapid diagnosis and management of ACS. ACS is a severe disease and the ability to rapidly diagnose and manage it with point of care ultrasound can significantly impact patient outcomes.
This review provides an overview of the evolution and current role of ultrasound, particularly the extended focused assessment with sonography in trauma (E-FAST). Ultrasound (US) has gained recognition for its efficacy o...This review provides an overview of the evolution and current role of ultrasound, particularly the extended focused assessment with sonography in trauma (E-FAST). Ultrasound (US) has gained recognition for its efficacy over physical examinations and standard radiography in trauma care. The introduction of chest US (E-FAST) further enhances its utility, particularly in identifying thoracic injuries where plain film radiography falls short. Despite its advantages, US has limitations, including lower sensitivity in detecting solid organ injuries and challenges in obese patients. This review aims to explore US's role, technique, and limitations in trauma evaluation, focusing on the components of the E-FAST.
Here we describe the evidence for point-of-care ultrasonography application in cardiac arrest. Most commonly, transthoracic echocardiography and transesophageal echocardiography imaging may identify reversible etiologies...Here we describe the evidence for point-of-care ultrasonography application in cardiac arrest. Most commonly, transthoracic echocardiography and transesophageal echocardiography imaging may identify reversible etiologies for arrest, guide chest compression quality, and provide prognostic information. Many arrest ultrasound protocols have been described, and emphasize qualitative assessment of cardiac and respiratory pathology while minimizing disruption to chest compressions.
Pulmonary embolism (PE) is a significant cause of illness and death. Computed Tomography pulmonary angiography is considered the gold standard for diagnosing PE, but it is costly, not practical in cases of shock and card...Pulmonary embolism (PE) is a significant cause of illness and death. Computed Tomography pulmonary angiography is considered the gold standard for diagnosing PE, but it is costly, not practical in cases of shock and cardiac arrest, and exposes the patient to radiation. In this review, we will discuss the role and characteristics of lung, venous, and cardiac ultrasound in point-of-care diagnosis and risk assessment of PE and suggest how to incorporate them into a diagnostic algorithm. Point-of-care ultrasound has numerous benefits, nevertheless, it is complex, has low individual sensitivity, and requires extensive training.
In recent years, there has been a significant increase in the use of lung ultrasound in critical care, as its value in the assessment of acute respiratory failure has been acknowledged. When performed by an experienced c...In recent years, there has been a significant increase in the use of lung ultrasound in critical care, as its value in the assessment of acute respiratory failure has been acknowledged. When performed by an experienced clinician, it enables rapid, accurate, and radiation-free evaluation of a range of conditions directly at the patient's bedside. Lung ultrasound is straightforward to execute and offers greater sensitivity and specificity than commonly used diagnostic methods (eg, chest radiography) for many pathologies. This article describes how to perform lung ultrasound in critically ill patients, discusses key pathologic findings, and describes its use to guide thoracocentesis.
Research indicates that 60% of intensive care unit (ICU) patients may not respond to intravenous fluids following an initial resuscitation of 30 mL/kg, highlighting the challenges of fluid administration, which can also...Research indicates that 60% of intensive care unit (ICU) patients may not respond to intravenous fluids following an initial resuscitation of 30 mL/kg, highlighting the challenges of fluid administration, which can also be associated with complications. Consequently, managing volume challenges in critically ill patients is not always risk-free. To mitigate these risks, it is advisable to employ less invasive methods for assessing blood volume status. Additionally, using dynamic maneuvers alongside echocardiography can provide a more accurate evaluation of the hemodynamic response, improving patient management in the ICU setting.
Shock is a common and deadly illness with a dynamic course over time. Echocardiography is an essential diagnostic tool in the management of shock. Each phase of shock management requires a specific approach with differen...Shock is a common and deadly illness with a dynamic course over time. Echocardiography is an essential diagnostic tool in the management of shock. Each phase of shock management requires a specific approach with different echocardiographic goals. The initial goal of echocardiography is to diagnose the cause of shock, followed by treatment optimization, stabilization, and deescalation. The initial examination is rapid and based on the recognition of patterns (low mean systemic pressure, left and right heart failure, tamponade, and catastrophic valve failure) using a qualitative 2-dimensional examination with selected Doppler techniques. Subsequent examinations are often more detailed, semiquantitative, and quantitative.
Lee S, Wischmeyer PE, Mintz CD
… +1 more, Serbanescu MA
Crit Care Clin
· 2025 Apr · PMID 40021286
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This review explores the evolving understanding of gut microbiota's role in critical illness, focusing on how acute illness and exposures in intensive care unit (ICU) environment negatively impact the gut microbiota and...This review explores the evolving understanding of gut microbiota's role in critical illness, focusing on how acute illness and exposures in intensive care unit (ICU) environment negatively impact the gut microbiota and the implications of these changes on host responses in critically-ill patients. Focusing on recent findings from clinical and preclinical studies, we discuss the effects of inflammation, enteral nutrient deprivation, and antibiotics on gut microbial dynamics. This review aims to enhance comprehension of microbial dynamics in the ICU and their implications for clinical outcomes and therapeutic strategies.
Selecting appropriate outcome measures is a critical component of clinical trial design. Core outcome sets, which utilize stakeholder input to define the most important outcomes for a particular research question, are va...Selecting appropriate outcome measures is a critical component of clinical trial design. Core outcome sets, which utilize stakeholder input to define the most important outcomes for a particular research question, are valuable in improving the consistency of research, such that conclusive recommendations can be made. Alongside these core outcomes, exploratory outcomes are keys to providing novel insights into disease pathophysiology and treatment response. Surrogate outcomes developed through exploratory methods may enable intervention at an earlier stage, with the potential for prevention rather than management of the sequalae of critical illness.
In this review, we outline key practical components of the nutritional management of critically-ill children in the context of the current peer reviewed literature and identify vital knowledge gaps for further investigat...In this review, we outline key practical components of the nutritional management of critically-ill children in the context of the current peer reviewed literature and identify vital knowledge gaps for further investigation. Emerging areas of research are discussed, including skeletal muscle ultrasonography for measurement of skeletal muscle, and the potential future role of pre- and probiotics.
During the past decade, there has been an increased research focus on the prevalence, nature, and impact of newly acquired critical illness dysphagia. Disordered function can impact the safety and efficiency across all s...During the past decade, there has been an increased research focus on the prevalence, nature, and impact of newly acquired critical illness dysphagia. Disordered function can impact the safety and efficiency across all stages of the swallow mechanism, with detrimental impacts on patients' body systems, function, and participation. Accurate assessment of swallow function is key to informed diagnosis and enhances intervention planning. We discuss the current evidence base around dysphagia pathophysiology with a detailed discussion considering the modes of ventilation commonly received in intensive care units. Assessment and management across critical illness are evaluated and future research efforts are presented.
During critical illness and while recovering, patients may experience varied nutrition interventions, nutrition-impacting symptoms, and challenges relating to the systems of hospital food services. All of these factors c...During critical illness and while recovering, patients may experience varied nutrition interventions, nutrition-impacting symptoms, and challenges relating to the systems of hospital food services. All of these factors can directly impact their experiences and nutrition intake. External factors that may indirectly influence the patient experience of nutrition include family involvement, clinician knowledge and communication, and the hospital environment. The experience of patients during hospitalization may affect behavior and ability to comply with nutrition-related recommendations. However, understanding and including these experiences may help to improve clinical practice, hospital food service systems, and research design.
The intensive care unit (ICU) environment is one of the most challenging for skeletal muscle health. Atrophy associated with clinical care is distinct from that seen with inactivity or immobilization in the absence of di...The intensive care unit (ICU) environment is one of the most challenging for skeletal muscle health. Atrophy associated with clinical care is distinct from that seen with inactivity or immobilization in the absence of disease and is exacerbated by aging. The substantial muscle loss in the ICU is likely due to the presence of inflammation, elevated proteolysis, bedrest, and undernutrition. Skeletal muscle parameters at admission are predictive of mortality and other clinically important outcomes. Treatment goals to mitigate muscle loss are early mobilization and adequate nutrient supply, especially protein, using an individualized approach to support skeletal muscle maintenance and recovery.
This narrative review provides an overview of body composition methods available for use in critically ill patients. It focuses on the relevance and discussion of the most commonly used techniques. Further, we discuss th...This narrative review provides an overview of body composition methods available for use in critically ill patients. It focuses on the relevance and discussion of the most commonly used techniques. Further, we discuss the validity of these methods with a focus on muscle mass assessment, measuring changes over time and the identification of patients with lower-than-normal muscularity. Current available evidence, as well as future directions is highlighted.
Artese AL, Winthrop HM, Beyer M
… +4 more, Haines KL, Molinger J, Pastva AM, Wischmeyer PE
Crit Care Clin
· 2025 Apr · PMID 40021279
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Full text
Survivors of critical illness experience significant morbidity, reduced physiologic reserve, and long-term complications that negatively impact quality of life. Although rehabilitative treatments are beneficial during ea...Survivors of critical illness experience significant morbidity, reduced physiologic reserve, and long-term complications that negatively impact quality of life. Although rehabilitative treatments are beneficial during early recovery, there is limited evidence regarding effective multimodal rehabilitation, nutrition, and anabolic nutrient/agent strategies for improving long-term outcomes. This review discusses novel personalized rehabilitation, nutrition, and anabolic nutrient/agent (ie, creatine, β-hydroxy-β-methylbutyrate, testosterone) approaches that allow for precise exercise and nutrition prescription and have potential to improve patient care, address continued medical needs, and optimize long-term recovery. Continued research is needed to further evaluate effectiveness and implementation of these strategies throughout the continuum of care.
Nutrition therapy is a complex intervention with several underlying considerations that may influence effectiveness. Considerations include the mechanism of action of the intervention and the patient phenotype, including...Nutrition therapy is a complex intervention with several underlying considerations that may influence effectiveness. Considerations include the mechanism of action of the intervention and the patient phenotype, including sex, ethnicity, body composition, and the patients' nutritional and inflammatory status. Energy and protein targets are elements of nutrition therapy that may be particularly influenced by individual patient factors. Biomarkers may provide a useful tool to monitor and individualize nutrition therapy in the future. The considerations mentioned, with many yet to be studied, highlight the rationale for more individualized interventions moving away from a 'one-size-fits-all' approach.