Authors:

Abstract

Background: Despite its regular use, no literature is available regarding the use of ultrasound (US) in intensive care units (ICU) in Sri Lanka.

Objectives & Methods: This audit analysed critical care ultrasonography (CCUS) in the ICU of a District General Hospital. Data of 100 patients, from October 2019 to October 2020, were evaluated against the Society of Critical Care Medicine (SCCM) consensus guidelines of 2015. Adherence to Grade 1 recommendations (strongly recommended) was considered when assessing institutional compliance with SCCM guidelines.

Results: There were 59 males and 41 females with a mean age of 51.2 years. Indications for ICU admission included advanced monitoring (62%) and ventilatory (49%) and inotropic (41%) support for which the CCUS was employed. Fluid status was assessed in 72 patients, 67 by inferior vena cava (IVC) collapsibility / distensibility and 5 by Internal jugular vein (IJV) distensibility. Bedside cardiac US (n=74) was used for assessment of cardiac functions in 46(62.2%), pericardial effusions in 23(31.1%), pulmonary embolism in 2(2.7%) and exclusion of reversible causes of cardiac arrest in 3(4%). Lung ultrasound (n=42) was used for diagnosis of effusions in 36(83%), consolidation in 24(56%), sequential assessment of acute respiratory distress syndrome in 14(32.5%) and drainage of effusions in 3(4.6%). US-guided central venous (CV) lines were inserted in 62(95%). Of all CV catheterizations, 46(74%) were successful at the first attempt. Arterial puncture and pneumothorax were prevented at all times. In 14(82.3%), the need for central lines was avoided by US-guided peripheral cannulation. Ultrasound abdomen was used in 33(86.8%) for diagnostic and in 5(13.2%) for therapeutic purposes. Interventions and optimal management were delayed due to the unavailability of US in 80%.

Conclusion: There was 95% compliance with SCCM guidelines in following strongly recommended (Grade 1) fluid responsiveness / fluid status and central venous access. Dedicated, portable US scanners in ICUs and training of medical officers would minimize delays and improve outcomes

Keywords: ultrasonography, Point of care ultrasound, POCUS, Critical care ultrasonography, CCUS, bed-side cardiac ultrasonography, Society of Critical Care Medicine