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Critical care Ultrasonography as a Decision Support and Therapeutic Assist Tool in the Intensive Care Unit: A Single Center Retrospective Survey in a District General Hospital, Sri Lanka.

Authors:

B.M Munasinghe ,

District General Hospital, Mannar, LK
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U.P.M Fernando,

National Blood Transfusion Service, LK
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Nimalan Srisothinathan,

District General Hospital, Mannar, LK
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Nishanthan Subramaniam,

District General Hospital, Mannar, LK
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B.D.W Jayamanne,

Faculty of Medicine, University of Kelaniya, LK
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Janaki Arulmoli

Teaching Hospital, Jaffna, LK
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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

How to Cite: Munasinghe, B.M., Fernando, U.P.M., Srisothinathan, N., Subramaniam, N., Jayamanne, B.D.W. and Arulmoli, J., 2021. Critical care Ultrasonography as a Decision Support and Therapeutic Assist Tool in the Intensive Care Unit: A Single Center Retrospective Survey in a District General Hospital, Sri Lanka.. Journal of the Postgraduate Institute of Medicine, 8(2), pp.E162 1–12. DOI: http://doi.org/10.4038/jpgim.8332
Published on 31 Dec 2021.
Peer Reviewed

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