Date: 23rd February 2025
Love is in the air... and so is learning!
Building on the success of our new monthly POCUS Papers blog, we're excited to share February's carefully curated collection of ultrasound literature. This month's selection showcases the growing evidence base for point-of-care ultrasound across critical care settings. From intensive care to emergency medicine, we've handpicked publications that demonstrate how POCUS continues to shape clinical decision-making and improve patient outcomes.
Whether you're an experienced practitioner or just starting your ultrasound journey, our summaries highlight the key findings and practical applications you can implement at the bedside. Remember, all our blog posts are freely accessible to newsletter subscribers, ensuring you stay current with the latest developments in critical care ultrasound.
Critical Care Echocardiography in Septic Shock: The ‘Good, Bad, and Ugly’ Phenotypes
🌐 Context and Background
Septic shock remains a major challenge in intensive care, with mortality rates of 30–40%. Traditional treatment approaches are increasingly shifting towards personalised haemodynamic management, where critical care echocardiography (CCE) helps classify septic shock into three key cardiovascular phenotypes.
🔍 Key Developments and Insights
The “Good” Phenotype: Preserved LV ejection fraction (EF) and ventricular function. These patients may still be in shock but require careful fluid titration.
The “Bad” Phenotype: Severe LV systolic dysfunction or LV hyperkinesia, linked to higher mortality rates (up to 51%). LV hyperkinesia may indicate persistent vasoplegia despite norepinephrine.
The “Ugly” Phenotype: Pre-existing LV dysfunction due to conditions like ischaemic heart disease, diabetes, or hypertension, making differentiation between acute and chronic dysfunction challenging.
💡 Impact and Significance
CCE enables dynamic reassessment of fluid responsiveness, vasopressor effects, and cardiac adaptation in septic shock. Regular monitoring helps detect transitions between phenotypes and optimise treatment strategies.
Ultrasound in Trauma: A ‘Top-to-Toe’ POCUS Approach
🌐 Context and Background
Whilst CT imaging remains the gold standard in trauma evaluation, POCUS plays a critical role in early identification of life-threatening injuries, particularly in pre-hospital settings and resource-limited environments.
🔍 Key Developments and Insights
A systematic ‘top-to-toe’ ultrasound approach enhances early trauma assessment:
Brain Perfusion: Transcranial Doppler (TCD) can detect intracranial hypertension based on cerebral blood flow velocity. Optic nerve sheath diameter (ONSD) >6 mm suggests raised intracranial pressure.
Chest Trauma: Lung ultrasound is superior to chest X-ray in detecting traumatic pneumothorax and haemothorax, allowing early intervention.
Haemorrhage Detection: FAST ultrasound detects free intraperitoneal fluid with high specificity (96%), guiding early damage control resuscitation.
Occult Hypovolaemia: IVC collapsibility >20% and LVOT VTI variability >10% suggest compensated hypovolaemia, aiding in fluid resuscitation decisions.
💡 Impact and Significance
POCUS allows early identification of life-threatening trauma complications, guiding timely surgical and resuscitative interventions. Future advancements in contrast-enhanced ultrasound (CEUS) may further improve solid organ injury detection.
Ultrasound in Weaning from Mechanical Ventilation: The ABCDE Approach
🌐 Context and Background
Difficult weaning from mechanical ventilation is associated with increased mortality and healthcare costs. Ultrasound can be a valuable tool in assessing weaning readiness, diagnosing causes of failure, and monitoring patient progress.
🔍 Key Developments and Insights
The ABCDE-ultrasound approach provides a structured framework for ventilator weaning assessment:
A – Aeration score and pleural effusion: Lung ultrasound helps predict extubation failure based on lung aeration patterns and B-line progression.
B – Below the diaphragm: Abdominal ultrasound detects ascites and elevated intra-abdominal pressure, which may impact breathing mechanics.
C – Cardiac function: Diastolic dysfunction and LV filling pressures correlate with weaning failure.
D – Diaphragm dysfunction: Diaphragm ultrasound (excursion and thickening fraction) predicts weaning failure when excursion is <10–15 mm or thickening fraction <30–35%.
E – Extra-diaphragmatic muscles: Intercostal and abdominal muscle assessment helps identify respiratory compensation mechanisms.
💡 Impact and Significance
POCUS provides real-time insights into weaning failure causes, allowing tailored intervention strategies to reduce re-intubation rates. Future research will explore continuous ultrasound monitoring during weaning trials.
Conclusion
February’s What’s Hot in POCUS? underscores the growing role of ultrasound in personalised critical care management—from septic shock classification to ventilator weaning and trauma resuscitation.
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About the writer
Hannah Conway, a clinical-academic and National FUSIC Heart Lead for the UK.
Interests lie in PoCUS education, Echocardiography, RV injury and telemedicine
Follow me on Twitter/X for more PoCUS related educational content https://x.com/cardiacaccp
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