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Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to...
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Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 25 May 2024 | Viewed by 24980

Special Issue Editor

Dr. Claudia Brusasco

E-Mail Website
Guest Editor
Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
Interests: point-of-care ultrasound; non-invasive mechanical ventilation; regional anesthesia; perioperative medicine; robotic surgery; acute kidney injury; enhanced recovery after surgery

Special Issue Information

Dear Colleagues,

Ultrasound in Anesthesiology and Critical Care Medicine is now used in many clinical settings and in all phases of care, from diagnosis to procedural guidance causing changes in clinical decision-making. In Critical Care Medicine, physicians are often faced with complex clinical pictures involving multiple organ failures including but not limited to heart failure, acute kidney injury, respiratory failure, trauma and brain injury. In a such complex scenario a real-time, bedside, rapidly available multi-faceted ultrasound approach is fundamental to personalize treatments. Thus, new diagnostic algorithms have been developed to provide simple answers to simple questions in a short timespan manner in order to guide specific treatments. This approach includes the assessment of respiratory failure and the optimization of ventilatory strategy by lung ultrasonography, the prediction of patient-ventilator interaction, early detection of weaning failure and the assessment of muscular weakness by the study of the diaphragm, the optimization of hemodynamics, heart-lung interactions, and brain-lung-splanchnic cross-talk through the assessment of perfusion and congestion by abdominal Doppler ultrasonography, the monitoring of neurocritical patients by optic nerve sheath diameter and transcranial Doppler. As a result of technological innovation, most evaluations can now be performed at the bedside, thus allowing better integration with clinical management.

The present Special Issue “Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications” welcomes original submissions in order to share new strategies as well as novel clinical applications in this evolving field.

Dr. Claudia Brusasco
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • point-of-care ultrasound
  • lung ultrasound
  • diaphragmatic ultrasonography
  • focused assessment sonography for trauma
  • echocardiography
  • brain ultrasonography
  • regional anesthesia
  • perioperative medicine
  • splanchnic perfusion
  • congestion

Published Papers (6 papers)

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Research

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12 pages, 1073 KiB  
Article
Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block
by Marco Micali, Giada Cucciolini, Giulia Bertoni, Michela Gandini, Marco Lattuada, Gregorio Santori, Carlo Introini, Francesco Corradi and Claudia Brusasco
J. Clin. Med. 2024, 13(2), 383; https://doi.org/10.3390/jcm13020383 - 10 Jan 2024
Viewed by 746
Abstract
Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound-guided bilateral transversus abdominis plane block (TAPB) on postoperative [...] Read more.
Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound-guided bilateral transversus abdominis plane block (TAPB) on postoperative analgesia after laparoscopic or robotic urologic surgery. This was a prospective observational study; 97 patients (ESPB-group) received bilateral ultrasound-guided ESPB with 20 mL of ropivacaine 0.375% plus 0.5 mcg/kg of dexmedetomidine in each side at the level of T7–T9 and 93 patients (TAPB-group) received bilateral ultrasound-guided TAPB with 20 mL ropivacaine 0.375% or 0.25%. The primary outcome was the postoperative numeric rating scale (NRS) pain score, which was significantly lower in the ESPB group on postoperative days 0, 1, 2, and 3 (p < 0.001) and, consequently, the number of patients requiring postoperative supplemental analgesic rescue therapies was significantly lower (p < 0.001). Concerning the secondary outcomes, consumption of ropivacaine was significantly lower in the group (p < 0.001) and the total amount of analgesic rescue doses was significantly lower in the ESPB-group than the TAPB-group in postoperative days from 2 to 4 (1 vs. 3, p > 0.001). Incidence of postoperative nausea and vomiting was higher in the TAPB group and no block-related complications were observed. Our data indicate that ESPB provides postoperative pain control at least as good as TAPB plus morphine, with less local anesthetic needed. Full article
(This article belongs to the Special Issue Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications)
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19 pages, 2521 KiB  
Article
Perioperative Renal Ultrasonography of Arterio-to-Venous Coupling Predicts Postoperative Complications after Major Laparoscopic Urologic Surgery
by Claudia Brusasco, Guido Tavazzi, Giada Cucciolini, Pierpaolo Di Nicolò, Adrian Wong, Antonia Di Domenico, Federico Germinale, Federico Dotta, Marco Micali, Federico Coccolini, Gregorio Santori, Federico Dazzi, Carlo Introini and Francesco Corradi
J. Clin. Med. 2023, 12(15), 5013; https://doi.org/10.3390/jcm12155013 - 30 Jul 2023
Cited by 2 | Viewed by 2213
Abstract
Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the [...] Read more.
Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery. The secondary outcome was represented by the development of any postoperative complication at day 7. We included 173 patients, subsequently divided for analysis depending on whether they did (n = 55) or did not (n = 118) develop postoperative AKI or any complications within the first 7 days. The main results of the present study were that: (1) the combination of arterial hypoperfusion and moderate-to-severe venous congestion inferred by POCUS were associated with worst outcomes (respectively, HR: 2.993, 95% CI: 1.522–5.884 and HR: 8.124, 95% CI: 3.542–18, p < 0.001); (2) high intra-operative abdominal pressure represents the only independent determinant of postoperative severe venous congestion (OR: 1.354, 95% CI: 1.017–1.804, p = 0.038); (3) the overall number of complications relies on the balance between arterial inflow and venous outflow in order to ensure the adequacy of peripheral perfusion; and (4) the overall reliability of splanchnic perfusion assessment by Doppler is high with a strong inter-rater reliability (ICC: 0.844, 95% CI: 0.792–0.844). The concomitant assessment of arterial and venous Doppler patterns predicts postoperative complications after major laparoscopic urologic surgery and may be considered a useful ultrasonographic biomarker to stratify vulnerable patients at risk for development of postoperative complications. Full article
(This article belongs to the Special Issue Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications)
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6 pages, 404 KiB  
Communication
Endogenous Catecholamine Release in COVID-19 Related Acute Respiratory Distress Syndrome: Link between Enhanced Sympathetic Stimulation, Cardiac Dysfunction and Outcome
by Valentino Dammassa, Marta Voltini, Costanza Natalia Julia Colombo, Gilda Maria Siano, Claudia Lo Coco, Vittoria Rizzo, Francesco Corradi, Francesco Mojoli and Guido Tavazzi
J. Clin. Med. 2023, 12(4), 1557; https://doi.org/10.3390/jcm12041557 - 16 Feb 2023
Cited by 1 | Viewed by 1402
Abstract
The aim of this study was to measure the serum levels of catecholamines in patients admitted to intensive care unit (ICU) with COVID-19-related acute respiratory distress syndrome (ARDS) and describe their relation with clinical, inflammatory and echocardiographic parameters. Serum levels of endogenous catecholamines [...] Read more.
The aim of this study was to measure the serum levels of catecholamines in patients admitted to intensive care unit (ICU) with COVID-19-related acute respiratory distress syndrome (ARDS) and describe their relation with clinical, inflammatory and echocardiographic parameters. Serum levels of endogenous catecholamines (norepinephrine, epinephrine and dopamine) were measured at ICU admission. We enrolled 71 patients consecutively admitted to ICU due to moderate to severe ARDS. 11 patients (15.5%) died during the admission in ICU. Serum levels of endogenous catecholamines were significantly elevated. Norepinephrine levels were higher in those with RV and LV systolic dysfunction, higher CRP, and higher IL-6. Patients with higher mortality rate were those with norepinephrine values ≥ 3124 ng/mL, CRP ≥ 17.2 mg/dL and IL-6 ≥ 102 pg/mL. Univariable analysis by Cox proportional hazards regression modelling showed that norepinephrine, IL-6 and CRP had the highest risk of acute mortality. Multivariable analysis showed that only norepinephrine and IL-6 retained in the model. Marked increase of serum catecholamine levels is present during acute phase of critically ill COVID-19 and it is associated with inflammatory and clinical parameters. Full article
(This article belongs to the Special Issue Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications)
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12 pages, 1927 KiB  
Article
Electrocardiographic Time-Intervals Waveforms as Potential Predictors for Severe Acute Kidney Injury in Critically Ill Patients
by Francesco Corradi, Gregorio Santori, Claudia Brusasco, Chiara Robba, Adrian Wong, Pierpaolo Di Nicolò, Ludovica Tecchi, Federico Dazzi, Erika Taddei, Alessandro Isirdi, Federico Coccolini, Francesco Forfori, Guido Tavazzi and on behalf of UCARE Research Group
J. Clin. Med. 2023, 12(2), 700; https://doi.org/10.3390/jcm12020700 - 16 Jan 2023
Cited by 1 | Viewed by 1960
Abstract
Background: Acute kidney injury (AKI) is common in critically ill patients admitted to intensive care units (ICU) and is frequently associated with poorer outcomes. Hence, if an indicator is available for predicting severe AKI within the first few hours of admission, management strategies [...] Read more.
Background: Acute kidney injury (AKI) is common in critically ill patients admitted to intensive care units (ICU) and is frequently associated with poorer outcomes. Hence, if an indicator is available for predicting severe AKI within the first few hours of admission, management strategies can be put into place to improve outcomes. Materials and methods: This was a prospective, observational study, involving 63 critically ill patients, that aimed to explore the diagnostic accuracy of different Doppler parameters in predicting AKI in critically ill patients from a mixed ICU. Participants were enrolled at ICU admission. All underwent ultrasonographic examinations and hemodynamic assessment. Renal Doppler resistive index (RDRI), venous impedance index (VII), arterial systolic time intervals (a-STI), and venous systolic time intervals (v-STI) were measured within 2 h from ICU admission. Results: Cox proportional hazards models, including a-STI, v-STI, VII, and RDRI as independent variables, returned a-STI as the only putative predictor for the development of AKI or severe AKI. An overall statistically significant difference (p < 0.001) was observed in the Kaplan–Meier plots for cumulative AKI events between patients with a-STI higher or equal than 0.37 and for cumulative severe AKI-3 between patients with a-STI higher or equal than 0.63. As assessed by the area under the receiver operating curves (ROC) curves, a-STI performed best in diagnosing any AKI and/or severe AKI-3. Positive correlations were found between a-STI and the N-terminal brain natriuretic peptide precursor (NT-pro BNP) (ρ = 0.442, p < 0.001), the sequential organ failure assessment (SOFA) score (ρ: 0.361, p = 0.004), and baseline serum creatinine (ρ: 0.529, p < 0.001). Conclusions: Critically ill patients who developed AKI had statistically significant different a-STI (on admission to ICU), v-STI, and VII than those who did not. Moreover, a-STI was associated with the development of AKI at day 5 and provided the best diagnostic accuracy for the diagnosis of any AKI or severe AKI compared with RDRI, VII, and v-STI. Full article
(This article belongs to the Special Issue Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications)
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Review

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16 pages, 3019 KiB  
Review
Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients
by Michele Umbrello, Etrusca Brogi, Paolo Formenti, Francesco Corradi and Francesco Forfori
J. Clin. Med. 2024, 13(1), 26; https://doi.org/10.3390/jcm13010026 - 20 Dec 2023
Viewed by 931
Abstract
Muscle wasting begins as soon as in the first week of one’s ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower [...] Read more.
Muscle wasting begins as soon as in the first week of one’s ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one’s ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness. Full article
(This article belongs to the Special Issue Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications)
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13 pages, 1700 KiB  
Review
Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled
by Pierpaolo Di Nicolò, Guido Tavazzi, Luca Nannoni and Francesco Corradi
J. Clin. Med. 2023, 12(6), 2217; https://doi.org/10.3390/jcm12062217 - 13 Mar 2023
Cited by 16 | Viewed by 16445
Abstract
The correct determination of volume status is a fundamental component of clinical evaluation as both hypovolaemia (with hypoperfusion) and hypervolaemia (with fluid overload) increase morbidity and mortality in critically ill patients. As inferior vena cava (IVC) accounts for two-thirds of systemic venous return, [...] Read more.
The correct determination of volume status is a fundamental component of clinical evaluation as both hypovolaemia (with hypoperfusion) and hypervolaemia (with fluid overload) increase morbidity and mortality in critically ill patients. As inferior vena cava (IVC) accounts for two-thirds of systemic venous return, it has been proposed as a marker of volaemic status by indirect assessment of central venous pressure or fluid responsiveness. Although ultrasonographic evaluation of IVC is relatively easy to perform, correct interpretation of the results may not be that simple and multiple pitfalls hamper its wider application in the clinical setting. In the present review, the basic elements of the pathophysiology of IVC behaviour, potential applications and limitations of its evaluation are discussed. Full article
(This article belongs to the Special Issue Ultrasound in Anesthesiology and Critical Care Medicine: From Concept to Clinical Applications)
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