Point-of-care ultrasound in critical care

Edited by Luke Flower and Pradeep Madhivthanan

I am at the beginning of my critical care POCUS journey, but I am starting to think about all the applications of POCUS I may need to be fluent in during my career in ICM. How can I integrate it into my ward rounds when I am a consultant?

Step forward POCUS for Critical care to help me answer this question…

Who are the authors?

The author list is a veritable rogues gallery of ultrascoundrels. Names such as Marcus Peck and Ashley Miller (co-chairs of the FUSIC committee) and Manni Waraich (neuro POCUS guru) reassure the reader that this is an absolute treasure trove of expert knowledge (in fact, many of the FUSIC committee are included in the list). There are over 40 contributors listed, each one bringing a career’s worth of expertise.

The book is edited by Dr Luke Flower, Trainee in anaesthesia and honorary clinical research fellow in ICM at the Central London School of Anaesthesia. Along with Dr Pradeep Madhivathanan, Consultant in Anaesthesia and ICM at Royal Papworth hospital.

Introduction

There are a fair few POCUS handbooks on the market at the moment, several of which have been reviewed on this website. With POCUS likely to become a core competency in ICM in the coming years, choosing a practical and easily accessible text is important. During this review, I will decide whether this is the right book for the job!

Structure

The book is divided into an introductory section with a useful chapter on basic ultrasound physics, as well as one on image optimisation and artefacts. Then there are 6 systems-based sections covering echocardiography, lung, abdominal (including the renal tract), vascular, neurological and airway ultrasound. The penultimate section entitled ‘situational ultrasound’ gives practical advice for using POCUS in the assessment of shock, fluid status, trauma, cardiac arrest and ICU acquired weakness. The final chapter explores ultrasound education in critical care. A pattern of an accessible descriptive initial chapter, with a more detailed study of the elements within, and finally an US-guided practical procedure is repeated throughout.

Content and Style

The systems-based sections are well laid out, starting with echocardiography, which begins with an accessible chapter on performing a scan with clear, instructional images. What follows is a deeper dive into left and right heart assessment, along with focussed valvular assessment and finally, assessment of the pericardium. This section contains a description of how to perform ultrasound-guided pericardiocentesis. There are red boxes containing ‘Echo tips’ and ‘potential pitfalls’ throughout. The Lung ultrasound section is similarly laid out, with a practical final chapter on US-guided thoracocentesis. The detailed chapters contain enough nitty-gritty to satisfy what most budding clinical ultrasonographers would need. There are US stills, original POCUS art line drawings and anatomical diagrams throughout. The summation of these helps the reader visualise the anatomy really nicely (at times it feels like an anatomy text in itself).

Images

The photographs of US images are useful and of good quality for the most part, although I am not sure about the stills of colour flow doppler studies. The anatomical drawings and line drawings of scan images add a completely new and memorable angle for the reader. There are video clips associated with all the detailed echo chapters, along with abdominal paracentesis and airway US, which give dynamic demonstrations of the assessments and images described. This has become fairly essential where text/ stills attempt to describe what is such a dynamic phenomenon.

Feel

This book is comprehensive but accessible, and it is clear the authors have tried hard to make it un-intimidating. I think they have succeeded! There are a great many of us who are unsure where to start with POCUS – FUSIC is a well-known, beautifully packaged programme for most. This book is small enough to put in your bag and will undoubtedly help you improve your practice, even if a mentor is not around.

Drawbacks

Like all textbooks these days, there is always the risk the text could become outdated, particularly when we live in a world of dynamically changing FOAMed. This is the harsh reality of the almost exponentially expanding sphere of medical knowledge and resources we see today. There are some sections I am not sure are particularly applicable to the general intensivist in a DGH, like the TOE chapter. It is tricky enough to get a cardiologist to do a TOE (and find the equipment), let alone be able to train oneself. Although with the FUSIC fTOE course, students will be pleased to have a quick reference text.

Conclusion

A highly useful book which has something for everyone, from beginner to advanced. One of the most comprehensive guides to all elements of critical care POCUS. The sections on those areas not covered by FUSIC will be very well read by enthusiasts, and the practical/descriptive approach taken by the authors affords easy application of these techniques at the bedside. Even though there is a wealth of online material covering POCUS, sometimes there’s nothing like a book to refer to. I expect this will be a regular in my work bag.

9/10

Review by Dr Fran Tait

Fran is a dual Intensive Care and Anaesthesia ST7 in the East Midlands deanery. She completed her medical school training at Guys, Kings and St Thomas’ in 2010 and after FY years spent in London, she has trained in anaesthesia and intensive care medicine in the East Midlands. She has accepted a 1 year sabbatical in ICM in New Zealand. She is vice chair of the Intensive Care Society Trainee Advisory Group and is involved in organising several sessions for the ICS State Of the Art meeting. She is an enthusiastic advocate for trainees and has been involved in near-peer mentoring. Outside of work Fran enjoys horse riding and growing vegetables and believes the benefits of being outdoors should be available for ICU patients too.