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Respiratory Medicine
Series Editors: Sharon I.S. Rounds · Anne E. Dixon · Lynn M. Schnapp
MichaelJ.Lanspa
AndrewT.LevinsonEditors
Echocardiography and
Ultrasonography in
theICU
AComprehensive Text
Respiratory Medicine
Series Editors
SharonI.S.Rounds, Brown University, Providence,USA
AnneE.Dixon, University of Vermont, Larner College of Medicine,
Burlington,VT,USA
LynnM.Schnapp, University of Wisconsin- Madison, Madison,USA
Respiratory Medicine oers clinical and research-oriented resources for
pulmonologists and other practitioners and researchers interested in
respiratory care. Spanning a broad range of clinical and research issues in
respiratory medicine, the series covers such topics as COPD, asthma and
allergy, pulmonary problems in pregnancy, molecular basis of lung disease,
sleep disordered breathing, and others.
e series editors are Sharon Rounds, MD, Professor of Medicine and of
Pathology and Laboratory Medicine at the Alpert Medical School at Brown
University, Anne Dixon, MD, Professor of Medicine and Director of the
Division of Pulmonary and Critical Care at Robert Larner, MD College of
Medicine at the University of Vermont, and Lynn M.Schnapp, MD, George
R. And Elaine Love Professor and Chair of Medicine at the University of
Wisconsin-Madison School of Medicine and Public Health.
Michael J. Lanspa • Andrew T. Levinson
Editors
Echocardiography
and Ultrasonography
in the ICU
A Comprehensive Text
Editors
Michael J. Lanspa
Pulmonary and Critical Care
Intermountain Medical Center
Murray, UT, USA
Andrew T. Levinson
Division of Pulmonary, Critical Care,
and Sleep Medicine
The Warren Alpert Medical School,
Brown University
Providence, RI, USA
ISSN 2197-7372 ISSN 2197-7380 (electronic)
Respiratory Medicine
ISBN 978-3-031-80037-5 ISBN 978-3-031-80038-2 (eBook)
https://doi.org/10.1007/978-3-031-80038-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
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The publisher, the authors and the editors are safe to assume that the advice and information in
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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
Preface
The specialty of critical care echocardiography is in its adolescence, having
grown considerably over the past two decades. Critical care ultrasound, previously used for procedural guidance or to make qualitative assessments for
simple diagnoses, is now used to quantify hemodynamics, identify subtle
abnormalities, and guide therapies. Over the same period, the specialties of
critical care and echocardiography have evolved to include these new ultrasound advances. The development of a board examination in the eld of critical care echocardiography underscores this growth. It is our hope that this
textbook might spark insight in the next generation of clinicians and scientists, who might propel our eld forward.
This textbook is an attempt to provide a comprehensive overview of the
eld of critical care echocardiography and ultrasound in its current state. The
rst chapters examine the fundamental principles and techniques that are the
foundation of current critical care ultrasound techniques. The following chapters detail the echocardiographic skills and techniques pertinent to critical
care practice. Lung, airway abdominal, vascular, and neurologic ultrasonography are then discussed in detail. The last third of the book explores complex
scenarios, ultrasound education, and practical aspects of critical care
ultrasound.
Throughout the text, we describe not only the current standard, but also
areas of evolving evidence. These areas of evolving evidence are identied as
such. It should be acknowledged that future investigation might invalidate
those areas of evolving evidence. Additionally, the reader should recognize
that the applications described herein presume a high-income and highresource clinical environment. Clinical applications described in this text
might require modication or additional considerations when used in
resource-limited environments.
This book could not have come into existence without the generous contributions of countless national and international expert educators in echocardiography and ultrasound. One strength of this textbook is the diversity of the
authors, who hail from multiple countries, disciplines, and specialties. We
thank them for their generosity, diligence, and patience.
Murray, UT, USA MichaelJ.Lanspa
Providence, RI, USA AndrewT.Levinson
v
Contents
Part I Ultrasound Basics
1 Physics of Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ziad S. Shaman and Faisal S. Qadir
2 Probes and Imaging Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chris Allison
3 Ultrasound Artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Taro Minami
4 Positioning, Safety, Manipulation of Probe . . . . . . . . . . . . . . . . . 45
Sameer Khanijo and Mangala Narasimhan
Part II Echocardiography
5 Transthoracic Windows and Views . . . . . . . . . . . . . . . . . . . . . . . . 51
Nova Panebianco and Michael O’Neil
6 Transthoracic M-Mode Echocardiography . . . . . . . . . . . . . . . . . 63
Becky Burk
7 Transthoracic Doppler Echocardiography . . . . . . . . . . . . . . . . . . 73
Enyo Ablordeppey and Aaron Murphy-Crews
8 Transesophageal Echocardiography:
Insertion, Manipulation, Risks, Complications . . . . . . . . . . . . . . 87
Christopher Koo and Daniel Walsh
9 Transesophageal Windows and Views . . . . . . . . . . . . . . . . . . . . . . 95
Mark Hamlin and Ariel Bensimhon
10 Artifacts and Pitfalls in Transesophageal
Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Marcus Behrens and Tonia Timperley Tauh
11 LV Systolic Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Jonathan N. Wilkinson and Feroz Mohammed
vii
viii
12 Assessment of Left Ventricular Systolic Function
in Patients with Difficult or Poor Acoustic Windows . . . . . . . . . . 149
Brandon M. Wiley
13 The Right Ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Siddharth Dugar and Saraschandra Vallabhajosyula
14 Atrial Size and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Taha Ahmed, Amit Arbune, and Vincent L. Sorrell
15 Left Ventricular Diastolic Function . . . . . . . . . . . . . . . . . . . . . . . . 193
Ryota Sato and Siddharth Dugar
16 Cardiomyopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
John C. Klick and Rachel Carlson
17 Aortic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Connor O’Brien and Christopher F. Barnett
18 Aortic and Pulmonic Regurgitation . . . . . . . . . . . . . . . . . . . . . . . 243
Jacqueline Sohn and Jose L. Diaz-Gomez
19 Mitral and Tricuspid Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Nicholas Levin and Christopher Kelly
20 Mitral and Tricuspid Regurgitation . . . . . . . . . . . . . . . . . . . . . . . 265
Mourad H. Senussi
Contents
21 Calculation of Intracardiac Pressures Using Doppler Flow . . . . 273
Courtney Bennett
22 Prosthetic Valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Gloria A. Ayuba and Vera Rigolin
23 Infective Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Flora Li and Sara Nikravan
24 Cardiac Tamponade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Gil Allen and MaryEllen Antkowiak
25 Ultrasound-Guided Pericardiocentesis . . . . . . . . . . . . . . . . . . . . . 325
Lisa Rapoport and Pranjal Gupta
26 Pericarditis and Constriction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Sarah Bain and Brooks Ohlson
27 Benign Masses, Normal Anatomic Variants, and Artifacts . . . . . 343
Tara Brakke and Stephen Brannan
28 Left Ventricular Thrombus Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . 357
Donald R. Maberry and Babar Fiza
29 Left Ventricular Thrombus Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . 367
John L. Maurer and Matthew E. Prekker
30 Left Atrial Thrombus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Megan H. Hicks and Manender Kumar Singla
Contents
ix
31 Right-Sided Thrombus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Karim El-Kersh and Bilal Athar Jalil
32 Diagnosing Acute Aortic Syndromes with Ultrasound . . . . . . . . 395
Meghan Snuckel and Andrew T. Levinson
33 Adult Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Erik Su and Saul Flores
Part III Ultrasonography
34 Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Nicholas A. Leverone and Daniel A. Sweeney
35 Point-of-Care Ultrasound for the Diagnosis
of Pneumothorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Joel Turner
36 Pulmonary Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Daniel Gerber and Paul K. Mohabir
37 Pneumonia and Consolidation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
Andrew Foderaro and Andrew T. Levinson
38 Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Idunn Morris and Ewan Goligher
39 Thoracentesis and Thoracostomy Procedural Guidance . . . . . . 457
Tahir Ahmad and Jen-Ting Chen
40 Ultrasound During Intubation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Youyou Duanmu and Erin J. Liang
41 Transcutaneous Laryngeal Ultrasonography:
Vocal Fold Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Akiva Leibowitz and Achikam Oren-Grinberg
42 Focused Assessment of Sonography in Trauma (FAST) . . . . . . . 477
Monica Saxena
43 Renal and Bladder Ultrasonography for the Intensivist . . . . . . . 481
David N. Suwondo and Cristiana Baloescu
44 Gastric, Biliary, and Hepatic Ultrasound in the ICU . . . . . . . . . 491
Maha Salama and Amira Mohamed
45 Ultrasound Guidance for Abdominal Procedures . . . . . . . . . . . . 497
Belal Noureddine and Kristin Dwyer
46 Vascular Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Hallie Brown and Viveta Lobo
47 Echocardiographic Guidance of Mechanical
Circulatory Support (ECMO, IABP, REBOA) . . . . . . . . . . . . . . 511
Matthew J. Griffee, Mina Khorashadi, and Linda Nguyen
x
48 Deep Venous Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
Megan Trieu and Nida Qadir
49 Carotid Sonography in Critical Care . . . . . . . . . . . . . . . . . . . . . . 533
James Korneld and Christopher Shaw
50 Optic Nerve Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Carla Venegas, Kimberly McPhearson, and Aarti Sarwal
51 Transcranial Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Nina Massad and Shivani Ghoshal
Part IV Complex Clinical Scenarios
52 Diagnostic Approach to Patient in Shock . . . . . . . . . . . . . . . . . . . 557
Jan Kasal and Chakra Venkata
53 Assessment of Fluid Responsiveness . . . . . . . . . . . . . . . . . . . . . . . 573
Xavier Monnet
54 Assessment of Venous Congestion with Ultrasound . . . . . . . . . . . 587
Korbin Haycock
55 Pulmonary Embolism and Acute Cor Pulmonale . . . . . . . . . . . . 595
Achikam Oren-Grinberg and Akiva Leibowitz
Contents
56 The Critically Ill Patient with Pulmonary Hypertension . . . . . . 607
Karim El-Kersh and Bilal Athar Jalil
57 ARDS and Respiratory Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . 619
Imrana Qawi and Kathleen M. Waybill
58 US, Diuresis, and Weaning from Mechanical Ventilation . . . . . . 631
Kathryn Hendrickson and Ellie Hirshberg
59 Ultrasound Diagnosis of Acute Respiratory Failure
and the BLUE-Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 637
Daniel A. Lichtenstein
60 Acute Coronary Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 647
Christopher W. Hoeger and Eli V. Gelfand
61 Extracorporeal Life Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 657
Mark Caridi-Scheible
62 Ultrasound in Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669
Danie Leahy and Stephanie Cha
Part V Ultrasound Education
63 Principles of Pedagogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 681
Christopher K. Schott and Mark M. Ramzy
64 Curriculum Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 689
Drew Brotherston, Robert Jackson, and Alberto Gof