Why are ICU doctors also equipped with ultrasound machines? Doctors tell the truth

If you go into the ICU, you will find that many ICU doctors often have an ultrasound machine next to them when they are working. Shouldn't ultrasound be available only in the ultrasound department? Why are there so many ultrasound machines in the ICU?

To make this clear, let us first introduce Professor Daniel A. Lichtenstein from France. In the past, ultrasound examinations were performed by ultrasound doctors, mainly for the diagnosis of diseases. When ICU patients need ultrasound examinations, they either go to the ultrasound department or the ultrasound doctor pushes the machine to the bedside to examine the patient. Since ultrasound cannot pass through the air, lung ultrasound examinations are often considered a forbidden area. Because many ICU patients have lung diseases, Dr. Lichtenstein wondered if ultrasound could be used to examine the patient's lung lesions. It happened that the ICU had a simple ultrasound machine at the time, which was used to examine the patient's heart, so it was used to study lung ultrasound. In 1991, Professor Lichtenstein proposed the concept of critical care ultrasound. Unlike the previous use of ultrasound as a simple diagnostic tool, critical care ultrasound links diagnosis with dynamic assessment of the patient's condition and timely decision-making on treatment. It is a brand-new discipline, completely different from the issues that ultrasound as an imaging science used in the past. In 1992, Professor Lichtenstein published the first monograph on critical care lung ultrasound, creatively proposing the use of special ultrasound images such as A-line, B-line, lung sliding sign, and lung point to diagnose lung lesions. Since then, lung ultrasound technology has gradually been recognized by more ICU doctors and has begun to be widely used in the diagnosis and treatment of critically ill patients. Unlike ultrasound doctors, ICU doctors often use ultrasound not simply to diagnose diseases, but to dynamically evaluate the patient's organ function, the severity of the disease, and observe the effect of treatment in real time. In addition, ultrasound can also assist in invasive operations and improve the safety of operations. Ultrasound is called the doctor's second "stethoscope."

Many ICU patients have lung diseases, such as pneumonia, atelectasis, pulmonary edema, pneumothorax, etc. These diseases are very dangerous and need to be treated in time. However, sending such patients to the radiology department for examination may be dangerous during transportation, and asking the radiologist to push the machine to the ICU for examination may delay time. At this time, ICU doctors can use ultrasound, adopt the methods and processes of critical ultrasound, quickly diagnose and rescue patients in time.

Many ICU doctors are proficient in using cardiac ultrasound. However, unlike ultrasound doctors, they use ultrasound not only to diagnose heart diseases, but also to quickly evaluate heart function, body volume status, identify the nature of shock, and dynamically evaluate the effect of fluid therapy. Sometimes, they also use cardiac ultrasound to diagnose some non-cardiac diseases, such as pulmonary embolism, which is completely different from the purpose of ultrasound doctors using ultrasound.

ICU patients may often need to undergo deep vein puncture and catheterization, radial artery pressure measurement, thoracoabdominal puncture and drainage, etc. These invasive operations themselves carry certain risks and may cause complications such as hematoma, pneumothorax, and puncture failure. Through ultrasound guidance, the movement of the puncture needle can be clearly seen on the screen, which can greatly reduce the risk of puncture and improve the success rate.

In addition, ICU doctors also use ultrasound to evaluate patients' gastrointestinal function, kidney function, cerebral blood flow, check lower extremity venous thrombosis, etc. In short, ultrasound is becoming more and more important to ICU doctors and is an indispensable tool for ICU doctors.

When the COVID-19 outbreak occurred in Wuhan in early 2020, a large number of ICU doctors also rushed to the front line of the fight against the epidemic. At the beginning, due to the large number of patients and the extremely tight medical resources, it was impossible for a large number of patients to undergo imaging examinations such as CT in a timely manner, especially for patients with infectious diseases. Leaving the ward for examinations was a huge risk for both patients and epidemic control. At this time, ultrasound played a vital role. ICU doctors were able to use ultrasound to evaluate the organ function of patients, diagnose diseases, and assist in various invasive operations in the isolation ward. At that time, some medical teams supporting Hubei not only brought protective clothing, masks and other protective items, but also tried to bring an ultrasound for doctors in the isolation ward. Later, the government also purchased a large number of ultrasounds to be transported to the front line of the fight against the epidemic, which greatly improved the working conditions of frontline doctors and made great contributions to the rescue of critically ill patients.

This article was scientifically reviewed by Wang Xuemin, chief physician of the Emergency and Critical Care Department of Songjiang District Central Hospital, Shanghai.

Contributed by "Da Yi Xiao Hu"