Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
Ultrasound for Critical Care Physicians: The Pleura and the Answers that Lie Within
Heidi L. Erickson MD
Division of Pulmonary, Critical Care and Occupational Medicine
University of Iowa Hospitals and Clinics
Iowa City, IA
A 67-year-old woman with a 40-pack-year smoking history was admitted to the intensive care unit with acute respiratory failure secondary to adult respiratory distress syndrome (ARDS) in the setting of pneumococcal bacteremia. On admission, she required endotracheal intubation and vasopressor support. She was ventilated using a low tidal volume strategy and was relatively easy to oxygenate with a PEEP of 5 and 40% FiO2. After 48 hours of clinical improvement, the patient developed sudden onset tachypnea and increased peak and plateau airway pressures. A bedside ultrasound was subsequently performed (Figures 1 and 2).
Figure 1. Two- dimensional ultrasound image of the right lung with associated M-mode image.
Figure 2. Two- dimensional ultrasound image of the left lung with associated M-mode image.
What is the cause of this patient’s acute respiratory decompensation and increased airway pressures? (Click on the correct answer for an explanation)
Cite as: Erickson HL. Ultrasound for critical care physicians: the pleura and the answers that lie within. Southwest J Pulm Crit Care. 2015;11(6):260-3. doi: http://dx.doi.org/10.13175/swjpcc149-15 PDF
Ultrasound for Critical Care Physicians: Lung Sliding and the Seashore Sign
Spencer M. Lee, MD
Gregory T. Chu, MD
Banner Good Samaritan Medical Center
Phoenix, AZ
A 70-year-old Native American woman was having increasing difficulty with ventilation. She had an extensive past medical history including quadriplegia after a motor vehicle accident in 2009, chronic mechanical ventilation since the accident, end-stage renal disease, and diabetes mellitus. A feeding tube had recently been inserted. A portable chest radiograph was performed (Figure 1).
Figure 1. Portable chest radiograph.
A lung ultrasound was performed (Figure 2).
Figure 2. Lung ultrasound of the left lung (upper panel) and of the right lung (lower panel).
M-mode images of the ultrasound are shown in Figure 3.
Figure 3. M-mode image of the left lung (panel A on left) and the right lung (Panel B on right).
Which of the following are true regarding the images presented? (Click on the correct answer to procced to the next and final panel)
- The chest x-ray shows the feeding tube in the right lung
- The M-mode image shows the seashore sign on the left suggestive of a pneumothorax
- The ultrasound shows an absence of lung sliding on the right suggestive of a pneumothorax
- 1 and 3
- All of the above
Reference as: Lee SM, Chu GT. Ultrasound for critical care physicians: lung sliding and the seashore sign. Southwest J Pulm Crit Care. 2014;9(6):337-40. doi: http://dx.doi.org/10.13175/swjpcc163-14 PDF