Point-of-care ultrasound of the diaphragm in a liver transplant patient with acute respiratory failure.

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Critical Ultrasound Journal Pub Date : 2015-03-28 eCollection Date: 2015-01-01 DOI:10.1186/s13089-015-0021-9
Federico Barbariol, Luigi Vetrugno, Livia Pompei, Adelisa De Flaviis, Giorgio Della Rocca
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引用次数: 11

Abstract

In some intensive care, nowadays, ultrasound diagnostics have become an extension of the physical examination (like a stethoscope). In this report, we discuss the case of an acute respiratory failure which arose immediately after the end of general anesthesia. An initial bedside ultrasound evaluation applying the 'BLUE protocol' showed no pathological changes capable of explaining the clinical picture; however, by evaluating also the right and left hemidiaphragms, we made a diagnosis of diaphragmatic dysfunction, which would probably have been difficult to diagnose without the aid of the diaphragm ultrasound. We therefore decided to avoid intubation, transfer the patient to the intensive care unit, and treat him conservatively with non-invasive ventilation only. To our knowledge, this is the first case report that has shown the usefulness of ultrasonography in detecting diaphragmatic dysfunction as a cause of acute respiratory failure with a subsequent change in patient management. The use of bedside ultrasonography provides practical functional information on the diaphragmatic function in patients with acute respiratory failure and can also be easily repeated if follow-up is required. This feature is still held in little consideration, but it can affect the diagnosis and the treatment of critically ill patients.

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急性呼吸衰竭肝移植患者膈肌的即时超声检查。
如今,在一些重症监护中,超声诊断已成为身体检查的延伸(如听诊器)。在这个报告中,我们讨论了一个急性呼吸衰竭的情况下,立即出现全麻结束后。应用“BLUE方案”的初步床边超声评估显示没有能够解释临床症状的病理改变;然而,通过同时评估左右半膈,我们诊断为膈功能障碍,如果没有膈超声的帮助,这可能很难诊断。因此,我们决定避免插管,将患者转移到重症监护病房,并仅使用无创通气对其进行保守治疗。据我们所知,这是第一个显示超声检查在检测膈肌功能障碍作为急性呼吸衰竭的原因并随后改变患者管理方面有用的病例报告。床边超声检查提供了急性呼吸衰竭患者膈肌功能的实用信息,如果需要随访,也可以很容易地重复。这一特点目前仍未得到充分重视,但它可以影响危重病人的诊断和治疗。
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Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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审稿时长
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