ISCCM Manual of Critical Care Ultrasound
Headquarter
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
E-mail: jaypee@jaypeebrothers.com
Overseas Office
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
E-mail: info@jpmedpub.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2020, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
ISCCM Manual of Critical Care Ultrasound
First Edition: 2020
9789389776911
Printed at
We dedicate this book to our friends and trainers of the World Interactive
Network Focused on Critical UltraSound (WINFOCUS) and the patients on
whom we learnt ultrasound skills.
- Ajeet Singh MD FNB EDICM
- Consultant
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Amol T Kothekar MD IDCCM
- Associate Professor
- Department of Anesthesia
- Critical Care and Pain
- Tata Memorial Centre
- Mumbai, Maharashtra, India
- Anand V Joshi
- MBBS DNB(Gen Med) FNB(Crit Care EDIC PGCC (Echocardiography–Melbourne University)
- Director and Senior Consultant
- Department of Critical Care Medicine
- Sunshine Hospitals
- Hyderabad, Telangana, India
- Anant Vikram Pachisia MD FNB
- Associate Consultant
- Department of Critical Care
- Medanta–The Medicity
- Gurugram, Haryana, India
- Ankit Sharma MBBS MD
- Assistant Professor
- Department of Anesthesiology and
- Critical Care
- Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
- New Delhi, India
- Anuj M Clerk MD FNB IDCCM EDIC FIECMO CCIDC
- Head
- Intensive Care Services
- Sunshine Global Hospital
- Surat, Gujarat, India
- Ashish Kumar Srivastava DA DNB FNB
- Consultant
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Balaji Rajaram MD IDCCM EDIC
- Senior Resident
- Department of Critical Care Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Charudatt Vaity
- MD DNB MRCP(UK) MFICM(UK) EDIC IFCCM
- Senior Consultant Intensivist
- Department of Critical Care
- Fortis Hospital
- Mumbai, Maharashtra, India
- Deeksha Singh Tomar DA IDCCM IFCCM EDICM
- Consultant
- Department of Critical Care
- Narayana Superspeciality Hospital
- Gurugram, Haryana, India
- Deepak Govil MD EDIC FCCM
- Director–Critical Care
- Institute of Critical Care and Anesthesiology
- Medanta–The Medicity
- Gurugram, Haryana, India
- Divya Pal MD IDCCM FNB
- Associate Consultant
- Department of Critical Care
- Medanta–The Medicity
- Gurugram, Haryana, India
- Jagadeesh KN MBBS
- Associate Consultant
- Department of Critical Care Medicine
- Medanta–The Medicity
- Gurugram, Haryana, India
- Jayant R Shelgaonkar DA MD FRCA FICCM
- Head
- Department of Critical Care
- Jupiter Hospitals
- Pune, Maharashtra, India
- Jitendra Choudhary MD FNB EDIC IDCCM
- Consultant Intensivist
- Department of Critical Care
- Fortis Hospital
- Mumbai, Maharashtra, India
- John J Kurien MD DNB DM EDIC
- Consultant Intensivist
- Medical Trust Hospital
- Kochi, Kerala, India
- Jose Chacko MD DNB EDIC
- Consultant
- Narayana Health
- Bengaluru, Karnataka, India
- Jyotsna Goswami MD
- Consultant and Head
- Department of Anesthesiology, Critical Care Medicine and Pain
- Tata Medical Center
- Kolkata, West Bengal, India
- Kapil D Soni MD
- Additional Professor
- Department of Critical and Intensive Care
- JPN Apex Trauma Center
- All India Institute of Medical Sciences
- New Delhi, India
- Kedar K Toraskar MD EDIC FAARC
- Director
- Department of Critical Care
- Wockhardt Hospitals
- Mumbai, Maharashtra, India
- Kishore Pichamuthu MD FNB EDIC MRCPS
- Professor
- Medical ICU, Division of Critical Care
- Christian Medical College Hospital
- Vellore, Tamil Nadu, India
- Manali Amol Patel DA
- Associate Consultant
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Manishprasad K Pathak
- DA FCPS(Anesthesiology) IDCCM
- Incharge
- Transplant Anesthesia and Critical Care
- Sahyadri Speciality Hospital
- Pune, Maharashtra, India
- Mozammil Shafi MD FNB EDIC
- Consultant
- Department of Critical Care Medicine
- Medanta–The Medicity
- Gurugram, Haryana, India
- Naren Hemachandran MD
- Senior Resident
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Parmender Shokeen DA IDCCM
- Associate Consultant
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Pradeep Michael D’Costa
- DNB(Gen Med) Certificate in Critical Care(ISCCM)
- ICU Incharge, KEM Hospital
- Intensivist
- Sahyadri Hospital
- Pune, Maharashtra, India
- Pralay S Ghosh MD DM
- Consultant
- Department of Anesthesiology, Critical Care Medicine and Pain
- Tata Medical Center
- Kolkata, West Bengal, India
- Praveen Kumar G MD FNB EDIC
- Associate Consultant
- Department of Critical Care
- Medanta–The Medicity
- Gurugram, Haryana, India
- Rahul Anil Pandit MD FCICM FJFICM EDIC FCCP DA
- Director
- Department of Critical Care
- Fortis Hospital
- Mumbai, Maharashtra, India
- Rahul Chauhan MD FNB
- Specialist
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Rahul Harne MBBS DA IDCCM
- Consultant
- Department of Critical Care Medicine
- Medanta–The Medicity
- Gurugram, Haryana, India
- Ravi Jagdish Prasad Gupta
- MD DNB(Cardiology) FACC FSCAI
- Director
- Department of Cardiology
- Wockhardt Hospitals
- Mumbai, Maharashtra, India
- Raymond Dominic Savio DM EDIC FICCM
- Consultant
- Department of Critical Care
- Apollo Hospitals
- Chennai, Tamil Nadu, India
- Sachin Gupta MD IDCCM IFCCM EDIC FCCM FICCM
- Head
- Department of Critical Care
- Narayana Superspeciality Hospital
- Gurugram, Haryana, India
- Sadhana Srivastava DA IDCCM
- Senior Resident
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Sandesh Kumar KJ MD FNB EDIC
- Consultant Intensivist
- Cloudphysician Healthcare Services
- Bengaluru, Karnataka, India
- Shrikanth Srinivasan MD DNB FNB EDIC FICCM
- Consultant and Head
- Department of Critical Care Medicine
- Manipal Hospital
- New Delhi, India
- Sonali Inamdar DM(Cardiology) MD(Medicine) FIAE
- Associate Consultant
- Department of Cardiology
- Sri HN Reliance Foundation Hospital
- Mumbai, Maharashtra, India
- Sudipta Mukherjee MD IDCCM FNB EDICM
- Consultant
- Department of Anesthesiology, Critical Care Medicine and Pain
- Tata Medical Center
- Kolkata, West Bengal, India
- Sweta J Patel MBBS DA IDCCM
- Senior Consultant
- Department of Critical Care Medicine
- Medanta–The Medicity
- Gurugram, Haryana, India
- Vel Murugan Selvam MD DM
- Associate Consultant
- Department of Critical Care Medicine
- Manipal Hospitals
- New Delhi, India
- Vivek Kumar
- MD(Medicine) DNB(Medicine) IFCCM EDIC FICCM FICP FACP MNAMS
- Chief Intensivist
- Sri HN Reliance Foundation Hospital
- Mumbai, Maharashtra, India
As, President of Indian Society of Critical Care Medicine (ISCCM), its my proud privilege to introduce the book ISCCM Manual of Critical Care Ultrasound to the critical care community.
With the ever-expanding field of critical care, an endeavor to strengthen the academics and ICU practices across the country, the ISCCM has come up with this book to serve as a bedside reference guide.
Ultrasound now has become the extension of the hand for critical care experts. Its utility has been proven and widely used as a useful tool to assist clinical judgment. The utilization should be integrated into clinical scenario and interact with other tests.
Experts from across the country have come together through the book to share their wide evidence-based literature and knowledge in the field of critical care.
All the contributors are renowned critical care ultrasound experts from leading institutions across the India.
This book represents an invaluable resource for critical care professionals, and covers the full spectrum of critical care ultrasound.
Intensivists, postgraduates across the country will find this book an invaluable reference text.
I would like to congratulate Dr Deepak Govil, Dr Shrikanth Srinivasan, Dr Sachin Gupta, and team on accomplishing the difficult task successfully.
I hope the book serves the purpose for critical care community in saving lives!
Best Wishes!!
Subhal Bhalchandra Dixit MD IDCCM FICCM FCCM FICP
President
Indian Society of Critical Care Medicine
2019-2020
Foreword
It is indeed a pleasure to write this for the ISCCM Manual of Critical Care Ultrasound by Dr Deepak Govil and his team to be released at the time of workshop on ultrasound at Indian Society of Critical Care Medicine (ISCCM), Hyderabad conference.
Dr Govil, who is also now the President elect of ISCCM has played a vital role in starting formal training of point-of-care ultrasound (POCUS) in India. It started off with the World Interactive Network Focused on Critical Ultrasound (WINFOCUS), initiated at Medanta by Luca Neri and Dr Govil, then continued at Medanta and few other institutions and now is formalized at ISCCM annual conference as a workshop. This book is a culmination of that!
Ultrasound has become a mandatory tool for ICU and is one of the quickest and surest way to reach the diagnosis and guide therapy in a critically sick patient in the ICU. From identifying cause of hypotension to finding a source of bleeding to placing lines to finding the reason of hypoxia to guiding tracheostomy, chest tube placement or placing pacing wires the modality has infinite and growing indications in the ICU patient. In the hands of a well-trained intensivist ultrasonography can save many lives.
The book has 22 chapters written by well-known authors and obviously is well-illustrated by Japyee Brothers Medical Publishers (P) Ltd. It will be a very useful book to have in any library.
Yatin Mehta MD MNAMS FRCA FAMS FIACTA FICCM FTEE
Adjunct Professor, NBE
Past President, ISCCM
Chairman
Medanta Institute of Critical Care and Anesthesiology
Medanta–The Medicity
Gurugram, Haryana, India
Preface
Point-of-care ultrasound has become an integral part of critical care medicine practice. This bedside modality provides us with a valuable, real-time insight into a patient's deranged physiology with a high level of sensitivity and specificity. Like all clinicians who are non-radiologists, we too had our learning curve when we started adopting and adapting to this new modality almost a decade back. At that time the portable ultrasound machine was newly introduced in India, and quiet a few articles had been published regarding the potential role of this wonder modality. As with any new technology, this was met with some measure of skepticism and a reluctance to move out of the comfort zone of well-established and time-tested clinical acumen and intuition.
However, we too realized that clinical practice requires constantly evolution and sometimes to evolve means being open to new technology and having a willingness to look for that extra edge, that one more clue that may strengthen or refute the clinical suspicion and benefit the patient or increase the safety with which we perform our ICU procedures. Over the past decade, the bedside, portable ultrasound machine has become an integral part of ICUs all over the world and is considered to be one of the most promising adjuncts to have with regards to diagnosis, therapy and monitoring of a critically ill patient.
Any device or modality is as good as its user, or in simple terms, there is a learning curve associated with this modality and a step wise approach to analysis of the data provided by this machine and its incorporation into a clinical decision-making pathway.
We have been conducting ultrasound workshops for many years now and the often-asked question or comments in these interactions have been that is that there is no consolidated, standardized course material or textbook for reference and further reading.
So, for the purpose of providing a comprehensive coverage of the various aspects of point-of-care ultrasound and to standardize the ultrasound training in intensive care, we are writing this book.
This book contains illustrated chapters written by experts in point-of-care ultrasound use. These chapters broadly cover the various aspects and the clinical utility and pitfalls of point- of-care ultrasound for the novice user.
Deepak Govil
Shrikanth Srinivasan
Sachin Gupta