Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2016; 8(5): 460-471
Published online May 28, 2016. doi: 10.4329/wjr.v8.i5.460
Incremental value of thoracic ultrasound in intensive care units: Indications, uses, and applications
Biagio Liccardo, Francesca Martone, Paolo Trambaiolo, Sergio Severino, Gian Alfonso Cibinel, Antonello D’Andrea
Biagio Liccardo, Francesca Martone, Sergio Severino, Antonello D’Andrea, Second University of Naples, AORN “dei Colli”, Monaldi Hospital, 80122 Naples, Italy
Paolo Trambaiolo, Intensive Care Unit, Sandro Pertini Hospital, 00157 Rome, Italy
Gian Alfonso Cibinel, Emergency Medicine Unit, ASL TO3, Pinerolo, 10064 Turin, Italy
Author contributions: All authors contributed equally to the conception and design of the study, literature review and analysis, drafting, critical revision, editing, and final approval of the manuscript for submission.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonello D’Andrea, MD, PhD, Chair of Cardiology, Second University of Naples, AORN “dei Colli”, Monaldi Hospital, Via M. Schipa, 44, 80122 Naples, Italy. antonellodandrea@libero.it
Telephone: +39-081-7062355 Fax: +39-081-7064234
Received: July 19, 2015
Peer-review started: July 19, 2015
First decision: September 30, 2015
Revised: January 25, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: May 28, 2016
Processing time: 304 Days and 8.1 Hours
Abstract

Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly “water-rich” or “air-rich”. The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.

Keywords: Intensive care unit; Heart failure; Pleural effusion; Pneumothorax; Echocardiography; Thoracic ultrasound

Core tip: The close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly “water-rich” or “air-rich”. The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.