Reviewer: David James Dries, MSE, MD (Regions Hospital)
Description: This book is a multiauthor manual describing the physics, physiology, and applications of point-of-care ultrasound (POCUS) in the critical care setting.
Purpose: POCUS is replacing the stethoscope in many settings as a key instrument for patient assessment in the critical care unit. Accordingly, this book provides a wide spectrum of content indicative of the many dimensions for POCUS as a tool for performing multi-system examinations of ICU patients and evaluating and treating various shock states and injury, particularly to the abdomen and chest, including acute cardiac insufficiency or arrest, in real-time.
Audience: Intensivists, anesthesiologists serving in the ICU, critical care trainees from various disciplines, or imaging consultants are an appropriate audience for this book, which emanates from multiple medical centers in the U.K. and Western Europe. The authors and contributors are members of the faculty or senior trainees of the Central London School of Anesthesia and the Royal Papworth Hospital in Cambridge.
Features: This attractive book contains 28 chapters. Consistent with the role of this book in training multidisciplinary ICU providers, initial chapters describe topics including ultrasound physics, optimal image creation, and the causes for development of artifacts which degrade ultrasound findings. A significant point of therapeutic emphasis in this work is ultrasound assessment of organs found in the torso. Echocardiography for assessment of various forms of acute heart disease includes chapters specifically devoted to transthoracic and transesophageal approaches. Individual chapters also describe left and right heart assessment, examination of heart valves, and interrogation of the pericardium. Chest ultrasound presentations also emphasize evaluation of lung pathology, along with ultrasound-guided thoracentesis and techniques specific to point-of-care evaluation for pleural changes. Evaluation of the abdomen is another important strategy for general surgeons and trauma specialists. Chapters devoted to this region include assessment of the hepatobiliary tree, an important technique given the prevalence of biliary tract disease, and the use of ultrasound for paracentesis as an important tool to interrogate the peritoneal cavity for hemoperitoneum or other intra-abdominal fluid collections. After brief presentations on aortic disease, with particular emphasis on aortic aneurysm, two brief summaries describe venous access and screening for deep vein thrombosis. Later subspecialty chapters include neurologic ultrasound as provided by transcranial Doppler, ultrasound for evaluation of spinal procedures, and use of POCUS to provide and confirm airway placement. Concluding chapters describe acute patient management situations where rapid availability of ultrasound information is of great importance. The book describes shock states in the context of cardiac chamber failure, fluid accumulation in the pericardium, individual valve failure, and pleural disease including tension pneumothorax. It provides a systematic approach to cardiovascular assessment with review of pertinent physiologic relationships to facilitate care of patients in shock. Key data includes identification of change in cardiac chamber dimensions and the presence or absence of vena cava collapse. These patterns of assessment may also be employed in hypovolemic injured patients or individuals at risk for cardiac arrest. Topic presentations are concise and clearly written. Images reproduce well but are not available to support comprehensive discussion for many of the presentation topics employed. The chapters provide a varying number of references, typically featuring significant reviews from the primary literature. The table of contents groups chapters according to broad topics and attributes authorship, while a brief index concludes. One unique feature is the brief clips from ultrasound studies intended to accompany seven chapters in the book, readily found on the publisher's website.
Assessment: This book is a well-written overview describing a tool of increasing importance in acute patient management. While the concise discussion includes the dimensions of POCUS utilization, a complementary set of illustrations and diagrams could be added to strengthen the presentations, particularly in the early chapters. Where included, the ultrasound images are of good quality. However, the "Fundamentals" chapters would be even more powerful with additional diagrams describing the concepts and sample images. Further imaging to review the physics of ultrasound would also be helpful for intensivists.
