An ultrasound-guided ABCDE approach with a sniff test to evaluate diaphragmatic function without acoustic windows

Naik, Latha; Sondekoppam, Rakesh V.; Tsui, Jenkin; Tsui, Ban C. H.

doi:10.1007/s12630-016-0685-z

Cited by 13 publications

(12 citation statements)

References 4 publications

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“…[60][61][62][63] The detailed description of these measures is beyond the scope of this review but has been described elsewere. [64][65][66][67] Two studies 60,61 comparing diaphragm excursion with the traditional weaning index found the sensitivity of diaphragm excursion to be 84.4 and 60% and specificity of 82.6 and 76%, respectively. Thickening of the diaphragm and thickening fraction is another measure used by DiNino et al 68 and Ferrari et al 69 against traditional measurement of the rapid shallow breathing index.…”

Section: Diaphragm Functionsmentioning

confidence: 99%

Point-of-care ultrasound (POCUS) of the upper airway

You-Ten

Siddiqui

Teoh³

et al. 2018

Can J Anesth/J Can Anesth

104

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Airway management is a critical skill in the practice of several medical specialities including anesthesia, emergency medicine, and critical care. Over the years mounting evidence has showed an increasing role of ultrasound (US) in airway management. The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. The use of US to guide and assist clinical airway management has potential benefits for both provider and patient. Ultrasound can be utilized to determine airway size and predict the appropriate diameter of single-lumen endotracheal tubes (ETTs), double-lumen ETTs, and tracheostomy tubes. Ultrasonography can differentiate tracheal, esophageal, and endobronchial intubation. Ultrasonography of the neck can accurately localize the cricothyroid membrane for emergency airway access and similarly identify tracheal rings for US-guided tracheostomy. In addition, US can identify vocal cord dysfunction and pathology before induction of anesthesia. A rapidly growing body of evidence showing ultrasonography used in conjunction with hands-on management of the airway may benefit patient care. Increasing awareness and use of POCUS for many indications have resulted in technologic advancements and increased accessibility and portability. Upper airway POCUS has the potential to become the first-line non-invasive adjunct assessment tool in airway management.

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Section: Diaphragm Functionsmentioning

confidence: 99%

Point-of-care ultrasound (POCUS) of the upper airway

You-Ten

Siddiqui

Teoh³

et al. 2018

Can J Anesth/J Can Anesth

104

View full text Add to dashboard Cite

show abstract

“…Also, similar to its use in association with the hepatic and splenic windows, performing a sniff test can easily provide further assessment of diaphragmatic movement. 29 With the probe directed cephalad, one will detect a brief descent of the diaphragm when the patient sniffs (reflected by a downward spike in M-mode) if the diaphragm is functioning normally. Because the technique allows direct visualization of the muscular portion of the diaphragm via a relatively superficial intercostal window, it eliminates most of the impact that body habitus has on the difficulty of imaging, allowing it to be used equally as effectively in obese adults and small pediatric patients.…”

Section: Using Intercostal Windowsmentioning

confidence: 99%

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Haskins

Tsui

Nejim

et al. 2017

Regional Anesthesia and Pain Medicine

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In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.

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“…2 Although promising in our preliminary experience, we caution that this method must undergo validation against well-established diaphragmatic excursion measurements. Similar to the ABCDE approach with a sniff test, 3 our method also interrogates the diaphragmatic zone of apposition and the adjacent pleura. Unlike the ABCDE approach, however, which measures the change in diaphragmatic muscle thickness on B-and M-mode sonograms, we simply measure a change in the pleural line position on the skin surface from full expiration to full inspiration.…”

Section: To the Editormentioning

confidence: 99%

“…Our scanning approach is therefore based on ''sonoanatomical'' observations to identify an ''ideal site'' to start scanning, and not a palatable mnemonic aid (ABCDE approach). 3 The value of our technique lies in assessing pleural movement before and after performing a block to detect diaphragmatic paresis. Thus, patients act as their own controls, allowing comparison of changes in excursion.…”

Section: To the Editormentioning

confidence: 99%