Bedside Endosonography and Endosonography-Guided Fine-Needle Aspiration in Critically III Patients: A Way out of the Deadlock?

Abstract

Endosonography and endosonography-guided fine-needle aspiration (EUS-FNA) are now established diagnostic techniques, which are performed electively in endoscopy suites. We report here the bedside use of EUS-FNA in three critically ill patients in an intensive-care unit, with a significant impact on the outcome. A mediastinal abscess after percutaneous dilational tracheotomy was aspirated in one patient, leading to appropriate antibiotic therapy and complete recovery. A paratracheal hematoma compressing the right main bronchus was aspirated in a patient with polytrauma, relieving the pressure effects. The third patient, who had end-stage dilated cardiomyopathy and was being evaluated for cardiac transplantation, was found to have an apical lung lesion suspicious for bronchogenic carcinoma. EUS was performed to exclude mediastinal metastasis and allow simultaneous resection at the time of transplantation. Although a metastasis was excluded by EUS-FNA, the patient died while awaiting surgery. We conclude that bedside EUS-FNA is a feasible procedure, and in experienced hands it can offer an alternative in life-threatening situations.

Cytopathologic Analysis of Paratracheal Masses

“…The high diagnostic yield of paratracheal FNA for sarcoidosis is confirmed by Annema et al 33 and Fritscher-Ravens et al, 34 who found a similar sensitivity of FNA in diagnosing sarcoidosis with a sensitivity and specificity of EUS-FNA of 100% and 94%, respectively. This cor-…”

Review of endoscopic ultrasound‐guided fine‐needle aspiration cytology

“…38,284 Aspiration of hematomas and mediastinal abscesses with instillation of antibiotic therapy. 285,286 Guided stenting for outlet obstruction improving the quality of life for patients with pancreatic cancer. 281 Selective injection of botulinum toxin in the muscle layer of the lower esophageal sphincter in the treatment of achalasia.…”

Bedside Endoscopic Ultrasound in Critically Ill patients

“…We found that the most common clinical impact made by EUS was providing a tissue diagnosis of malignancy. However, as the other two reported series [1, 2] found, diagnostic EUS provided important clinical information as well. One of our patients underwent transrectal EUS during which sampling of a pelvic fluid collection correctly excluded a suspected abscess.…”

“…Fritscher-Ravens et al [1] reported the bedside use of EUSFNA in three patients to diagnose a mediastinal abscess following tracheotomy ( n = 1), relieve pressure from a paratracheal hematoma compressing the right main bronchus ( n = 1) and diagnose lung cancer in a patient awaiting cardiac transplantation ( n = 1). The authors concluded that bedside EUS-FNA was feasible and could offer an alternative in life-threatening situations.…”

“…However, it is mainly used for elective procedures in outpatients and occasionally inpatients who are at low risk for complications from moderate or deep sedation. While diagnostic and therapeutic endoscopy procedures such as PEG placement or evaluation of GI bleeding are routinely performed at the bedside in intensive care units (ICUs), the use of EUS for this indication has been described in only two small case series [1, 2]. In this study, we report a single center experience of the indications and impact of bedside EUS on the care of ICU patients.…”