Critical Care Ultrasound (CCUS) is a term that applies to a diverse array of applications from focused echocardiography to lung ultrasound to procedural guidance2,3. Guidelines and expert consensus documents have emerged that advocate for Critical Care Medicine training programs across North American to establish CCUS training programs, adopt training standards and develop mechanisms for quality assurance2,3.

The goal of CCUS is not to supplant modalities such as comprehensive echocardiography or abdominal ultrasonography, but to provide a new skill set to acute-care physicians and other allied health care providers alike that can facilitate urgent decisions at the bedside and improve patient safety. Internationally, we have seen the critical care community engaging in CCUS from research to education for the benefit of democratization of this innovative technology.

  • How does it compare to comprehensive ultrasound modalities such as conventional echocardiography?

    CCUS and comprehensive ultrasound should be viewed as complimentary modalities in the care of the critically ill patient. CCUS is most often performed by acute care physicians at the bedside and is goal-directed, performed in the context of immediate and time-sensitive decision making. Ultrasound modalities such as comprehensive echocardiography and abdominal ultrasound are also essential; however, urgent access around the clock may be limited, constrained by resources and frequently requires patient transport.

    CCUS empowers acute care physicians with the ability to confront dilemmas that are beyond the realm of bedside examination and at times, conventional radiographs. One example of CCUS is thoracic ultrasound, a non-invasive technique that has demonstrated superiority to chest x-rays in identification of parenchymal and pleural pathology4,5. Furthermore, modalities such as basic critical care echocardiography can be taught in an accelerated fashion with favorable inter-rater reliability6,7. CCUS modalities such as focused echocardiography6,8,9 and lung ultrasound, have demonstrated the ability to reduce the differential diagnosis, improve the time to diagnosis and frequently lead to changes in management 9,10. These are only a select few of a diverse array of CCUS applications.

  • What are the indications for CCUS?
    1. Volume status assessment
    2. Undifferentiated hypotension or hemodynamic instability
    3. Undifferentiated respiratory failure and thoracic pathology (ie. effusions, consolidation).
    4. Procedural guidance including paracentesis, thoracentesis and vascular access
    5. Detection of intra-abdominal free fluid including ascites, hemoperitoneum, etc.
    6. Undifferentiated sepsis and septic shock (i.e. pneumonia, acute cholecystitis).
  • What are the primary modalities of CCUS?
    1. Focused echocardiography including IVC assessment
    2. Thoracic ultrasound (pleural, parenchymal, pleural space)
    3. Focused abdominal ultrasound (free fluid, kidneys, bladder, aorta, gallbladder)
    4. Procedural guidance (thoracentesis, paracentesis)
    5. Vascular access (Central/peripheral lines) and assessment (for VTE)
  • What are the strengths of CCUS?
    1. Brings skilled health care providers back to the bedside
    2. A non-invasive extension to clinical exam
    3. Portable
    4. Minimize difficult or impossible patient transfers at time of severe critical illness
    5. Goal-directed to address specific answerable questions
    6. Repeatable, minimal time delay to study
    7. Evidence for strong inter-rater reliability with specific modalities
    8. Improve patient safety and reduced time to diagnosis
  • Why a website?

    This website will serve as an integral touch point to the CCUS community at the University of Alberta and beyond. From rounds to teaching modules to program updates, we hope to provide acute care physicians with the resources needed to become highly skilled in the application of CCUS.

    We are striving for a new level of educational infrastructure, safety and quality assurance to raise the training profile at the University of Alberta, specifically in the realm of critical care and emergency ultrasound. Our primary goal is to promote safe, skilled and judicious application of this modality and become a center of excellence in CCUS.

    Construction of this website is underway, stay tuned for more details.

  1. Mayo PH. American College of Chest Physicians Statement on Competence in Critical Care Ultrasonography. CHEST J. 2009;135(4):1050. http://journal.publications.chestnet.org/article.aspx?doi=10.1378/chest.08-2305.
  2. Mayo PH. American College of Chest Physicians Statement on Competence in Critical Care Ultrasonography. CHEST J. 2009;135(4):1050. http://journal.publications.chestnet.org/article.aspx?doi=10.1378/chest.08-2305.
  3. Arntfield RT, Millington SJ, Ainsworth CD, et al. Canadian recommendations for critical care ultrasound training and competency. 2014;21(6):341-345. http://www.ncbi.nlm.nih.gov.libaccess.lib.mcmaster.ca/pubmed/25255460.
  4. Xirouchaki N, Magkanas E, Vaporidi K, et al. Lung ultrasound in critically ill patients: Comparison with bedside chest radiography. Intensive Care Med. 2011;37:1488-1493. doi:10.1007/s00134-011-2317-y.
  5. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Ph D. Comparative Diagnostic Performances of Auscultation , Chest Radiography , and Lung Ultrasonography in Acute. 2004;(1):9-15.
  6. Vignon P, Chastagner C, François B, et al. Diagnostic ability of hand-held echocardiography in ventilated critically ill patients. Crit Care. 2003;7(5):R84-R91. doi:10.1186/cc2360.
  7. Vignon P, Mücke F, Bellec F, et al. Basic critical care echocardiography: validation of a curriculum dedicated to noncardiologist residents. Crit Care Med. 2011;39:636-642. doi:10.1097/CCM.0b013e318206c1e4.
  8. Stanko LK, Jacobsohn E, Tam JW, De Wet CJ, Avidan M. Transthoracic echocardiography: Impact on diagnosis and management in tertiary care intensive care units. Anaesth Intensive Care. 2005;33(4):492-496.
  9. Kanji HD, McCallum J, Sirounis D, MacRedmond R, Moss R, Boyd JH. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 2014;29(5):700-705. doi:10.1016/j.jcrc.2014.04.008.
  10. Jones AE, Tayal VS, Sullivan DM, Kline J a. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004;32(8):1703-1708. doi:10.1097/01.CCM.0000133017.34137.82.