The role of ultrasound might be more relevant for patients with Pompe disease (PD) than initially thought, according to a study recently published in Clinics and Practice.
“Sonographic techniques can not only be used to reveal new abnormalities and guide further therapy, but can also contribute immensely to making the decision to transition from curative treatment to supportive care,” the authors wrote.
This single-arm retrospective study included 5 representative complex clinical cases from the intensive care unit (ICU) in which ultrasonography could potentially play a key role in the management of the patient.
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One of the cases described a 71-year-old male previously diagnosed with PD who had undergone a coronary artery bypass grafting 18 days prior to presenting with atrial fibrillation, hypotension, and dyspnea. After emergency intubation, the patient exhibited pulseless electrical activity with a return of spontaneous circulation after 20 minutes of resuscitative measures.
Despite multiple attempts, liberation from mechanical ventilation was unsuccessful. A sonographic diaphragm excursion accurately correlated with respiratory fatigue reported by the patient. The final weaning process was then guided by ultrasound measurements of different diaphragmatic locations.
The authors identified 6 different phases of the ultrasound-guided weaning process in which, despite complications, the sonography allowed the healthcare team to assess and correct them promptly. Among the adverse events, the researchers described bleeding from the tracheostomy site, food aspiration, diaphragmatic excursion, panic attacks, and depression.
The remaining vignettes described cases related to the respiratory system, including acute respiratory distress syndrome and pulmonary hypertension, associated with other comorbidities of mainly cardiovascular nature, noted Schmidt et al.
“Compared with many bedside examination tools, ultrasonography of the respiratory system, GCCUS techniques, and haemodynamic CCE offers advantages in caring for critically ill patients in common ICU scenarios, but especially in the most complex scenarios, exceptional circumstances, and when experimental therapy approaches are used,” the study concluded.
Schmidt S, Dieks J, Quintel M, Moerer O. Clinical decision-making in practice with new critical care ultrasound methods for assessing respiratory function and haemodynamics in critically ill patients. Clin Pract. Published online November 25 2022. doi:10.3390/clinpract12060102