title: Critical care ultrasonography in acute respiratory failure.
abstract: Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript.
authors.affiliation: Medical-surgical Intensive Care Unit, Limoges Teaching hospital, F-87000, Limoges, France. philippe.vignon@unilim.fr.|Center of Clinical Investigation, INSERM 1435, F-87000, Limoges, France. philippe.vignon@unilim.fr.|University of Limoges, Faculty of Medicine, F-87000, Limoges, France. philippe.vignon@unilim.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.affiliation: Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne-Billancourt, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Repessé
authors.affiliation: Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne-Billancourt, France.|University of Versailles Saint-Quentin en Yvelines, Faculty of Medicine Paris Ile-de-France Ouest, 78280, Saint-Quentin en Yvelines, France.|INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807, Villejuif, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
authors.affiliation: Medical Intensive Care Unit, University Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.|INSERM U 1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Paris, F-75012, France.|Sorbonne University, UPMC Univ Paris 06, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
mesh_terms: D003422:Critical Care / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D011654:Pulmonary Edema / Q000175:diagnosis / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography / Q000379:methods*; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods
keywords: Echocardiography; Echocardiography Doppler; Pulmonary edema; Respiratory distress syndrome; Respiratory insufficiency; Ultrasonography