Ecografia à Cabeceira do Doente na Medicina Interna: Uma Mudança de Paradigma na Avaliação do Doente Agudo
DOI:
https://doi.org/10.24950/rspmi/revisao/151/4/2018Palavras-chave:
Doença Aguda, Ecografia, Medicina Interna/ educação, Serviço de Urgência HospitalarResumo
A ecografia à cabeceira do doente apresenta-se como “o quinto pilar do exame físico”, juntamente com a inspeção, percussão, palpação e auscultação. Após o início de sua utilização nos anos 80 para avaliação do trauma abdominal, tornou-se prática diária na avaliação do doente crítico, tanto nas Unidades de Cuidados Intensivos quanto nos Serviços de Urgência, sendo, hoje, componente fundamental de diversos protocolos clínicos. Neste artigo, pretende-se mostrar as aplicações estabelecidas da ecografia à cabeceira do doente na avaliação de situações clínicas agudas, com foco nas implicações para a prática do médico internista. Pretende-se também deixar patente o impacto que a ecografia pode e deve ter na educação médica geral. Os autores têm a forte convicção que as competências aqui apresentadas farão parte, muito em breve, do núcleo de competências básicas de qualquer médico internista a exercer em Portugal.
Downloads
Referências
Kugler J. Price and the evolution of the physical examination. JAMA Cardiol.2018;3: 351. doi: 10.1001/jamacardio.2018.0002.
Narula J, Chandrashekhar Y, Braunwald E. Time to add a fifth pillar to bedside physical examination. JAMA Cardiol. 2018; 3: 346-50. doi: 10.1001/jamacardio.2018.0001.
Chen L, Malek T. Point-of-care ultrasonography in emergency and critical care medicine. Crit Care Nurs Q. 2018; 41: 94-101. doi: 10.1097/ CNQ.0000000000000190.
Kirkpatrick AW, Sirois M, Laupland KB Liu D, Rowan K, Ball CD, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: The extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004; 57: 288–95.
Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011; 364: 749–57. doi: 10.1056/NEJMra0909487.
Blans MJ, Bosch FH. Ultrasound in acute internal medicine; time to set a European standard. Eur J Intern Med. 2017; 45: 51–3. doi: 10.1016/j. ejim.2017.09.040.
Adhikari S, Stolz L, Amini R, Blaivas M. Impact of point-of-care ultrasound on quality of care in clinical practice. Rep Med Imaging. 2014; 7: 81-93.
Bhagra A, Tierney DM, Sekiguchi H, Soni NJ. Point-of-care ultrasonography for primary care physicians and general internists. Mayo Clin Proc. 2016; 91: 1811–27. doi: 10.1016/j.mayocp.2016.08.023.
Arienti V, Camaggi V. Clinical applications of bedside ultrasonography in internal and emergency medicine. Intern Emerg Med. 2011; 6: 195– 201. doi: 10.1007/s11739-010-0424-3.
Blaivas M. Lung ultrasound in evaluation of pneumonia. J Ultrasound Med. 2012; 31: 823–6.
Rantanen NW. Diseases of the thorax. Vet Clin North Am: Equine Practice 1986; 2: 49–66.
Lichtenstein DA. Applications nouvelles de l´echographie en reanimation. Rev Pneumol Clin. 1997; 53: 63–8.
Diacon AH, Theron J, Bolliger CT. Transthoracic ultrasound for the pulmonologist. Curr Opin Pulm Med. 2005; 11: 307–12.
Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006; 130: 533–8.
Arbelot C, Ferrari F, Bouhemad B, Rouby JJ. Lung ultrasound in acute respiratory distress syndrome and acute lung injury. Curr Opin Crit Care. 2008; 14: 70–4. doi: 10.1097/MCC.0b013e3282f43d05.
Volpicelli G, Elbarbary M, Blaivas M, Lichteinstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38: 577–91. doi: 10.1007/s00134-012-2513-4.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004; 100: 9–15.
Winkler MH, Touw HR, van de Ven PM, Twisk J, Tuinman PR. Diagnostic accuracy of chest radiograph, and when concomitantly studied lung ultrasound, in critically ill patients with respiratory symptoms. A systematic review and meta-analysis. Crit Care Med. 2018; 46: e707-14. doi: 10.1097/ CCM.0000000000003129.
Piette E, Daoust R, Denault A. Basic concepts in the use of thoracic and lung ultrasound. Curr Opin Anaesthesiol. 2013; 26: 20. 20–30. doi: 10.1097/ACO.0b013e32835afd40.
Gargani L, Volpicelli G. How I do it: Lung ultrasound. Cardiovasc Ultrasound. 2014; ;12:25. doi: 10.1186/1476-7120-12-25.
Dietrich CF, Mathis G, Blaivas M, Volpicelli G, Seibel A, Wastl D, et al. Lung artefacts and their use. Med Ultrason. 2016; 18:488–99.
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE Protocol. Chest. 2008; 134: 117–25. doi: 10.1378/chest.07-2800.
Bugalho A, Semedo J, Alpendre J, Ribeiro JC, Carreiro L. Ultrasound chest disease. Rev Port Pneumol. 2010; 16: 589–606.
Volpicelli G. Sonographic diagnosis of pneumothorax. Intensive Care Med. 2011; 37: 224–32. doi: 10.1007/s00134-010-2079-y.
Lichtenstein D, Mezière G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000; 26: 1434–40.
Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF. Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. Am J Emerg Med. 2008; 26: 585–91. doi: 10.1016/j. ajem.2007.09.014.
Santos TM, Franci D, Coutinho CMG, Ribeiro DL, Schweller M, Matos-Souza JR, et al. A simplified ultrasound-based edema score to assess lung injury and clinical severity in septic patients. Am J Emerg Med. 2013; 31: 1656–60. doi: 10.1016/j.ajem.2013.08.053.
Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012; 29: 19–23. doi: 10.1136/emj.2010.101584.
Chavez MA, Shams N, Ellington LE, Naithani N, Gilman RH, Steinhoff MC, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50. doi: 10.1186/1465- 9921-15-50.
Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. Alungultrasound sign of alveolar consolidation ruling out atelectasis. Chest. 2009;135:1421-5. doi: 10.1378/chest.08-2281
Havelock T, Teoh R, Laws D, Gleeson F, BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Thorax. 2010; 65(Suppl 2): i61–76. doi: 10.1136/ thx.2010.137026.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014; 4: 1.
Lichtenstein DA. BLUE-Protocol and FALLS-Protocol: two applications of lung ultrasound in the critically ill. Chest. 2015; 147:1659–70. doi: 10.1378/ chest.14-1313.
Zanobetti M, Poggioni C, Pini R. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest. 2011; 139: 1140–7. doi: 10.1378/chest.10-0435.
Neskovic AN, Hagendorff A, Lancellotti P, Guarracino F, Varga A, Cosyns B, et al. Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging. 2013; 14:1–11. doi: 10.1177/2048872614568073.
Lancellotti P, Price S, Edvardsen T, Cosyns B, Neskovic AN, Dulgheru R, et al. The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 2015; 4: 3–5. doi: 10.1177/2048872614568073.
Jardin F, Valtier B, Beauchet A, Dubourg O, Bourdarias JP. Invasive monitoring combined with two-dimensional echocardiographic study in septic shock. Intensive Care Med. 1994; 20: 550–4.
Vieillard-Baron A, Slama M, Cholley B, Janvier G, Vignon P. Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med. 2008; 34: 243–9.
Dias FS, Rezende EA de C, Mendes CL, Silva JM, Sanches JL. Hemodynamic monitoring in the intensive care unit: a Brazilian perspective. Rev Bras Ter Intensiva. 2014; 26:360–6.
Arntfield RT, Millington SJ. Point of care cardiac ultrasound applications in the emergency department and intensive care unit-a review. Curr Cardiol Rev. 2012; 8: 98–108.
Kimura BJ. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart. 2017; 103: 987–94. doi: 10.1136/ heartjnl-2016-309915.
Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, et al. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound. 2008; 6: 49.
Gudmundsson P, Rydberg E, Winter R, Willenheimer R. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol .2005; 101: 209–12.
Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure. Am J Cardiol. 2007; 99: 1614–6.
Stone MB, Huang J V. Inferior vena cava assessment: correlation with CVP and plethora in tamponade. Glob Heart. 2013; 8: 323–7.
Weekes AJ, Tassone HM, Babcock A, Quirke DP, Norton HJ, Jayarama K, et al. Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients. Acad Emerg Med. 2011; 18: 912–21. doi: 10.1111/j.1553-2712.2011.01157.x.
Himelman RB, Kircher B, Rockey DC, Schiller NB. Inferior vena cava plethora with blunted respiratory rResponse: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol. 1988; 12:1470–7.
Molokoane-Mokgoro K, Goldstein LN, Wells M. Ultrasound evaluation of the respiratory changes of the inferior vena cava and axillary vein diameter at rest and during positive pressure ventilation in spontaneously breathing healthy volunteers. Emerg Med J. 2018; 35: 297-302. doi: 10.1136/emermed-2016-205944.
Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2873–926. doi: 10.1093/eurheartj/ehu281.
Tayal VS, Graf CD, Gibbs MA. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med. 2003; 10: 867–71.
Costantino TG, Bruno EC, Handly N, Dean AJ. Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm. J Emerg Med. 2005; 29: 455–60.
Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: rapid ultrasound in shock in the evaluation of the critically ill. Emerg Med Clin North Am. 2010; 28: 29–56.
Blaivas M, Lambert MJ, Harwood RA, Wood JP, Konicki J. Lower-extremity doppler for deep venous thrombosis-can emergency physicians be accurate and fast? Acad Emerg Med 2000; 7: 120-6.
Pomero F, Dentali F, Borretta V, Bonzini M, Melchio R, Douketis JD, et al. Accuracy of emergency physician-performed ultrasonography in the diagnosis of deep-vein thrombosis: A systematic review and meta-analysis. Thromb Haemost. 2013; 109: 137–45. doi: 10.1160/TH12-07-0473
Tapson VF, Carroll BA, Davidson BL, Elliot CG, Fedullo PF, Hales CA, et al. The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society. Am J Respir Crit Care Med. 1999; 160: 1043–66.
Nazerian P, Vanni S, Volpicelli G, Giggli Z, Zanobetti M, Bartolucci M, et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest. 2014; 145:950–7. doi: 10.1378/chest.13-1087.
Noble VE, Brown DF. Renal ultrasound. Emerg Med Clin North Am. 2004; 22: 641–59.
Dalziel PJ, Noble VE. Bedside ultrasound and the assessment of renal colic: a review. Emerg Med J. 2013; 30: 3–8. doi: 10.1136/emermed-2012-201375.
Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017; 21: 225. doi: 10.1186/s13054-017-1814-y.
Mahan AF, McEvoy MD, Gravenstein N. Long-axis view for ultrasound-guided central venous catheter placement via the internal jugular vein. Rom J Anaesth Intensive Care. 2016; 23: 27–31.
Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 2015; 1: CD006962. doi: 10.1002/14651858. CD011447.
American Society Anesthesiologists Task Force on Central Venous Access, Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, et al. Practice guidelines for central venous access: A report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2012; 116: 539–73. doi: 10.1097/ALN.0b013e31823c9569.
French JLH, Raine-Fenning NJ, Hardman JG, Bedforth NM. Pitfalls of ultrasound guided vascular access: the use of three/four-dimensional ultrasound. Anaesthesia. 2008 ;63 :806–13. doi: 10.1111/j.1365-2044.2008.05513.x.
Gryminski J, Krakówka P, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest.1976; 70 : 33–7.
Yu CJ, Yang PC, Wu HD, Chang DB, Kuo SH, Luh KT. Ultrasound study in unilateral hemithorax opacification: image comparison with computed tomography. Am Rev Respir Dis. 1993; 147: 430–4.
Raptopoulos V, Davis LM, Lee G, Umali C, Lew R, Irwin RS. Factors affecting the development of pneumothorax associated with thoracentesis. Am J Roentgenol. 1991; 156: 917–20.
Barnes TW, Morgenthaler TI, Olson EJ, Hesley GK, Decker PA, Ryu JH. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound. 2005; 33: 442–6.
Feller-Kopman D. Ultrasound-guided thoracentesis. Chest. 2006; 129: 1709–14.
Weingardt JP, Guico RR, Nemcek AA, Li YP, Chiu ST. Ultrasound findings following failed, clinically directed thoracenteses. J Clin Ultrasound. 1994; 22: 419–26.
Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest.2013; 143: 532–8. doi: 10.1378/chest.12-0447.
Kurup AN, Lekah A, Reardon ST, Schimt GD, McDonald JS, Carter RE, et al. Bleeding rate for ultrasound-guided paracentesis in thrombocytopenic patients. J Ultrasound Med. 2015; 34: 1833–8. doi: 10.7863/ultra.14.10034.
Edwards C, Leira EC, Gonzalez-Alegre P. Residency training: a failed lumbar puncture is more about obesity than lack of ability. Neurology. 2015; 84: e69–72. doi: 10.1212/WNL.0000000000001335.
Grau T, Leipold RW, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 2001; 45: 766–71.
Lee WS, Jeong WJ, Yi HY, Ryu S, Lee JW, Kim SW, et al. The usefulness of ultrasound-assisted lumbar puncture on adult patients in the emergency center: Comparison with classic lumbar puncture. J Korean Soc Emerg Med. 2008; 19: 562–8.
Rose JS, Bair AE, Mandavia D, Kinser DJ. The UHP ultrasound protocol: A novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient. Am J Emerg Med. 2001; 19: 299–302. doi: 10.1053/ajem.2001.24481.
Jones AE, Tayal VS, Sullivan DM, Kline JA. 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: 1703–8.
Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004; 21: 700–7.
Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: Cardiac arrest ultra-sound exam—A better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008; 76: 198–206.
Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract. 2012; 2012:503254. doi: 10.1155/2012/503254.
Hoppmann R, Blaivas M, Elbarbary M. Better medical education and health care through point-of-care ultrasound. Acad Med. 2012; 87: 134. doi: 10.1097/ACM.0b013e31823f0e8f.
Hoppmann R, Cook T, Hunt P, Fowler S, Paulman L, Wells J, et al. Ultrasound in medical education: a vertical curriculum at the University of South Carolina School of Medicine. J S C Med Assoc. 2006; 102: 330–4.
Ten Cate OTJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59. Med Teach. 2011; 33: 961–73.
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
Acesso livre
