Point-of-Care Ultrasound for Oncologic Critical Care

  • Wendell H. WilliamsEmail author
  • Anna D. Dang
  • Dilip R. Thakar
Reference work entry


In this chapter, we will focus our limited review of point-of-care ultrasonography (POCUS) specifically on those components arguably most pertinent to the care of the oncologic patient. A more thorough review of some topics, such as the FAST exam for the detection of intraperitoneal fluid, can be found elsewhere. In the presence of systemic morbidity and an expanding differential diagnosis, rapid and accurate assessment of these patients can be challenging. POCUS can potentially narrow the differential and avoid significant delays in treatment. The foundation of ultrasonography is a practical understanding of ultrasound physics, equipment, and artifacts. POCUS of the heart and IVC can help guide the resuscitation of the hemodynamically unstable patient. Lung sonography can suggest the etiology of the dyspnea and guide weaning from mechanical ventilation. Routine use of POCUS can potentially avoid significant delays in treatment for many conditions, from intracranial hypertension to VTE. Despite the enormous potential of POCUS, it is important to remember that guided training and continued research are requisites if patient care is to be improved and iatrogenic injury avoided.


Point-of-care ultrasound (POCUS) Echocardiography Goal-directed resuscitation Transthoracic Venous thromboembolism Intracranial hypertension 


  1. 1.
    Adhikari S, Zeger W, Thom C, Fields JM. Isolated deep venous thrombosis: implications for 2-point compression ultrasonography of the lower extremity. Ann Emerg Med. 2015;66(3):262–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Antonio ACP, Knorst MM, Teixeira C. Lung ultrasound prior to spontaneous breathing trial is not helpful in weaning the decision making process. Respir Care. 2018;63(7):873–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Blanco P, Volpicelli G. Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians. Crit Ultrasound J. 2016;8(1):15.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Blumhof S, Wheeler D, Thomas K, McCool FD, Mora J. Change in diaphragmatic thickness during the respiratory cycle predicts extubation success at various levels of pressure support ventilation. Lung. 2016;194(4):519–25.PubMedCrossRefGoogle Scholar
  5. 5.
    Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: bedside lung ultrasound in critical care practice. Crit Care. 2007;11(1):205.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Chavez MA, Shams N, Ellington LE, Naithani N, Gilman RH, Steinhoff MC, Santosham M, Black RE, Price C, Gross M, Checkley W. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Ciozda W, Kedan I, Kehl D, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound. 2016;14(1):33.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Coiro S, Rossignol P, Ambrosio G, Carluccio E, Alunni G, Murrone A, Tritto I, Zannad F, Girerd N. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail. 2015;17(11):1172–81.PubMedCrossRefGoogle Scholar
  9. 9.
    DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69(5):423–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Fagley RE, Haney MF, Beraud AS, Comfere T, Kohl BA, Merkel MJ, Pustavoitau A, von Homeyer P, Wagner CE, Wall MH, Society of Critical Care Anesthesiologists. Critical care basic ultrasound learning goals for American anesthesiology critical care trainees: recommendations from an expert group. Anesth Analg. 2015;120(5):1041–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care. 2017;30(1):37–43.PubMedCrossRefGoogle Scholar
  12. 12.
    Fox JC, Bertoglio KC. Emergency physician performed ultrasound for DVT evaluation. Thrombosis. 2011;2011:938709.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Gargani L, Pang PS, Frassi F, Miglioranza MH, Dini FL, Landi P, Picano E. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovasc Ultrasound. 2015;13:40.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Goffi A, Kruisselbrink R, Volpicelli G. The sound of air: point-of-care lung ultrasound in perioperative medicine. Can J Anaesth. 2018;65(4):399–416.PubMedCrossRefGoogle Scholar
  15. 15.
    Hightower S, Chin EJ, Heiner JD. Detection of increased intracranial pressure by ultrasound. J Spec Oper Med. 2012;12(3):19–22.PubMedGoogle Scholar
  16. 16.
    Hu WC, Xu L, Zhang Q, Wei L, Zhang W. Point-of-care ultrasound versus auscultation in determining the position of double-lumen tube. Medicine (Baltimore). 2018;97(13):e9311.CrossRefGoogle Scholar
  17. 17.
    Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004;21(9):700–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Kent A, Bahner DP, Boulger CT, Eiferman DS, Adkins EJ, Evans DC. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. J Surg Res. 2013;184(1):561–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:4902–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Killu K, Coba V, Mendez M, Reddy S, Adrzejewski T, Huang Y, Ede J, Horst M. Model point-of-care ultrasound curriculum in an intensive care unit fellowship program and its impact on patient management. Crit Care Res Pract. 2014;2014:934796.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Kuderer NM, Lyman GH. Guidelines for treatment and prevention of venous thromboembolism among patients with cancer. Thromb Res. 2014;133(Suppl 2):S122–7.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Lee FCY. Lung ultrasound – a primary survey of the acutely dyspneic patient. J Intensive Care. 2016;4(1):57.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Lichtenstein D. Novel approaches to ultrasonography of the lung and pleural space: where are we now? Breathe (Sheff). 2017;13(2):100–11.CrossRefGoogle Scholar
  24. 24.
    Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156(5):1640–6.PubMedCrossRefGoogle Scholar
  25. 25.
    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(1):9–15.PubMedCrossRefGoogle Scholar
  26. 26.
    Lichtenstein DA, Mezière GA, Lagoueyte JF, Biderman P, Goldstein I, Gepner A. A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest. 2009;136(4):1014–20.PubMedCrossRefGoogle Scholar
  27. 27.
    Liu LX, Su D, Hu ZJ. The value of the excursion of diaphragm tested by ultrasonography to predict weaning from mechanical ventilation in ICU patients. Zhonghua Nei Ke Za Zhi. 2017;56(7):495–9.PubMedGoogle Scholar
  28. 28.
    Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Accuracy of lung ultrasonography in the diagnosis of pneumonia in adults: systematic review and meta-analysis. Chest. 2017a;151(2):374–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest. 2017b;152(6):1140–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Somerfield MR, Falanga A, American Society of Clinical Oncology. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol. 2015;33(6):654–6.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Miller A. Practical approach to lung ultrasound. BJA Educ. 2016;16(2):39–45.CrossRefGoogle Scholar
  32. 32.
    Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the optic nerve sheath diameter for detection of raised intracranial pressure compared to computed tomography: a systematic review and meta-analysis. J Ultrasound Med. 2015;34(7):1285–94.PubMedCrossRefGoogle Scholar
  33. 33.
    Pomero F, Dentali F, Borretta V, Bonzini M, Melchio R, Douketis JD, Fenoglio LM. Accuracy of emergency physician-performed ultrasonography in the diagnosis of deep-vein thrombosis: a systematic review and meta-analysis. Thromb Haemost. 2013;109(1):137–45.PubMedCrossRefGoogle Scholar
  34. 34.
    Ramsingh D, Alexander B, Le K, Williams W, Canales C, Cannesson M. Comparison of the didactic lecture with the simulation/model approach for the teaching of a novel perioperative ultrasound curriculum to anesthesiology residents. J Clin Anesth. 2014;26(6):443–54.PubMedCrossRefGoogle Scholar
  35. 35.
    Ramsingh D, Rinehart J, Kain Z, Strom S, Canales C, Alexander B, Capatina A, Ma M, Le KV, Cannesson M. Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents. Anesthesiology. 2015;123(3):670–82.PubMedCrossRefGoogle Scholar
  36. 36.
    Ramsingh D, Singh S, Ross M, Williams W, Cannesson M. Review of point-of-care (POC) ultrasound for the 21st century perioperative physician. Curr Anesthesiol Rep. 2015;5(4):452–64.CrossRefGoogle Scholar
  37. 37.
    Ramsingh D, Frank E, Haughton R, Schilling J, Gimenez KM, Banh E, Rinehart J, Cannesson M. Auscultation versus point-of-care ultrasound to determine endotracheal versus bronchial intubation: a diagnostic accuracy study. Anesthesiology. 2016;124(5):1012–20.PubMedCrossRefGoogle Scholar
  38. 38.
    Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.PubMedCrossRefGoogle Scholar
  39. 39.
    Stawicki SP, Adkins EJ, Eiferman DS, Evans DC, Ali NA, Njoku C, Lindsey DE, Cook CH, Balakrishnan JM, Valiaveedan S, Galwankar SC, Boulger CT, Springer AN, Bahner DP. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014;76(4):956–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Stawicki SP, Papadimos TJ, Bahner DP, Evans DC, Jones C. Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: an exploratory study. Int J Crit Illn Inj Sci. 2016;6(4):194–9.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49(4):508–14.PubMedCrossRefGoogle Scholar
  42. 42.
    Vignon P, Chastagner C, Berkane V, Chardac E, Francois B, Normand S, Bonnivard M, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med. 2005;33(8):1757–63.PubMedCrossRefGoogle Scholar
  43. 43.
    Zitek T, Baydoun J, Yepez S, Forred W, Slattery D. Mistakes and pitfalls associated with two-point compression ultrasound for deep vein thrombosis. West J Emerg Med. 2016;17(2):201–8.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Zuker-Herman R, Ayalon Dangur I, Berant R, Sitt EC, Baskin L, Shaya Y, Shiber S. Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis. J Thromb Thrombolysis. 2018;45(1):99–105.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Wendell H. Williams
    • 1
    Email author
  • Anna D. Dang
    • 2
  • Dilip R. Thakar
    • 3
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.University of Texas Health Science Center at HoustonHoustonUSA
  3. 3.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  • Ninotchka Brydges
    • 2
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Critical Care and Respiratory CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations