ICU · Resuscitation

Critical care ultrasound (POCUS) in ICU

Also known as Point-of-care ultrasound (POCUS) · Focused cardiac ultrasound (FoCUS) · Bedside ultrasound · Lung ultrasound (BLUE protocol) · RUSH protocol · Critical care ultrasonography (CCUS) · FATE (Focused Assessed Transthoracic Echo) · FALLS (Fluid Administration Limited by Lung Sonography)

Critical care ultrasound (CCUS), or point-of-care ultrasound (POCUS), is a core ICU skill — a rapid, non-invasive, repeatable, bedside imaging modality performed and interpreted by the treating clinician at the moment of decision-making. It is an EXTENSION of the clinical examination, not a replacement for formal imaging. Applications span five domains: (1) Cardiac — focused cardiac ultrasound (FoCUS/FATE) for LV and RV function, pericardial effusion and tamponade, volume status, and gross valve pathology, with the RUSH protocol integrating the 'pump' into shock assessment; (2) Lung — the BLUE protocol using A-lines (normal air), B-lines (interstitial syndrome — oedema, ARDS, fibrosis), consolidation, pleural effusion, and absent lung sliding with a lung point for pneumothorax; (3) Abdominal — FAST/eFAST for free fluid (haemorrhage), gallbladder (cholecystitis), bladder volume, and AAA screening; (4) Vascular — two-point or whole-leg compression sonography for DVT, and real-time ultrasound guidance for central venous catheter (CVC) insertion; (5) Procedural — line placement, thoracentesis, paracentesis, drain insertion. Organising protocols include RUSH (Rapid Ultrasound in Shock — pump, tank, pipes), BLUE (Bedside Lung Ultrasound in Emergency), FATE (Focused Assessment with Transthoracic Echocardiography), and FALLS (using B-lines to titrate fluids). POCUS does NOT replace formal echocardiography, CT, or comprehensive departmental ultrasound: it is goal-directed, focused, repeatable, and integrated with the clinical picture. Competency is defined by international consensus statements (ACCP/SRLF competence statement, the WINFOCUS/ICM evidence-based lung ultrasound recommendations, and the EACVI focus cardiac ultrasound core curriculum) and assessed through structured certification (FATE, CEUS/ICS FoCCUS, FUSIC, ACEP emergency ultrasound).