In every patient included in the SICS we try to obtain images of the heart, lungs, kidney and vena cava. We consider imaging other organs to get an even broader picture. Our team of researchers consists of student researchers and experts.
CARDIAC ULTRASOUND
Within the SICS-I and SICS-II cardiac ultrasonography is used to obtain images of the heart. In SICS-I the primary focus was on cardiac output. For cardiac output the diameter of the left ventricle outflow tract is measured and the flow in the left ventricle outflow tract. An independent core laboratory validated all images, obtained by trained student researchers, and the measures of these images.
In the next image, the parasternal long axis (PLAX) view is shown. Here the diameter of the left ventricle outflow tract (LVOT) can be measured.
In the next image, the apical 4 chamber (AP4CH) view is shown. Here the MAPSE, TAPSE and strains can be measured.
In addition to measuring the diameter of the LVOT, we also measure the flow in the LVOT in the apical 5 chamber (AP5CH) view. In that way the cardiac output can be measured.
PULMONARY ULTRASOUND
Within the SICS-I and the SICS-II pulmonary ultrasonography is used to obtain information about the presence of pulmonary edema by the evaluation of the number of Kerley B-lines in multiple lung fields.
In this image, one view of pulmonary ultrasound in a patient with fluid overload is shown.
RENAL ULTRASOUND
Within the SICS-II renal ultrasonography is used to determine intrarenal hemodynamics, that possibly reflect overall hemodynamics and may predict acute kidney injury.
Variables obtained are:
- Doppler Renal Resistive Index (DRRI)
- Intra Renal Venous Flow (IRVF)
- Venous Impedance Index (VII)
An independent radiologist will validate at least 10% of all images. The images are obtained by trained student-researchers.
Here a doppler image of the kidney is shown. The blood flow labeled as red is arterial and the blood flow labeled as blue is venous. The size of the kidney can also be measured in this image.
In the next image, the renal resistive index is shown by measuring the arterial (red) flow.
ULTRASOUND OF THE INFERIOR VENA CAVA
Within the SICS-II the inferior vena cava is envisioned to assess its diameter during in- and expiration. By adding this measurement to our protocol we can further assess a patients fluid status.
Variables obtained are:
- Inferior caval vein diameter
- Collapsibility Index (IVC-CI)
In this image, the inferior vena cava is shown in M-mode, allowing for precise measurement of the diameter.
WHOLE BODY ULTRASOUND
Within the SICS-II various images of different organs are obtained. One of the possibilities is to see whether associations exist between measurements like cardiac output and renal perfusion.
VALIDATION
CCUS images and measurements will be obtained by trained researchers. Complete images will be saved which could later be analysed in an ultrasonography lab to perform more extensive and advanced measurements in subsets of patients. Exact ultrasonographic methods for obtaining the images and completing the measurements can be found in the online protocols.
