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. 2019 Jul 10:11:133-145.
doi: 10.2147/OAEM.S199137. eCollection 2019.

Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation

João Tavares  1 , Rita Ivo  2 , Filipe Gonzalez  3 , Tomás Lamas  4 , João João Mendes  4
Affiliations

Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation

João Tavares et al. Open Access Emerg Med. .

Retraction in

Abstract

Ultrasound technology is an essential tool in the management of critically ill patients. Point-of-care ultrasonography (POCUS) enables data collection from different anatomic areas to achieve the most probable diagnosis and administer the right therapy at the right time. Despite the increasing utilization of POCUS, there is still a lack of standards to establish how to use different bedside ultrasound protocols, and it is imperative to develop a unifying protocol. Thus, the aim of this paper is to establish a new systematized approach that can be adopted by all physicians to implement POCUS for critically ill patient management. To achieve this, we propose a new systematized approach-Global Ultrasound Check for the Critically Ill (GUCCI)-that integrates multiple protocols. This protocol is organized based on three syndromes (acute respiratory failure, shock, and cardiac arrest) and includes ultrasound-guided procedures.

Keywords: cardiac arrest; echocardiography; intensive care; interventional ultrasonography; respiratory failure; shock; ultrasonography.

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Conflict of interest statement

The authors declare that they have no conflict of interest in this work.

Figures

Figure 1
Figure 1
Acute respiratory failure algorithm. ARDS: Acute Respiratory Distress Syndrome.
Figure 2
Figure 2
Systematic approach for lung ultrasound probe placement locations. Abbreviations: AS, anterior-superior area; LS, lateral-superior area; AI, anterior-inferior area; LI, lateral-inferior area; 5ºIS, fifth intercostal space; MAL, midaxillary line.
Figure 3
Figure 3
Ultrasound images of normal lung pattern (A-profile): A) B-mode and B) M-mode (seashore sign).
Figure 4
Figure 4
Ultrasound image of abnormal lung presentation with the absence of lung sliding (M-mode): barcode sign.
Figure 5
Figure 5
Tissue-like pattern characteristic of pneumonia.
Figure 6
Figure 6
B-profile with more than three B-lines in the same intercostal space.
Figure 7
Figure 7
Two-point compression ultrasound for the diagnosis of deep venous thrombosis: (A) Left femoral vein-non-compressible thrombus; (B) Normal, compressible popliteal vein.
Figure 8
Figure 8
Shock algorithm. Abbreviations: RV, right ventricle; LV, left ventricle; IVS, interventricular septum.
Figure 9
Figure 9
Systematic approach for cardiac ultrasound placement locations. Abbreviations: PLAX, parasternal long axis; A4C, apical four-chamber; SX, subxiphoid; RV, right ventricle; LV, left ventricle; LA, left atrium; RA, right atrium; L, liver; Ao, aortic valve.
Figure 10
Figure 10
Pericardial effusion with tamponade.
Figure 11
Figure 11
Massive pulmonary thromboembolism.
Figure 12
Figure 12
"Kissing" ventricular walls in hypovolemic shock.
Figure 13
Figure 13
Aortic aneurysm using FAST views.
Figure 14
Figure 14
Shock treatment algorithm. *Tidal volume 8-10 mL/Kg, volume-controlled ventilation, positive end-expiratory pressure (PEEP) 4-6 cm H2O and plateau pressure <30 cm H2O.
Figure 15
Figure 15
Cardiopulmonaryresuscitation diagnosis algorithm. Abbreviations: PEA, pulseless electrical activity; TOR, termination of resuscitation; VF, ventricular fibrillation; EtCO2, end-tidal CO2; DBP, diastolic blood pressure.
Figure 16
Figure 16
Ultrasound check member position in CPR team.
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