ANAESTHESIA AND PATIENT MONITORING
The TUBE approach to point-of-care ultrasound
Anaesthetists working in perioperative medicine have increasingly taken a whole body approach to patient evaluation known as TUBE – Total Ultrasound Body Examination – thanks to the development of point-of-care ultrasound. Dr Christophe Aveline, consultant anaesthetist in critical care and surgery at the Sévigné Private hospital in Rennes, discusses the importance of this approach for anaesthetists who specialise in patient care in surgical and emergency procedures, as well as intensive care.
The Sévigné Private hospital in Rennes offers oncology, haematology, surgical and emergency services for more than 20,000 patients a year, covering trauma and orthopaedics, thoracic, abdominal, urological, ophthalmic, reconstructive (breast) and ENT surgery. It has a mixed surgical and medical perioperative department, with eight beds dedicated to postoperative continuous care, plus eight in intensive care. These are almost exclusively used for patients who have undergone complex thoracic, abdominal and orthopaedic or spinal procedures, and trauma patients. The site’s team of 15 anaesthetists take daily charge of patients in the emergency department, intensive care and surgical theatres, as well as those needing perioperative consultations. We routinely use ultrasound for venous access, regional anaesthesia, and cardiac and pulmonary evaluations, performing upwards of 40 procedures every day on our point-of-care equipment; it is an essential tool for today’s anaesthetist, helping them to care for patients and follow recent recommendations. Historically, anaesthetists first began to use point-of-care ultrasound for guiding regional anaesthesia and, in the last five years, they have become knowledgeable and skilful in this
Dr Christophe Aveline, consultant anaesthetist in critical care and surgery at the Sévigné Private hospital in Rennes
different approach to performing and interpreting scans at the patients’ bedside. We now use point-of-care ultrasound to answer complex questions about our patients. For example, when a patient is admitted to the emergency department with a fractured hip, the first use of ultrasound is to treat the pain with a guided femoral nerve block, then a full evaluation looks at the lungs, the heart, volaemia, and for a distended bladder. This kind of injury is often seen in older patients, who may have underlying
Point-of-care ultrasound allows us to look for intra- abdominal, retro-peritoneal and pleural effusions, or pneumothorax, to evaluate the presence of pulmonary oedema and pneumopathy.
50 l JULY 2018 l OPERATING THEATRE
comorbidities, such as cardiac or pulmonary problems, or are on many different treatments. Looking for major cardiorespiratory dysfunction reduces the risk of medical complications related to or aggravated by the injury, and optimises patient care under anaesthesia. Similarly, in trauma patients, point-
of-care ultrasound allows us to look for intra-abdominal, retro-peritoneal and pleural effusions, or pneumothorax, to evaluate the presence of pulmonary oedema and pneumopathy. Evaluating blood volume guides vascular filling in cases of hypovolaemia. This whole body approach, known as TUBE, delivers a strategy for evaluating lesions and analgesia. Ultrasound also gives us information on the presence of a distended bladder that may need to be drained.
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