A comprehensive overd overview of acute mesenteric ischemia, was long Because awareness of this complex disease entity, which clinicians often think about too late, especially in the intensive care setting, urgently needs improving (). The authors mention the problems in capturing symptoms in critically ill patients in intensive care: analgesic sedation, mechanical ventilation, volume replacement, and vasopressor therapy rarely allow for targeted diagnostic evaluation. On the other hand increasingly aging and comorbid patients would lead us to expect higher estimated number of unknown cases of mesenteric underperfusion — but exact data are currently lacking.
The authors emphasize that urgent imaging (contrast-enhanced computed tomography / angiography) is the diagnostic method of choice. For ventilated, critically ill patients in intensive care, this requires huge efforts with an inherent (transport) risk. Furthermore, the incidence of contrast-induced renal failure with subsequent need for renal substitution treatment is some 16%, associated with longer-term intensive care and hospital treatment and higher mortality ().
Contrast-enhanced ultrasound might offer an innovative diagnostic approach: injecting contrast medium that is free from side effects (phospholipid coated, sulfur hexafluoride gas containing microbubbles as reflectors for ultrasound waves) increases the imaging resolution of many vessels times. Encouraging reports are available for the reliable diagnosis of complex vascular structures, for example, after surgery for abdominal aortic aneurysm (), and convincing prospective evaluation has been undertaken for the early detection of intestinal ischemia (). Our own positive experiences have convinced us that contrast-enhanced ultrasound could replace “traditional” imaging — which is expensive and takes time, while also having higher side effect profile — at least in some cases.
DOI: 10.3238 / arztebl.2012.0710a
Prof. Dr. med. Thomas Bein
Clinic for Anaesthesiology
Clinic for Surgery
PD Dr. med. Karin Pfister
PD Dr. med. Piotr Kasprzak
Department of Vascular Surgery
Prof. Dr. med. Hans Jürgen Schlitt
Clinic for Surgery
Prof. Dr. med. Bernhard M. Graf
Clinic for Anaesthesiology
Prof. Dr. med. Ernst-Michael Jung
Institute for X-ray Diagnostics
University Medical Center Regensburg
thomas.bein@klinik.uni-regensburg.de
< p> Conflict of interest statement Dr Pfister has received delegate fees for attending conference. She has also received travel and hotel expenses and lecture honorarium from Bracco Altana.
A comprehensive overd overview of acute mesenteric ischemia, was long Because awareness of this complex disease entity, which clinicians often think about too late, especially in the intensive care setting, urgently needs improving (). The authors mention the problems in capturing symptoms in critically ill patients in intensive care: analgesic sedation, mechanical ventilation, volume replacement, and vasopressor therapy rarely allow for targeted diagnostic evaluation. On the other hand increasingly aging and comorbid patients would lead us to expect higher estimated number of unknown cases of mesenteric underperfusion — but exact data are currently lacking.
The authors emphasize that urgent imaging (contrast-enhanced computed tomography / angiography) is the diagnostic method of choice. For ventilated, critically ill patients in intensive care, this requires huge efforts with an inherent (transport) risk. Furthermore, the incidence of contrast-induced renal failure with subsequent need for renal substitution treatment is some 16%, associated with longer-term intensive care and hospital treatment and higher mortality ().
Contrast-enhanced ultrasound might offer an innovative diagnostic approach: injecting contrast medium that is free from side effects (phospholipid coated, sulfur hexafluoride gas containing microbubbles as reflectors for ultrasound waves) increases the imaging resolution of many vessels times. Encouraging reports are available for the reliable diagnosis of complex vascular structures, for example, after surgery for abdominal aortic aneurysm (), and convincing prospective evaluation has been undertaken for the early detection of intestinal ischemia (). Our own positive experiences have convinced us that contrast-enhanced ultrasound could replace “traditional” imaging — which is expensive and takes time, while also having higher side effect profile — at least in some cases.
DOI: 10.3238 / arztebl.2012.0710a
Prof. Dr. med. Thomas Bein
Clinic for Anaesthesiology
Clinic for Surgery
PD Dr. med. Karin Pfister
PD Dr. med. Piotr Kasprzak
Department of Vascular Surgery
Prof. Dr. med. Hans Jürgen Schlitt
Clinic for Surgery
Prof. Dr. med. Bernhard M. Graf
Clinic for Anaesthesiology
Prof. Dr. med. Ernst-Michael Jung
Institute for X-ray Diagnostics
University Medical Center Regensburg
thomas.bein@klinik.uni-regensburg.de
< p> Conflict of interest statementDr Pfister has received delegate fees for attending conference. She has also received travel and hotel expenses and lecture honorarium from Bracco Altana.
Dr Kasprzak has received honoraria for preparing continuing medical educational events from Bracco Altana.
Professors Bein, Schlitt, Graf, and Jung declare that no conflict of interest exists.
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