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Perez-Sanchez A, Jensen TP, Soni NJ. Clinical progress note: 5 Essential point-of-care ultrasound skills for hospitalists. J Hosp Med 2024; 19:304-311. [PMID: 38230881 DOI: 10.1002/jhm.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/09/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Ariadna Perez-Sanchez
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Trevor P Jensen
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nilam J Soni
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Medicine, Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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2
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Halpern NA, Tan KS, Bothwell LA, Boyce L, Dulu AO. Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010-2020. Crit Care Med 2024; 52:223-236. [PMID: 38240506 DOI: 10.1097/ccm.0000000000005984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians. DESIGN Systematic search of PubMed, Embase, and Web of Science (2010-2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non-data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test. SETTING U.S. adult ICUs and databases. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B-E) as their definition, 63 studies (60%) used more than one parameter (B-E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter "Works in ICU" (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001). CONCLUSIONS There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Critical Care Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lilly A Bothwell
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lindsay Boyce
- MSK Library, Technology Division, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alina O Dulu
- Department of Anesthesiology and Critical Care Medicine, Critical Care Center, Memorial Sloan Kettering Cancer Center, New York, NY
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3
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Devangam S, Sigakis M, Palmer LJ, Goeddel L, Fiza B. Point-of-Care Ultrasound: A Moving Picture Is Worth a Thousand Tests. Anesthesiol Clin 2023; 41:231-248. [PMID: 36872001 DOI: 10.1016/j.anclin.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The effective utilization of point-of-care ultrasound may decrease the utilization of conventional diagnostic modalities. This review describes the various pathologies that can be effectively and rapidly identified with point-of-care cardiac, lung, abdominal, vascular airway, and ocular ultrasonography.
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Affiliation(s)
- Suhas Devangam
- Department of Anesthesiology, Division of Critical Care, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA
| | - Matthew Sigakis
- Department of Anesthesiology, Division of Critical Care, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA
| | - Louisa J Palmer
- Department of Anesthesiology, Division of Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, USA
| | - Lee Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Bloomberg 6320, 1800 Orleans Street, Baltimore, MD, USA 21287
| | - Babar Fiza
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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4
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Integrated Assessment of Heart, Lung and Lower Extremity Veins Using Hand-Held Ultrasound Device in COVID-19 Patients: Feasibility and Clinical Application. Diagnostics (Basel) 2023; 13:diagnostics13040724. [PMID: 36832210 PMCID: PMC9954818 DOI: 10.3390/diagnostics13040724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/24/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
The emergence of the COVID-19 pandemic caused a significant shortage of medical personnel and the prioritization of life-saving procedures on internal medicine and cardiology wards. Thus, the cost- and time-effectiveness of each procedure proved vital. Implementing elements of imaging diagnostics into the physical examination of COVID-19 patients could prove beneficial to the treatment process, providing important clinical data at the moment of admission. Sixty-three patients with positive COVID-19 test results were enrolled into our study and underwent physical examination expanded with a handheld ultrasound device (HUD)-performed bedside assessment included: right ventricle measurement, visual and automated LVEF assessment, four-point compression ultrasound test (CUS) of lower extremities and lung ultrasound. Routine testing consisting of computed-tomography chest scanning, CT-pulmonary angiogram and full echocardiography performed on a high-end stationary device was completed in the following 24 h. Lung abnormalities characteristic for COVID-19 were detected in CT in 53 (84%) patients. The sensitivity and specificity of bedside HUD examination for detecting lung pathologies was 0.92 and 0.90, respectively. Increased number of B-lines had a sensitivity of 0.81, specificity 0.83 for the ground glass symptom in CT examination (AUC 0.82; p < 0.0001); pleural thickening sensitivity 0.95, specificity 0.88 (AUC 0.91, p < 0.0001); lung consolidations sensitivity 0.71, specificity 0.86 (AUC 0.79, p < 0.0001). In 20 patients (32%), pulmonary embolism was confirmed. RV was dilated in HUD examination in 27 patients (43%), CUS was positive in two patients. During HUD examination, software-derived LV function analysis failed to measure LVEF in 29 (46%) cases. HUD proved its potential as the first-line modality for the collection of heart-lung-vein imaging information among patients with severe COVID-19. HUD-derived diagnosis was especially effective for the initial assessment of lung involvement. Expectedly, in this group of patients with high prevalence of severe pneumonia, HUD-diagnosed RV enlargement had moderate predictive value and the option to simultaneously detect lower limb venous thrombosis was clinically attractive. Although most of the LV images were suitable for the visual assessment of LVEF, an AI-enhanced software algorithm failed in almost 50% of the study population.
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Škulec R. Point‑of‑Care Ultrasound - accuracy, education. VNITRNI LEKARSTVI 2023; 69:223-228. [PMID: 37468288 DOI: 10.36290/vnl.2023.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
A review article discussing the reliability of Point-of-Care ultrasound and education in this method in various fields of medicine.
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Greenstein YY, Guevarra K. Point-of-Care Ultrasound in the Intensive Care Unit: Applications, Limitations, and the Evolution of Clinical Practice. Clin Chest Med 2022; 43:373-384. [PMID: 36116807 DOI: 10.1016/j.ccm.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The use of point-of-care ultrasonography in the intensive care unit has been rapidly advancing over the past 20 years. This review will provide a broad overview of the discipline spanning lung ultrasonography to advanced critical care echocardiography. It will highlight new research that questions the utility of the inferior vena cava for determining volume responsiveness and will introduce the reader to cutting-edge technology including artificial intelligence, which is likely to revolutionize ultrasound teaching and image interpretation, increasing the reach of this modality for the frontline clinician.
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Affiliation(s)
- Yonatan Y Greenstein
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers - New Jersey Medical School, University Hospital Building, Room I-354, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Keith Guevarra
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers - New Jersey Medical School, University Hospital Building, Room I-354, 150 Bergen Street, Newark, NJ 07103, USA
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7
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Lisciandro GR, Puchot ML, Gambino JM, Lisciandro SC. The wedge sign: A possible lung ultrasound sign for pulmonary thromboembolism. J Vet Emerg Crit Care (San Antonio) 2022; 32:663-669. [PMID: 35522423 DOI: 10.1111/vec.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/05/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the finding of the lung ultrasound (LUS) "wedge sign" in dogs with presumptive pulmonary thromboembolism (PTE). CASE SERIES SUMMARY This case series describes 2 dogs with predisposing risk factors of (1) right transvenous pacemaker terminating in its right ventricle, severe protein-losing nephropathy, and glucocorticoid therapy, and (2) caval syndrome, each having the LUS "wedge sign" in upper lung regions, a sign consistent with pulmonary infarction and peripheral PTE. NEW OR UNIQUE INFORMATION PROVIDED Historically, the diagnosis of canine PTE has been made through supportive findings because the gold standard test, computed tomography pulmonary angiography (CTPA), poses limitations. The use of LUS has shown promise in people for detecting PTE, with the advantages of availability, being radiation- and contrast medium-sparing, rapid (<90 s), point-of-care, real-time information. Our cases suggest a possible new first-line approach for suspecting canine PTE by using LUS and the finding of the "wedge sign" in nongravity-dependent caudodorsal and perihilar lung regions.
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8
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Millington SJ, Arntfield RT, Koenig SJ, Mayo PH, Vieillard-Baron A. Ten Influential Point-of-Care Ultrasound Papers: 2021 in Review. J Intensive Care Med 2022; 37:1535-1539. [PMID: 35440211 PMCID: PMC9548919 DOI: 10.1177/08850666221095050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ongoing rapid expansion of point-of-care ultrasound (POCUS) and its
corresponding supporting literature leaves the frontline clinician in a
difficult position when trying to keep abreast of the latest developments. Our
group of POCUS experts has selected ten influential POCUS-related papers from
the past twelve months and provided a short summary of each. Our aim is to give
to emergency physicians, intensivists, and other acute care providers key
information, helping them to keep up to date on rapidly evolving POCUS
literature.
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Affiliation(s)
| | | | | | - Paul H Mayo
- 5799Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Rice JA, Brewer J, Speaks T, Choi C, Lahsaei P, Romito BT. The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making. Int J Gen Med 2021; 14:9789-9806. [PMID: 34938102 PMCID: PMC8685447 DOI: 10.2147/ijgm.s339476] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jake A Rice
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Brewer
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler Speaks
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Lahsaei
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Correspondence: Bryan T Romito Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9068, USATel +1 214 648 7674Fax +1 214 648 5461 Email
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10
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Kapoor S, Chand S, Dieiev V, Fazzari M, Tanner T, Lewandowski DC, Nalla A, Abdulfattah O, Aboodi MS, Shiloh AL, Gong MN. Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission. J Intensive Care Med 2021; 36:1483-1490. [PMID: 33021131 PMCID: PMC7539230 DOI: 10.1177/0885066620964392] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT). METHODS We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam. RESULTS The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81). CONCLUSIONS Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.
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Affiliation(s)
- Sumit Kapoor
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Sudham Chand
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Vladyslav Dieiev
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Melissa Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tristan Tanner
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - David C. Lewandowski
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Anil Nalla
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Omar Abdulfattah
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michael S. Aboodi
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Ariel L. Shiloh
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michelle N. Gong
- Division of Critical Care Medicine, Division of Pulmonary Medicine,
Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
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11
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Belligund P, Lee D, Balasubramaniam M, Khanijao S, Damania D, Vallumsetla N, Sajawal Q, Perez-Gandara B, Perez-Perez J, Shalom I, Dubey G, Sanghavi S, Lu C, Mitre C, Zein J, Al-Ajam M. Right Ventricle Dilation Detected on Point-of-Care Ultrasound Is a Predictor of Poor Outcomes in Critically Ill Patients With COVID-19. Fed Pract 2021; 38:396-401. [PMID: 34737535 DOI: 10.12788/fp.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background During the COVID-19 pandemic, the need for judicious use of diagnostic tests and to limit personnel exposure has led to increased use and dependence on point-of-care ultrasound (POCUS) examinations. We reviewed POCUS findings in patients admitted to the intensive care unit (ICU) for acute respiratory failure with COVID-19 and correlated the findings to severity of illness and 30-day outcomes. Methods Patients admitted to the ICU in March and April 2020 were reviewed for inclusion (acute hypoxemic respiratory failure secondary to COVID-19 pneumonia; documentation of POCUS findings). Results Forty-three patients met inclusion criteria. B lines and pleural thickening were associated with a lower PaO2/FiO2 by 71 (P = .005; adjusted R 2 = 0.24). Right ventricle (RV) dilation was more common in patients with 30-day mortality (P = .02) and was a predictor of mortality when adjusted for hypertension, diabetes mellitus, and age (odds ratio, 12.0; P = .048). All patients with RV dilation had bilateral B lines with pleural irregularities. Conclusions Although lung ultrasound abnormalities are prevalent in patients with severe disease, RV involvement seems to be predictive of outcomes. Further studies are needed to discern the etiology and pathophysiology of RV dilation in COVID-19.
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Affiliation(s)
- Pooja Belligund
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - David Lee
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Mehrala Balasubramaniam
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Suchit Khanijao
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Dushyant Damania
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Nishant Vallumsetla
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Qasim Sajawal
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Brais Perez-Gandara
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Jessica Perez-Perez
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Isaac Shalom
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Gangacharan Dubey
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Sarah Sanghavi
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Chen Lu
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Cristina Mitre
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Joe Zein
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
| | - Mohammad Al-Ajam
- , , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio
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12
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Watkins LA, Dial SP, Koenig SJ, Kurepa DN, Mayo PH. The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. J Intensive Care Med 2021; 37:1029-1036. [PMID: 34632837 DOI: 10.1177/08850666211047824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.
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Affiliation(s)
- Laura A Watkins
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 6923Present Affiliation: University of Rochester, Rochester, NY, USA
| | - Sharon P Dial
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Seth J Koenig
- 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dalibor N Kurepa
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paul H Mayo
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 5799Northwell LIJ/NSUH Hospital, New Hyde Park, NY, USA
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13
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Schrift D, Barron K, Arya R, Choe C. The Use of POCUS to Manage ICU Patients With COVID-19. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1749-1761. [PMID: 33174650 DOI: 10.1002/jum.15566] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
Since the advent of SARS-CoV-2, the virus that causes COVID-19, clinicians have had to modify how they provide high-value care while mitigating the risk of viral spread. Routine imaging studies have been discouraged due to elevated transmission risk. Patients who have been diagnosed with COVID-19 often have a protracted hospital course with progression of disease. Given the need for close follow-up of patients, we recommend the use of ultrasonography, particularly point-of-care ultrasound (POCUS), to manage patients with COVID-19 through their entire ICU course. POCUS will allow a clinician to evaluate and monitor cardiac and pulmonary function, as well as evaluate for thromboembolic disease, place an endotracheal tube, confirm central venous catheter placement, and rule out a pneumothorax. If a patient improves sufficiently to perform weaning trials, POCUS can also help evaluate readiness for ventilator liberation.
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Affiliation(s)
- David Schrift
- Division of Pulmonary, Critical Care, and Sleep Medicine, Prisma Health USC Medical Group, Columbia, South Carolina, USA
| | - Keith Barron
- Department of Internal Medicine, Prisma Health USC Medical Group, Columbia, South Carolina, USA
| | - Rohan Arya
- Division of Pulmonary, Critical Care, and Sleep Medicine, Prisma Health USC Medical Group, Columbia, South Carolina, USA
| | - Carol Choe
- Department of Critical Care Medicine, Lexington Medical Center, West Columbia, South Carolina, USA
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14
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Alharthy A, Abuhamdah M, Balhamar A, Faqihi F, Nasim N, Ahmad S, Noor A, Tamim H, Alqahtani SA, Abdulaziz Al Saud AAASB, Kutsogiannis DJ, Brindley PG, Memish ZA, Karakitsos D, Blaivas M. Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness: A Prospective Longitudinal Point-of-Care Lung Ultrasound Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1823-1838. [PMID: 33185316 DOI: 10.1002/jum.15563] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 05/06/2023]
Abstract
UNLABELLED Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia. OBJECTIVE We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization. METHODS We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2-4 MHz), convex (2-6 MHz) and linear (10-15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors. RESULTS Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68-0.96, p = .048), increased lactate (HR: 1.17, 95% CI: 0.94-1.46, p = 0.049), and D-dimers (HR: 1.21, 95% CI: 1.03-1.44, p = .03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < .05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76-0.89) and specificity of 0.91 (95% CI: 0.94-0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. CONCLUSION POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.
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Affiliation(s)
| | - Mohamed Abuhamdah
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nasir Nasim
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Shahzad Ahmad
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Alfateh Noor
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saleh A Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | | | | | - Peter G Brindley
- Critical Care Department, Alberta Health Care Services, Edmonton, Alberta, Canada
| | - Ziad A Memish
- Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Michael Blaivas
- Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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15
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Varrias D, Palaiodimos L, Balasubramanian P, Barrera CA, Nauka P, Melainis AA, Zamora C, Zavras P, Napolitano M, Gulani P, Ntaios G, Faillace RT, Galen B. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med 2021; 10:3903. [PMID: 34501350 PMCID: PMC8432124 DOI: 10.3390/jcm10173903] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Acute lower extremity proximal deep venous thrombosis (DVT) requires accurate diagnosis and treatment in order to prevent embolization and other complications. Point-of-care ultrasound (POCUS), a clinician performed, and clinician interpreted bedside ultrasound examination has been increasingly used for DVT evaluation mainly in the urgent and critical care setting, but also in the ambulatory clinics and the medical wards. Studies have demonstrated that POCUS has excellent diagnostic accuracy for acute proximal DVT when performed by well-trained users. However, there is significant heterogeneity among studies on the necessary extent of training and universally acceptable standardized education protocols are needed. In this review, we summarize the evidence that supports the use of POCUS to diagnose acute proximal DVT and focus on methodology and current technology, sensitivity and specificity, pre-test probability and the role of D-dimer, time and resources, education, limitations, and future directions.
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Affiliation(s)
- Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Prasanth Balasubramanian
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian A Barrera
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Peter Nauka
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Angelos Arfaras Melainis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian Zamora
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Phaedon Zavras
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Marzio Napolitano
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Perminder Gulani
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - George Ntaios
- Department of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece;
| | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Benjamin Galen
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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16
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Soni NJ, Le MPT, Velez MI, Proud KC. Incidental catheter-associated upper extremity deep venous thrombosis detected by point-of-care ultrasound. BMJ Case Rep 2021; 14:e244357. [PMID: 34446517 PMCID: PMC8395361 DOI: 10.1136/bcr-2021-244357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nilam J Soni
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Minh-Phuong T Le
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Maria Inez Velez
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Kevin C Proud
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
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17
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Schizodimos T, Soulountsi V, Iasonidou C, Kapravelos N. Thromboprophylaxis in critically ill patients: balancing on a tightrope. Minerva Anestesiol 2021; 87:1239-1254. [PMID: 34337918 DOI: 10.23736/s0375-9393.21.15755-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a common and potentially fatal complication in the intensive care unit (ICU). Critically ill patients have some special characteristics that increase the risk for VTE and complicate risk stratification and diagnosis. Given the positive effect of thromboprophylaxis on main outcomes, its use is mandatory in these patients, which is documented by various studies and recommended by all published guidelines. However, anticoagulation management is not an easy issue in clinical practice, as the critical patient may be at high risk for thrombosis or, conversely, at increased risk of bleeding or may balance between thrombotic and bleeding risk. Thrombotic and bleeding risk scoring should be evaluated daily in order to select the appropriate form of thromboprophylaxis. The selection depends on the degree of bleeding risk and the subgroup of ICU patients involved, such as patients with sepsis, acute brain injury, major trauma or coronavirus disease-2019. If there is no bleeding risk or other contraindication, the patient should receive pharmacologic thromboprophylaxis with unfractionated heparin or low molecular weight heparins, weighing the advantages of each agent. If the patient is at high risk of bleeding or there is a contraindication to pharmacologic prophylaxis, he should receive mechanical thromboprophylaxis mainly with intermittent pneumatic compression or graduated compression stockings. Thromboprophylaxis compliance with the guidelines is a prerequisite for moving from theory to practice. Direct oral anticoagulants have been studied in ICU patients and have no place at present in VTE prophylaxis requiring further research.
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Affiliation(s)
- Theodoros Schizodimos
- Second Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece -
| | - Vasiliki Soulountsi
- First Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Christina Iasonidou
- Second Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - Nikos Kapravelos
- Second Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
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18
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Salvi A, Nitti C, Fabbri A, Groff P, Ruggiero EG, Agnelli G. Diagnosis and Treatment of Deep Vein Thrombosis in the Emergency Department: Results of an Italian Nominal Group Technique Study. Clin Appl Thromb Hemost 2021; 26:1076029620959720. [PMID: 33112649 PMCID: PMC7791439 DOI: 10.1177/1076029620959720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Early diagnosis and treatment of deep vein thrombosis (DVT) is a main issue in
the Emergency setting. With the aim of assisting clinicians in the diagnosis and
the subsequent management of DVT in the Emergency Departments, a Nominal Group
Technique (NGT) study was conducted. A panel of 5 Italian experts developed 21
consensus statements based on available evidence and their clinical experience.
The agreed consensus statements may assist clinicians in applying the results of
clinical studies and clinical experience to routine care settings, providing
guidance on all aspects of the risk assessment, prophylaxis, early diagnosis and
appropriate treatment of DVT in the EDs.
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Affiliation(s)
- Aldo Salvi
- Emergency Department, 18494"Ospedali Riuniti Ancona", Ancona, Italy
| | - Cinzia Nitti
- Emergency Department, 18494"Ospedali Riuniti Ancona", Ancona, Italy
| | - Andrea Fabbri
- Emergency Department, "Presidio ospedaliero Morgagni-Pierantoni", Forlì, Italy
| | - Paolo Groff
- Emergency Department, 18633"Azienda ospedaliera di Perugia", Perugia, Italy
| | | | - Giancarlo Agnelli
- Internal and Vascular Medicine-Stroke Unit, 9309University of Perugia, Perugia, Italy
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19
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Barrosse-Antle ME, Patel KH, Kramer JA, Baston CM. How I Do It: Point-of-Care Ultrasound for Bedside Diagnosis of Lower Extremity DVT. Chest 2021; 160:1853-1863. [PMID: 34270964 DOI: 10.1016/j.chest.2021.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022] Open
Abstract
The point-of-care ultrasound (POCUS) DVT examination can facilitate rapid bedside diagnosis and treatment of lower extremity DVT. Awaiting radiology-performed Doppler ultrasonography and interpretation by radiologists can lead to delays in lifesaving anticoagulation, and the POCUS DVT examination can provide timely diagnostic information in the patient with lower extremity symptoms. This article outlines accepted techniques for the POCUS DVT examination, discusses the historical context from which the current recommendations have evolved, and provides illustrations alongside ultrasound images of relevant venous anatomy to orient the clinician. Finally, common pitfalls and methods to avoid them are described.
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Affiliation(s)
| | - Kamin H Patel
- Hospital of the University of Pennsylvania, Philadelphia, PA
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20
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Omari AM, Parcells BW, Levine HB, Seidenstein A, Parvizi J, Klein GR. 2021 John N. Insall Award: Aspirin is effective in preventing propagation of infrapopliteal deep venous thrombosis following total knee arthroplasty. Bone Joint J 2021; 103-B:18-22. [PMID: 34053277 DOI: 10.1302/0301-620x.103b6.bjj-2020-2436.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The optimal management of an infrapopliteal deep venous thrombosis (IDVT) following total knee arthroplasty (TKA) remains unknown. The risk of DVT propagation and symptom progression must be balanced against potential haemorrhagic complications associated with administration of anticoagulation therapy. The current study reports on a cohort of patients diagnosed with IDVT following TKA who were treated with aspirin, followed closely for development of symptoms, and scanned with ultrasound to determine resolution of IDVT. METHODS Among a cohort of 5,078 patients undergoing TKA, 532 patients (695 TKAs, 12.6%) developed an IDVT between 1 January 2014 to 31 December 2019 at a single institution, as diagnosed using Doppler ultrasound at the first postoperative visit. Of the entire cohort of 532 patients with IDVT, 91.4% (486/532) were treated with aspirin (325 mg twice daily) and followed closely. Repeat lower limb ultrasound was performed four weeks later to evaluate the status of IDVT. RESULTS Follow-up Doppler ultrasound was performed on 459/486 (94.4%) patients and demonstrated resolution of IDVT in 445/459 cases (96.9%). Doppler diagnosed propagation of IDVT to the popliteal vein had occurred in 10/459 (2.2%) cases. One patient with an IDVT developed a pulmonary embolus six weeks postoperatively. CONCLUSION The results of this study demonstrate a low rate of IDVT propagation in patients managed with aspirin. Additionally, no significant bleeding episodes, wound-related complications, or other adverse events were noted from aspirin therapy. Cite this article: Bone Joint J 2021;103-B(6 Supple A):18-22.
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Affiliation(s)
- Ali M Omari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Harlan B Levine
- Hackensack University Medical Center, Hackensack, New Jersey, USA.,Rothman Orthopaedic Institute, Montvale, New Jersey, USA
| | - Ari Seidenstein
- Hackensack University Medical Center, Hackensack, New Jersey, USA.,Rothman Orthopaedic Institute, Montvale, New Jersey, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregg R Klein
- Hackensack University Medical Center, Hackensack, New Jersey, USA.,Rothman Orthopaedic Institute, Montvale, New Jersey, USA
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21
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Galien S, Hultström M, Lipcsey M, Stattin K, Frithiof R, Rosén J. Point of care ultrasound screening for deep vein thrombosis in critically ill COVID-19 patients, an observational study. Thromb J 2021; 19:38. [PMID: 34078399 PMCID: PMC8170442 DOI: 10.1186/s12959-021-00272-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Deep vein thrombosis (DVT) is common in critically ill patients with Coronavirus disease 2019 (COVID-19) and may cause fatal pulmonary embolism (PE) prior to diagnosis due to subtle clinical symptoms. The aim of this study was to explore the feasibility of bedside screening for DVT in critically ill COVID-19 patients performed by physicians with limited experience of venous ultrasound. We further aimed to compare inflammation, coagulation and organ dysfunction in patients with and without venous thromboembolism (VTE). METHODS This observational study included patients with COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital in Sweden and screened for DVT with proximal compression ultrasound of the lower extremities between April and July 2020. Screening was performed by ICU residents having received a short online education and one hands-on-session. Pathological screening ultrasound was confirmed by formal ultrasound whereas patients with negative screening underwent formal ultrasound on clinical suspicion. Clinical data, laboratory findings and follow-up were extracted from medical records. RESULTS Of 90 eligible patients, 56 were screened by seven ICU residents with no (n = 5) or limited (n = 2) previous experience of DVT ultrasound who performed a median of 4 (IQR 2-19) examinations. Four (7.1%) patients had pathological screening ultrasound of which three (5.6%) were confirmed by formal ultrasound. None of the 52 patients with negative screening ultrasound were diagnosed with DVT during follow-up. Six patients were diagnosed with PE of which four prior to negative screening and two following negative and positive screening respectively. Patients with VTE (n = 8) had higher median peak D-dimer (24.0 (IQR 14.2-50.5) vs. 2.8 (IQR 1.7-7.2) mg/L, p = 0.004), mean peak C-reactive protein (363 (SD 80) vs. 285 (SD 108) mg/L, p = 0.033) and median peak plasma creatinine (288 (IQR 131-328) vs. 94 (IQR 78-131) μmol/L, p = 0.009) compared to patients without VTE (n = 48). Five patients (63%) with VTE received continuous renal replacement therapy compared to six patients (13%) without VTE (p = 0.005). CONCLUSION ICU residents with no or limited experience could detect DVT with ultrasound in critically ill COVID-19 patients following a short education. VTE was associated with kidney dysfunction and features of hyperinflammation and hypercoagulation. TRIAL REGISTRATION ClinicalTrials ID: NCT04316884 . Registered 20 March 2020.
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Affiliation(s)
- Sarah Galien
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, entrance 78, 1 floor, 751 85, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, entrance 78, 1 floor, 751 85, Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, entrance 78, 1 floor, 751 85, Uppsala, Sweden
- Hedenstierna laboratory, CIRRUS, Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Karl Stattin
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, entrance 78, 1 floor, 751 85, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, entrance 78, 1 floor, 751 85, Uppsala, Sweden
| | - Jacob Rosén
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, entrance 78, 1 floor, 751 85, Uppsala, Sweden.
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22
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Mackenzie DC. "I Know It When I See It". Chest 2021; 158:844-845. [PMID: 32892877 DOI: 10.1016/j.chest.2020.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, ME.
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23
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Alharthy A, Faqihi F, Abuhamdah M, Noor A, Naseem N, Balhamar A, Al Saud AAASBA, Brindley PG, Memish ZA, Karakitsos D, Blaivas M. Prospective Longitudinal Evaluation of Point-of-Care Lung Ultrasound in Critically Ill Patients With Severe COVID-19 Pneumonia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:443-456. [PMID: 32797661 PMCID: PMC7436430 DOI: 10.1002/jum.15417] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To perform a prospective longitudinal analysis of lung ultrasound findings in critically ill patients with coronavirus disease 2019 (COVID-19). METHODS Eighty-nine intensive care unit (ICU) patients with confirmed COVID-19 were prospectively enrolled and tracked. Point-of-care ultrasound (POCUS) examinations were performed with phased array, convex, and linear transducers using portable machines. The thorax was scanned in 12 lung areas: anterior, lateral, and posterior (superior/inferior) bilaterally. Lower limbs were scanned for deep venous thrombosis and chest computed tomographic angiography was performed to exclude suspected pulmonary embolism (PE). Follow-up POCUS was performed weekly and before hospital discharge. RESULTS Patients were predominantly male (84.2%), with a median age of 43 years. The median duration of mechanical ventilation was 17 (interquartile range, 10-22) days; the ICU length of stay was 22 (interquartile range, 20.2-25.2) days; and the 28-day mortality rate was 28.1%. On ICU admission, POCUS detected bilateral irregular pleural lines (78.6%) with accompanying confluent and separate B-lines (100%), variable consolidations (61.7%), and pleural and cardiac effusions (22.4% and 13.4%, respectively). These findings appeared to signify a late stage of COVID-19 pneumonia. Deep venous thrombosis was identified in 16.8% of patients, whereas chest computed tomographic angiography confirmed PE in 24.7% of patients. Five to six weeks after ICU admission, follow-up POCUS examinations detected significantly lower rates (P < .05) of lung abnormalities in survivors. CONCLUSIONS Point-of-care ultrasound depicted B-lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings were significantly decreased by ICU discharge, suggesting persistent but slow resolution of at least some COVID-19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20% of patients at the bedside, nearly one-fourth of all patients were found to have computed tomography-proven PE.
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Affiliation(s)
| | - Fahad Faqihi
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | | | - Alfateh Noor
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | - Nasir Naseem
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | | | | | - Peter G. Brindley
- Critical Care DepartmentAlberta Health Care ServicesEdmontonAlbertaCanada
| | - Ziad A. Memish
- Research and Innovation CenterKing Saud Medical City–Ministry of Health, College of Medicine, Al Faisal University RiyadhSaudi Arabia
| | - Dimitrios Karakitsos
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
- Department of MedicineUniversity of South Carolina School of MedicineColumbiaSouth CarolinaUSA
| | - Michael Blaivas
- Department of MedicineUniversity of South Carolina School of MedicineColumbiaSouth CarolinaUSA
- Department of Emergency MedicineSt Francis HospitalColumbusGeorgiaUSA
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24
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Kalagara H, Coker B, Gerstein NS, Kukreja P, Deriy L, Pierce A, Townsley MM. Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:1132-1147. [PMID: 33563532 DOI: 10.1053/j.jvca.2021.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022]
Abstract
Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.
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Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley Coker
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Albert Pierce
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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25
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Prevention, diagnosis, and management of venous thromboembolism in the critically ill surgical and trauma patient. Curr Opin Crit Care 2021; 26:640-647. [PMID: 33027148 DOI: 10.1097/mcc.0000000000000771] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is common among trauma patients and critically ill surgical patients admitted to the ICU. Critical care surgical patients are at an extremely high risk for VTE and the related morbidity and mortality associated with it. The present review aims to provide an overview of the importance of identifying risk factors, prescribing effective prohylaxis, accurate diagnosis, and timely appropriate treatment for trauma and critically ill surgical patients with VTE in the ICU. RECENT FINDINGS VTE is a healthcare burden among critically ill surgical patients that is mostly preventable through adherence to prophylactic protocols that aim to recognize VTE risk factors while simultaneously providing guidance to appropriate timing and administration prophylaxis regimens. Newer pharmacologic therapies for prophylaxis and treatment, diagnostic modalities, and indications for therapy of VTE have continued to evolve. SUMMARY Critical care surgical and trauma patients represent a population that are at a heightened risk for VTE and associated complications. Appropriate screening, prevention strategies, accurate diagnosis, and timely administration of appropriate treatment must be utilized to reduce morbidity and mortality.
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26
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Lau A, Sligl W, Sun K, Barrie J, Long R. Incidence and significance of venous thromboembolism in critically ill pulmonary tuberculosis patients. Eur Respir J 2020; 56:13993003.01753-2020. [PMID: 32586889 DOI: 10.1183/13993003.01753-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/17/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Angela Lau
- Dept of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wendy Sligl
- Dept of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ken Sun
- Dept of Medicine, University of Alberta, Edmonton, AB, Canada
| | - James Barrie
- Dept of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Richard Long
- Dept of Medicine, University of Alberta, Edmonton, AB, Canada
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27
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Kruser JM, Schmidt GA, Kory PD. COUNTERPOINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? No. Chest 2020; 157:498-500. [PMID: 32145806 DOI: 10.1016/j.chest.2019.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jacqueline M Kruser
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gregory A Schmidt
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Pierre D Kory
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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28
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A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study). Ann Intensive Care 2020; 10:122. [PMID: 32926245 PMCID: PMC7490313 DOI: 10.1186/s13613-020-00739-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.
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29
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Abstract
Purpose of Review This article summarizes the utility and evidence supporting the use of ultrasound exams in the intensive care unit. Recent Findings Point-of-care ultrasonography (POCUS) is widely used by intensivists managing critically ill patients whereby they can accurately and rapidly assess for many pathologies such as pneumothorax, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis among others. Basic and advanced critical care echocardiography, including transesophageal echocardiography, are routinely performed to determine the etiology of hemodynamic instability in undifferentiated shock and to guide subsequent therapy. The use of POCUS in the assessment of volume status is controversial with studies demonstrating that respiratory variation of the IVC is not reliable and with analysis of aortic blood flow velocity after passive leg raising maneuvers being the most promising. Summary Point-of-care ultrasonography allows frontline clinicians to make real-time diagnoses and treatment decisions. This article will provide the reader with a broad overview of this important topic. Electronic supplementary material The online version of this article (10.1007/s11886-020-01393-z) contains supplementary material, which is available to authorized users.
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30
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Skulec R, Kohlova A, Miksova L, Cerny V. The reliability of ultrasound compression test performed by general ICU nurses in the critically ill patients: A preliminary prospective clinical study. Eur J Intern Med 2020; 76:130-131. [PMID: 32216998 DOI: 10.1016/j.ejim.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Roman Skulec
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic; Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic; Department of Anesthesiology and Intensive Care, Charles University, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.
| | - Alena Kohlova
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic; Department of Nursing and Midwifery, Faculty of Health Studies, J.E. Purkinje University, Pasteurova 3544/1, Usti nad Labem 400 96, Czech Republic
| | - Lenka Miksova
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, Usti nad Labem 400 11, Czech Republic; Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic; Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
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31
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Dugar S, Duggal A, Bassel A, Soliman M, Moghekar A. Spontaneous echo contrast in venous ultrasound of severe COVID-19 patients. Intensive Care Med 2020; 46:1637-1639. [PMID: 32462324 PMCID: PMC7251216 DOI: 10.1007/s00134-020-06094-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Lerner School of Medicine of Case Western Reserve University, Cleveland, OH, USA.
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.,Lerner School of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Akbik Bassel
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Mona Soliman
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ajit Moghekar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.,Lerner School of Medicine of Case Western Reserve University, Cleveland, OH, USA
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32
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A proposed lung ultrasound and phenotypic algorithm for the care of COVID-19 patients with acute respiratory failure. Can J Anaesth 2020; 67:1393-1404. [PMID: 32440906 PMCID: PMC7241588 DOI: 10.1007/s12630-020-01704-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/08/2023] Open
Abstract
Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID-19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. Clinical presentation, pathophysiology, pulmonary mechanics, radiological and ultrasound findings of these two phenotypes are different. Consequently, the therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure.
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33
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Zhang M, Parikh B, Dirlikov B, Cage T, Lee M, Singh H. Elevated risk of venous thromboembolism among post-traumatic brain injury patients requiring pharmaceutical immobilization. J Clin Neurosci 2020; 75:66-70. [PMID: 32245600 DOI: 10.1016/j.jocn.2020.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
Traumatic brain injury (TBI) patients are known to have a high rate of venous thromboembolism (VTE), and additional neuromuscular blockade or barbiturate coma therapy has the theoretical risk of exacerbating baseline hemostasis and elevating the incidence of thromboembolic events. We conducted a single-institution retrospective review of patients surviving severe TBI, as determined by need for intracranial pressure (ICP) monitoring, who further required paralytics or barbiturate therapy to maintain ICP control. Patients were administered VTE prophylaxis as clinically appropriate. Predictors for VTE were subsequently determined with univariate and logistic multivariate regression analyses. The main cohort includes 144 patients, 34 of whom received pharmaceutical immobilization for ICP control. Mean ISS and GCS at intake were 31.9 and 5.2, respectively. Among those receiving vs not-receiving paralytics and/or barbiturate therapy, there was a statistical difference of 12/34 (35.3%) vs 18/110 (16.4%, p = 0.0280) in VTE events, at a mean time greater than two weeks from the time of trauma. Multivariate logistics regression indicated 3.2 times increased odds of developing a VTE (log odds = 1.17, p = 0.023). No pediatric patients were positive for an event (0/12 vs 7/22, p = 0.0356), and infections were only documented among those with VTE (0/22 vs 4/12, p = 0.0107). Overall, paralytics and barbiturate therapy were correlated with a higher incidence of VTE among TBI patients. Although the need for ICP control will outweigh an increase in thromboembolic risk, there is value for increased surveillance and screening during the prolonged inpatient stay of these patients.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA
| | - Bhavya Parikh
- Meharry Medical College, School of Medicine, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Ben Dirlikov
- Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Tene Cage
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Marco Lee
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
| | - Harminder Singh
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305, USA; Department of Neurosurgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA.
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34
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Shiloh AL, McPhee C, Eisen L, Koenig S, Millington SJ. Better With Ultrasound: Detection of DVT. Chest 2020; 158:1122-1127. [PMID: 32087215 DOI: 10.1016/j.chest.2020.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/04/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022] Open
Abstract
Ultrasound studies to detect DVT are traditionally performed and interpreted by sonographers and radiologists, respectively, but the growth of point-of-care ultrasound is putting this powerful tool in the hands of front-line physicians. Literature from ambulatory patients in the ED suggests this tool performs well in the hands of nonconventional users, and it is now being commonly deployed to aid in the management of critically ill patients. This article presents an approach for incorporating these tools into bedside practice, including illustrative figures and narrated video presentations to demonstrate the techniques described.
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Affiliation(s)
- Ariel L Shiloh
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Christa McPhee
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Lewis Eisen
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Seth Koenig
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
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35
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Poole D, Mayo PH, Møller MH. The wicked path of causal inference in observational studies. Intensive Care Med 2020; 46:799-801. [PMID: 31980840 DOI: 10.1007/s00134-020-05938-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Daniele Poole
- Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy.
| | - Paul H Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, Barbara and Donald Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA
| | - Morten Hylander Møller
- Department of Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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36
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Canty D, Mufti K, Bridgford L, Denault A. Point-of-care ultrasound for deep venous thrombosis of the lower limb. Australas J Ultrasound Med 2019; 23:111-120. [PMID: 34760590 DOI: 10.1002/ajum.12188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The incidence and morbidity of deep venous thrombosis (DVT) and pulmonary embolus are high. Although efforts to increase screening for DVT have been recommended, this is limited by resources. Venous duplex ultrasound has replaced venography as the first-line investigation of choice for DVT, increasing availability and reducing patient exposure to radiation and intravenous contrast. Furthermore, an abbreviated ultrasound where DVT is inferred from incomplete venous compressibility has an equivalent accuracy to venous duplex, requiring less time and training enabling its widespread use by emergency, critical care and anaesthesia clinicians. In this review, the evolution and method of lower limb venous compression ultrasound is described along with evidence for its use in patients at high risk for DVT in these clinical settings.
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Affiliation(s)
- David Canty
- Department of Surgery (Royal Melbourne Hospital) University of Melbourne Level 6 Centre for Medical Research, PO Box 2135 Melbourne Victoria 3050 Australia.,Department of Anaesthesia and Pain Management Royal Melbourne Hospital 300 Grattan Street, Parkville Melbourne Victoria 3050 Australia.,Department of Medicine, Nursing and Health Sciences Monash University Wellington Rd Clayton Victoria 3800 Australia.,Department of Anaesthesia and Perioperative Medicine Monash Health 246 Clayton Rd Clayton Victoria 3168 Australia
| | - Kavi Mufti
- Department of Medicine, Nursing and Health Sciences Monash University Wellington Rd Clayton Victoria 3800 Australia.,Intensive Care Unit Frankston Hospital 2 Hastings Road Frankston Victoria 3199 Australia
| | - Lindsay Bridgford
- Department of Surgery (Royal Melbourne Hospital) University of Melbourne Level 6 Centre for Medical Research, PO Box 2135 Melbourne Victoria 3050 Australia.,Department of Emergency Medicine Maroondah Hospital 1-15 Davey Dr Ringwood East Victoria 3135 Australia
| | - André Denault
- Department of Anesthesiology and Critical Care Faculty of Medicine University of Montreal 2900 Edouard Montpetit Blvd Montreal Quebec H3T 1J4 Canada.,Department of Anesthesiology and Critical Care Montreal Heart Institute 5000 Rue Bélanger Montreal Quebec QC H1T 1C8 Canada
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Hospitalist-Operated Compression Ultrasonography: a Point-of-Care Ultrasound Study (HOCUS-POCUS). J Gen Intern Med 2019; 34:2062-2067. [PMID: 31388904 PMCID: PMC6816719 DOI: 10.1007/s11606-019-05120-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/26/2018] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. Compression ultrasonography is the most common way to evaluate DVT and is typically performed by sonographers and interpreted by radiologists. Yet there is evidence that ultrasound examinations can be safely and accurately performed by clinicians at the bedside. OBJECTIVE To measure the operating characteristics of hospital medicine providers performing point-of-care ultrasound (POCUS) for evaluation of DVT. DESIGN This is a prospective cohort study enrolling a convenience sample of patients. Hospital medicine providers performed POCUS for DVT and the results were compared with the corresponding formal vascular study (FVS) interpreted by radiologists. PARTICIPANTS Hospitalized non-ICU patients at four tertiary care hospitals for whom a DVT ultrasound was ordered. MAIN MEASURES The primary outcomes were the sensitivity, specificity, and predictive values of the POCUS compression ultrasound compared with a FVS. The secondary outcome was the elapsed time between order and the POCUS study compared with the time the FVS was ordered to when the formal radiology report was finalized. KEY RESULTS One hundred twenty-five limbs from 73 patients were scanned. The prevalence of DVT was 6.4% (8/125). The sensitivity of POCUS for DVT was 100% (95% CI 74-100%) and specificity was 95.8% (95% CI 91-98%) with a positive predictive value of 61.5% (95% CI 35-84%) and a negative predictive value of 100% (95% CI 98-100%). The median time from order to POCUS completion was 5.8 h versus 11.5 h median time from order until the radiology report was finalized (p = 0.001). CONCLUSION Hospital medicine providers can perform compression-only POCUS for DVT on inpatients with accuracy similar to other specialties and settings, with results available sooner than radiology. The observed prevalence of DVT was lower than expected. POCUS may be reliable in excluding DVT but further study is required to determine how to incorporate a positive POCUS DVT result into clinical practice.
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Miles MJ, Islam S. Point of care ultrasound in thoracic malignancy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:350. [PMID: 31516896 DOI: 10.21037/atm.2019.05.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Ultrasonography is a safe, efficient and cost-effective mode of imaging that can assist clinicians with important treatment decisions and provide procedural guidance. Today, point of care ultrasound plays an essential role in the assessment of benign and malignant conditions of chest, both in the outpatient and inpatient setting. Small, ultra-portable, affordable units can now be carried in the coat pocket. Advanced lung cancer, metastatic diseases to the lungs or thoracic malignancies can present with pleural effusion, pulmonary edema, post-obstructive pneumonia, or ascites that can be assessed by the clinician with ultrasound. It can be used to evaluate the extent of thoracic tumors beyond the parenchyma to the parietal pleura or chest wall, assess cervical, supraclavicular lymphadenopathy prior to fine needle aspiration or to determine venous thromboembolism (VTE) associated with malignancy. Thoracic ultrasound is currently being practiced by the pulmonologists, thoracic surgeons and intensivists to provide guidance during placement of pleural catheters, chest tubes or to evaluate the pleural cavity before thoracoscopy. Point of care ultrasound can improve efficiency in procedures by decreasing complications, increasing success and reducing financial strain on the health care system.
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Affiliation(s)
- Matthew J Miles
- Department of Pulmonary and Critical Care, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Shaheen Islam
- Department of Interventional Pulmonology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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A Smoldering Case of Breathlessness Exposed by Bedside Ultrasound. Ann Am Thorac Soc 2019; 14:456-458. [PMID: 28248580 DOI: 10.1513/annalsats.201610-771cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Beitland S, Wimmer H, Lorentsen T, Jacobsen D, Drægni T, Brunborg C, Kløw NE, Sandset PM, Sunde K. Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome. Acta Anaesthesiol Scand 2019; 63:630-638. [PMID: 30623406 DOI: 10.1111/aas.13316] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients. METHODS Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason. RESULTS Among 70 included patients, 79% were males and mean age was 62 (±12.1) years. All received thromboprophylaxis with dalteparin, and 44 (63%) used graduated compression stockings. VTE was found in 19 (27%) patients; deep vein thrombosis in 15 (21%) and pulmonary embolism in 4 (6%). Among the VTEs, 11 (58%) presented within the first 48 hours after admission, two (11%) were located in the lower limbs and five (26%) were symptomatic. Risk factors for VTE in multivariable analyses were malignancy, abdominal surgery and SAPS II score <41 with an AuROC (95% CI) of 0.72 (0.58-0.85, P = 0.01). Patients with and without VTE had comparable ICU LOS (13 vs 11 days, P = 0.27) and mortality (16% vs 20%, P = 0.72). CONCLUSION Venous thromboembolism was observed in 27% of ICU patients receiving thromboprophylaxis. Factors associated with increased risk of VTE were malignancy, abdominal surgery and SAPS II score <41. Presence of VTE did not impact on patient outcome.
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Affiliation(s)
- Sigrid Beitland
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
| | - Henning Wimmer
- Department of Acute Medicine Oslo University Hospital Oslo Norway
| | | | - Dag Jacobsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Acute Medicine Oslo University Hospital Oslo Norway
| | - Tomas Drægni
- Department of Research and Development Oslo University Hospital Oslo Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
| | - Nils Einar Kløw
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Radiology Oslo University Hospital Oslo Norway
| | - Per Morten Sandset
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Haematology Oslo University Hospital Oslo Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
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Lee JH, Lee SH, Yun SJ. Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department: A meta-analysis. Medicine (Baltimore) 2019; 98:e15791. [PMID: 31145304 PMCID: PMC6709014 DOI: 10.1097/md.0000000000015791] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To our knowledge, so far, no studies have comprehensively examined the performance of 2-point and 3-point point-of-care compression ultrasound (POCUS) in the diagnosis of lower extremity deep vein thrombosis (DVT). The aim of this meta-analysis was to compare the performance of 2-point and 3-point POCUS techniques for the diagnosis of DVT and evaluate the false-negative rate of each POCUS method. METHODS A computerized search of the PubMed, EMBASE, and Cochrane library databases was performed to identify relevant original articles. Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the diagnostic performance of 2-point and 3-point POCUS. The pooled proportions of the false-negative rate for each POCUS method were assessed using a DerSimonian-Laird random-effects model. Meta-regression analyses were performed according to the patient and study characteristics. RESULTS Seventeen studies from 16 original articles were included (2-point, 1337 patients in 9 studies; 3-point, 1035 patients in 8 studies). Overall, 2-point POCUS had similar pooled sensitivity [0.91; 95% confidence interval (95% CI), 0.68-0.98; P = .86) and specificity (0.98; 95% CI, 0.96-0.99; P = .60) as 3-point POCUS (sensitivity, 0.90; 95% CI, 0.83-0.95 and specificity, 0.95; 95% CI, 0.83-0.99). The false-negative rates of 2-point (4.0%) and 3-point POCUS (4.1%) were almost similar. Meta-regression analysis showed that high sensitivity and specificity tended to be associated with an initial POCUS performer (including attending emergency physician > only resident) and separate POCUS training for DVT (trained > not reported), respectively. CONCLUSION Both 2-point and 3-point POCUS techniques showed excellent performance for the diagnosis of DVT. We recommend that POCUS-trained attending emergency physicians perform the initial 2-point POCUS to effectively and accurately diagnose DVT.
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Affiliation(s)
- Ju Hyung Lee
- Department of Medical Service, 8311 unit, the Republic of Korea Air Force, Chungcheongnam-do
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:833-849. [PMID: 30895665 DOI: 10.1002/jum.14972] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
Spreading beyond the realm of tertiary academic medical centers, point-of-care ultrasound in the intensive care unit is an important diagnostic tool. The real-time feedback garnered can lead to critical and clinically relevant changes in management and decrease potential complications. Bedside ultrasound evaluation in the intensive care setting with a small, portable equipment is well-suited for placement of central lines, lumbar puncture, thoracentesis or other bedside ICU procedures and in the evaluation of cardiac activity, pleural and abdominal cavity and the overall fluid volume. Formalized curriculums centering on point-of-care ultrasound are emerging that will enhance its applicability and relevance.
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Affiliation(s)
- Steven J Campbell
- Section of Interventional Pulmonology, Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, 201 DHLRI, 473 West 12th Avenue, Columbus, OH 43210, USA
| | - Rabih Bechara
- Cancer Treatment Centers of America, Southeastern Regional Medical Center, 600 Celebrate Life Parkway, Newnan, GA 30265, USA
| | - Shaheen Islam
- Section of Interventional Pulmonology, Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, 201 DHLRI, 473 West 12th Avenue, Columbus, OH 43210, USA.
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Brief report of a novel advanced practice provider-led course for ultrasound novices. J Am Assoc Nurse Pract 2019; 30:64-68. [PMID: 29757817 DOI: 10.1097/jxx.0000000000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Formal training for ultrasound use is essential for critical care providers. Despite a national increase in the utilization of advanced practice providers in critical care, ultrasound education is not routinely provided in their training programs. This study describes and evaluates a 1-day advanced care provider (APP)-led course designed to provide fellow APPs with the skills to obtain and evaluate basic ultrasound images. METHODS A 15-question pretest was administered via anonymous use of a clicker response system. Participants had didactic lectures followed by hands-on experience with live models and instructor. Posttest was administered after achievement of basic ultrasound views. Postcourse evaluations were also administered. CONCLUSIONS Pretest and posttest questions included identifying anatomy, pathology, quantifying cardiac function, and clinical decision making. Scores improved from 58% on the pretest to 78% on the posttest. All participants acknowledged the need for the course and their ability to transfer the course into practice. IMPLICATIONS FOR PRACTICE This course established that APPs can both teach and learn from their peers in a formal setting. In addition, this course demonstrated that an APP-led course with a combined hands-on and didactic approach is an effective method for critical care ultrasound skills acquisition in ultrasound-novice APPs.
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Point-of-Care Ultrasonography for the Evaluation of Life-Threatening Hypotension. Ann Am Thorac Soc 2018; 13:2272-2274. [PMID: 27925788 DOI: 10.1513/annalsats.201605-394cc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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A Woman in Her 70s With Profound Hypoxemia. Chest 2018; 150:e13-7. [PMID: 27396795 DOI: 10.1016/j.chest.2016.02.688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 11/21/2022] Open
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Dversdal RK, Piro KM, LoPresti CM, Northcutt NM, Schnobrich DJ. Point-of-Care Ultrasound in the Inpatient Setting: A Tale of Four Patients. South Med J 2018; 111:382-388. [DOI: 10.14423/smj.0000000000000837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Diagnostic Accuracy of Point-of-Care Ultrasound Performed by Pulmonary Critical Care Physicians for Right Ventricle Assessment in Patients With Acute Pulmonary Embolism. Crit Care Med 2017; 45:2040-2045. [PMID: 28953498 DOI: 10.1097/ccm.0000000000002723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Risk stratification for acute pulmonary embolism using imaging presence of right ventricular dysfunction is essential for triage; however, comprehensive transthoracic echocardiography has limited availability. We assessed the accuracy and timeliness of Pulmonary Critical Care Medicine Fellow's performance of goal-directed echocardiograms and intensivists' interpretations for evaluating right ventricular dysfunction in acute pulmonary embolism. DESIGN Prospective observational study and retrospective chart review. SETTING Four hundred fifty bed urban teaching hospital. PATIENTS Adult in/outpatients diagnosed with acute pulmonary embolism. INTERVENTIONS Pulmonary critical care fellows performed and documented their goal-directed echocardiogram as normal or abnormal for right ventricular size and function in patients with acute pulmonary embolism. Gold standard transthoracic echocardiography was performed on schedule unless the goal-directed echocardiogram showed critical findings. Attending intensivists blinded to the clinical scenario reviewed these exams at a later date. MEASUREMENTS AND MAIN RESULTS Two hundred eighty-seven consecutive patients were evaluated for acute PE. Pulmonary Critical Care Medicine Fellows performed 154 goal-directed echocardiograms, 110 with complete cardiology-reviewed transthoracic echocardiography within 48 hours for comparison. Pulmonary Critical Care Medicine Fellow's area under the curve for size and function was 0.83 (95% CI, 0.75-0.90) and 0.83 (95% CI, 0.75-0.90), respectively. Intensivists' 1/2 area under the curve for size and function was (1) 0.87 (95% CI, 0.82-0.94), (1) 0.87 (95% CI, 0.80-0.93) and (2) 0.88 (95% CI, 0.82-0.95), (2) 0.88 (95% CI, 0.82-0.95). Median time difference between goal-directed echocardiogram and transthoracic echocardiography was 21 hours 18 minutes. CONCLUSIONS This is the first study to evaluate pulmonary critical care fellows' and intensivists' use of goal-directed echocardiography in diagnosing right ventricular dysfunction in acute pulmonary embolism. Pulmonary Critical Care Medicine Fellows and intensivists made a timely and accurate assessment. Screening for right ventricular dysfunction using goal-directed echocardiography can and should be performed by pulmonary critical care physicians in patients with acute pulmonary embolism.
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