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Ultrasonography Comparison of Diaphragm Morphological Structure and Function in Young and Middle-Aged Subjects with and without Non-Specific Chronic Low Back Pain: A Case-Control Study. Pain Res Manag 2022; 2022:7929982. [PMID: 36569461 PMCID: PMC9788885 DOI: 10.1155/2022/7929982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/06/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
Background It is reported that impaired postural control in patients with non-specific chronic low back pain (NCLBP) was associated with "core" trunk muscle incoordination. However, as the diaphragm is an important component of the "core" deep trunk muscle group, we still know little about the potential relationship between diaphragm dysfunction and NCLBP. Objectives This case-control study is intended to investigate the changes of diaphragm morphological structure and function in young and middle-aged subjects with and without NCLBP by ultrasound evaluation and its possible validity in predicating the occurrence of NCLBP. Methods 31 subjects with NCLBP (NCLBP group) and 32 matched healthy controls (HC group) were enrolled in this study. The diaphragm thickness at the end of inspiration (T ins) or expiration (T exp) during deep breathing was measured through B-mode ultrasound, and the diaphragm excursion (T exc) was estimated at deep breathing through M-mode ultrasound. The diaphragm thickness change rate (T rate) was calculated by the formula: T rate=(T ins - T exp)/T exp × 100%. Results Compared with the HC group, the NCLBP group had a significant smaller degree of Tins (t = -3.90, P < 0.001), T exp (Z = -2.79, P=0.005), and T rate (t = -2.03, P=0.047). However, there was no statistical difference in T exc between the two groups (t = -1.42, P=0.161). The binary logistic regression analysis indicated that T rate (OR = 16.038, P=0.014) and T exp (OR = 7.714, P=0.004) were potential risk factors for the occurrence of NCLBP. Conclusions The diaphragm morphological structure and function were changed in young and middle-aged subjects with NCLBP, while the diaphragm thickness change rate (T rate) and diaphragm thickness at the end of expiration (T exp) may be conductive to the occurrence of NCLBP. Furthermore, these findings may suggest that abnormal diaphragm reeducation is necessary for the rehabilitation of patients with NCLBP.
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Ibarra-Estrada M, Gamero-Rodríguez MJ, García-de-Acilu M, Roca O, Sandoval-Plascencia L, Aguirre-Avalos G, García-Salcido R, Aguirre-Díaz SA, Vines DL, Mirza S, Kaur R, Weiss T, Guerin C, Li J. Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study. Crit Care 2022; 26:189. [PMID: 35761404 PMCID: PMC9235111 DOI: 10.1186/s13054-022-04064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background Awake prone positioning (APP) reduces the intubation rate in COVID-19 patients treated by high-flow nasal cannula (HFNC). However, the lung aeration response to APP has not been addressed. We aimed to explore the lung aeration response to APP by lung ultrasound (LUS).
Methods This two-center, prospective, observational study enrolled patients with COVID-19-induced acute hypoxemic respiratory failure treated by HFNC and APP. LUS score was recorded 5–10 min before, 1 h after APP, and 5–10 min after supine in the first APP session within the first three days. The primary outcome was LUS score changes in the first three days. Secondary outcomes included changes in SpO2/FiO2 ratio, respiratory rate and ROX index (SpO2/FiO2/respiratory rate) related to APP, and the rate of treatment success (patients who avoided intubation). Results Seventy-one patients were enrolled. LUS score decreased from 20 (interquartile range [IQR] 19–24) to 19 (18–21) (p < 0.001) after the first APP session, and to 19 (18–21) (p < 0.001) after three days. Compared to patients with treatment failure (n = 20, 28%), LUS score reduction after the first three days in patients with treatment success (n = 51) was greater (− 2.6 [95% confidence intervals − 3.1 to − 2.0] vs 0 [− 1.2 to 1.2], p = 0.001). A decrease in dorsal LUS score > 1 after the first APP session was associated with decreased risk for intubation (Relative risk 0.25 [0.09–0.69]). APP daily duration was correlated with LUS score reduction in patients with treatment success, especially in dorsal lung zones (r = − 0.76; p < 0.001). Conclusions In patients with acute hypoxemic respiratory failure due to COVID-19 and treated by HFNC, APP reduced LUS score. The reduction in dorsal LUS scores after APP was associated with treatment success. The longer duration on APP was correlated with greater lung aeration. Trial registration This study was prospectively registered on clinicaltrials.gov on April 22, 2021. Identification number NCT04855162. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04064-3.
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Liu K, Yao YL, Wang YX, Wei BL, Li LC, Wang QX, Ge HQ, Wang ES, Yang LM, Chen H, Yang YQ, Qin H, Zhai WJ, Yu SJ, Wang XT, Luo Z, Tu GW. A cross-sectional survey on the lung ultrasound training and practice of respiratory therapists in mainland China. BMC Pulm Med 2022; 22:425. [PMID: 36401235 PMCID: PMC9672549 DOI: 10.1186/s12890-022-02213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose This national study aimed to investigate the lung ultrasound (LUS) training and practice of respiratory therapists (RTs) in mainland China. Methods A cross-sectional multicenter survey was conducted from May 22, 2021 to August 12, 2021, through online platforms. This survey included RTs in mainland China. The survey was divided into four sections: (1) demographic characteristics and basic information; (2) basic information about LUS training and practice; (3) LUS practice details; and (4) Other ultrasound training and practice. Results A total of 514 responses were received, and 494 valid responses were included in the analysis. 81.2% (401/494) participants’ highest degree of education was a bachelor’s degree, and 43.1% (213/494) participants were at level II in terms of job ranking. 99.2%(490/494) participants agreed that the RTs needed to learn lung ultrasound, but only 12.3% (61/494) participants had received a LUS training course. Further, 66.2% (327/494) experienced participants responded to Sect. 3. Most of RTs used LUS when the patient had hypoxia (265/327, 81%) or dyspnea (260/317, 79.5%); they also used it during spontaneous breathing trial(SBT) (191/327, 58.4%) or in prone position (177/327, 54.1%). The A-line (302/327, 92.4%), B-line (299/327, 91.4%), lung slide (263/327, 80.4%), and bat sign (259/327, 79.2%) were well known as LUS signs. Also, 30.6% (100/327) participants did not use the LUS protocol in their clinical practice, and only 25.4%(83/327) participants said they had used LUS scores. Moreover, 55.7% (182/327) participants frequently changed the respiratory therapy strategy according to LUS results. Conclusions We should improve the number and workplace of RTs in mainland China in the future. We should also standardize the application of LUS practice and training for RTs in mainland China and establish corresponding certification pathways. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02213-6.
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Messina A, Bakker J, Chew M, De Backer D, Hamzaoui O, Hernandez G, Myatra SN, Monnet X, Ostermann M, Pinsky M, Teboul JL, Cecconi M. Pathophysiology of fluid administration in critically ill patients. Intensive Care Med Exp 2022; 10:46. [PMID: 36329266 PMCID: PMC9633880 DOI: 10.1186/s40635-022-00473-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Fluid administration is a cornerstone of treatment of critically ill patients. The aim of this review is to reappraise the pathophysiology of fluid therapy, considering the mechanisms related to the interplay of flow and pressure variables, the systemic response to the shock syndrome, the effects of different types of fluids administered and the concept of preload dependency responsiveness. In this context, the relationship between preload, stroke volume (SV) and fluid administration is that the volume infused has to be large enough to increase the driving pressure for venous return, and that the resulting increase in end-diastolic volume produces an increase in SV only if both ventricles are operating on the steep part of the curve. As a consequence, fluids should be given as drugs and, accordingly, the dose and the rate of administration impact on the final outcome. Titrating fluid therapy in terms of overall volume infused but also considering the type of fluid used is a key component of fluid resuscitation. A single, reliable, and feasible physiological or biochemical parameter to define the balance between the changes in SV and oxygen delivery (i.e., coupling “macro” and “micro” circulation) is still not available, making the diagnosis of acute circulatory dysfunction primarily clinical. Fluids are drugs used in patients with shock to increase the cardiac output with the aim to improve oxygen delivery to the cells. The response to fluid administration is determined by the physiological interaction of cardiac function and venous return. In septic shock, the beneficial clinical response of fluid administration is rapidly reduced after few hours and fluid titration is crucial to avoid detrimental fluid overload. The fluid challenge is a fluid bolus given at a defined quantity and rate to assess fluid responsiveness. The ideal fluid for critically ill patients does not exist; however, crystalloids should be used as first choice. Balanced crystalloid solutions may be associated with better outcomes but the evidence is still low. Albumin infusion may have a role in already fluid resuscitated patients at risk of fluid overload. Fluid administration is integrated into the complex management of pressure and flow “macro” hemodynamic variables, coupled to the “micro” local tissue flow distribution and regional metabolism. Macro-variables are managed by measuring systemic blood pressure and evaluating the global cardiac function. The critical threshold of oxygen delivery to the cells is difficult to estimate, however, several indexes and clinical signs may be considered as surrogate of that, and integrated in a decision-making process at the bedside.
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Affiliation(s)
- Antonio Messina
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Jan Bakker
- NYU Langone Health and Columbia University Irving Medical Center, New York, USA.,Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Olfa Hamzaoui
- Service de Reanimation PolyvalenteHopital Antoine Béclère, Hopitaux Universitaires Paris-Saclay, Clamart, France
| | - Glenn Hernandez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Xavier Monnet
- Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Medical Intensive Care Unit, Le Kremlin-Bicêtre, Paris, France
| | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Michael Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jean-Louis Teboul
- Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Medical Intensive Care Unit, Le Kremlin-Bicêtre, Paris, France
| | - Maurizio Cecconi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Makris D, Tsolaki V, Robertson R, Dimopoulos G, Rello J. The future of training in intensive care medicine: A European perspective. JOURNAL OF INTENSIVE MEDICINE 2022; 3:52-61. [PMID: 36789360 PMCID: PMC9923960 DOI: 10.1016/j.jointm.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Ross Robertson
- Medical School, University of Thessaly, Larisa 41110, Greece
| | - George Dimopoulos
- Third Department of Critical Care, Medical School, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Jordi Rello
- CRIPS Department, Vall d'Hebron Institut of Research, Barcelona 08035, Spain,Clinical Research, CHU Nîmes, Nîmes 30029, France,Medical School, Universitat Internacional de Catalunya, Campus Sant Cugat, Sant Cugat del Valles, Barcelona 08195, Spain,Corresponding author: Jordi Rello, CRIPS Department, Vall d'Hebron Institut of Research, Barcelona 08035, Spain.
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Adrian M, Borgquist O, Kröger T, Linné E, Bentzer P, Spångfors M, Åkeson J, Holmström A, Linnér R, Kander T. Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study. Br J Anaesth 2022; 129:843-850. [DOI: 10.1016/j.bja.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 11/02/2022] Open
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Trabelsi B, Hajjej Z, Drira D, Yedes A, Labbene I, Ferjani M, Ben Ali M. Comparison of ultrasound-guided internal jugular vein and supraclavicular subclavian vein catheterization in critically ill patients: a prospective, randomized clinical trial. Ann Intensive Care 2022; 12:91. [PMID: 36183049 PMCID: PMC9526766 DOI: 10.1186/s13613-022-01065-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to compare the effectiveness and safety of ultrasound-guided out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSCV) catheterization in adult intensive care unit. Methods A total of 250 consecutive patients requiring central venous catheterization, were randomly assigned to undergo either ultrasound-guided OOP-IJV or IP-SSCV cannulation. All catheterizations were carried out by three physicians. The primary outcome was the first attempt success rate. Ultrasound scanning time, venous puncture time, insertion time, overall access time, number of puncture attempts, number of needle redirections, success rate, guidewire advancing difficulties, venous collapse and adverse events were also documented. Results The first attempt success rate was significantly higher in IP-SSCV group (83.2%) compared to OOP-IJV group (63.2%) (p = 0.001). The IP-SSCV group was associated with a longer ultrasound scanning time (16.54 ± 13.51 vs. 5.26 ± 4.05 s; p < 0.001) and a shorter insertion time (43.98 ± 26.77 vs. 53.12 ± 40.21 s; p = 0.038). In the IP-SCCV group, we recorded a fewer number of puncture attempts (1.16 ± 0.39 vs. 1.47 ± 0.71; p < 0.001), needle redirections (0.69 ± 0.58 vs. 1.17 ± 0.95; p < 0.001), difficulties in guidewire advancement (2.4% vs. 27.4%; p < 0.001), venous collapse (2.4%, vs. 18.4%; p < 0.001) and adverse events (8.8% vs. 13.6%; p = 0.22). Conclusions The IP-SSCV approach is an effective and a safe alternative to the classic OOP-IJV catheterization in critical adult patients. Trial registration: Clinicaltrials.gov, NCT03879954. Registered March 19, 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03879954. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01065-x.
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Affiliation(s)
- Becem Trabelsi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Taher Maamouri Teaching Hospital of Nabeul, University of Tunis El Manar, 8000, Nabeul, Tunisia.
| | - Zied Hajjej
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Military Hospital of Tunis, University of Tunis El Manar, 1008 Montfleury, LR12DN01, Tunis, Tunisia
| | - Dhouha Drira
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Taher Maamouri Teaching Hospital of Nabeul, University of Tunis El Manar, 8000, Nabeul, Tunisia
| | - Azza Yedes
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Taher Maamouri Teaching Hospital of Nabeul, University of Tunis El Manar, 8000, Nabeul, Tunisia
| | - Iheb Labbene
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Military Hospital of Tunis, University of Tunis El Manar, 1008 Montfleury, LR12DN01, Tunis, Tunisia
| | - Mustapha Ferjani
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Military Hospital of Tunis, University of Tunis El Manar, 1008 Montfleury, LR12DN01, Tunis, Tunisia
| | - Mechaal Ben Ali
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine of Tunis, Taher Maamouri Teaching Hospital of Nabeul, University of Tunis El Manar, 8000, Nabeul, Tunisia
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Han C, Shao P, Li H, Shi R, Wang Y. Effects of Unilateral Intermediate Cervical Plexus Block on the Diaphragmatic Function in Patients Undergoing Unilateral Thyroidectomy: A Randomized Controlled Study. J Pain Res 2022; 15:2663-2672. [PMID: 36106312 PMCID: PMC9464641 DOI: 10.2147/jpr.s374739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Although unilateral intermediate cervical plexus block (ICPB) can be used for perioperative analgesia in neck surgery, its effect on diaphragm function remains controversial. This prospective study aimed to examine whether unilateral ICPB with different concentrations of ropivacaine resulted in the diaphragmatic dysfunction in unilateral thyroidectomy. Methods A total of 54 patients scheduled to undergo unilateral thyroidectomy under general anesthesia were randomly allocated to receive either 10 mL of 0.3% (Group L) or 0.5% (Group H) ropivacaine for ICPB. General anesthesia was then administered for surgery. The diaphragm thickness and diaphragmatic excursion were measured at three different times: before the ICPB, at 40 min and 4 h after the block. The primary outcome was the incidence of diaphragmatic dysfunction of the block side at 40 min and 4 h after ICPB. Secondary outcomes included the maximum pain score within 24 h after the surgery, rescue analgesics within 24 h after the surgery, and time to first ambulation. Results The incidence of diaphragmatic dysfunction on the block side of Group H was higher than that of Group L at 40 min after block (58% vs 29%, P = 0.01). However, the incidence of diaphragmatic dysfunction was comparable between Group H and Group L (65% vs 46%) at 4 h after block placement. Within 24 h after the operation, the maximum VAS pain score of Group H was significantly lower than Group L (P = 0.04), and fewer patients in Group H required rescue analgesics (P < 0.01). Conclusion The ICPB with different concentrations of ropivacaine can induce the ipsilateral diaphragmatic dysfunction. The high concentration of ropivacaine results in higher incidence of diaphragmatic dysfunction at 40 min, but comparable incidence at 4 h after block compared with lower concentration of ropivacaine. Chinese Clinical Trial Registry ChiCTR2000029348.
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Affiliation(s)
- Chao Han
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Anesthesiology, Beijing Longfu Hospital, Beijing, People's Republic of China
| | - Peiqi Shao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huili Li
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rong Shi
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Blanco JB, Esquinas A. Diaphragm Evaluation and Lung Ultrasound Score during Weaning. Indian J Crit Care Med 2022; 26:1054-1055. [PMID: 36213714 PMCID: PMC9492736 DOI: 10.5005/jp-journals-10071-24312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Blanco JB, Esquinas A. Diaphragm Evaluation and Lung Ultrasound Score during Weaning. Indian J Crit Care Med 2022;26(9):1054–1055.
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Affiliation(s)
- Jacobo Bacariza Blanco
- Department of Intensive Care Medicine Unit, Hospital Garcia de Orta, Almada, Setubal, Portugal
- Jacobo Bacariza Blanco, Department of Intensive Care Medicine Unit, Hospital Garcia de Orta, Almada, Setubal, Portugal, Phone: +351 00351916593806, e-mail:
| | - Antonio Esquinas
- Department of Intensive Care Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain
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Mongodi S, Bonomi F, Vaschetto R, Robba C, Salve G, Volta CA, Bignami E, Vetrugno L, Corradi F, Maggiore SM, Pelosi P, Mojoli F. Point-of-care ultrasound training for residents in anaesthesia and critical care: results of a national survey comparing residents and training program directors' perspectives. BMC MEDICAL EDUCATION 2022; 22:647. [PMID: 36031630 PMCID: PMC9420188 DOI: 10.1186/s12909-022-03708-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/19/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has become an essential tool for anaesthesia and critical care physicians and dedicated training is mandatory. This survey describes the current state of Italian residency training programs through the comparison of residents' and directors' perspective. METHODS Observational prospective cross-sectional study: 12-question national e-survey sent to Italian directors of anaesthesia and critical care residency programs (N = 40) and residents (N = 3000). Questions focused on POCUS teaching (vascular access, transthoracic echocardiography, focused assessment for trauma, transcranial Doppler, regional anaesthesia, lung and diaphragm ultrasound), organization (dedicated hours, teaching tools, mentors), perceived adequacy/importance of the training and limiting factors. RESULTS Five hundred seventy-one residents and 22 directors completed the survey. Bedside teaching (59.4-93.2%) and classroom lessons (29.7-54.4%) were the most frequent teaching tools. Directors reported higher participation in research projects (p < 0.05 for all techniques but focused assessment for trauma) and simulation (p < 0.05 for all techniques but transthoracic echocardiography). Use of online teaching was limited (< 10%); however, 87.4% of residents used additional web-based tools. Consultants were the most frequent mentors, with different perspectives between residents (72.0%) and directors (95.5%; p = 0.013). Residents reported self-training more frequently (48.5 vs. 9.1%; p < 0.001). Evaluation was mainly performed at the bedside; a certification was not available in most cases (< 10%). Most residents perceived POCUS techniques as extremely important. Residents underestimated the relevance given by directors to ultrasound skills in their evaluation and the minimal number of exams required to achieve basic competency. Overall, the training was considered adequate for vascular access only (62.2%). Directors mainly agreed on the need of ultrasound teaching improvement in all fields. Main limitations were the absence of a standardized curriculum for residents and limited mentors' time/expertise for directors. CONCLUSION POCUS education is present in Italian anaesthesia and critical care residency programs, although with potential for improvement. Significant discrepancies between residents' and directors' perspectives were identified.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
- Rianimazione I, Fondazione IRCCS Policlinico S. Matteo, DEA piano -1, Viale Golgi 19, 27100, Pavia, Italy.
| | - Francesca Bonomi
- Anesthesia and Intensive Care, ASST-Pavia - Civil Hospital of Vigevano, Pavia, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Anesthesia and Intensive Care, Ospedale Maggiore della Carità, Novara, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Giulia Salve
- Anesthesia and Intensive Care 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Elena Bignami
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Francesco Corradi
- Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Salvatore Maurizio Maggiore
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy
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Feng H, Qi Y, Wang X, Chen F, Li X. Treadmill Exercise Decreases Inflammation Via Modulating IL-6 Expression in the Rat Model of Middle Cerebral Artery Occlusion. Neurocrit Care 2022; 38:279-287. [PMID: 35982267 DOI: 10.1007/s12028-022-01575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-term bed rest in neurointensive care (NIC) patients leads to skeletal muscle atrophy and cognitive dysfunction, which seriously affects the physical fitness and final prognosis of critically ill patients. Exercise therapy plays an increasingly important role in the treatment and rehabilitation of patients with sarcopenia. However, the therapeutic effect and mechanism of exercise therapy for patients with neurological impairment remain unclear. METHODS Serum samples of NIC patients before and after exercise therapy and normal people were collected to detect interleukin-6 (IL-6) and interleukin-1β levels by enzyme-linked immunosorbent assay (ELISA). Middle cerebral artery occlusion (MCAO) was used for the construction of a rat model. The Morris water maze test, exploration test, and open-field test were used to assess neurological function in rats. Western blot and quantitative real-time polymerase chain reaction were performed to evaluate the activation of IL-6/adenosine-monophosphate-activated protein kinase (AMPK) signaling. RESULTS Exercise therapy attenuated IL-6 expression in NIC patients. Exercise therapy alleviated cognitive dysfunctions and decreased IL-6 expression in MCAO rats. Exercise therapy alleviated gastrocnemius muscle injury in rats after MCAO by modulating IL-6/AMPK signaling. CONCLUSIONS Treadmill exercise decreases inflammation in MCAO rats via modulating IL-6/AMPK signaling.
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Affiliation(s)
- Hui Feng
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Dongshan Street, Jiangning District, Nanjing, 210000, Jiangsu, China.
| | - Yinliang Qi
- Department of Hyperbaric Oxygen, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Xinlong Wang
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Dongshan Street, Jiangning District, Nanjing, 210000, Jiangsu, China
| | - Fangyu Chen
- Department of Rehabilitation, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Dongshan Street, Jiangning District, Nanjing, 210000, Jiangsu, China
| | - Xueping Li
- Department of Rehabilitation, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Qinhuai District, Nanjing, 210000, Jiangsu, China
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62
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Flower L, Parulekar P, Roshdy A. The challenges of defining right ventricular dysfunction in critical illness. Anaesthesia 2022; 77:1307-1308. [PMID: 35737442 DOI: 10.1111/anae.15794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Affiliation(s)
- L Flower
- William Harvey Research Institute, Queen Mary University of London, UK
| | - P Parulekar
- William Harvey Hospital, East Kent Hospitals, Canterbury, UK
| | - A Roshdy
- North Middlesex University Hospital, London, UK
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63
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Cox EGM, Koeze J, van der Horst ICC, Wiersema R. Calculated left ventricular outflow tract diameter for critically ill patients. J Intensive Care 2022; 10:31. [PMID: 35729661 PMCID: PMC9210692 DOI: 10.1186/s40560-022-00623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
A fast and reliable left ventricular outflow diameter (LVOTd) estimation may aid in quickly estimating cardiac output. However, obtaining a correct LVOTd can be difficult in intensive care patients, potentially leading to errors and a cardiac output deviation. In this study, the measured LVOTd was compared with the expected LVOTd when estimated using an existing formula in 1177 critically ill patients. We show that estimated LVOTd based on baseline data can aid when obtaining LVOTd is difficult or impossible and simplified estimation based on a formula may allow for more reliable and accessible measurement of cardiac output.
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Affiliation(s)
- Eline G M Cox
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Jacqueline Koeze
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University, Maastricht University Medical Centre+ Maastricht, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Renske Wiersema
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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64
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Giustiniano E, Palma S, Meco M, Ripani U, Nisi F. Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View. Diagnostics (Basel) 2022; 12:diagnostics12061460. [PMID: 35741270 PMCID: PMC9221662 DOI: 10.3390/diagnostics12061460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
In critically ill patients, standard transthoracic echocardiography (TTE) generally does not facilitate good image quality during mechanical ventilation. We propose a prone-TTE in prone positioned patients, which allows clinicians to obtain a complete apical four-chamber (A-4-C) view. A basic cardiac assessment can be performed in order to evaluate right ventricle function and left ventricle performance, even measuring objective parameters, i.e., tricuspid annular plane systolic excursion (TAPSE); pulmonary artery systolic pressure (PAP), from the tricuspid regurgitation peak Doppler velocity; RV end-diastolic diameter and its ratio to left ventricular end-diastolic diameter; the S’ wave peak velocity with tissue Doppler imaging; the ejection fraction (EF); the mitral annular plane systolic excursion (MAPSE); diastolic function evaluation by the mitral valve; and annular Doppler velocities. Furthermore, by tilting the probe, we can obtain the apical-five-chamber (A-5-C) view, which facilitates the analysis of blood flow at the level of the output tract of the left ventricle (LVOT) and then the estimation of stroke volume. Useful applications of this technique are hemodynamic assessment, titration of fluids, vasoactive drugs therapy, and evaluation of the impact of prone positioning on right ventricle performance and right pulmonary resistances. We believe that considerable information can be drawn from a single view and hope this may be helpful to emergency and critical care clinicians whenever invasive hemodynamic monitoring tools are not available or are simply inconvenient due to clinical reasons.
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Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
| | - Sergio Palma
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
| | - Massimo Meco
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni Clinics, Via Mauro Gavazzeni, 21, 24125 Bergamo, Italy;
| | - Umberto Ripani
- Division of Clinic Anaesthesia, Department of Emergency Hospital Riuniti, Conca Street 71, 60126 Ancona, Italy;
| | - Fulvio Nisi
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
- Correspondence: ; Tel.: +39-02-8224-4115; Fax: +39-02-8224-4190
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65
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Rezoagli E, Laffey JG, Bellani G. Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation. Semin Respir Crit Care Med 2022; 43:346-368. [PMID: 35896391 DOI: 10.1055/s-0042-1748917] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure burden by high hospital mortality. No specific pharmacologic treatment is currently available and its ventilatory management is a key strategy to allow reparative and regenerative lung tissue processes. Unfortunately, a poor management of mechanical ventilation can induce ventilation induced lung injury (VILI) caused by physical and biological forces which are at play. Different parameters have been described over the years to assess lung injury severity and facilitate optimization of mechanical ventilation. Indices of lung injury severity include variables related to gas exchange abnormalities, ventilatory setting and respiratory mechanics, ventilation intensity, and the presence of lung hyperinflation versus derecruitment. Recently, specific indexes have been proposed to quantify the stress and the strain released over time using more comprehensive algorithms of calculation such as the mechanical power, and the interaction between driving pressure (DP) and respiratory rate (RR) in the novel DP multiplied by four plus RR [(4 × DP) + RR] index. These new parameters introduce the concept of ventilation intensity as contributing factor of VILI. Ventilation intensity should be taken into account to optimize protective mechanical ventilation strategies, with the aim to reduce intensity to the lowest level required to maintain gas exchange to reduce the potential for VILI. This is further gaining relevance in the current era of phenotyping and enrichment strategies in ARDS.
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Affiliation(s)
- Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy
| | - John G Laffey
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Saolta University Hospital Group, Galway, Ireland.,Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy
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66
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Wong A, Robba C, Mayo P. Critical care ultrasound. Intensive Care Med 2022; 48:1069-1071. [PMID: 35648197 DOI: 10.1007/s00134-022-06735-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/09/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK.
| | - Chiara Robba
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy.,Italy and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
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67
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Abstract
PURPOSE OF REVIEW Due to heart, lung and diaphragm interactions during weaning from mechanical ventilation, an ultrasound integrated approach may be useful in the detection of dysfunctions potentially leading to weaning failure. In this review, we will summarize the most recent advances concerning the ultrasound applications relevant to the weaning from mechanical ventilation. RECENT FINDINGS The role of ultrasonographic examination of heart, lung and diaphragm has been deeply investigated over the years. Most recent findings concern the ability of lung ultrasound in detecting weaning induced pulmonary edema during spontaneous breathing trial. Furthermore, in patients at high risk of cardiac impairments, global and anterolateral lung ultrasound scores have been correlated with weaning and extubation failure, whereas echocardiographic indexes were not. For diaphragmatic ultrasound evaluation, new indexes have been proposed for the evaluation of diaphragm performance during weaning, but further studies are needed to validate these results. SUMMARY The present review summarizes the potential role of ultrasonography in the weaning process. A multimodal integrated approach allows the clinician to comprehend the pathophysiological processes of weaning failure.
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68
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Robba C. Measuring optic nerve sheath diameter using ultrasonography for the detection of non invasive intracranial pressure: what it is and what it is not. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:547-549. [PMID: 35946717 PMCID: PMC9387181 DOI: 10.1590/0004-282x-anp-2022-e006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Chiara Robba
- San Martino Policlinico Hospital, Anesthesia and Critical Care, IRCCS for Oncology and Neuroscience, Genoa, Italy
- University of Genoa, Department of Surgical Sciences and Integrated Diagnostics, Genoa, Italy
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69
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Wong A, Robba C, Vieillard-Baron A. Basic ultrasound skill for intensivists: future scope for expansion of the recommendations of the European Society of Intensive Care Medicine. Author's reply. Intensive Care Med 2022; 48:973-974. [PMID: 35579688 DOI: 10.1007/s00134-022-06673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK. .,European Society of Intensive Care Medicine (ESICM), 19 Rue Belliard, 1040, Brussels, Belgium.
| | - Chiara Robba
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia E Le Neuroscienze, Genoa, Italy.,Italy and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy.,European Society of Intensive Care Medicine (ESICM), 19 Rue Belliard, 1040, Brussels, Belgium
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, 92100, Boulogne, France.,INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, Versailles, France.,European Society of Intensive Care Medicine (ESICM), 19 Rue Belliard, 1040, Brussels, Belgium
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70
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Kumar S, Das AK, Paliwal B, Sharma A, Bhatia P. Basic ultrasound skill for intensivists: future scope for expansion of the recommendations of the European Society of Intensive Care Medicine. Intensive Care Med 2022; 48:971-972. [PMID: 35577993 DOI: 10.1007/s00134-022-06717-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sandeep Kumar
- Critical Care Medicine, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akshaya Kumar Das
- Critical Care Medicine, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Paliwal
- Critical Care Medicine, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Ankur Sharma
- Critical Care Medicine, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Critical Care Medicine, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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71
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Mongodi S, Wong A, Baron AV, Robba C. Defining basic (lung) ultrasound skills; not so basic after all? Author's reply. Intensive Care Med 2022; 48:630-631. [PMID: 35357545 DOI: 10.1007/s00134-022-06682-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Silvia Mongodi
- Anaesthesia and Intensive Care, San Matteo Hospital, Pavia, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK
| | - Antoine Vieillard Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
- INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Chiara Robba
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa, Italy.
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy.
- IRCCS for Oncology and Neuroscience, Policlinico San Martino, University of Genoa, Genoa, Italy.
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72
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Defining basic (lung) ultrasound skills: not so basic after all? Intensive Care Med 2022; 48:628-629. [PMID: 35355097 DOI: 10.1007/s00134-022-06666-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022]
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73
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Bittencourt Rynkowski C, Caldas J. Ten Good Reasons to Practice Neuroultrasound in Critical Care Setting. Front Neurol 2022; 12:799421. [PMID: 35095741 PMCID: PMC8793827 DOI: 10.3389/fneur.2021.799421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 01/13/2023] Open
Abstract
In the beginning, cerebral ultrasound (US) was not considered feasible because the intact skull was a seemingly impenetrable obstacle. For this reason, obtaining a clear image resolution had been a challenge since the first use of neuroultrasound (NUS) for the assessment of small deep brain structures. However, the improvements in transducer technologies and advances in signal processing have refined the image resolution, and the role of NUS has evolved as an imaging modality for the brain parenchyma within multiple pathologies. This article summarizes ten crucial applications of cerebral ultrasonography for the evaluation and management of neurocritical patients, whose transfer from and to intensive care units poses a real problem to medical care staff. This also encompasses ease of use, low cost, wide acceptance by patients, no radiation risk, and relative independence from movement artifacts. Bedsides, availability and reliability raised the interest of critical care intensivists in using it with increasing frequency. In this mini-review, the usefulness and the advantages of US in the neurocritical care setting are discussed regarding ten aspects to encourage the intensivist physician to practice this important tool.
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Affiliation(s)
- Carla Bittencourt Rynkowski
- Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil.,Intensive Care Unit, Hospital Ernesto Dornelles, Porto Alegre, Brazil
| | - Juliana Caldas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Salvador, Brazil
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74
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Messina A, Robba C, Bertuetti R, Biasucci D, Corradi F, Mojoli F, Mongodi S, Rocca E, Romagnoli S, Sanfilippo F, Vetrugno L, Cammarota G. Head to toe ultrasound: a narrative review of experts’ recommendations of methodological approaches. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:44. [PMCID: PMC9589874 DOI: 10.1186/s44158-022-00072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Critical care ultrasonography (US) is widely used by intensivists managing critically ill patients to accurately and rapidly assess different clinical scenarios, which include pneumothorax, pleural effusion, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis. Basic and advanced critical care ultrasonographic skills are routinely used to supplement physical examination of critically ill patients, to determine the etiology of critical illness and to guide subsequent therapy. European guidelines now recommend the use of US for a number of practical procedures commonly performed in critical care. Full training and competence acquisition are essential before significant therapeutic decisions are made based on the US assessment. However, there are no universally accepted learning pathways and methodological standards for the acquisition of these skills. Therefore, in this review, we aim to provide a methodological approach of the head to toe ultrasonographic evaluation of critically ill patients considering different districts and clinical applications.
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Affiliation(s)
- Antonio Messina
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center – IRCCS, Rozzano (Milano), Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Chiara Robba
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L’Oncologia E Le Neuroscienze, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento Di Scienze Chirurgiche E Diagnostiche Integrate, Università Di Genova, Genoa, Italy
| | - Rita Bertuetti
- grid.412725.7Department of Anesthesiology, Intensive Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Daniele Biasucci
- grid.6530.00000 0001 2300 0941Department of Clinical Science and Translational Medicine, Tor Vergata’ University of Rome, Rome, Italy ,grid.413009.fEmergency Department, Tor Vergata’ University Hospital, Rome, Italy
| | - Francesco Corradi
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Mojoli
- grid.8982.b0000 0004 1762 5736Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Anestesia E Rianimazione I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Mongodi
- grid.419425.f0000 0004 1760 3027Anestesia E Rianimazione I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eduardo Rocca
- grid.16563.370000000121663741Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Stefano Romagnoli
- grid.8404.80000 0004 1757 2304Department of Health Science, University of Florence, Florence, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. “Policlinico-San Marco”, Catania, Italy
| | - Luigi Vetrugno
- grid.412451.70000 0001 2181 4941Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Gianmaria Cammarota
- grid.9027.c0000 0004 1757 3630Dipartimento Di Medicina E Chirurgia, Università Degli Studi Di Perugia, Perugia, Italy
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