151
|
Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:9719751. [PMID: 32185080 PMCID: PMC7060409 DOI: 10.1155/2020/9719751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/06/2020] [Accepted: 02/01/2020] [Indexed: 12/03/2022] Open
Abstract
Objective The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. Methods A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient's intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher's exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy. Results 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was −4 in 14 (66.7%) patients, −3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient ( Conclusion Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of −4 to −2 more likely represents hypovolemia, −1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.
Collapse
|
152
|
Hezzell MJ, Ostroski C, Oyama MA, Harries B, Drobatz KJ, Reineke EL. Investigation of focused cardiac ultrasound in the emergency room for differentiation of respiratory and cardiac causes of respiratory distress in dogs. J Vet Emerg Crit Care (San Antonio) 2020; 30:159-164. [PMID: 32067327 DOI: 10.1111/vec.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/28/2018] [Accepted: 06/03/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether focused cardiac ultrasound (FOCUS) performed by emergency and critical care (ECC) specialists or residents in training improves differentiation of cardiac (C) versus non-cardiac (NC) causes of respiratory distress in dogs compared to medical history and physical examination alone. DESIGN Prospective cohort study (May 2014 to February 2016). SETTING University hospital. ANIMALS Thirty-eight dogs presenting with respiratory distress. INTERVENTIONS FOCUS. MEASUREMENTS AND MAIN RESULTS Medical history, physical examination, and FOCUS were obtained at presentation. Emergency and critical care clinicians, blinded to any radiographic or echocardiographic data, categorized each patient (C vs NC) before and after FOCUS. Thoracic radiography (within 3 h) and echocardiography (within 24 h) were performed. Percent agreement was calculated against a reference diagnosis that relied on agreement of a board-certified cardiologist and ECC specialist with access to all diagnostic test results. Reference diagnosis included 22 dogs with cardiac and 13 dogs with noncardiac causes of respiratory distress. In 3 dogs a reference diagnosis was not established. Prior to FOCUS, positive and negative percent agreement to detect cardiac causes was 90.9% (95% CI, 70.8-98.9) and 53.9% (25.1-80.8), respectively. Overall agreement occurred in 27 of 35 dogs (77.1%). Two C and 6 NC cases were incorrectly categorized. Following FOCUS, positive and negative percent agreement to detect cardiac causes was 95.5% (77.2-99.9) and 69.2% (38.6-90.9), respectively. Overall agreement occurred in 30 of 35 dogs (85.7%). Three dogs with discrepant pre-FOCUS diagnoses were correctly re-categorized post-FOCUS. One C and 4 NC cases remained incorrectly categorized. No correctly categorized dogs were incorrectly re-categorized following FOCUS. The proportions of dogs correctly classified pre- versus post-FOCUS were not significantly different (P = 0.25). CONCLUSIONS FOCUS did not significantly improve differentiation of C vs NC causes of respiratory distress compared to medical history and physical examination alone.
Collapse
Affiliation(s)
- Melanie J Hezzell
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cassandra Ostroski
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark A Oyama
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Harries
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kenneth J Drobatz
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica L Reineke
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
153
|
Kameda T, Kimura A. Basic point-of-care ultrasound framework based on the airway, breathing, and circulation approach for the initial management of shock and dyspnea. Acute Med Surg 2020; 7:e481. [PMID: 31988793 PMCID: PMC6971464 DOI: 10.1002/ams2.481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/06/2023] Open
Abstract
Ultrasound (US) carried out and interpreted by clinicians at the bedside is now called point‐of‐care US (POCUS). Clinical studies on POCUS have been carried out based on the ideas of “creation”, “extraction”, and “combination”. “Creation” refers to findings for the upper airway and lung being obtained at the bedside. “Extraction” refers to findings suitable for POCUS being extracted from comprehensive US, including echocardiography, abdominal US, and whole‐leg US. “Combination” refers to these POCUS applications being combined for the comprehensive assessment of patients with trauma, shock, or dyspnea. Emergency and critical care physicians have many opportunities to encounter trauma or non‐trauma patients with shock, dyspnea, or both. Furthermore, the scope of POCUS includes many diseases and injuries that present with both shock and dyspnea. Therefore, we propose a basic POCUS framework based on the systematic airway, breathing, and circulation approach for the initial management of shock and dyspnea in adult patients. In this article, we update and review each application of POCUS and their combination in this framework. Furthermore, we propose the practical usage of the framework based on clinical presentations to improve the management of shock and dyspnea.
Collapse
Affiliation(s)
- Toru Kameda
- Department of Emergency Medicine Red Cross Society Azumino Hospital Nagano Japan
| | - Akio Kimura
- Department of Emergency and Critical Care Center Hospital of the National Center for Global Health and Medicine Tokyo Japan
| |
Collapse
|
154
|
Victor VRMBBSDMRDRDMS, James ADMDMBA, Samantha FM, Jasmine RHMMAPMP, Dale RCMBACAE. Role of PCA in Offering Certifications and Other Related Services to POCUS Users Worldwide. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
155
|
Lenk T, Whittle J, Miller TE, Williams DGA, Bronshteyn YS. Focused cardiac ultrasound in preoperative assessment: the perioperative provider's new stethoscope? Perioper Med (Lond) 2019; 8:16. [PMID: 31832180 PMCID: PMC6873469 DOI: 10.1186/s13741-019-0129-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
Focused cardiac ultrasound (FoCUS)—a simplified, qualitative version of echocardiography—is a well-established tool in the armamentarium of critical care and emergency medicine. This review explores the extent to which FoCUS could also be used to enhance the preoperative physical examination to better utilise resources and identify those who would benefit most from detailed echocardiography prior to surgery. Among the range of pathologies that FoCUS can screen for, the conditions it provides the most utility in the preoperative setting are left ventricular systolic dysfunction (LVSD) and, in certain circumstances, significant aortic stenosis (AS). Thus, FoCUS could help answer two common preoperative diagnostic questions. First, in a patient with high cardiovascular risk who subjectively reports a good functional status, is there evidence of LVSD? Second, does an asymptomatic patient with a systolic murmur have significant aortic stenosis? Importantly, many cardiac pathologies of relevance to perioperative care fall outside the scope of FoCUS, including regional wall motion abnormalities, diastolic dysfunction, left ventricular outflow obstruction, and pulmonary hypertension. Current evidence suggests that after structured training in FoCUS and performance of 20–30 supervised examinations, clinicians can achieve competence in basic cardiac ultrasound image acquisition. However, it is not known precisely how many training exams are necessary to achieve competence in FoCUS image interpretation. Given the short history of FoCUS use in preoperative evaluation, further research is needed to determine what additional questions FoCUS is suited to answer in the pre-operative setting.
Collapse
Affiliation(s)
- Tara Lenk
- 1Department of Anesthesiology, Mission Hospital, 509 Biltmore Ave, Asheville, NC 28801 USA
| | - John Whittle
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| | - Timothy E Miller
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| | - David G A Williams
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| | - Yuriy S Bronshteyn
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| |
Collapse
|
156
|
Prada G, Fritz AV, Restrepo-Holguín M, Guru PK, Díaz-Gómez JL. Focused Cardiac Ultrasonography for Left Ventricular Systolic Function. N Engl J Med 2019; 381:e36. [PMID: 31747728 DOI: 10.1056/nejmvcm1802841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Gabriel Prada
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - Ashley V Fritz
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - Mariana Restrepo-Holguín
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - Pramod K Guru
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - José L Díaz-Gómez
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| |
Collapse
|
157
|
Not All Pericardiac Fluid Is Pericardial: Ultrasound of Pericardial Effusion and Two of Its Mimics. Anesthesiology 2019; 132:584-585. [PMID: 31743139 DOI: 10.1097/aln.0000000000003047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text.
Collapse
|
158
|
Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J 2019; 39:739-749d. [PMID: 29106452 DOI: 10.1093/eurheartj/ehx319] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/13/2017] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndromes (AAS) encompass a constellation of life-threatening medical conditions including classic acute aortic dissection (AAD), intramural haematoma, and penetrating atherosclerotic aortic ulcer. Given the non-specific symptoms and physical signs, a high clinical index of suspicion is necessary to detect the disease before irreversible lethal complications occur. In order to reduce the diagnostic time delay, a comprehensive flowchart for decision-making based on pre-test sensitivity of AAS has been designed by the European Society of Cardiology guidelines on aortic diseases and should be thus applied in the emergency scenario. When the definitive diagnosis is made, prompt and appropriate therapeutic interventions should be undertaken if indicated by a highly specialized aortic team. Urgent surgery for AAD involving the ascending aorta (Type A) and medical therapy alone for AAD not involving the ascending aorta (Type B) are typically recommended. In complicated Type B AAD, thoracic endovascular aortic repair (TEVAR) is generally indicated. On the other hand, in uncomplicated Type B AAD, pre-emptive TEVAR rather than medical therapy alone to prevent late complications, while intuitive, requires further study in randomized cohorts. Finally, it should be highlighted that there is an urgent need to increase awareness of AAS worldwide, including dedicated education/prevention programmes, and to improve diagnostic and therapeutic strategies, outcomes, and lifelong surveillance.
Collapse
Affiliation(s)
| | - Troy M LaBounty
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, USA
| | - Kim A Eagle
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, USA
| |
Collapse
|
159
|
Upadhrasta S, Raafat MH, Conti RAS. Reliability of focused cardiac ultrasound performed by first-year internal medicine residents at a community hospital after a short training. J Community Hosp Intern Med Perspect 2019; 9:373-376. [PMID: 31723379 PMCID: PMC6830195 DOI: 10.1080/20009666.2019.1659666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022] Open
Abstract
The use of bedside ultrasound over the past few decades has created a new wave of options for visualizing pathological processes allowing for faster and better detection of disease. We aimed to evaluate the reliability of focused cardiac ultrasound (FCU) performed by first-year internal medicine residents at a community hospital after a short period of training. They received a two-hour lecture and initially performed a supervised FCU followed by ten unsupervised/independent FCUs each. The four parameters that were assessed were left systolic ventricular function, right systolic ventricular function, presence of pericardial effusion, and presence of IVC dilation. Interpretation and analysis of ultrasound images were then carried out by both the residents and an attending physician with expertise in FCU analysis and interpretation. Cohen's Kappa values were obtained comparing the results found by the interns versus the attending. Our findings indicate that more training is required for reliable analysis of FCU by first-year medical residents. Our results also emphasize the need to carefully evaluate the medical residents' FCU skills after the training.
Collapse
Affiliation(s)
| | | | - Ricardo A S Conti
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| |
Collapse
|
160
|
Jagła M, Grudzień A, Starzec K, Tomasik T, Zasada M, Kwinta P. Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:518-525. [PMID: 31361036 DOI: 10.1002/jcu.22766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/07/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Lung ultrasound (LUS) at the point-of-care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. METHODS LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X-ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. RESULTS LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5-98.5%), and specificity was 92.6% (95%CI: 74.2-98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0-85.9%) and 81.5% (95%CI: 61.2-92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5-99.1%) and a specificity of 100% (95%CI: 89.9-100%). For CXR, sensitivity was 16.7% (95%CI: 0.01-63.5%) and specificity was 97.7% (95%CI: 86.4-99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI: 0.40-0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI: 0.74-0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. CONCLUSION LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.
Collapse
Affiliation(s)
- Mateusz Jagła
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Grudzień
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Starzec
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tomasik
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Zasada
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Przemko Kwinta
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
161
|
Fluid Removal With Ultrasound Guided Protocol Improves the Efficacy and Safety of Dehydration in Post-Resuscitated Critically Ill Patients: A Quasi-Experimental, Before and After Study. Shock 2019; 50:401-407. [PMID: 29351128 DOI: 10.1097/shk.0000000000001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fluid overload is associated with increased morbidity and mortality in critically ill patients. However, researches rarely study the precise start or end point of fluid removal and no protocol was developed to control the fluid removal process. We hypothesized that individualized fluid removal with ultrasound-guided protocol could improve the efficacy and safety of fluid removal in post-resuscitated critically ill patients. A quasi-experimental, before and after trial was conducted to identify the benefits of ultrasound-guided fluid removal. Fluid removal was performed either following the doctor's experience in Control group, or abiding the ultrasound guided protocol in Ultrasound group. The study end points were the start time, end time, length of fluid removal, and the complications related to fluid removal. A total of 85 subjects were finally analyzed in this study. The fluid removal was started earlier, completed quicker and ended earlier (21.0 ± 14.6 h vs. 35.1 ± 26.5 h, 49.8 ± 32.6 vs. 93.0 ± 42.8 h, 69.0 ± 32.2 h vs. 126.4 ± 52.5 h, P < 0.05) in Ultrasound group than in Control. The subjects had more daily negative fluid balance and urine output (-990.4 ± 636.1 mL vs. -723.6 ± 549.5 mL, 2425.8 ± 886.7 mL vs. 1560.7 ± 1125.3 mL, P < 0.05) in Ultrasound group. The time of lung B-lines to reduce to zero was shorter and B-line at the end point was less (49.5 ± 36.6 h vs. 75.6 ± 58.8 h, 0[1] vs. 0[0], P < 0.05) in Ultrasound group. The length of intensive care unit stay in shock subgroup had a tendency to shorten (96.1 ± 61.5 h vs. 174.6 ± 132.0 h, P > 0.05) in Ultrasound group. We concluded that fluid removal with individualized ultrasound-guided protocol improves the efficacy and safety of dehydration in critically ill patients.
Collapse
|
162
|
Spies C, Metze M, Stöbe S, Hagendorff A. [Echocardiographic emergency diagnostics]. Herz 2019; 44:267-286. [PMID: 31020335 DOI: 10.1007/s00059-019-4799-2] [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: 11/28/2022]
Abstract
Echocardiography is a non-invasive, versatile imaging modality for the diagnostics and monitoring of life-threatening cardiac diseases. This article summarizes the currently valid recommendations on emergency echocardiography of the German Cardiac Society and the European Association of Cardiovascular Imaging and provides practical guidance for their implementation in emergency medicine. Echocardiography is especially important for the diagnostics of acute coronary syndrome and its potential complications, of pulmonary embolism and endocarditis as well as the differential diagnosis of patients in shock and in emergencies. A domain of increasing importance in echocardiography is the treatment monitoring of patients supported by modern cardiac assist devices.
Collapse
Affiliation(s)
- C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| |
Collapse
|
163
|
Haimovich AD, Lehmann Z, Taylor RA. US-Pro: An Application Enabling Efficient, High-Throughput Ultrasound Video Processing. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2761-2767. [PMID: 30714642 DOI: 10.1002/jum.14951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/30/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
We describe a new graphical user interface-based application, US-Pro, designed to enable customized, high-throughput ultrasound video anonymization and dynamic cropping before output to video or high-efficiency disk storage. This application is distributed in a Docker container environment, which supports facile software installation on the most commonly used operating systems, as well as local processing of data sets, precluding the external transfer of electronic protected health information. The US-Pro application will facilitate the reproducible production of large-scale ultrasound video data sets for varied applications, including machine-learning analysis, educational distribution, and quality assurance review.
Collapse
Affiliation(s)
- Adrian D Haimovich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zachary Lehmann
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
164
|
Boretsky KR, Kantor DB, DiNardo JA, Oren-Grinberg A. Focused Cardiac Ultrasound in the Pediatric Perioperative Setting. Anesth Analg 2019; 129:925-932. [DOI: 10.1213/ane.0000000000004357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
165
|
Gutiérrez Rodríguez J, Solla Suárez PE, López Álvarez EM, Solano Jaurrieta JJ. [The elderly patient with heart failure: usefulness of cardiac ultrasound in routine clinical practice]. Rev Esp Geriatr Gerontol 2019; 54:356-357. [PMID: 31493934 DOI: 10.1016/j.regg.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/31/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
|
166
|
Elfwén L, Hildebrand K, Schierbeck S, Sundqvist M, Ringh M, Claesson A, Olsson J, Nordberg P. Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients. Resuscitation 2019; 142:16-22. [DOI: 10.1016/j.resuscitation.2019.06.282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
|
167
|
Point-of-care ultrasound: Is it time to include it in the paediatric specialist training programme? An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
168
|
Hopkins A, Doniger SJ. Point-of-Care Ultrasound for the Pediatric Hospitalist's Practice. Hosp Pediatr 2019; 9:707-718. [PMID: 31405888 DOI: 10.1542/hpeds.2018-0118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.
Collapse
Affiliation(s)
- Akshata Hopkins
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
| | | |
Collapse
|
169
|
Lembrikov I, Rudis E, Weiniger CF. Postpartum Cardiogenic Shock Diagnosed by Focused Cardiac Ultrasound and Treated With Venoarterial Extracorporeal Membrane Oxygenation: A Case Report. A A Pract 2019; 12:277-280. [PMID: 30312178 DOI: 10.1213/xaa.0000000000000909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the case of a primigravid patient, who developed cardiogenic shock during the early postpartum period in the setting of retained placenta, uterine atony, and hemorrhage. Focused cardiac ultrasound played a central role in identifying the cause of hemodynamic instability. The decision to initiate venoarterial extracorporeal membrane oxygenation was instrumental in the successful outcome for our patient, characterized by a full recovery without major neurological and cardiovascular sequelae.
Collapse
Affiliation(s)
- Ilya Lembrikov
- From the Departments of Anesthesiology and Critical Care Medicine
| | - Ehud Rudis
- Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Carolyn F Weiniger
- From the Departments of Anesthesiology and Critical Care Medicine.,Division of Anesthesiology & Critical Care & Pain, Tel Aviv Medical Center, Tel Aviv, Israel
| |
Collapse
|
170
|
Mayordomo-Colunga J, González-Cortés R, Bravo MC, Martínez-Mas R, Vázquez-Martínez JL, Renter-Valdovinos L, Conlon TW, Nishisaki A, Cabañas F, Bilbao-Sustacha JÁ, Oulego-Erroz I. [Point-of-care ultrasound: Is it time to include it in the paediatric specialist training program?]. An Pediatr (Barc) 2019; 91:206.e1-206.e13. [PMID: 31395389 DOI: 10.1016/j.anpedi.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022] Open
Abstract
Point-of-care ultrasound (POCUS) has become an essential tool for clinical practice in recent years. It should be considered as an extension of the standard physical examination, which complements and enriches it without substituting it. POCUS enables the physician to answer specific clinical questions about the diagnosis, to understand better the pathophysiological context, to orientate the treatment, and to perform invasive procedures more safely. Despite its current use in many centres, and in most paediatric sub-specialties, there are currently no specific recommendations addressing educational aims in the different training areas, as well as methodology practice and the certification process in paediatrics. These ingredients are essential for POCUS implementation in daily practice, with a quality guarantee in terms of efficiency and safety. Several POCUS experts in different paediatric medicine environments performed a non-systematic review addressing the main paediatric POCUS applications in paediatrics. The lack of educational programs in POCUS in Spain is also discussed, and the experience in the United States of America in this topic is provided. Considering the current situation of POCUS in paediatrics, we strongly believe that it is urgent to establish evidence-based recommendations for POCUS training that should be the base to develop educational programs and to include POCUS in the paediatric residency training.
Collapse
Affiliation(s)
- Juan Mayordomo-Colunga
- Sección de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Rafael González-Cortés
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Red de Salud Materno Infantil y del Desarrollo. RETICS financiada por el ISCIII (Ref. 16/0022), Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - María Carmen Bravo
- Departamento de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - Roser Martínez-Mas
- Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Barakaldo, Vizcaya, España; Grupo de Trabajo de Ecografía a Pie de Cama de la Sociedad Española de Urgencias Pediátricas (SEUP), España
| | - José Luis Vázquez-Martínez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Ramón y Cajal, Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - Luis Renter-Valdovinos
- Unidad de Cuidados Intensivos Pediátricos, Servicio de Medicina Pediátrica, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, España; Unidad de Transporte Pediátrico, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Base SEM-Pediátrico BP61, Sistema de Emergencias Médicas de Catalunya (SEM), Barcelona, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Filadelfia, Pensilvania, Estados Unidos
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Filadelfia, Pensilvania, Estados Unidos
| | - Fernando Cabañas
- Departamento de Pediatría y Neonatología, Hospital Universitario Quironsalud, Madrid, España; Fundación de Investigación Biomédica, Hospital Universitario La Paz, Madrid, España
| | - José Ángel Bilbao-Sustacha
- Área Básica de Salud de Riudoms, Riudoms, Tarragona, España; Grupo de Trabajo de Ecografía Clínica de la Asociación Española de Pediatría de Atención Primaria (AEPAP), España
| | - Ignacio Oulego-Erroz
- Cardiología Infantil, Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España; IBIOMED, Instituto de Biomedicina de León, León, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España.
| |
Collapse
|
171
|
Curriculum for Fundamentals of Ultrasound in Clinical Practice. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1937-1950. [PMID: 31318483 DOI: 10.1002/jum.15090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
172
|
Adler AC, Brown KA, Conlin FT, Thammasitboon S, Chandrakantan A. Cardiac and lung point-of-care ultrasound in pediatric anesthesia and critical care medicine: Uses, pitfalls, and future directions to optimize pediatric care. Paediatr Anaesth 2019; 29:790-798. [PMID: 31211472 DOI: 10.1111/pan.13684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 12/20/2022]
Abstract
Point-of-care ultrasound (POCUS) has found many relevant applications in pediatric anesthesia and critical care medicine. Specifically, the cardiac and pulmonary POCUS examinations provide a wealth of information from physical examination assistance to diagnostic evaluation and assessment of treatment response. However, as with any adjunct, potentially dangerous pitfalls exist when POCUS is performed, interpreted, and applied by the novice sonographer. Using case illustrations, we highlight the clinical application of POCUS in addition to potential dangers. Additionally, suggestions for learning POCUS, assessing competency and credentialing are reviewed.
Collapse
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas.,Section of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Kyle A Brown
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Frederick T Conlin
- Department of Anesthesiology and Pain Medicine, Baystate Medical Center, Springfield, Massachusetts.,University of Massachusetts School of Medicine, Worcester, Massachusetts
| | - Satid Thammasitboon
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas.,Section of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
173
|
Using point-of-care ultrasound: Shock. JAAPA 2019; 32:43-48. [PMID: 31348101 DOI: 10.1097/01.jaa.0000569796.06694.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
174
|
Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, Edvardsen T, Galderisi M, Sicari R, Donal E, Stefanidis A, Delgado V, Zamorano J, Popescu BA. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
Collapse
Affiliation(s)
- Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal.,Faculdade Ciências Médicas da Universidade nova de Lisboa, Campo Mártires da Pátria 130, Lisbon, Portugal
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Alexsandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, VIa S. Pansini 5, Napples, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, Pisa, Italy
| | - Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jose Zamorano
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9, 100, Madrid, Spain.,CIBERV, Madrid, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Institute of cardiovascular diseases "Prof. Dr. C C Iliescu, Bucharest, Romania
| |
Collapse
|
175
|
Evaluation of the efficacy of a self-training programme in focus cardiac ultrasound with simulator. Arch Cardiovasc Dis 2019; 112:576-584. [PMID: 31350012 DOI: 10.1016/j.acvd.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Focus cardiac ultrasound is a great tool for quick evaluation of cardiac function in acute settings with limited time and expertise in echocardiography. Adequate training is essential for physicians willing to use this imaging technique. AIM The goal of this study was to assess the efficacy of a self-training programme using a cardiac ultrasound simulator. METHODS Thirty-five trainees in cardiology, emergency medicine or anaesthesiology entered the programme, which started with an e-learning lecture on focus cardiac ultrasound, with practice on a simulator, followed by implementation on patients, and ended with self-training in image analysis on an online platform. A post-test evaluation was carried out at the end of the theoretical training, followed by a final live evaluation on patients (timed acquisition of the five reference views used in focus cardiac ultrasound, grading each view on a scale of 1 to 5). Trainees were also evaluated online regarding their interpretation of 20 video clips. RESULTS The median (interquartile range) interpretability scores following simulator training were 5 (4-5) for the parasternal long-axis view, 5 (4-5) for the apical four-chamber view, and 4 (4-5) for the subcostal window. Interpretability was significantly inferior in the live evaluation compared with the post-test evaluation, except for the parasternal long-axis and subcostal views. The mean score for the video clips (out of 20) was 14.5±2.4. CONCLUSIONS After a short self-training programme, trainees were able to acquire the main views of focus cardiac ultrasound with sufficient quality and in a short time period.
Collapse
|
176
|
Loughran KA, Rush JE, Rozanski EA, Oyama MA, Larouche-Lebel É, Kraus MS. The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats. J Vet Intern Med 2019; 33:1892-1901. [PMID: 31317580 PMCID: PMC6766524 DOI: 10.1111/jvim.15549] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Focused cardiac ultrasound (FCU) helps detect occult heart disease in human patients. Hypothesis Focused cardiac ultrasound by a nonspecialist practitioner (NSP) will increase the detection of occult heart disease in asymptomatic cats compared with physical examination and ECG. Animals Three hundred forty‐three client‐owned cats: 54 excluded and 289 analyzed. Methods Multicenter prospective cohort study. Twenty‐two NSPs were trained to perform FCU. Cats without clinical signs of heart disease were recruited, and NSPs performed the following in sequential order: physical examination, ECG, FCU, and point‐of‐care N‐terminal pro‐B‐type natriuretic peptide assay (POC‐BNP). After each step, NSPs indicated yes, no, or equivocal as to whether they believed heart disease was present. The level of agreement between the NSP diagnosis and a blinded cardiologist's diagnosis after echocardiogram was evaluated using Cohen's kappa test. Results Cardiologist diagnoses included 148 normal cats, 102 with heart disease, and 39 equivocal ones. Agreement between NSP and cardiologist was slight after physical examination (kappa 0.253 [95% CI, 0.172‐0.340]), did not increase after ECG (0.256 [0.161‐0.345]; P = .96), increased after FCU (0.468 [0.376‐0.558]; P = .002), and the level of agreement was similar after POC‐BNP (0.498 [0.419‐0.580]; P = .67). In cats with mild, moderate, and marked occult heart disease, the proportion of cats having a NSP diagnosis of heart disease after FCU was 45.6%, 93.1%, and 100%, respectively. Conclusions and Clinical Importance Focused cardiac ultrasound performed by NSPs increased the detection of occult heart disease, especially in cats with moderate to marked disease. Focused cardiac ultrasound appears to be a feasible and useful tool to assist NSPs in the detection of heart disease in cats.
Collapse
Affiliation(s)
- Kerry A Loughran
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts.,Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc S Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
177
|
Kingwill A, Barker G, Wong A. Point-of-care ultrasound: its growing application in hospital medicine. Br J Hosp Med (Lond) 2019; 78:492-496. [PMID: 28898139 DOI: 10.12968/hmed.2017.78.9.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Point-of-care ultrasound is emerging as an important adjunct to the clinical examination. Ultrasonography has long been seen as a modality for experts but this is changing and it is hoped that, with appropriate training, point-of-care ultrasound will become a modern-day diagnostic necessity.
Collapse
Affiliation(s)
- Aidan Kingwill
- Senior Clinical Fellow in Adult Intensive Care, Oxford Critical Care Ultrasound Learning and Research, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX2 9DU
| | - Graham Barker
- Consultant Intensivist and Anaesthetist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Adrian Wong
- Consultant Intensivist and Anaesthetist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| |
Collapse
|
178
|
Bessmann EL, Østergaard HT, Nielsen BU, Russell L, Paltved C, Østergaard D, Konge L, Nayahangan LJ. Consensus on technical procedures for simulation-based training in anaesthesiology: A Delphi-based general needs assessment. Acta Anaesthesiol Scand 2019; 63:720-729. [PMID: 30874309 DOI: 10.1111/aas.13344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/21/2018] [Accepted: 01/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anaesthesiologists are expected to master an increasing number of technical procedures. Simulation-based procedural training can supplement and, in some areas, replace the classical apprenticeship approach during patient care. However, simulation-based training is very resource-intensive and must be prioritised and optimised. Developing a curriculum for simulation-based procedural training should follow a systematic approach, eg the Six-Step Approach developed by Kern. The aim of this study was to conduct a national general needs assessment to identify and prioritise technical procedures for simulation-based training in anaesthesiology. METHODS A three-round Delphi process was completed with anaesthesiology key opinion leaders. In the first round, the participants suggested technical procedures relevant to simulation-based training. In the second round, a needs assessment formula was used to explore the procedures and produce a preliminary prioritised list. In the third round, participants evaluated the preliminary list by eliminating and re-prioritising the procedures. RESULTS All teaching departments in Denmark were represented with high response rates in all three rounds: 79%, 77%, and 75%, respectively. The Delphi process produced a prioritised list of 30 procedure groups suitable for simulation-based training from the initial 138 suggestions. Top-5 on the final list was cardiopulmonary resuscitation, direct- and video laryngoscopy, defibrillation, emergency cricothyrotomy, and fibreoptic intubation. The needs assessment formula predicted the final prioritisation to a great extent. CONCLUSION The Delphi process produced a prioritised list of 30 procedure groups that could serve as a guide in future curriculum development for the simulation-based training of technical procedures in anaesthesiology.
Collapse
Affiliation(s)
- Ebbe L. Bessmann
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Helle T. Østergaard
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia Herlev Hospital Herlev Denmark
| | - Bjørn U. Nielsen
- TechSim ‐ The Technical Simulation Centre of Southern Denmark Odense University Hospital Odense Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Department of Anaesthesia Zealand University Hospital Roskilde Denmark
- Department of Intensive Care 4131 Copenhagen University Hospital / Rigshospitalet Copenhagen Denmark
| | - Charlotte Paltved
- MidtSim ‐ Centre for Human Resources, Central Region of Denmark Aarhus University Aarhus Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | | |
Collapse
|
179
|
Spencer KT, Flachskampf FA. Focused Cardiac Ultrasonography. JACC Cardiovasc Imaging 2019; 12:1243-1253. [DOI: 10.1016/j.jcmg.2018.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022]
|
180
|
A practical approach to critical care ultrasound. J Crit Care 2019; 51:156-164. [DOI: 10.1016/j.jcrc.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
|
181
|
Riishede M, Laursen CB, Teglbjærg LS, Rancinger E, Pedersen PB, Luef SM, Clausen JH, Graumann O, Lassen AT, Baatrup G. Diagnostic value of whole-body-focused ultrasonography in high-acuity patients in the emergency department: a prospective single-center cross-sectional study. Ultrasound J 2019; 11:11. [PMID: 31359192 PMCID: PMC6638611 DOI: 10.1186/s13089-019-0126-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A fast and diagnostic accurate tool to assess the unselected category of high-acuity patients, in whom the underlying pathology is not always obvious, is needed in the emergency departments (ED). We aim to describe the feasibility, validity and diagnostic yield of a routine whole-body-focused ultrasonography (wbf-us) in an unselected group of high-acuity ED patients. METHODS In a prospective observational study, a convenience sample of ED patients (≥ 18 years) with a high-acuity score or systolic blood pressure < 100 mmHg received a routine wbf-us of the heart, lungs, abdomen and deep veins by two non-expert sonographers. Final diagnosis was established by experienced auditors. Investigators were blinded to the patients' medical history and emergency physicians and auditors were blinded to the investigators assessments. Diagnostic accuracy was assessed by comparing the investigators' ultrasonography findings to a structured double-blinded clinical audit of patient files. RESULTS We included 171 patients, initiated a whole-body-focused ultrasonography examination (wbf-us) in 160 and completed it in 128 patients with an average time of a full examination of 28 min. We found pathology in 65/171 (38%) of the patients whose most frequent symptoms upon arrival were cardiopulmonary. Among the patients who received wbf-us, we found the majority of pathology by wbf-us of the lungs (n = 50, 31%), the heart (n = 26, 16%), few in the abdomen (n = 5, 3%) and none in the deep veins. The overall sensitivity was 50-100%, specificity 84-94%, positive predictive value 11-44% and negative predictive value 94-100%. CONCLUSION Focused cardiopulmonary ultrasonography might be considered for routine use in high-acuity ED patients with cardiopulmonary symptoms whereas focused ultrasonography of the abdomen and deep veins performed by non-expert sonographers only seems indicated in selected patients. Trial registration Danish Data Protection Agency (ID 13/12076). Committee on Biomedical Research Ethics for the Region of Southern Denmark (ID S-20130047).
Collapse
Affiliation(s)
- M Riishede
- The Research Section, Department of Surgery (A), Odense University Hospital, Baagoes Allé 15, 5700, Svendborg, Denmark. .,Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark. .,Department of Internal Medicine & Emergency Medicine (M/FAM), Odense University Hospital, Svendborg, Denmark.
| | - C B Laursen
- Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - L S Teglbjærg
- Department of Internal Medicine & Emergency Medicine (M/FAM), Odense University Hospital, Svendborg, Denmark
| | - E Rancinger
- The Research Section, Department of Surgery (A), Odense University Hospital, Baagoes Allé 15, 5700, Svendborg, Denmark
| | - P B Pedersen
- Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark.,Department of Internal Medicine & Emergency Medicine (M/FAM), Odense University Hospital, Svendborg, Denmark
| | - S M Luef
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - J H Clausen
- Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark
| | - O Graumann
- Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - A T Lassen
- Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark.,Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - G Baatrup
- The Research Section, Department of Surgery (A), Odense University Hospital, Baagoes Allé 15, 5700, Svendborg, Denmark.,Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark
| |
Collapse
|
182
|
Tarrazo Suárez JA, Morales Cano JM, Pujol Salud J, Sánchez Barrancos IM, Diaz Sánchez S, Conangla Ferrín L. [Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. Aten Primaria 2019; 51:367-379. [PMID: 31101376 PMCID: PMC6836943 DOI: 10.1016/j.aprim.2019.03.004] [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: 02/16/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
La ecografía clínica es una herramienta que complementa a la anamnesis y a la exploración física, lo que facilita y agiliza la toma de decisiones en cualquier entorno de atención médica El médico de familia es el especialista que más se puede beneficiar del empleo de la ecografía porque debe ser competente en todos los terrenos de la enfermedad El estudio mediante ecografía, por su fiabilidad, seguridad, reproducibilidad y bajo coste debe estar accesible para su empleo en atención primaria, tanto en el ámbito de la atención normal como la urgente Esta técnica, aplicada en escenarios concretos y con una sistemática de estudio definida, confirma o descarta enfermedades, lo que orienta el diagnóstico con elevada fiabilidad, así como sustenta de modo eficaz la conducta del profesional Este artículo revisa la fiabilidad y la utilidad de la ecografía clínica en escenarios como la enfermedad cervical, y en diferentes situaciones de urgencia, como sospecha de trombosis venosa profunda en la extremidad inferior, traumatismo toracoabdominal, inestabilidad hemodinámica o parada cardiaca
La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca.
Collapse
Affiliation(s)
- José Antonio Tarrazo Suárez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Siero-Sariego, Servicio Asturiano de Salud, Pola de Siero, Asturias, España
| | - José Manuel Morales Cano
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Ciudad Real 2, Servicio de Salud de Castilla-La Mancha, Ciudad Real, España
| | - Jesús Pujol Salud
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Balaguer, Instituto Catalán de Salud, Balaguer, Lleida, España
| | - Ignacio Manuel Sánchez Barrancos
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio de Membrilla, Centro de Salud Manzanares 2, Servicio de Salud de Castilla-La Mancha, Membrilla, Ciudad Real, España.
| | - Santiago Diaz Sánchez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Pintores de Parla, Servicio Madrileño de Salud, Parla, Madrid. España
| | - Laura Conangla Ferrín
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Badalona-2, Centre Dalt la Vila, Instituto Catalán de Salud, Badalona, Barcelona, España
| |
Collapse
|
183
|
Adler AC, Chandrakantan A, Conlin FT. Perioperative point of care ultrasound in pediatric anesthesiology: a case series highlighting real-time intraoperative diagnosis and alteration of management augmenting physical examination. J Anesth 2019; 33:435-440. [PMID: 31076947 DOI: 10.1007/s00540-019-02654-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/02/2019] [Indexed: 01/06/2023]
Abstract
Use of diagnostic point of care ultrasound, has come to the forefront of interest within anesthesiology. Much data on the use of point of care ultrasound in emergency medicine and critical care medicine for diagnosis and treatment in acute situations exists. While use of point of care ultrasound has become more prevalent in anesthesia practice, documentation of its use and especially alteration in management based on real-time ultrasound findings in the perioperative period remains scarce. This case series discusses six pediatric patients in which real-time intra-operative use of point of care ultrasound resulted in alteration of management.
Collapse
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | - Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Frederick T Conlin
- Department of Anesthesiology, Baystate Medical Center, University of Massachusetts, Springfield, MA, USA
| |
Collapse
|
184
|
Riley AF, Ocampo EC, Hagan J, Lantin-Hermoso MR. Hand-held echocardiography in children with hypoplastic left heart syndrome. CONGENIT HEART DIS 2019; 14:706-712. [PMID: 30973683 DOI: 10.1111/chd.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/26/2019] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND When performed by cardiologists, hand-held echocardiography (HHE) can assess ventricular systolic function and valve disease in adults, but its accuracy and utility in congenital heart disease is unknown. In hypoplastic left heart syndrome (HLHS), the echocardiographic detection of depressed right ventricular (RV) systolic function and higher grade tricuspid regurgitation (TR) can identify patients who are at increased risk of morbidity and mortality and who may benefit from additional imaging or medical therapies. METHODS Children with HLHS after Stage I or II surgical palliation (Norwood or Glenn procedures) were prospectively enrolled. Subjects underwent HHE by a pediatric cardiologist on the same day as standard echocardiography (SE). Using 4-point scales, bedside HHE assessment of RV systolic function and TR were compared with blinded assessment of offline SE images. Concordance correlation coefficient (CCC) was used to evaluate agreement. RESULTS Thirty-two HHEs were performed on 15 subjects (Stage I: n = 17 and Stage II: n = 15). Median subject age was 3.4 months (14 days-4.2 years). Median weight was 5.9 kg (2.6-15.4 kg). Bedside HHE assessment of RV systolic function and TR severity had substantial agreement with SE (CCC = 0.80, CCC = 0.74, respectively; P < .001). HHE sensitivity and specificity for any grade of depressed RV systolic function were 100% and 92%, respectively, and were 94% and 88% for moderate or greater TR, respectively. Average HHE scan time was 238 seconds. CONCLUSIONS HHE offers a rapid, bedside tool for pediatric cardiologists to detect RV systolic dysfunction and hemodynamically significant TR in HLHS.
Collapse
Affiliation(s)
- Alan F Riley
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Elena C Ocampo
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Joseph Hagan
- Newborn Center, Texas Children's Hospital, Houston, Texas
| | - M Regina Lantin-Hermoso
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
185
|
Barron KR, Wagner MS, Hunt PS, Rao VV, Bell FE, Abdel-Ghani S, Schrift D, Norton D, Bornemann PH, Haddad R, Hoppmann RA. A Primary Care Ultrasound Fellowship: Training for Clinical Practice and Future Educators. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1061-1068. [PMID: 30182369 DOI: 10.1002/jum.14772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As ultrasound devices become smaller, more portable, and more user friendly, there is now widespread use of this technology by physicians of all specialties, yet there are currently few structured opportunities for ultrasound education outside of emergency and critical care medicine. Anticipating the rising educational demand in the primary care specialties, the University of South Carolina School of Medicine created a primary care ultrasound fellowship in 2011, the first yearlong training program in point-of-care ultrasonography for graduates of internal medicine, medicine-pediatrics, pediatrics, and family medicine residencies. This paper reviews the history of point-of-care ultrasonography fellowships and then provides an overview of the primary care ultrasound fellowship.
Collapse
Affiliation(s)
- Keith R Barron
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Michael S Wagner
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Patrick S Hunt
- Department of Emergency Medicine, Palmetto Health Richland, Columbia, South Carolina
| | - Victor V Rao
- Ultrasound Institute, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Floyd E Bell
- Department of Radiology, University of South Carolina School of Medicine, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Saaid Abdel-Ghani
- Department of Hospital Medicine, Medical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - David Schrift
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Duncan Norton
- Department of Pediatrics, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Paul H Bornemann
- Department of Family Medicine, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Robert Haddad
- Ultrasound Institute, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Richard A Hoppmann
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
- Ultrasound Institute, Palmetto Health-USC Medical Group, Columbia, South Carolina
| |
Collapse
|
186
|
Luong CL, Ong K, Kaila K, Pellikka PA, Gin K, Tsang TSM. Focused Cardiac Ultrasonography: Current Applications and Future Directions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:865-876. [PMID: 30146784 DOI: 10.1002/jum.14773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.
Collapse
Affiliation(s)
- Christina L Luong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendeep Kaila
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth Gin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
187
|
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]
|
188
|
Diaz Sánchez S, Conangla Ferrín L, Sánchez Barrancos IM, Pujol Salud J, Tarrazo Suárez JA, Morales Cano JM. [Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound]. Aten Primaria 2019; 51:172-183. [PMID: 30685205 PMCID: PMC6837151 DOI: 10.1016/j.aprim.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/22/2018] [Indexed: 12/23/2022] Open
Abstract
The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound.
Collapse
Affiliation(s)
- Santiago Diaz Sánchez
- Especialista en Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria, España; Centro de Salud Los Pintores, Servicio Madrileño de Salud, Parla, Madrid, España
| | - Laura Conangla Ferrín
- Especialista en Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria, España; Centro de Atención Primaria Badalona2, Centre Dalt la Vila, Instituto Catalán de la Salud, Badalona, Barcelona, España
| | - Ignacio Manuel Sánchez Barrancos
- Especialista en Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria, España; Consultorio de Membrilla, Centro de Salud Manzanares 2, Servicio de Salud de Castilla-La Mancha, Membrilla, Ciudad Real, España.
| | - Jesús Pujol Salud
- Especialista en Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria, España; Centro de Atención Primaria Balaguer, Instituto Catalán de la Salud, Balaguer, Lleida, España
| | - José Antonio Tarrazo Suárez
- Especialista en Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria, España; Centro de Salud Siero-Sariego, Servicio Asturiano de Salud, Pola de Siero, Asturias, España
| | - José Manuel Morales Cano
- Especialista en Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria, España; Centro de Salud Ciudad Real 2, Servicio de Salud de Castilla-La Mancha, Ciudad Real, España
| |
Collapse
|
189
|
Camarda JA, Patel A, Carr MR, Young LT. Practice Variations in Pediatric Echocardiography Laboratories. Pediatr Cardiol 2019; 40:537-545. [PMID: 30353314 DOI: 10.1007/s00246-018-2012-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/11/2018] [Indexed: 11/25/2022]
Abstract
Quantification guidelines for pediatric echocardiograms were published in 2010 establishing consensus regarding standard measurements. However, a standard protocol for performance and analysis of pediatric echocardiograms was not defined. This study aims to identify practice variations among pediatric laboratories. A survey was sent to 85 North American pediatric laboratory directors. The survey included 29 questions assessing: demographics, methods of image acquisition, parameters routinely evaluated and reported, and methods used to assess chamber sizes, valves, and ventricular function. There were 47/85 (55%) responses; 83% were academic centers and 77% in an urban setting. Wide variations exist in acquisition method (clips versus sweeps) and color scale settings. The most commonly used methods for left ventricular (LV) function are M-mode shortening fraction, qualitative assessment, and Doppler Tissue Imaging. The most commonly used parameter for right ventricular function is qualitative. LV mass is routinely measured by the majority of centers with variations in methods of calculation. Conversely, while a minority measure left atrial volume, there is consensus regarding the preferred method. While multiple techniques exist for assessing valves, qualitative assessment is reported to be the preferred method. Despite quantification guidelines, there is a lack of uniformity in performance and analysis of pediatric echocardiograms. Further studies are needed to determine why variations exist and whether development of consensus guidelines might improve interpretation, consistency and quality of reports, patient care, and provide a standardized system allowing for comparative research among centers.
Collapse
Affiliation(s)
- Joseph A Camarda
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA.
| | - Angira Patel
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA
| | - Michael R Carr
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA
| | - Luciana T Young
- Division of Cardiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| |
Collapse
|
190
|
Henry J, Haji D. Expanding our FoCUS: the utility of advanced echocardiography in the emergency department. Australas J Ultrasound Med 2019; 22:6-11. [PMID: 34760530 DOI: 10.1002/ajum.12130] [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: 12/23/2022] Open
Abstract
Point-of-care ultrasound (POCUS) use is widespread amongst emergency physicians (EPs). Many sonographic modalities have proven useful in the emergency department (ED), including basic echocardiography. Progressing to more advanced echocardiography allows for improved accuracy when making time-critical diagnoses and management decisions, particularly among the sickest patients. Acquisition of this skill set by EPs is feasible and enhances patient care.
Collapse
Affiliation(s)
- Jonathan Henry
- Middlemore Hospital 100 Hospital Rd Otahuhu Auckland 2025 New Zealand
| | - Darsim Haji
- Peninsula Health 2 Hastings Rd Frankston Victoria 3199 Australia
| |
Collapse
|
191
|
Neskovic AN, Skinner H, Price S, Via G, De Hert S, Stankovic I, Galderisi M, Donal E, Muraru D, Sloth E, Gargani L, Cardim N, Stefanidis A, Cameli M, Habib G, Cosyns B, Lancellotti P, Edvardsen T, Popescu BA. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2019. [PMID: 29529170 DOI: 10.1093/ehjci/jey006] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There is a growing trend of using ultrasound examination of the heart as a first-line diagnostic tool for initial patient evaluation in acute settings. Focus cardiac ultrasound (FoCUS) is a standardized but restricted cardiac ultrasound examination that may be undertaken by a range of medical professionals with diverse backgrounds. The intention of this core curriculum and syllabus is to define a unifying framework for educational and training processes/programmes that should result in competence in FoCUS for various medical professionals dealing with diagnostics and treatment of cardiovascular emergencies. The European Association of Cardiovascular Imaging prepared this document in close cooperation with representatives of the European Society of Anaesthesiology, the European Association of Cardiothoracic Anaesthesiology, the Acute Cardiovascular Care Association of the European Society of Cardiology and the World Interactive Network Focused On Critical Ultrasound. It aims to provide the key principles and represents a guide for teaching and training of FoCUS. We offer this document to the emergency and critical care community as a reference outline for teaching materials and courses related to FoCUS, for promoting teamwork and encouraging the development of the field.
Collapse
Affiliation(s)
- Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, 11080 Belgrade, Faculty of Medicine, University of Belgrade, Serbia
| | - Henry Skinner
- Department of Anaesthesiology, Nottingham University Hospitals, Hucknall Rd, Nottingham NG5 1PB, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - Gabriele Via
- Department of Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Stefan De Hert
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, 11080 Belgrade, Faculty of Medicine, University of Belgrade, Serbia
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, 80131 Napoli, Italy
| | - Erwan Donal
- Department of Cardiology, University Hospital of Rennes, rue H Le Guillou - Hôpital Pontchaillou, 35000 Rennes, France
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Erik Sloth
- Department of Anaesthesiology and Intensive Care Medicine, Operation and Intensive Care East Section, Aarhus University Hospital, Skejby, 99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Luna Gargani
- Institute of Clinical Physiology - National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100 - 1500-650 Lisbon, Portugal
| | | | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico Le Scotte, 53100 Siena, Italy
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Boulevard Jean Moulin, 13005 Marseille, France.,Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Boulevard Jean Moulin, 13005, Marseille, France
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten (CHVZ), Unversitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman - B.35?-?4000 Liège, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognvannsveien 20, NO-0027 Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila' - Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | | |
Collapse
|
192
|
Salinas PD, Gifford A. A Man in His 60s With Shortness of Breath, Shock, and Cardiac Arrest. Chest 2019; 151:e103-e105. [PMID: 28483132 DOI: 10.1016/j.chest.2016.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/27/2016] [Accepted: 11/30/2016] [Indexed: 10/19/2022] Open
Affiliation(s)
- Pedro D Salinas
- Department of Inpatient Medicine, Intensive Care Unit, Kadlec Regional Medical Center, Richland, WA.
| | - Alex Gifford
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Lebanon, NH
| |
Collapse
|
193
|
Abstract
Supplemental Digital Content is available in the text. Objective The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. Background Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally. Methods and results A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications. Conclusion The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.
Collapse
|
194
|
Morgan R, Murdock R, Leng P. A Man in His 50s Presenting With Rapid-Onset Dyspnea and Obstructive Shock. Chest 2018; 154:e153-e156. [PMID: 30526980 DOI: 10.1016/j.chest.2018.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Robert Morgan
- Legacy Good Samaritan Medical Center, Graduate Medical Education - Internal Medicine, Portland, OR.
| | - Robert Murdock
- Legacy Good Samaritan Medical Center, Graduate Medical Education - Internal Medicine, Portland, OR
| | - Poh Leng
- Legacy Good Samaritan Medical Center, Graduate Medical Education - Internal Medicine, Portland, OR
| |
Collapse
|
195
|
Ding X, Liu DW, Cao YG, Zhang HM, Chen H, Zhao H, Wang XT. Ten Things to be Considered in Practicing Critical Care Echocardiography. Chin Med J (Engl) 2018; 131:1738-1743. [PMID: 29998895 PMCID: PMC6048937 DOI: 10.4103/0366-6999.235868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Xin Ding
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yan-Gong Cao
- Department of Critical Care Medicine, Hua Xin Hospital First Hospital of Tsinghua University, Beijing 100016, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huan Chen
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hua Zhao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | | |
Collapse
|
196
|
Thomas-Mohtat R, Sable C, Breslin K, Weinberg JG, Prasad A, Zinns L, Cohen JS. Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists. Crit Ultrasound J 2018; 10:33. [PMID: 30536155 PMCID: PMC6286908 DOI: 10.1186/s13089-018-0113-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 10/26/2018] [Indexed: 01/24/2023] Open
Abstract
Background Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. Methods PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms. Results Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19–90.8) and specificity of 100.0% (95% CI 91.1–100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67–97.33) and specificity of 98.1% (95% CI 88.42–99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7–88.8) and specificity 75% (95% CI 67.0–81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0–85.0) and specificity 94.4% (95% CI 89.0–97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows’ interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59–0.73) for effusion and 0.31 (95% CI 0.24–0.38) for function among the fellows. Conclusion Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice. Electronic supplementary material The online version of this article (10.1186/s13089-018-0113-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rosemary Thomas-Mohtat
- Department of Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC, USA. .,Faculty, George Washington University School of Medicine, Washington, DC, USA.
| | - Craig Sable
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA.,Faculty, George Washington University School of Medicine, Washington, DC, USA
| | - Kristen Breslin
- Department of Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC, USA.,Faculty, George Washington University School of Medicine, Washington, DC, USA
| | | | - Aparna Prasad
- Department of Cardiology, Goryeb Children's Hospital, Morristown, NJ, USA
| | - Lauren Zinns
- Department of Emergency Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Joanna S Cohen
- Department of Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC, USA.,Faculty, George Washington University School of Medicine, Washington, DC, USA
| |
Collapse
|
197
|
|
198
|
Tavazzi G, Neskovic AN, Popescu BA, Via G. Letter on "Pre-hospital transthoracic echocardiography for early identification of non-ST-elevation myocardial infarction in patients with acute coronary syndrome". CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:311. [PMID: 30463586 PMCID: PMC6249853 DOI: 10.1186/s13054-018-2201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Guido Tavazzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Anaesthesia, Intensive Care and Pain Therapy Unit, University of Pavia, Pavia, Italy. .,Emergency Department, Anaesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila" - Euroecolab Emergency Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| |
Collapse
|
199
|
Morrow D, Cupp J, Schrift D, Nathanson R, Soni NJ. Point-of-Care Ultrasound in Established Settings. South Med J 2018; 111:373-381. [PMID: 29978220 DOI: 10.14423/smj.0000000000000838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The original and most widely accepted applications for point-of-care ultrasound (POCUS) are in the settings of trauma, shock, and bedside procedures. Trauma was the original setting for the introduction of POCUS and has been standardized under the four-plus view examination called the Focused Assessment with Sonography in Trauma (FAST). This examination was found to be especially practice changing for achieving rapid diagnoses in critically ill patients who are too unstable for the delays and transportation inherent in more advanced imaging with computed tomography. This application was broadened from the critically ill trauma patient to any critically ill patient, particularly the patient in undifferentiated shock. Although the Focused Assessment with Sonography in Trauma examination originally focused on sources of hemorrhage causing hypovolemic shock, POCUS also can quickly differentiate cardiogenic, obstructive, and distributive shock and help identify the more specific etiology such as massive pulmonary emboli, pericardial tamponade, and pneumothoraces. By expediting diagnosis, POCUS facilitates faster definitive treatment of life-threatening conditions. In pursuing treatment, US continues to serve a role in the form of visually guiding many procedures that were previously done blindly. US guidance of procedures has improved the safety of central line insertion, thoracentesis, and paracentesis, and has an emerging role in lumbar puncture. Experience in bedside US is becoming a vital tool in the clinician's bedside assessment and management, filling a void between the stethoscope and the more advanced studies and interventions available through radiology. Understanding the strengths and limitations of US enables clinicians to identify the appropriate situations in which they can apply this tool confidently.
Collapse
Affiliation(s)
- Dustin Morrow
- From the Departments of Emergency Medicine and Internal Medicine, Greenville Health System, University of South Carolina School of Medicine, Greenville, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine, Columbia, and the Department of Medicine, Division of General and Hospital Medicine, University of Texas Health, San Antonio
| | - Julia Cupp
- From the Departments of Emergency Medicine and Internal Medicine, Greenville Health System, University of South Carolina School of Medicine, Greenville, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine, Columbia, and the Department of Medicine, Division of General and Hospital Medicine, University of Texas Health, San Antonio
| | - David Schrift
- From the Departments of Emergency Medicine and Internal Medicine, Greenville Health System, University of South Carolina School of Medicine, Greenville, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine, Columbia, and the Department of Medicine, Division of General and Hospital Medicine, University of Texas Health, San Antonio
| | - Robert Nathanson
- From the Departments of Emergency Medicine and Internal Medicine, Greenville Health System, University of South Carolina School of Medicine, Greenville, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine, Columbia, and the Department of Medicine, Division of General and Hospital Medicine, University of Texas Health, San Antonio
| | - Nilam J Soni
- From the Departments of Emergency Medicine and Internal Medicine, Greenville Health System, University of South Carolina School of Medicine, Greenville, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine, Columbia, and the Department of Medicine, Division of General and Hospital Medicine, University of Texas Health, San Antonio
| |
Collapse
|
200
|
Royse C, Canty D, Sessler D. Perioperative ultrasound-assisted clinical evaluation - A case based review. Australas J Ultrasound Med 2018; 21:204-218. [PMID: 34760525 PMCID: PMC8409857 DOI: 10.1002/ajum.12113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Ultrasound is increasingly being adopted into anaesthesia and intensive care practice. The range of ultrasound examination has also increased from transoesophageal echocardiography in cardiac surgery and ultrasound-guided nerve blocks and vascular access, to examination of the heart, lungs, abdomen and deep veins. Typically, the use of ultrasound is focused or basic, designed to be performed by the anaesthetist at the patient's bedside in real time to answer clinical questions and to direct therapy. Ultrasound is not performed in isolation, but used to complement clinical evaluation, and accordingly can be considered as 'ultrasound-assisted perioperative evaluation'. Whilst there is good evidence that ultrasound improves diagnostic accuracy and in turn alters management, there are few data examining whether ultrasound leads to improved clinical outcomes. This review will examine multiple uses of perioperative ultrasound with case studies to illustrate potential utility.
Collapse
Affiliation(s)
- Colin Royse
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
| | - David Canty
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
- Department of MedicineMonash UniversityScenic Blvd & Wellington RoadClaytonVictoria3050Australia
- Department of Anaesthesia and Perioperative Medicine3rd FloorMonash Medical Centre246 Clayton RoadMelbourneVictoria3168Australia
| | - Daniel Sessler
- Department of Outcomes ResearchAnesthesiology InstituteCleveland ClinicClevelandOhioUSA
| |
Collapse
|