1
|
Latif RK, Clifford SP, Ghafghazi S, Phipps Z, Chen JJ, Sangroula D, Khan AZ, Saleem J, Farah I, Huang J, Businger JR. Echocardiography and Management for Cardiac Trauma. J Cardiothorac Vasc Anesth 2022; 36:3265-3277. [DOI: 10.1053/j.jvca.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
|
2
|
Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, Denault A, Desjardins G, Fayad A, Funk D, Hegazy AF, Kim H, Kruger M, Kruisselbrink R, Perlas A, Prabhakar C, Syed S, Sidhu S, Tanzola R, Van Rensburg A, Talab H, Vegas A, Bainbridge D. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth 2020; 68:376-386. [DOI: 10.1007/s12630-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
|
3
|
Krichevskiy LA, Dzybinskaya EV. Fifteen Years of Transesophageal Echocardiography in Cardiac Anesthesia in Russia. J Cardiothorac Vasc Anesth 2019; 33:3375-3382. [PMID: 31253523 DOI: 10.1053/j.jvca.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/24/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022]
Abstract
Transesophageal echocardiography was first introduced in Russia as a component of anesthesiology monitoring in 2003 following its successful implementation in the practice of cardiac anesthesia in the United States and Western Europe. This novel opportunity for perioperative hemodynamic evaluation was enthusiastically adopted at several cardiac surgical clinics despite the presence of critical barriers. The most important of these were the lack of certification programs for anesthesiologists, limited equipment, and a lack of understanding of the responsibility of the anesthesiologist as the coordinator of perioperative therapeutic decisions. Although intraoperative transesophageal echocardiography as a part of the anesthesiology protocol has been introduced in less than 10% of Russian cardiac surgery clinics, a group of interested anesthesiologists has formed over the last 15 years. Both the technical conditions and professional mentality of anesthesiologists need to be changed substantially for successful further development of intraoperative echocardiography. This review aims to highlight the milestones, successes, and challenges in the implementation of intraoperative echocardiography in the practice of cardiac anesthesiology in Russia, which may be interesting to a wide range of cardiac anesthesiologists.
Collapse
Affiliation(s)
- Lev A Krichevskiy
- City Clinical Hospital n.a. S.S.Yudin, Department of Health of Moscow, Department of Anesthesiology and Intensive Care, Moscow, Russia.
| | - Elena V Dzybinskaya
- National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Department of Anesthesiology and Intensive Care, Moscow, Russia
| |
Collapse
|
4
|
Fayad A, Shillcutt S, Meineri M, Ruddy TD, Ansari MT. Comparative Effectiveness and Harms of Intraoperative Transesophageal Echocardiography in Noncardiac Surgery: A Systematic Review. Semin Cardiothorac Vasc Anesth 2018; 22:122-136. [DOI: 10.1177/1089253218756756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraoperative use of transesophageal echocardiography (TEE) has become commonplace in high-risk noncardiac surgeries but the balance of benefits and harms remains unclear. This systematic review investigated the comparative effectiveness and harms of intraoperative TEE in noncardiac surgery. We searched Ovid MEDLINE, PubMed, EMBASE, and the Cochrane Library from 1946 to March 2017. Two reviewers independently screened the literature for eligibility. Studies were assessed for the risk of selection bias, confounding, measurement bias, and reporting bias. Three comparative and 13 noncomparative studies were included. Intraoperative TEE was employed in a total of 1912 of 3837 patients. Studies had important design limitations. Data were not amenable to quantitative synthesis due to clinical and methodological diversity. Reported incidence of TEE complications ranged from 0% to 1.7% in patients undergoing various procedures (5 studies, 540 patients). No serious adverse events were observed for mixed surgeries (2 studies, 197 patients). Changes in surgical or medical management attributable to the use of TEE were noted in 17% to 81% of patients (7 studies, 558 patients). The only randomized trial of intraoperative TEE was grossly underpowered to detect meaningful differences in 30-day postoperative outcomes. There is lack of high-quality evidence of effectiveness and harms of intraoperative TEE in the management of non-cardiac surgeries. Evidence, however, indicates timely evaluation of cardiac function and structure, and hemodynamics. Future studies should be comparative evaluating confounder-adjusted impact on both intraoperative and 30-day postoperative clinical outcomes.
Collapse
|
5
|
De Marchi L, Meineri M. POCUS in perioperative medicine: a North American perspective. Crit Ultrasound J 2017; 9:19. [PMID: 28993991 PMCID: PMC5633585 DOI: 10.1186/s13089-017-0075-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
Ultrasound (US) performed at the point of care has found fertile ground in perioperative medicine. In the hands of anesthesiologists, transesophageal echocardiography (TEE) has become established as a powerful diagnostic and monitoring tool in the perioperative care of cardiac and non-cardiac patients. A number of point-of-care US (POCUS) applications are relevant to perioperative care, including airway, cardiac, lung and gastric US. Although guidelines exist to define the scope of practice for basic and advanced TEE, there remains a lack of such guidelines for perioperative point-of-care ultrasound (POCUS), despite a number of recent calls for action in the academic anesthesia community. POCUS training has been integrated into anesthesia residency curricula in Canada and the United States of America (USA). However, a nation-wide curriculum is still lacking. Many limitations to the development of perioperative POCUS curricula exist, including the need to define the scope of practice and design integrated longitudinal learning approaches. The main anesthesiologist societies in both the USA and Canada are promoting the development of guidelines and have introduced POCUS courses into their national conferences. Although bedside US imaging has been integrated into the curricula of many medical schools in North America, the need for specific national guidelines for the training and practice of POCUS in the perioperative setting by anesthesiologists is crucial to the further development of POCUS in perioperative medicine.
Collapse
Affiliation(s)
- Lorenzo De Marchi
- Department of Anesthesia, Georgetown University, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, CCC Building, Lower Level, Washington, DC, USA
| | - Massimiliano Meineri
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street EN 3-400, Toronto, ON, M5G 2C4, Canada.
| |
Collapse
|
6
|
Mahmood F, Matyal R, Skubas N, Montealegre-Gallegos M, Swaminathan M, Denault A, Sniecinski R, Mitchell JD, Taylor M, Haskins S, Shahul S, Oren-Grinberg A, Wouters P, Shook D, Reeves ST. Perioperative Ultrasound Training in Anesthesiology. Anesth Analg 2016; 122:1794-804. [DOI: 10.1213/ane.0000000000001134] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
7
|
Vegas A, Meineri M, Jerath A, Corrin M, Silversides C, Tait G. Impact of Online Transesophageal Echocardiographic Simulation on Learning to Navigate the 20 Standard Views. J Cardiothorac Vasc Anesth 2013; 27:531-5. [DOI: 10.1053/j.jvca.2012.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Indexed: 11/11/2022]
|
8
|
Intraoperative Monitoring with Transesophageal Echocardiography in Cardiac Surgery. Braz J Anesthesiol 2011; 61:495-512. [DOI: 10.1016/s0034-7094(11)70058-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022] Open
|
9
|
The anesthesiologist and the intraoperative transesophageal echocardiography. Rev Bras Anestesiol 2010; 60:670-2, 372-3. [PMID: 21146065 DOI: 10.1016/s0034-7094(10)70084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
10
|
Jerath A, Vegas A, Meineri M, Silversides C, Feindel C, Beattie S, Corrin M, Tait G. An interactive online 3D model of the heart assists in learning standard transesophageal echocardiography views. Can J Anaesth 2010; 58:14-21. [DOI: 10.1007/s12630-010-9410-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022] Open
|
11
|
|
12
|
Effects of phlebotomy and phenylephrine infusion on portal venous pressure and systemic hemodynamics during liver transplantation. Transplantation 2010; 89:920-7. [PMID: 20216483 DOI: 10.1097/tp.0b013e3181d7c40c] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A regimen of fluid restriction, phlebotomy, vasopressors, and strict, protocol-guided product replacement has been associated with low blood product use during orthotopic liver transplantation. However, the physiologic basis of this strategy remains unclear. We hypothesized that a reduction of intravascular volume by phlebotomy would cause a decrease in portal venous pressure (PVP), which would be sustained during subsequent phenylephrine infusion, possibly explaining reduced bleeding. Because phenylephrine may increase central venous pressure (CVP), we questioned the validity of CVP as a correlate of cardiac filling in this context and compared it with other pulmonary artery catheter and transesophageal echocardiography-derived parameters. In particular, because optimal views for echocardiographic estimation of preload and stroke volume are not always applicable during liver transplantation, we evaluated the use of transmitral flow (TMF) early peak (E) velocity as a surrogate. METHODS In study 1, the changes in directly measured PVP and CVP were recorded before and after phlebotomy and phenylephrine infusion in 10 patients near the end of the dissection phase of liver transplantation. In study 2, transesophageal echocardiography-derived TMF velocity in early diastole was measured in 20 patients, and the changes were compared with changes in CVP, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and calculated systemic vascular resistance (SVR) at the following times: postinduction, postphlebotomy, preclamping of the inferior vena cava, during clamping, and postunclamping. RESULTS Phlebotomy decreased PVP along with CO, PAP, PCWP, CVP, and TMF E velocity. Phenylephrine given after phlebotomy increased CVP, SVR, and arterial blood pressure but had no significant effect on CO, PAP, PCWP, or PVP. The change in TMF E velocity correlated well with the change in CO (Pearson correlation coefficient 95% confidence interval 0.738-0.917, P< or =0.015) but less well with the change in PAP (0.554-0.762, P< or =0.012) and PCWP (0.576-0.692, P< or =0.008). TMF E velocity did not correlate significantly with CVP or calculated SVR. CONCLUSION Phlebotomy during the dissection phase of liver transplantation decreased PVP, which was unaffected when phenylephrine infusion was used to restore systemic arterial pressure. This may contribute to a decrease in operative blood loss. CVP often increased in response to phenylephrine infusion and did not seem to reflect cardiac filling. The changes in TMF E velocity correlated well with the changes in CO, PAP, and PCWP during liver transplantation but not with the changes in CVP.
Collapse
|
13
|
Errando CL. [Ultrasound images for venous puncture and venous access]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:593-594. [PMID: 19177858 DOI: 10.1016/s0034-9356(08)70668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
14
|
Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, Talmor D. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound 2008; 6:49. [PMID: 18837986 PMCID: PMC2586628 DOI: 10.1186/1476-7120-6-49] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 10/06/2008] [Indexed: 03/06/2023] Open
Abstract
Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways - either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level--obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs.
Collapse
Affiliation(s)
- Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP London, UK
| | - Gabriele Via
- 1st Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, P.zzale Golgi 2, 27100 Pavia, Italy
| | - Erik Sloth
- Department of Anaesthesiology, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Fabio Guarracino
- Cardiothoracic Anaesthesia and ICU, Azienda Ospedaliera Pisana, via Paradisa 2, 56124 Pisa, Italy
| | - Raoul Breitkreutz
- Department of Anesthesiology, Intensive Care, and Pain therapy, Hospital of the Johann-Wolfgang-Goethe University, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Emanuele Catena
- Department of Cardiothoracic Anesthesia, Azienda Ospedaliera Niguarda Ca'Granda, P.za Osp. Maggiore 3, 20100, Milan, Italy
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | | |
Collapse
|
15
|
Bosenberg C, Dobson J, Vuksic S. Training pathways for perioperative transesophageal echocardiography. Can J Anaesth 2007; 54:157-8; author reply 158-9. [PMID: 17272259 DOI: 10.1007/bf03022018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
16
|
Béïque F, Ali M, MacKenzie S, Hynes M. Reply. Can J Anaesth 2007. [DOI: 10.1007/bf03022019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
17
|
Finegan BA. Progress through cooperation: Securing a sound training pathway for perioperative transesophageal echocardiography. Can J Anaesth 2006; 53:969-72. [PMID: 16987849 DOI: 10.1007/bf03022523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|