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Mathew CS, Dias E, Sreedharan JK, Al Ahmari M, Trujillo L, West A, Karthika M. Lung ultrasound in respiratory therapy: a global reflective survey. Multidiscip Respir Med 2024; 19:980. [PMID: 38953856 PMCID: PMC11229826 DOI: 10.5826/mrm.2024.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a non-invasive point of care diagnostic tool used to assess the presence and severity of various lung disorders for more than two decades. Within the healthcare professionals are the respiratory therapists (RTs) who play a vital role in managing ventilated and other patients requiring respiratory support, but the incorporation of LUS into their scope of practice has not been well highlighted. This international cross-sectional survey was specifically designed to evaluate the knowledge, attitude, and practice of RTs with respect to LUS. METHODS This observational cross-sectional study was conducted among RTs from different parts of the world using a questionnaire-based study tool. 514 RTs responded to all the questions and were considered for statistical analysis. Descriptive statistics, Analysis of variance, Fisher's exact, Chi-square, Bonferroni post-hoc analysis, and Binomial logistic regression analyses were performed to identify the significance of the data. RESULTS From 22 countries, 514 RTs responded to the survey, with the major share from the middle eastern countries. Out of the 514 responders, 44.9% of the responders were in the age group of 23-30 years; 67.1% were bachelor's degree holders; and 40.9% of participants had more than 10 years of experience. The knowledge-based questions revealed that RTs with higher experience and academic qualification provided more positive responses. While in the attitude-related domain it is observed that standardized training in LUS helps them to enhance the current practice and to add LUS to the academic curriculum of respiratory therapy schools; however there remains barriers to practice LUS based on their responses. The practice-based questions revealed that RTs expect some additional seminars/workshops/webinars to be done on LUS frequently. More than half of the participants are found to be knowledgeable with a positive attitude and working towards the inclusion of LUS in respiratory therapy profession. CONCLUSION It is concluded that respiratory therapists have a positive attribute towards the inclusion of lung ultrasound in their clinical practice. Providing more structured training for professional respiratory therapists and including lung ultrasound modules in the respiratory therapy school curriculum may facilitate mastering their diagnostic skills, thereby expanding the scope of practice.
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Affiliation(s)
- Chris Sara Mathew
- Srinivas Institute of Medical Sciences and Research Center, Srinivas University, Mangalore, India
- Faculty of Medical and Health Sciences, Liwa College, Abu Dhabi, UAE
| | - Edwin Dias
- Srinivas Institute of Medical Sciences and Research Center, Srinivas University, Mangalore, India
| | | | | | - Lisa Trujillo
- Department of Respiratory Care and Diagnostic Science, University of Kansas Medical Center, Kansas, USA
| | - Andrew West
- Canadian Society of Respiratory Therapists, Canada
| | - Manjush Karthika
- Faculty of Medical and Health Sciences, Liwa College, Abu Dhabi, UAE
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Ultrasound procedure for the diagnosis of mass lesions in the oral region. Oral Radiol 2023; 39:93-100. [PMID: 35332418 DOI: 10.1007/s11282-022-00605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To examine the diagnostic usefulness and procedures of ultrasonography (US) for mass lesions in the soft tissue of the oral region. METHODS This study involved patients with mass lesions (tumorous lesions and cysts) who had undergone US and histopathological examinations from January 2017 to December 2019. The following points were evaluated by two observers using an evaluation scale: vascularity, echo intensity level, boundary, margin shape, distribution of internal echoes, and capsule. The usefulness of each point for differential diagnosis of tumorous lesions and cysts was statistically analyzed. RESULTS Forty-five mass lesions in the soft tissue of the oral region (33 tumorous lesions and 12 cysts) were analyzed. There were significant differences in four evaluation points between the tumorous lesions and cysts: vascularity, echo intensity level, boundary, and margin shape. Cysts were almost completely excluded diagnostically, especially when vascularity was observed. There were also significant differences in two evaluation points between nonvascular tumorous lesions and cysts: echo intensity level and boundary. CONCLUSIONS In US examination for mass lesions in the oral region, it was possible to diagnose tumorous lesions and exclude cysts when vascularity was observed. When vascularity was not observed, however, tumorous lesions and cysts could be identified using two evaluation points: echo intensity level and boundary.
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Ultrasound to Verify Gastric Tube Position in Infants and Children: A Systematic Review. Adv Neonatal Care 2022; 22:531-538. [PMID: 35587385 DOI: 10.1097/anc.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Placement of gastric tubes is commonly performed in infants and children but malpositioning is common and is associated with significant complications. OBJECTIVE The aim of this systematic review is to identify the evidence on the use of ultrasound to verify correct gastric tube placement in infants and children and gaps in the research. METHODS This review was performed using CINAHL, PUBMED, EMBASE and Web of Science databases. Studies were included if they used an empirical study design, were published in English, included infants or children, and evaluated the use of ultrasound to verify correct gastric tube placement compared to radiograph. Sensitivity, specificity, positive and negative predictive values were evaluated. RESULTS Four articles were included in the review. Sensitivity estimates were 0.88 to 1.00 and a positive predictive value of 0.99 was reported in one study. Specificity was not reported in any of the included studies. Ultrasound may be an important method to correctly identify gastric tube placement in infants and children with less radiation exposure and cost. IMPLICATIONS FOR PRACTICE Ultrasound could be a used to verify gastric tube positioning in infants and children for both initial placement and continued verification leading to reduced radiation exposure and cost. IMPLICATIONS FOR RESEARCH Research should focus on evaluating ultrasound specificity and the clinical feasibility of using ultrasound as a standard practice, including cost and time required to complete the exam, as well as the ability of ultrasound to verify gastric tube placement in infants weighing less than 1500 grams.
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Sreedharan JK, Karthika M, Alqahtani JS, AlRabeeah SM, Alnasser M, Alqahtani AS, AlAhmari MD, Zechariah Jebakumar A, AlEnezi M, Ghazwani AA, Sara Mathew C, Aldhahir AM, Nair SG. Routine Application of Lung Ultrasonography in Respiratory Care: Knowledge, Perceptions, and Barriers to Instigate. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1395-1406. [PMID: 36411749 PMCID: PMC9675578 DOI: 10.2147/amep.s389013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Background Lung Ultrasound (LUS) had proved to be beneficial in detecting respiratory disorders at the bedside. Understanding the important role of Respiratory Therapists (RTs) in the critical care, we aimed to assess their knowledge, perceived relevance of LUS to clinical practice, current skill gaps, and barriers to practice. Methods A cross-sectional, nationwide survey conducted among the RTs working in the Kingdom of Saudi Arabia. The validated questionnaire included 4 sections; the demographics, knowledge and perceptions, applicability and self-reported proficiency, and barriers to the use of LUS by RTs. Results A total of 256 RTs across different regions of Saudi Arabia participated in this survey. 71.9% of them were males, and 46.1% of the participants were having <5 years of working experience. Only (18.1%) of the participants used LUS in their clinical practice, and (43%) of them had never received any training. 66% of the participants perceived LUS as an effective tool in the RT practice and immensely valuable in their daily practice (70%). A large proportion of RTs perceived LUS to be ineffective in calculating the lung score (50.4%), assessing the diaphragm (40.2%), and detecting pulmonary edema (38.3%). Calculating lung score has a lower mean score of 2.55 on both skills, and identifying its applicability to clinical practice with a mean score of 2.71 than other indications. Lack of training and curriculum (154/256; 60.2%) remains the top barrier that prevented RTs from using LUS in their clinical practice. Conclusion While many RTs in Saudi Arabia perceived LUS as an effective tool in the RT practice, considerable competence gap exist, indicating the need for LUS training. There is a need for incorporating LUS into the curriculum of RT schools and promoting competency-based training for the current RT workforce to help improve patient care.
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Affiliation(s)
- Jithin K Sreedharan
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Manjush Karthika
- Respiratory Care, Department of Health and Medical Sciences, Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saad M AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Musallam Alnasser
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Mohammed D AlAhmari
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | - Meshal AlEnezi
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah A Ghazwani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Chris Sara Mathew
- Respiratory Care, Department of Health and Medical Sciences, Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Suresh G Nair
- Department of Anesthesiology and Critical Care Medicine, Aster Medicity, Kochi, Kerala, India
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Suzuki R, Kanai M, Oya K, Harada Y, Horie R, Sekiguchi H. A prospective randomized study to compare standard versus intensive training strategies on long-term improvement in critical care ultrasonography proficiency. BMC MEDICAL EDUCATION 2022; 22:732. [PMID: 36280812 PMCID: PMC9594969 DOI: 10.1186/s12909-022-03780-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Critical care ultrasonography (CCUS) has become a daily diagnostic tool for intensivists. While the effective training measures for ultrasound novices are discussed widely, the best curriculum for the novices to retain a long-term proficiency is yet to be determined. METHODS Critical care medicine fellows who underwent an introductory CCUS workshop were randomly allocated into the standard training (ST) or the intensive training (IT) group. The IT group received an 8-h training besides the standardized fellowship education that the ST group received. Participant improvement in CCUS proficiency tests (maximum score, 200) after a 6-month training intervention was compared between the groups. CCUS examinations performed in patient care were observed over 2 years. RESULTS Twenty-one fellows were allocated into the ST (n = 10) or the IT (n = 11) group. No statistically significant difference was observed in the median (interquartile range [IQR]) improvement in CCUS proficiency tests between the ST group and the IT group: 18 (3.8-38) versus 31 (21-46) (P = .09). Median (IQR) test scores were significantly higher in postintervention than preintervention for both groups: ST, 103 (87-116) versus 124 (111-143) (P = .02), and IT, 100 (87-113) versus 143 (121-149) (P < .01). Participating fellows performed 226 examinations over the 2 years of observation. CONCLUSIONS Fellows improved their CCUS proficiency significantly after 6-month training intervention. However, an additional 8-h training did not provide further benefits.
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Affiliation(s)
- Reina Suzuki
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Mio Kanai
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kazumasa Oya
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yohei Harada
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ryohei Horie
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hiroshi Sekiguchi
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, 85054, USA.
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Declerck C, Mahieu R, Sanderink D, de la Chapelle M, Abgueguen P, Vandamme YM, Dubée V. Implementation of point-of-care ultrasonography in an infectious disease ward. Infect Dis Now 2021; 52:87-92. [PMID: 34896661 DOI: 10.1016/j.idnow.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Point-of-care ultrasonography (POCUS) has emerged as an essential supplement to physical examination in many specialties. In contrast, its use by infectious diseases (ID) specialists remains anecdotal. Here, we report on the acquisition of an ultrasonography device in a French ID ward, and we describe its everyday use. METHODS A preliminary audit was conducted to evaluate the potential impact of the acquisition of an ultrasonography device. A second audit was performed during the first year following the acquisition of the device to quantify its everyday use. We also evaluated the impact of POCUS implementation on medical imaging requests by comparing the number of intra-hospital transports before and after the acquisition. RESULTS According to the first audit, 81 of the 199 (41%) imaging examinations that were prescribed during a two-month period could have been replaced by POCUS. During the first year following the acquisition of the ultrasonography device, POCUS was performed 240 times by 31 different operators. The operators were a senior physician, an intern, and a medical student in 94 (39%), 135 (57%), and 11 (5%) cases, respectively. The organs most frequently explored were the genito-urinary tract (n=74), the joints (n=35), and the lungs/pleura (n=35). Acquisition of the device was followed by a significant decrease in the number of transports to the ultrasonography room, whereas the total number of transports to the medical imaging ward did not change. CONCLUSION Opportunities to use POCUS in the ID ward are numerous. POCUS training should be part of the ID specialist's curriculum.
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Affiliation(s)
- C Declerck
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France.
| | - R Mahieu
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - D Sanderink
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - M de la Chapelle
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - P Abgueguen
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - Y M Vandamme
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - V Dubée
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
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Zhang X, Fu Y, Yue G, Yang S, Ju R. Lung ultrasound for the assessment of lung recruitment in neonates with massive pneumothorax during extracorporeal membrane oxygenation: a case report. J Artif Organs 2021; 25:163-169. [PMID: 34292454 DOI: 10.1007/s10047-021-01287-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/13/2021] [Indexed: 01/02/2023]
Abstract
Bedside lung ultrasound may be an effective method for the assessment of lung recruitment in newborns with extracorporeal membrane oxygenation (ECMO). We report a case of a neonate who had severe hypoxemia with persistent pulmonary hypertension and massive pneumothorax due to meconium aspiration syndrome and was treated with ECMO. Positive pressure mechanical ventilation resulted in persistent massive air leakage from the disrupted pulmonary tissue. When ECMO was initiated, a "total lung rest" ventilation strategy was used to facilitate healing of the lung rupture and absorption of the pneumothorax. After complete absorption of the pneumothorax, lung recruitment was performed by progressively increasing the positive end-expiratory pressure under the guidance of lung ultrasound. Bedside lung ultrasound was successfully used to assess pneumothorax absorption and improvement of pulmonary inflammation and successfully guided the recruitment of collapsed alveoli and the withdrawal of ECMO.
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Affiliation(s)
- Xiaolong Zhang
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
| | - Yiyong Fu
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Guang Yue
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
| | - Sheng Yang
- Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 611731, China
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Bhatt M, Kumar A, Gupta K, Halkur Shankar S, Vyas S, Khan MA, Soneja M, Baitha U, Jadon RS, Wig N. Effectiveness of Bedside Sonography by Residents for Fluid Management by Inferior Vena Cava Assessment. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321990610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To study the utility of point of care ultrasound (POCUS) in the diagnosis and management of shock when performed by medicine residents. Methods: A retrospective, case-control study was carried out in the medical intensive care unit at a tertiary care hospital. Consecutive patients who had received bolus fluid for hypotension during the hospital stay were screened from the case sheets and recorded. Results: A total of 57 patients were recruited into the study. Baseline parameters were comparable in both groups. The median amount of fluid given by the physician was 1000 milliliters (500, 1500) in the inferior vena cava (IVC) group as compared with 1000 milliliters (500, 1000) in the clinical group which was similar between the groups ( P = .51). The median quantity of fluid received in the first hour in the IVC group (500 milliliters; 75, 750) was significantly higher than in the clinical group (100 milliliters; 100, 125) ( z = 2.98; P = .003). More improvement in heart rate ( P = .0004), mean arterial pressure (MAP; P = .04), and Acute Physiology and Chronic Health Evaluation (APACHE; P = .0004) score was seen in the IVC group which was statistically significant. Conclusion: In this cohort, there was a significant increase in MAP, reduction in the APACHE II score, and heart rate in the IVC group when compared with the clinical group.
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Affiliation(s)
- Manasvini Bhatt
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sujay Halkur Shankar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - M. A. Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ranveer S. Jadon
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Jangsirikul S, Siripongsakun S, Chaiteerakij R. Video-assisted liver ultrasound training for non-radiologists: protocol and preliminary results. HPB (Oxford) 2021; 23:962-969. [PMID: 33191107 DOI: 10.1016/j.hpb.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultrasound (US) is increasingly used as a bedside diagnostic tool, with training courses for non-radiologists being developed. However, the training time constraint is an important barrier for non-radiologists. We therefore created a short self-learning course for liver-US for non-radiologists. AIM Assess the participants' ability in identifying the organ structures during a liver-US. METHOD A short video-lecture on liver-US training and a portable guidebook for image acquisition were developed. Eighteen non-radiologist physicians studied the course and attended hands-on liver-US examinations to capture the assigned images and label the acquired organ/structures, which were evaluated by an expert radiologist. RESULT 130 liver-US examinations were performed, 44 (33.8%) was cirrhosis. The overall of mean image acquisition score was 84.5 ± 9.7%. The mean score of the 1st examination was 75.2 ± 16.4. The mean score was >80% since the 2nd examination. The score was significant lower in cirrhotic cases as compared to non-cirrhotic cases (78.8 ± 17.3 vs. 88.3 ± 14.4, p = 0.001). The participants' year of study and experience in previous US training did not affect the image acquisition score. CONCLUSION The liver-US training course in a short video format with a portable guidebook is effective and relatively low time-consuming for teaching non-radiologists to perform bedside liver-US.
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Affiliation(s)
- Sureeporn Jangsirikul
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Surachate Siripongsakun
- Sonographer School, Faculty of Health Science Technology, Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Teleguided self-ultrasound scanning for longitudinal monitoring of muscle mass during spaceflight. iScience 2021; 24:102344. [PMID: 33870138 PMCID: PMC8047175 DOI: 10.1016/j.isci.2021.102344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Loss of muscle mass is a major concern for long duration spaceflight. However, due to the need for specialized equipment, muscle size has only been assessed before and after spaceflight where ~20% loss is observed. Here, we demonstrate the utility of teleguided self-ultrasound scanning (Tele-SUS) to accurately monitor leg muscle size in astronauts during spaceflight. Over an average of 168 ± 57 days of spaceflight, 74 Tele-SUS sessions were performed. There were no significant differences between panoramic ultrasound images obtained by astronauts seven days prior to landing and expert sonographer after flight or between change in muscle size assessed by ultrasound and magnetic resonance imaging. These findings extend the current capabilities of ultrasound imaging to allow self-monitoring of muscle size with remote guidance. We examined teleguided self-ultrasound to monitor leg muscle size on the ISS Muscle thickness ultrasound does not detect change in muscle size during spaceflight Panoramic ultrasound accurately monitors change in muscle size compared to MRI Teleguided self-ultrasound reveals upper and lower leg muscle loss during spaceflight
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Kise Y, Møystad A, Bjørnland T, Shimizu M, Ariji Y, Kuwada C, Nishiyama M, Funakoshi T, Yoshiura K, Ariji E. Effects of 1 year of training on the performance of ultrasonographic image interpretation: A preliminary evaluation using images of Sjögren syndrome patients. Imaging Sci Dent 2021; 51:129-136. [PMID: 34235058 PMCID: PMC8219445 DOI: 10.5624/isd.20200294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/26/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose This study investigated the effects of 1 year of training on imaging diagnosis, using static ultrasonography (US) salivary gland images of Sjögren syndrome patients. Materials and Methods This study involved 3 inexperienced radiologists with different levels of experience, who received training 1 or 2 days a week under the supervision of experienced radiologists. The training program included collecting patient histories and performing physical and imaging examinations for various maxillofacial diseases. The 3 radiologists (observers A, B, and C) evaluated 400 static US images of salivary glands twice at a 1-year interval. To compare their performance, 2 experienced radiologists evaluated the same images. Diagnostic performance was compared between the 2 evaluations using the area under the receiver operating characteristic curve (AUC). Results Observer A, who was participating in the training program for the second year, exhibited no significant difference in AUC between the first and second evaluations, with results consistently comparable to those of experienced radiologists. After 1 year of training, observer B showed significantly higher AUCs than before training. The diagnostic performance of observer B reached the level of experienced radiologists for parotid gland assessment, but differed for submandibular gland assessment. For observer C, who did not complete the training, there was no significant difference in the AUC between the first and second evaluations, both of which showed significant differences from those of the experienced radiologists. Conclusion These preliminary results suggest that the training program effectively helped inexperienced radiologists reach the level of experienced radiologists for US examinations.
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Affiliation(s)
- Yoshitaka Kise
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Anne Møystad
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Mayumi Shimizu
- Department of Oral and Maxillofacial Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Chiaki Kuwada
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Masako Nishiyama
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Takuma Funakoshi
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Kazunori Yoshiura
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
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Garnier M, Hafiani EM, Arbelot C, Blayau C, Labbe V, Stankovic-Stojanovic K, Lionnet F, Bonnet F, Fulgencio JP, Fartoukh M, Quesnel C. Morpho-functional evaluation of lung aeration as a marker of sickle-cell acute chest syndrome severity in the ICU: a prospective cohort study. Ann Intensive Care 2019; 9:109. [PMID: 31565756 PMCID: PMC6766460 DOI: 10.1186/s13613-019-0583-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/21/2019] [Indexed: 01/11/2023] Open
Abstract
Background Acute chest syndrome (ACS) is the main cause of morbi-mortality in patients with sickle-cell disease in the intensive care unit (ICU). ACS definition encompasses many types of lung damage, making early detection of the most severe forms challenging. We aimed to describe ACS-related lung ultrasound (LU) patterns and determine LU performance to assess ACS outcome. Results We performed a prospective cohort study including 56 ICU patients hospitalized for ACS in a tertiary university hospital (Paris, France). LU and bedside spirometry were performed at admission (D0) and after 48 h (D2). Complicated outcome was defined by the need for transfusion of ≥ 3 red blood cell units, mechanical ventilation, ICU length-of-stay > 5 days, or death. A severe loss of lung aeration was observed in all patients, predominantly in inferior lobes, and was associated with decreased vital capacity (22 [15–33]% of predicted). The LU Score was 24 [20–28] on D0 and 20 [15–24] on D2. Twenty-five percent of patients (14/56) had a complicated outcome. Neither oxygen supply, pain score, haemoglobin, LDH and bilirubin values at D0; nor their change at D2, differed regarding patient outcome. Conversely, LU re-aeration score and spirometry change at D2 improved significantly more in patients with a favourable outcome. A negative LU re-aeration score at D2 was an independent marker of severity of ACS in ICU. Conclusions ACS is associated with severe loss of lung aeration, whose resolution is associated with favourable outcome. Serial bedside LU may accurately and early identify ACS patients at risk of complicated outcome.
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Affiliation(s)
- Marc Garnier
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France. .,Université Pierre et Marie Curie Sorbonne Université, Paris, France.
| | - El Mahdi Hafiani
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Charlotte Arbelot
- Département d'Anesthésie et Réanimation, APHP Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Clarisse Blayau
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Vincent Labbe
- Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Katia Stankovic-Stojanovic
- Service de Médecine Interne et Centre de Référence de la Drépanocytose, APHP Hôpital Tenon, Paris, France
| | - François Lionnet
- Service de Médecine Interne et Centre de Référence de la Drépanocytose, APHP Hôpital Tenon, Paris, France
| | - Francis Bonnet
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université Pierre et Marie Curie Sorbonne Université, Paris, France
| | - Jean-Pierre Fulgencio
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Muriel Fartoukh
- Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie Sorbonne Université, Paris, France
| | - Christophe Quesnel
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université Pierre et Marie Curie Sorbonne Université, Paris, France
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13
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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]
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14
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Kramer MR, Porfido CL, Mitroff SR. Evaluation of strategies to train visual search performance in professional populations. Curr Opin Psychol 2019; 29:113-118. [PMID: 30731261 DOI: 10.1016/j.copsyc.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/07/2018] [Accepted: 01/04/2019] [Indexed: 12/01/2022]
Abstract
Visual search, the act of finding targets amongst distractors, is central to many professions with life-or-death implications including aviation security, radiology, lifeguarding, military, and more. As such, every effort should be taken to improve visual search performance. One potential path to improvement is to ensure that workforces are optimally trained. Broadly, there are three general components to train: (1) specific use of the machinery and user interface (i.e. 'knobology'), (2) target and distractor identification, and (3) search strategy. The current review considers the cognitive psychology aspects of these three components; each is evaluated in light of short-term and long-term training goals, as well as profession-specific constraints.
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Affiliation(s)
- Michelle R Kramer
- The George Washington University, Department of Psychology, 2125 G Street NW, Washington, DC 20052, United States.
| | - Courtney L Porfido
- The George Washington University, Department of Psychology, 2125 G Street NW, Washington, DC 20052, United States
| | - Stephen R Mitroff
- The George Washington University, Department of Psychology, 2125 G Street NW, Washington, DC 20052, United States
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15
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Mahendran M, Gupta K, Kumar A, Bhatt M, Khan MA, Vyas S, Makkar N, Baitha U, Jadon RS, Wig N. Bedside sonography by medicine residents in critically Ill patients: A retrospective study from a teaching hospital in India. J Family Med Prim Care 2019; 8:2517-2521. [PMID: 31463287 PMCID: PMC6691465 DOI: 10.4103/jfmpc.jfmpc_379_19] [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] [Indexed: 11/22/2022] Open
Abstract
Context: Ultrasonography has become the frontline diagnostic tool for emergency care because of its non-invasive nature and the feasibility to perform repeated quick assessments in sick patients. The effectiveness of this modality, when used by trainee doctors to take clinically important decisions in patients requiring emergency care, is not much explored. In this pilot study, we analyzed whether use of this technology by Medicine resident doctors can help in better decision making in acutely and critical ill patients. Setting and Design: This is a retrospective study conducted in the Department of Medicine, All India Institute of Medical Sciences, New Delhi. Methods and Materials: The study was conducted using patient data collected from acutely ill and critical care patients, who underwent bedside ultrasonography from August 2017 to August 2018. In all cases, resident doctor's finding had been assessed by an experienced operator before a treatment decision was made. Statistical Analysis Used: Continuous variables with normal distribution were computed using t test. Ordinal variables and variables following non-normal distribution were analyzed using the Wilcoxon rank-sum test. Results: Thirty-two patients were recruited. There was agreement on 78% (25/32) ultrasound records between the trainee and the experienced operator. Among patients evaluated for shock, agreement reached 83% (15/18). Among patients who underwent transthoracic echocardiography, agreement was 66.7% (4/6). Among patients who underwent lung ultrasound, agreement was 70% (7/10). In both the patients in whom abdominal ultrasound was done, final inferences were consistent between the residents and experts. Conclusions: The results show that in majority of critically ill patients, Medicine residents made sonographic observations correctly and took clinically precise sonography guided decisions on par with expert sonologists even with minimal training and ultrasound exposure.
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Affiliation(s)
- Manjit Mahendran
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manasvini Bhatt
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A Khan
- Department of Biostatistics, Faculty of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiology, Faculty of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nayani Makkar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ranveer S Jadon
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
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16
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Lu X, Wu C, Gao Y, Zhang M. Bedside Ultrasound Assessment of Lung Reaeration in Patients With Blunt Thoracic Injury Receiving High-Flow Nasal Cannula Oxygen Therapy: A Retrospective Study. J Intensive Care Med 2018; 35:1095-1103. [PMID: 30514149 DOI: 10.1177/0885066618815649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: High-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce the need for mechanical ventilation and decrease the duration of hospital and intensive care unit (ICU) stays for patients with a severely compromised respiratory system. This study aims to observe the evolution of lung aeration via lung ultrasound score (LUS) in a chest-injured population who had been treated with HFNC oxygen therapy, and to assess the benefit of the HFNC oxygen therapy in trauma patients. Methods: A retrospective study examined trauma patients with moderate to severe thoracic injuries who were admitted to the ICU at a tertiary hospital between October 2015 and March 2017. The decision to initiate HFNC oxygen therapy was made at the discretion of the trauma surgeon and respiratory therapist when supplemental oxygen delivery was required. All of the patients were assessed by transthoracic lung ultrasound every day after being admitted into the ICU. We retrospectively analyzed 3 time points for this study: the initial emergency intensive care units presentation within 12 hours (T1), 24 to 48 hours after the treatment (T2), and 72 to 96 hours after the treatment (T3). Transthoracic lung ultrasound was performed by an experienced investigator with level 3 certification using a Mindray M9 echograph and a 2- to 4-MHz round-tipped probe. Primary outcomes were the need for intubation after HFNC oxygen therapy for respiratory failure during the treatment within 72 hours, the length of ICU stay, and mortality of 28 days. Results: During the study period, 50 patients with blunt chest trauma were admitted to the study; 18 patients received HFNC therapy and 32 received conventional oxygen therapy (COT); there was no significant difference in the baseline clinical characteristics between the 2 groups. The length of ICU stay and intubation rate for respiratory failure within 72 hours were significantly different between the 2 groups ( P < .05), but there was no difference in the 28-day mortality. The LUS of the COT group was not significantly different from T1 to T2 or from T2 to T3 ( P > .05). However, the LUS decreased significantly—by 25% from T1 to T2 ( P < .05) and by 31% from T1 to T3 ( P < .05) in the HFNC therapy group. The LUS of the patients intubated for respiratory failure within 72 hours, in the COT group increased from T1 (17 ± 3) to T3 (21 ± 3), and the LUS (21 ± 3) was much higher than the patients who were not intubated (11 ± 3) at T3; the LUS of the HFNC group was all above 15, which was not significantly different from T1 to T2 or from T2 to T3 ( P > .05). Conclusions: High-flow nasal cannula oxygen therapy may be considered as an initial respiratory therapy for trauma patients with blunt chest injury. High-flow nasal cannula therapy could improve lung aeration as noted by the transthoracic lung ultrasound assessment, and LUS may help the attending physicians identify the usefulness of HFNC therapy and decide whether to continue the use of HFNC therapy or intubate the patient.
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Affiliation(s)
- Xiao Lu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - ChunShuang Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - YuZhi Gao
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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See KC, Chua JW, Verstegen D, Van Merrienboer JJG, Van Mook WN. Focused echocardiography: Dyad versus individual training in an authentic clinical context. J Crit Care 2018; 49:50-55. [PMID: 30366250 DOI: 10.1016/j.jcrc.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. MATERIALS AND METHODS We conducted a quasi-experimental study within a 20-bed medical intensive care unit from June 2016 to March 2017. For supervised practice, residents were divided into individual versus dyad training groups. Residents then performed at least five FSE examinations, which were remotely scored by a blinded observer for image quality and correct interpretation. The main outcome measure was the mean composite image quality and interpretation score for the first five echoes done under indirect supervision (composite score range 1-8). RESULTS 16 residents received individual training and 17 residents received dyad training. The mean composite score did not differ between the individual and dyad training groups (6.0 ± 0.4 versus 5.9 ± 0.4, 95% CI of difference - 0.2 to 0.4). CONCLUSIONS Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Joo Wei Chua
- Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Danielle Verstegen
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Jeroen J G Van Merrienboer
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Walther N Van Mook
- Department of Intensive Care Medicine, Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
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18
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Dancel R, Schnobrich D, Puri N, Franco-Sadud R, Cho J, Grikis L, Lucas BP, El-Barbary M, Soni NJ. Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2018; 13:126-135. [PMID: 29377972 DOI: 10.12788/jhm.2940] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Executive Summary: 1) We recommend that ultrasound should be used to guide thoracentesis to reduce the risk of complications, the most common being pneumothorax. 2) We recommend that ultrasound guidance should be used to increase the success rate of thoracentesis. 3) We recommend that ultrasound-guided thoracentesis should be performed or closely supervised by experienced operators. 4) We suggest that ultrasound guidance be used to reduce the risk of complications from thoracentesis in mechanically ventilated patients. 5) We recommend that ultrasound should be used to identify the chest wall, pleura, diaphragm, lung, and subdiaphragmatic organs throughout the respiratory cycle before selecting a needle insertion site. 6) We recommend that ultrasound should be used to detect the presence or absence of an effusion and approximate the volume of pleural fluid to guide clinical decision-making. 7) We recommend that ultrasound should be used to detect complex sonographic features, such as septations, to guide clinical decision-making regarding the timing and method of pleural drainage. 8) We suggest that ultrasound be used to measure the depth from the skin surface to the parietal pleura to help select an appropriate length needle and determine the maximum needle insertion depth. 9) We suggest that ultrasound be used to evaluate normal lung sliding pre- and postprocedure to rule out pneumothorax. 10) We suggest avoiding delay or interval change in patient position from the time of marking the needle insertion site to performing the thoracentesis. 11) We recommend against performing routine postprocedure chest radiographs in patients who have undergone thoracentesis successfully with ultrasound guidance and are asymptomatic with normal lung sliding postprocedure. 12) We recommend that novices who use ultrasound guidance for thoracentesis should receive focused training in lung and pleural ultrasonography and hands-on practice in procedural technique. 13) We suggest that novices undergo simulation-based training prior to performing ultrasound-guided thoracentesis on patients. 14) Learning curves for novices to become competent in lung ultrasound and ultrasound-guided thoracentesis are not completely understood, and we recommend that training should be tailored to the skill acquisition of the learner and the resources of the institution.
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Affiliation(s)
- Ria Dancel
- Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
- Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Schnobrich
- Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nitin Puri
- Division of Critical Care Medicine Services, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Ricardo Franco-Sadud
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joel Cho
- Department of Hospital Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Loretta Grikis
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Brian P Lucas
- White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Mahmoud El-Barbary
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Nilam J Soni
- Division of General & Hospital Medicine, The University of Texas School of Medicine at San Antonio, San Antonio, Texas, USA
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
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19
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Robertson TE, Levine AR, Verceles AC, Buchner JA, Lantry JH, Papali A, Zubrow MT, Colas LN, Augustin ME, McCurdy MT. Remote tele-mentored ultrasound for non-physician learners using FaceTime: A feasibility study in a low-income country. J Crit Care 2017; 40:145-148. [PMID: 28402924 DOI: 10.1016/j.jcrc.2017.03.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/15/2017] [Accepted: 03/29/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. MATERIALS AND METHODS Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques. A volunteer was connected to an intensivist located in the USA via FaceTime. The intensivist remotely instructed the non-physicians to ultrasound five anatomic sites. The tele-intensivist evaluated the image quality and clinical utility of performing tele-ultrasound in a LMIC. RESULTS The intensivist agreed (defined as "agree" or "strongly agree" on a five-point Likert scale) that 90% (57/63) of the FaceTime images were high quality. The intensivist felt comfortable making clinical decisions using FaceTime images 89% (56/63) of the time. CONCLUSIONS Non-physicians can feasibly obtain high-quality and clinically relevant US images using video chat software in LMICs. Commercially available software can connect providers in institutions in LMICs to geographically removed intensivists at a relatively low cost and without the need for extensive training of local providers.
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Affiliation(s)
- Thomas E Robertson
- Department of Medicine, University of Pittsburgh Medical Center, 200 N Lothrop St, Montefiore N715, Pittsburgh, PA 15213, United States
| | - Andrea R Levine
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA 15213, United States
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States
| | - Jessica A Buchner
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States
| | - James H Lantry
- Uniform Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD 21201, United States
| | - Marc T Zubrow
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., 5th Floor, Baltimore, MD 21201, United States
| | - L Nathalie Colas
- Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti
| | - Marc E Augustin
- Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD 21201, United States.
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20
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Dickson R, Duncanson K, Shepherd S. The path to ultrasound proficiency: A systematic review of ultrasound education and training programmes for junior medical practitioners. Australas J Ultrasound Med 2017; 20:5-17. [PMID: 34760465 DOI: 10.1002/ajum.12039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is a form of diagnostic ultrasonography, which has a defined role as a clinical adjunct in patient assessment and management. If it is to continue to develop as a core clinical skill, junior medical practitioners and trainees may benefit from dedicated ultrasound education and familiarisation early in their training. Controversy endures, however, as inappropriate use of this highly technical and operator-dependent imaging modality has negative clinical implications. Aims A systematic review was performed to assess the ability of doctors in training to perform clinically appropriate and beneficial diagnostic ultrasound after undergoing a formal training programme. Methods Studies meeting pre-defined inclusion criteria were identified in electronic databases MEDLINE, EMBASE, CINAHL, PUBMED and through Google Scholar. Methodological quality was assessed using an established series of indicators. Results Fifteen studies were included in the review. Ten of these were performed in the United States, and eight focused on emergency medicine trainees. After the teaching intervention, ten studies assessed overall ultrasound capacity by calculating the collective sensitivity and specificity of trainee-performed ultrasound. Five studies used a standardised objective assessment tool to evaluate ultrasound skills and technique. Studies varied in terms of the specific ultrasound use investigated, teaching programmes used and methodological quality. Consistently identified areas for further research included the definition of the trainee learning curve and what constitutes competency in ultrasound. Conclusions Ultrasound can feasibly be incorporated into junior medical practitioner training, but more research is required to assess its effectiveness and appropriateness.
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Affiliation(s)
- Robert Dickson
- Orange Health Service 1502 Forest Road Orange NSW 2800 Australia
| | - Kerith Duncanson
- Health Education and Training Institute Locked Bag 5022 Gladesville NSW 1675 Australia.,University of Newcastle University Drive Callaghan NSW 2308 Australia
| | - Shamus Shepherd
- Orange Health Service 1502 Forest Road Orange NSW 2800 Australia
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21
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High-Dose Desflurane for Tocolysis During Intrapartum Myelomeningocele Repair in a Patient With Post-Adriamycin Cardiomyopathy. ACTA ACUST UNITED AC 2017; 7:49-52. [PMID: 27182782 DOI: 10.1213/xaa.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High-dose desflurane is an uncommon need during general anesthesia. At our institution, open fetal surgery cases are managed with high desflurane concentrations to ensure uterine relaxation. We present a case of a 32-year-old parturient with a history of mild cardiomyopathy undergoing open fetal myelomeningocele repair. Phenylephrine and dopamine infusions helped maintain hemodynamic stability at 18% desflurane, while cardiac function was monitored with transthoracic echocardiography. This case is notable for the unknown risk of using high-dose desflurane with a preexisting cardiomyopathy and raises the question of the acceptable maternal risk in the setting of fetal surgery.
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22
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Levine AR, Buchner JA, Verceles AC, Zubrow MT, Mallemat HA, Papali A, McCurdy MT. Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine. J Crit Care 2016; 33:51-5. [PMID: 27006267 DOI: 10.1016/j.jcrc.2016.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/20/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Remote telementored ultrasound (RTMUS) systems can deliver ultrasound (US) expertise to regions lacking highly trained bedside ultrasonographers and US interpreters. To date, no studies have evaluated the quality and clinical utility of US images transmitted using commercially available RTMUS systems. METHODS This prospective pilot evaluated the quality of US images (right internal jugular vein, lung apices and bases, cardiac subxiphoid view, bladder) obtained using a commercially available iPad operating FaceTime software. A bedside non-physician obtained images and a tele-intensivist interpreted them. All US screen images were simultaneously saved on the US machine and captured via a FaceTime screen shot. The tele-intensivist and an independent US expert rated image quality and utility in guiding clinical decisions. RESULTS The tele-intensivist rated FaceTime images as high quality (90% [69/77]) and could comfortably make clinical decisions using these images (96% [74/77]). Image quality did not differ between FaceTime and US images (97% (75/77). Strong inter-rater reliability existed between tele-intensivist and US expert evaluations (Spearman's rho 0.43; P<.001). CONCLUSION An RTMUS system using commercially available two-way audiovisual technology can transmit US images without quality degradation. For most anatomic sites assessed, US images acquired using FaceTime are not inferior to those obtained directly with the US machine.
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Affiliation(s)
- Andrea R Levine
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA, 15213, United States.
| | - Jessica A Buchner
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Marc T Zubrow
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., Suite 5-N-162, Baltimore, MD, 21201, United States.
| | - Haney A Mallemat
- University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
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Abstract
The clinical practice of pulmonary and critical care medicine requires procedural competence in many technical domains, including vascular access, airway management, basic and advanced bronchoscopy, pleural procedures, and critical care ultrasonography. Simulation provides opportunities for standardized training and assessment in procedures without placing patients at undue risk. A growing body of literature supports the use and effectiveness of low-fidelity and high-fidelity simulators for procedural training and assessment. In this manuscript by the Skills-based Working Group of the American Thoracic Society Education Committee, we describe the background, available technology, and current evidence related to simulation-based skills training within pulmonary and critical care medicine. We outline working group recommendations for key procedural domains.
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Álvarez-Fernández JA, Núñez-Reiz A. Clinical ultrasound in the ICU: changing a medical paradigm. Med Intensiva 2015; 40:246-9. [PMID: 26724248 DOI: 10.1016/j.medin.2015.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
In recent decades there has been an evolution from the traditional paradigm of sporadic ultrasound performed by radiologists and cardiologists in the ICU to clinical ultrasound performed by intensivists as an extension of patient evaluation rather than as a complementary test. Such clinical ultrasound aims to diagnose and treat the patient directly. All ultrasound modalities could be interesting in the ICU, either helping in decision making or guiding procedures. Clinical ultrasound training should include all the possibilities of ultrasound, and the tutelage of other trained intensivists and other specialists with more experience should be available at all times. Training should be phased into basic, advanced and expert levels, with adjustment to the contents of the CoBaTrICE Project and the recommendations of the SEMICYUC.
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Affiliation(s)
- J A Álvarez-Fernández
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - A Núñez-Reiz
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
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Adler AC, Greeley WJ, Conlin F, Feldman JM. Perioperative Anesthesiology UltraSonographic Evaluation (PAUSE): A Guided Approach to Perioperative Bedside Ultrasound. J Cardiothorac Vasc Anesth 2015; 30:521-9. [PMID: 27013122 DOI: 10.1053/j.jvca.2015.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - William J Greeley
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Frederick Conlin
- Department of Anesthesiology, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA
| | - Jeffrey M Feldman
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Maury É, Pichereau C, Bourcier S, Galbois A, Lejour G, Baudel JL, Ait-Oufella H, Guidet B. [Diagnostic ultrasound in pneumothorax]. Rev Mal Respir 2015; 33:682-691. [PMID: 26320604 DOI: 10.1016/j.rmr.2015.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/12/2015] [Indexed: 11/18/2022]
Abstract
For a long time the lung has been regarded as inaccessible to ultrasound. However, recent clinical studies have shown that this organ can be examined by this technique, which appears, in some situations, to be superior to thoracic radiography. The examination does not require special equipment and is possible using a combination of simple qualitative signs: lung sliding, the presence of B lines and the demonstration of the lung point. The lung sliding corresponds to the artefact produced by the movement of the two pleural layers, one against the other. The B lines indicate the presence of an interstitial syndrome. The presence of lung sliding and/or B lines has a negative predictive value of 100% and formally excludes a pneumothorax in the area where the probe has been applied. The presence of the lung point is pathognomonic of pneumothorax but the sensitivity is no more than 60%. Ultrasound is therefore a rapid and simple means of excluding a pneumothorax (lung sliding or B lines) and of confirming a pneumothorax when the lung point is visible. The question that remains is whether ultrasound can totally replace radiography in the management of this disorder.
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Affiliation(s)
- É Maury
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
| | - C Pichereau
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - S Bourcier
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - A Galbois
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - G Lejour
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - J-L Baudel
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - H Ait-Oufella
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - B Guidet
- Service de réanimation médicale, université Pierre-et-Marie-Curie, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
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Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study. Crit Care Res Pract 2015; 2015:675041. [PMID: 26346694 PMCID: PMC4540974 DOI: 10.1155/2015/675041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/27/2015] [Indexed: 01/02/2023] Open
Abstract
Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows' attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course. Results. There was a significant improvement in CCM fellows' written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course. Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows' proficiency and confidence with ultrasound use in both the short- and long-term settings.
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Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 2015. [PMID: 26160727 DOI: 10.1007/s00134‐015‐3952‐5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU). BACKGROUND POCUS is of growing importance in the ICU. Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown. METHODS Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified. RESULTS Among 1954 patients hospitalized during the study period, 1073 (55%) POCUS/day were performed in 709 (36%) patients. POCUS served for diagnostic assessment in 932 (87%) cases and procedural guidance in 141 (13%) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16% of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69%, respectively. Ultrasound guidance was used in 54 and 15% of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts. CONCLUSIONS With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.
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Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 2015; 41:1638-47. [DOI: 10.1007/s00134-015-3952-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/26/2015] [Indexed: 12/12/2022]
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30
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Ojeda JC, Colbert J, Yialamas M. Pocket-Sized Ultrasound for Physical Diagnosis. J Gen Intern Med 2015; 30:884. [PMID: 25947880 PMCID: PMC4471028 DOI: 10.1007/s11606-015-3319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jason C Ojeda
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Levine AR, McCurdy MT, Zubrow MT, Papali A, Mallemat HA, Verceles AC. Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images. J Crit Care 2015; 30:871-5. [PMID: 26122274 DOI: 10.1016/j.jcrc.2015.05.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/25/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Intensive care unit telemedicine (tele-ICU) uses audiovisual systems to remotely monitor and manage patients. Intensive care unit ultrasound can augment an otherwise limited bedside evaluation. To date, no studies have utilized tele-ICU technology to assess the quality and clinical use of real-time ultrasound images. We assessed whether tele-intensivists can instruct nonphysicians to obtain high-quality, clinically useful ultrasound images. METHODS This prospective pilot evaluated the effectiveness of a brief educational session of nonphysician "ultrasonographers" on their ability to obtain ultrasound images (right internal jugular vein, bilateral lung apices and bases, cardiac subxiphoid view, bladder) with real-time tele-intensivist guidance. All ultrasound screen images were simultaneously photographed with a 2-way camera and saved on the ultrasound machine. The tele-intensivist assessed image quality, and an independent ultrasound expert rated their use in guiding clinical decisions. RESULTS The intensivist rated the tele-ICU camera images as high quality (70/77, 91%) and suitable for guiding clinical decisions (74/77, 96%). Only bilateral lung apices demonstrated differences in quality and clinical use. All other images were rated noninferior and clinically useful. CONCLUSION Tele-intensivists can guide minimally trained nonphysicians to obtain high-quality, clinically useful ultrasound images. For most anatomic sites, tele-ICU images are of similar quality to those acquired directly by ultrasound.
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Affiliation(s)
- Andrea R Levine
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, United States.
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Marc T Zubrow
- Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., Suite 5-N-162, Baltimore, MD, 21201, United States.
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Haney A Mallemat
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
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Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr 2015; 15:63. [PMID: 25993984 PMCID: PMC4494717 DOI: 10.1186/s12887-015-0380-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background Clinical assessment is the gold standard for diagnosis of bronchiolitis. To date, only one study found LUS (Lung Ultrasound) to be a valuable tool in the diagnosis of bronchiolitis. Aim of this study is to evaluate the accuracy of lung ultrasonography in the diagnosis and management of bronchiolitis in infants. Methods This was an observational cohort study of infants admitted to our Pediatric Unit with suspected bronchiolitis. A physical examination and lung ultrasound scans were performed on each patient. Diagnosis and grading of bronchiolitis was assessed according to a clinical and a ultrasound score. An exploratory analysis was used to assess correspondence between the lung ultrasound findings and the clinical evaluation and to evaluate the inter-observer concordance between the two different sonographs. Results One hundred six infants were studied (average age 71 days). According to our clinical score, 74 infants had mild bronchiolitis, 30 had moderate bronchiolitis and two had severe bronchiolitis. 25 infants composed the control group. Agreement between the clinical and sonographic diagnosis was good (90.6 %) with a statistically significant inter-observer ultrasound diagnosis concordance (89.6 %). Lung ultrasound permits the identification of infants who are in need of supplementary oxygen with a specificity of 98.7 %, a sensitivity of 96.6 %, a positive predictive value of 96.6 % and a negative predictive value of 98.7 %. An aberrant ultrasound lung pattern in posterior chest area was collected in 86 % of infants with bronchiolitis. In all patients clinical improvement at discharge was associated with disappearance of the previous LUS findings. Subpleural lung consolidation of 1 cm or more in the posterior area scan and a quantitative classification of interstitial syndrome based on intercostal spaces involved bilaterally, good correlate with bronchiolitis severity and oxygen use. Conclusions The lung ultrasound findings strictly correlate with the clinical evaluations in infants with bronchiolitis and permit the identification of infants who are in need of supplementary oxygen with high specificity. Scans of the posterior area are more indicative in ascertaining the severity of bronchiolitis. Trial registration Clinical Trial Registration NCT01993797
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Ahn C, Kim C, Kang BS, Choi HJ, Cho JH. Variation of availability and frequency of emergency physician-performed ultrasonography between adult and pediatric patients in the academic emergency department in Korea. Clin Exp Emerg Med 2015; 2:16-23. [PMID: 27752568 PMCID: PMC5052851 DOI: 10.15441/ceem.14.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 07/25/2014] [Accepted: 08/10/2014] [Indexed: 11/23/2022] Open
Abstract
Objective This study investigates the availability and frequency of emergency physician-performed ultrasonography (USG) in the emergency department (ED) and the status of USG training programs in emergency medicine residencies in academic EDs in Korea. Methods In spring 2014, a link to a 16-question, multiple-choice, and rating scale web-based survey was e-mailed to all 97 academic ED residency training directors in Korea. Results The response rate was 83.5% (81/97). All respondents had their own USG machines in the ED. In total, 82.7% of respondents reported that emergency physician-performed adult USGs were usually conducted daily, whereas only 23.6% performed pediatric USGs daily. Moreover, 55.5% performed pediatric USG fewer than once a week. 74.1% of respondents had education programs for adult USG in residency training, but only 21.0% had programs for pediatric USG. There was a high association between the presence of education programs and the use of USG in both groups. The faculty members who most commonly participated in teaching ED residents how to perform USG were emergency physicians (67.9%). Only 17.3% of respondents reported that they always supported a quality assurance process. The training directors generally agreed with the advantages in emergency physician-performed USGs. Conclusion The availability of ultrasound machines was high both for adult and pediatric EDs. Nevertheless, the frequency of Emergency physician-performed USG for pediatric patients was low, which was related to the lack of the training programs for treating pediatric patients.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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Zieleskiewicz L, Cornesse A, Hammad E, Haddam M, Brun C, Vigne C, Meyssignac B, Remacle A, Chaumoitre K, Antonini F, Martin C, Leone M. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost. Anaesth Crit Care Pain Med 2015; 34:41-4. [PMID: 25829314 DOI: 10.1016/j.accpm.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of implementing a daily lung ultrasound round on the number of chest radiographs and chest computed tomography (CT) scans in a polyvalent intensive care unit (ICU). STUDY DESIGN Retrospective study comparing two consecutive periods. PATIENTS All patients hospitalized for longer than 48 hours in a polyvalent ICU. METHODS Implementation of a daily lung ultrasound round after a short educational program. The number of chest radiographs and chest CT scans and the patient outcome were measured before (group PRE) and after (group POST) the implementation of a daily lung ultrasound round. RESULTS No demographic difference was found between the two groups, with the exception of a higher severity score in the group POST. For each ICU stay, the number of chest radiographs was 10.3 ± 12.4 in the group PRE and 7.7 ± 10.3 in the group POST, respectively (P<0.005) The number of chest CT scans was not reduced in the group POST, as compared with the group PRE (0.5 ± 0.7 CT scan/patient/ICU stay versus 0.4 ± 0.6 CT scan/patient/ICU stay, P=0.01). The ICU mortality was similar in both groups (21% versus 22%, P=0.75) CONCLUSION: The implementation of a daily lung ultrasound round was associated with a reduction in radiation exposure and medical cost without altering patient outcome.
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Affiliation(s)
- L Zieleskiewicz
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - A Cornesse
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - E Hammad
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - M Haddam
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Brun
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Vigne
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - B Meyssignac
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - A Remacle
- Department of medical informatics, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - K Chaumoitre
- Department of radiology, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - F Antonini
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Martin
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - M Leone
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
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Abstract
OBJECTIVE The purpose of this study was to assess the learning needs of pediatric critical care (PCC) physicians in bedside ultrasound (BUS) use. METHODS This was a survey-based study conducted at an academic center with a PCC fellowship program. We surveyed PCC fellows and faculty to elicit their views on BUS and asked them about the frequency of use, their perception of the clinical utility, and their level of confidence in performing different BUS applications. RESULTS There was no statistical difference in the self-reported use of BUS applications in the faculty and fellows, except for cardiac arrest, which 66.7% of the faculty used but none of the fellows did (P < 0.05). There were no statistically significant differences between perceived usefulness and confidence in the performance of BUS applications between the fellows and faculty. The largest gaps between perceived usefulness and confidence in performing BUS applications were for left ventricle ejection fraction (Δ = 2.72), inferior vena cava collapse (Δ = 2.67), pulmonary edema (Δ = 2.22), and pneumothorax (Δ = 2.11). CONCLUSIONS Pediatric critical care providers report limited confidence in several applications that they perceive as useful and are therefore likely motivated to learn BUS applications. Concentrating curricula on those applications with the greatest differences between usefulness and confidence and building on the confidence of those applications the PCC providers are already using will serve to expand availability and increase use of this high-impact technology.
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Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III. J Thromb Thrombolysis 2015; 37:298-302. [PMID: 23722715 DOI: 10.1007/s11239-013-0945-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Doppler ultrasonography is a standard in diagnosis of deep vein thrombosis (DVT) but is often delayed. Clinician-performed focused vascular sonography (FVS) has proven to accurately diagnose DVT in the ambulatory and emergency room settings. Whether trained medical residents can perform quality FVS in the critically ill is unknown. Medical residents were trained in a 2-hour module in FVS assessing for complete compressibility of common femoral and popliteal veins. Residents imaged consecutive medical ICU and intermediate care patients awaiting comprehensive, sonographer-performed and radiologist-interpreted examinations. Sensitivity, specificity, positive and negative predictive values of the focused examination were calculated against the comprehensive study. Fleiss Kappa (κ), the degree of agreement between resident and radiologist, was calculated. Time savings was measured. Nineteen residents performed 143 studies on 75 patients. Twelve patients had above-the-knee DVTs, a prevalence of 16 %. All 6 common femoral and 7 of 9 popliteal vein DVTs were identified. None of 6 isolated superficial femoral DVTs were identified. Sensitivity for above-the-knee DVT was 63 %, specificity 97 %. Sensitivity for common femoral and popliteal DVT was 86 %, specificity 97 %. Residents showed substantial agreement with radiologists for diagnosis of DVT (κ = 0.70, SE 0.114, p < 0.001).Time from order of a formal ultrasound to a radiologist's read averaged 14.7 h. The two-point compression ultrasound method demonstrated insufficient sensitivity in a cohort of critically ill medical patients due to a high-incidence of superficial femoral DVT. However, residents demonstrated substantial agreement with radiologists for the diagnosis of clinically relevant DVT after a 2-hour course. FVS should include the superficial femoral vein and is associated with a significant time savings.
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Ojeda JC, Colbert JA, Lin X, McMahon GT, Doubilet PM, Benson CB, Wu J, Katz JT, Yialamas MA. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med 2015; 30:199-206. [PMID: 25387438 PMCID: PMC4314490 DOI: 10.1007/s11606-014-3086-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/17/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded. OBJECTIVE We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice. DESIGN This was a randomized parallel group controlled trial. PARTICIPANTS Forty internal medicine residents in a single program at an academic medical center participated in the study. INTERVENTION Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice. MAIN MEASURES The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound. KEY RESULTS Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p = 0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group's 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p = 0.023). CONCLUSIONS The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice. TRIAL REGISTRATION clinicaltrials.gov: number NCT01948076; URL http://clinicaltrials.gov/ct2/show/study/NCT01948076?term=ultrasound+physical+exam&rank=2.
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Affiliation(s)
- Jason C Ojeda
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
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Beaulieu Y, Laprise R, Drolet P, Thivierge RL, Serri K, Albert M, Lamontagne A, Bélliveau M, Denault AY, Patenaude JV. Bedside ultrasound training using web-based e-learning and simulation early in the curriculum of residents. Crit Ultrasound J 2015; 7:1. [PMID: 25852842 PMCID: PMC4384705 DOI: 10.1186/s13089-014-0018-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Focused bedside ultrasound is rapidly becoming a standard of care to decrease the risks of complications related to invasive procedures. The purpose of this study was to assess whether adding to the curriculum of junior residents an educational intervention combining web-based e-learning and hands-on training would improve the residents' proficiency in different clinical applications of bedside ultrasound as compared to using the traditional apprenticeship teaching method alone. METHODS Junior residents (n = 39) were provided with two educational interventions (vascular and pleural ultrasound). Each intervention consisted of a combination of web-based e-learning and bedside hands-on training. Senior residents (n = 15) were the traditionally trained group and were not provided with the educational interventions. RESULTS After the educational intervention, performance of the junior residents on the practical tests was superior to that of the senior residents. This was true for the vascular assessment (94% ± 5% vs. 68% ± 15%, unpaired student t test: p < 0.0001, mean difference: 26 (95% CI: 20 to 31)) and even more significant for the pleural assessment (92% ± 9% vs. 57% ± 25%, unpaired student t test: p < 0.0001, mean difference: 35 (95% CI: 23 to 44)). The junior residents also had a significantly higher success rate in performing ultrasound-guided needle insertion compared to the senior residents for both the transverse (95% vs. 60%, Fisher's exact test p = 0.0048) and longitudinal views (100% vs. 73%, Fisher's exact test p = 0.0055). CONCLUSIONS Our study demonstrated that a structured curriculum combining web-based education, hands-on training, and simulation integrated early in the training of the junior residents can lead to better proficiency in performing ultrasound-guided techniques compared to the traditional apprenticeship model.
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Affiliation(s)
- Yanick Beaulieu
- />Faculty of Medicine, Department of Medicine and Hôpital Sacré-Coeur, 5400 boul. Gouin ouest, Montréal, H4J 1C5 Canada
| | - Réjean Laprise
- />Faculty of Medicine, Department of Medicine and Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, H3T 1J4 Canada
| | - Pierre Drolet
- />Faculty of Medicine, Department of Medicine and Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, H3T 1J4 Canada
| | - Robert L Thivierge
- />Faculty of Medicine, Department of Medicine and Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, H3T 1J4 Canada
| | - Karim Serri
- />Faculty of Medicine, Department of Medicine and Hôpital Sacré-Coeur, 5400 boul. Gouin ouest, Montréal, H4J 1C5 Canada
| | - Martin Albert
- />Faculty of Medicine, Department of Medicine and Hôpital Sacré-Coeur, 5400 boul. Gouin ouest, Montréal, H4J 1C5 Canada
- />Research Centre, Hôpital Sacré-Coeur, 5400 boul. Gouin ouest, Montréal, H4J 1C5 Canada
| | - Alain Lamontagne
- />Faculty of Medicine, Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Bélanger, Montréal, H1T 1C8 Canada
| | - Marc Bélliveau
- />Faculty of Medicine, Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Bélanger, Montréal, H1T 1C8 Canada
| | - André-Yves Denault
- />Faculty of Medicine, Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Bélanger, Montréal, H1T 1C8 Canada
| | - Jean-Victor Patenaude
- />Faculty of Medicine, Department of Medicine and Centre d’Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, H3T 1J4 Canada
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Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model*. Crit Care Med 2014; 42:2169-77. [PMID: 24797377 DOI: 10.1097/ccm.0000000000000413] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The spread of basic critical care echocardiography may be limited by training resources. Another barrier is the lack of information about the learning trajectory and prognostic impact of individual basic critical care echocardiography domains like acute cor pulmonale determination and left ventricular function estimation. We thus developed a minimally resourced training model and studied the latter outcomes. DESIGN Prospective observational study. SETTING Twenty-bed medical ICU. SUBJECTS Echocardiography-naive trainees enrolled in the first year of our Pulmonary Medicine Fellowship Program from September 2012 to September 2013. INTERVENTIONS We described the learning trajectory in six basic critical care echocardiography domains (adequate views, pericardial effusion, acute cor pulmonale, left ventricular ejection fraction, mitral regurgitation, and inferior vena cava variability) and correlated abnormalities in selected basic critical care echocardiography domains with clinical outcomes (mortality and length of stay). MEASUREMENTS AND MAIN RESULTS Three-hundred forty-three basic critical care echocardiography scans were done for 318 patients by seven fellows (median of 40 scans per fellow; range, 34-105). Only one-third patients had normal basic critical care echocardiography studies. Accuracy in various basic critical care echocardiography domains was high (> 90%), especially beyond the first 30 examinations. Acute cor pulmonale was associated with ICU mortality when adjusted for Acute Physiology and Chronic Health Evaluation II score and presence of sepsis, whereas mitral regurgitation was associated with longer hospitalization only on univariate analysis. CONCLUSIONS Basic critical care echocardiography training using minimal resources is feasible. New trainees can achieve reasonable competency in most basic critical care echocardiography domains after performing about 30 examinations within the first year. The relatively high prevalence of abnormalities and the significant association of acute cor pulmonale with ICU mortality support the need for basic critical care echocardiography training.
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Mayo PH, Maury E. Echography is mandatory for the initial management of critically ill patients: we are not sure. Intensive Care Med 2014; 40:1760-2. [PMID: 25288206 DOI: 10.1007/s00134-014-3460-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Paul H Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, North Shore/LIJ Medical Center, Hofstra North Shore/LIJ School of Medicine, Hempstead, NY, USA,
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Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging 2014; 5:253-79. [PMID: 24519789 PMCID: PMC3999368 DOI: 10.1007/s13244-014-0309-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. METHODS This is a narrative review combined with a structured Medline literature search. RESULTS Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size. CONCLUSIONS Ultrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits. TEACHING POINTS • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesia, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Denmark,
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Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, Davidsen JR, Rasmussen F. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2014; 144:1868-1875. [PMID: 23948720 DOI: 10.1378/chest.13-0882] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute respiratory symptoms. METHODS A prospective blinded observational study was conducted in a medical ED. Inclusion criteria were the presence of one or more of the following: respiratory rate > 20/min, oxygen saturation < 95%, oxygen therapy initiated, dyspnea, cough, or chest pain. After the initial assessment, focused sonography of the heart, lungs, and deep veins was performed by a physician blinded to patient history and the results of the primary assessment. RESULTS One hundred thirty-nine patients were included. The focused sonographic examinations could be performed in 134 patients (96%). Focused sonography identified 19 patients (14%) with an acute life-threatening condition missed at the primary assessment. Diagnostic performance of focused sonography for the diagnosis of an acute life-threatening condition, when using audit as gold standard, was as follows: sensitivity, 100% (95% CI, 85.2%-100%); specificity, 93.3% (95% CI, 86.7%-97.3%); positive predictive value, 76.7% (95% CI, 57.7%-90.1%); and negative predictive value, 100% (95% CI, 96.3%-100%). CONCLUSIONS Focused sonography of the heart, lungs, and deep veins is fast, highly feasible, and able to diagnose life-threatening conditions missed at the primary assessment in admitted patients with acute respiratory symptoms. In an ED setting sonography can be used both for ruling in and ruling out acute life-threatening conditions in these patients.
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Affiliation(s)
- Christian B Laursen
- Research Unit at the Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Erik Sloth
- Department of Anesthesia and Intensive Care, Aarhus University Hospital, Skejby, Denmark
| | - Jess Lambrechtsen
- Department of Medicine, Odense University Hospital-Svendborg, Svendborg, Denmark
| | | | | | - Daniel Pilsgaard Henriksen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Finn Rasmussen
- Department of Allergy and Respiratory Medicine, Near East University Hospital, Nicosia, North Cyprus, Turkey
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Caronia J, Panagopoulos G, Devita M, Tofighi B, Mahdavi R, Levin B, Carrera L, Mina B. Focused renal sonography performed and interpreted by internal medicine residents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2007-2012. [PMID: 24154905 DOI: 10.7863/ultra.32.11.2007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Intensivist-performed focused sonography, including renal sonography, is becoming accepted practice. Whether internal medicine residents can be trained to accurately rule out renal obstruction and identify sonographic findings of chronic kidney disease is unknown. The purpose of this study was to test the ability of residents to evaluate for this specific constellation of findings. METHODS Internal medicine residents were trained in a 5-hour module on focused renal sonography evaluating renal length, echogenicity, hydronephrosis, and cysts on a convenience sample of medical ward, intermediate care, and medical intensive care unit patients. All patients underwent comprehensive sonography within 24 hours. The primary outcome was represented by the Fleiss κ statistic, which indicated the degree of interobserver agreement between residents and radiologists. Sensitivity, specificity, and positive and negative predictive values were calculated using the comprehensive radiologist-read examination as the reference. RESULTS Seventeen internal medicine residents imaged 125 kidneys on 66 patients. The average number of studies performed was 7.3 (SD, 6.6). Residents demonstrated excellent agreement with radiologists for hydronephrosis (κ = 0.73; P < .001; SE, 0.15; sensitivity, 94%; specificity, 93%), moderate agreement for echogenic kidneys (κ = 0.43; P < .001; SE, 0.13; sensitivity, 40%; specificity, 98%), and substantial agreement for renal cysts (κ = 0.61; P < .001; SE, 0.12; sensitivity, 60%; specificity, 96%). Residents showed sensitivity of 100% and specificity of 88% for identification of atrophic kidneys, defined as length less than 8 cm. CONCLUSIONS After a 5-hour training course, medical residents accurately identified hydronephrosis and key sonographic findings of chronic kidney disease in a cohort of medical patients. Screening for hydronephrosis and renal atrophy can be performed by medical residents after adequate training.
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Affiliation(s)
- Jonathan Caronia
- Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, 100 E 77th St, New York, NY 10075 USA.
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Schmidt GA, Kory P. Ultrasound-guided central venous catheter insertion: teaching and learning. Intensive Care Med 2013; 40:111-3. [PMID: 24013437 DOI: 10.1007/s00134-013-3093-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Gregory A Schmidt
- Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, IA, USA,
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Ashton-Cleary D. Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting? Br J Anaesth 2013; 111:152-60. [DOI: 10.1093/bja/aet076] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Zhou Z, Xiao G. Conformational conversion of prion protein in prion diseases. Acta Biochim Biophys Sin (Shanghai) 2013; 45:465-76. [PMID: 23580591 DOI: 10.1093/abbs/gmt027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prion diseases are a group of infectious fatal neurodegenerative diseases. The conformational conversion of a cellular prion protein (PrP(C)) into an abnormal misfolded isoform (PrP(Sc)) is the key event in prion diseases pathology. Under normal conditions, the high-energy barrier separates PrP(C) from PrP(Sc) isoform. However, pathogenic mutations, modifications as well as some cofactors, such as glycosaminoglycans, nucleic acids, and lipids, could modulate the conformational conversion process. Understanding the mechanism of conformational conversion of prion protein is essential for the biomedical research and the treatment of prion diseases. Particularly, the characterization of cofactors interacting with prion protein might provide new diagnostic and therapeutic strategies.
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Affiliation(s)
- Zheng Zhou
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China
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Abstract
Radiology is critical in managing patients on intensive care units. The portable chest X-ray is widely used, but ultrasound and computed tomography are of diagnostic value in selected cases. This article discusses the role of thoracic imaging in the intensive care unit.
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Maslove DM, Chen BTM, Wang H, Kuschner WG. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med 2013; 28:24-36. [PMID: 22080544 DOI: 10.1177/0885066611403264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pleural effusions are common in critically ill patients. Most effusions in intensive care unit (ICU) patients are of limited clinical significance; however, some are important and require aggressive management. Transudative effusions in the ICU are commonly caused by volume overload, decreased plasma oncotic pressure, and regions of altered pleural pressure attributable to atelectasis and mechanical ventilation. Exudates are sequelae of pulmonary or pleural infection, pulmonary embolism, postsurgical complications, and malignancy. Increases in pleural fluid volume are accommodated principally by chest wall expansion and, to a lesser degree, by lung collapse. Studies in mechanically ventilated patients suggest that pleural fluid drainage can result in improved oxygenation for up to 48 hours, but data on clinical outcomes are limited. Mechanically ventilated patients with pleural effusions should be semirecumbant and treated with higher levels of positive-end expiratory pressure. Rarely, large effusions can cause cardiac tamponade or tension physiology, requiring urgent drainage. Bedside ultrasound is both sensitive and specific for diagnosing pleural effusions in mechanically ventilated patients. Sonographic findings of septation and homogenous echogenicity may suggest an exudative effusion, but definitive diagnosis requires pleural fluid sampling. Thoracentesis should be carried out under ultrasound guidance. Antibiotic regimens for parapneumonic effusions should be based on current pneumonia guidelines, and anaerobic coverage should be included in the case of empyema. Decompression of the pleural space may be necessary to improve respiratory mechanics, as well as to treat complicated effusions. While small-bore catheters inserted under ultrasound guidance may be used for nonseptated effusions, surgical consultation should be sought in cases where this approach fails, or where the effusion appears complex and septated at the outset. Further research is needed to determine the effects of pleural fluid drainage on clinical outcomes in mechanically ventilated patients, to evaluate weaning strategies that include pleural fluid drainage, and to better identify patients in whom pleural effusions are more likely to be infected.
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Affiliation(s)
- David M Maslove
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
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