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Martocchia A, Bentivegna E, Sergi D, Luciani M, Barlattani M, Notarangelo MF, Piccoli C, Sesti G, Martelletti P. The Point-of-Care Ultrasound (POCUS) by the Handheld Ultrasound Devices (HUDs) in the COVID-19 Scenario: a Review of the Literature. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:1. [PMID: 36407770 PMCID: PMC9665043 DOI: 10.1007/s42399-022-01316-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/10/2023]
Abstract
The use of portable ultrasound (US) devices is increasing, due to its accessibility, versatility, non-invasiveness, and its significant support in the patient management, extending the traditional physical examination through the POCUS (point-of-care ultrasound). The pocket-size or handheld ultrasound devices (HUDs) can easily perform focused exams, not aiming to substitute for the high-end US systems (gold standard), since the HUDs usually have more limited functions. The HUDs are promising tools for the diagnosis, prognosis, and monitoring of the COVID-19 infection and its related disorders. In conclusion, the routine use of HUDs may ameliorate the management of COVID-19 pandemic, according to the guidelines for the POCUS approach and the procedures for the protection of the patients and the professionals.
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Affiliation(s)
- Antonio Martocchia
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Enrico Bentivegna
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Daniela Sergi
- Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michelangelo Luciani
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Michela Barlattani
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Fortunato Notarangelo
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Cinzia Piccoli
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
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Pneumonia-related infiltration of the pericardium mimics pericardial effusion, with an echocardiographic finding, surgical result, and outcome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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3
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Ávila-Reyes D, Acevedo-Cardona AO, Gómez-González JF, Echeverry-Piedrahita DR, Aguirre-Flórez M, Giraldo-Diaconeasa A. Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article. Ultrasound J 2021; 13:46. [PMID: 34855015 PMCID: PMC8639882 DOI: 10.1186/s13089-021-00248-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022] Open
Abstract
The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.
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Affiliation(s)
- Diana Ávila-Reyes
- Department of Critical Care Medicine, Universidad Tecnológica de Pereira, Grupo de Investigación Medicina Crítica Y Cuidados Intensivos (GIMCCI), Pereira, Colombia.
| | - Andrés O Acevedo-Cardona
- Department of Critical Care Medicine, Universidad Tecnológica de Pereira,, Pereira, Colombia
- Master en Ecocardiografía en Cuidados Intensivos, Sociedad Española de Imagen Cardíaca/Universidad Francisco de Vitoria, España, Pereira, Spain
| | - José F Gómez-González
- Department of Critical Care Medicine, Universidad Tecnológica de Pereira, Pereira, Colombia
- Grupo Investigación de Medicina Crítica Y Cuidados Intensivos (GIMCCI), Pereira, Colombia
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Lekic M, Lekic V, Riaz IB, Mackstaller L, Marcus FI. The Cardiovascular Physical Examination - Is It Still Relevant? Am J Cardiol 2021; 149:140-144. [PMID: 33753042 DOI: 10.1016/j.amjcard.2021.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
Advances in technology have reshaped the practice of medicine. These changes have greatly benefited our patients. However, in the setting of these advances, the importance of basic clinical tools is more pertinent than ever. Despite the growing reliance on technology, the physical exam remains valuable and cost effective, often enabling the well-trained clinician to arrive at the diagnosis, rapidly and accurately. The physical exam must not become a relic of a distant past. We aim to investigate current competency and proficiency, proposals for change in teaching curriculums, and the relationship with technology such as hand-held echocardiography. A skillful exam provides both emotional and intellectual satisfaction. It may be a lost art but it is well worth the effort to restore.
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Affiliation(s)
- Mateja Lekic
- Department of Primary Care, Phoenix VA Health Care System, Phoenix, Arizona; University of Arizona College of Medicine, Phoenix, Arizona.
| | - Viktor Lekic
- University of Arizona College of Medicine, Tucson, Arizona
| | - Irbaz Bin Riaz
- Department of Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Lorraine Mackstaller
- Department of Internal Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Frank I Marcus
- Department of Cardiology, University of Arizona College of Medicine, Tucson, Arizona
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Martin PV, Chataigneau A, Arnaud FX, Rozwadowski F, Cournac JM, Martin AC. Transthoracic Doppler echocardiography during a military mission in a French role II in Mali: is it useful to learn this practice? Mil Med 2020; 185:e1562-e1568. [DOI: 10.1093/milmed/usaa126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Ultrasound is now recognized as a key tool in the practice of medicine in isolated situations. This study aims to evaluate the impact of transthoracic echocardiography (TTE) in a military mission when performed by a trained military practitioner (MP).
Materials and Methods
We conducted a 2-month retrospective observational study on the use of TTE in a French medical complex in Mali with a mission that included providing a medical aid to the population. All patients were included. Every ultrasound performed by the MP was listed, and the epidemiologic data, indication for the exam and results were collected for each TTE.
Results
A total of 349 patients were included, 16 were war-wounded patients and 333 came for a general medical consultation. In all, 153 ultrasounds were performed, including 48 TTEs. Sixteen TTEs were performed to evaluate injuries in war-wounded patients. During the 333 medical consultations, 32 TTEs were realized. The indications were dyspnoea (10), heart murmur (7), acute chest pain (5) and assessment of heart disease (10). TTE permitted a direct positive diagnosis for 18 patients: 7 with acute heart failure and 11 with morphologic problems. The normality of the exam was a supplementary argument to exclude a cardiac implication for eight patients.
Conclusions
TTE can provide important information with a direct impact on the management of patients. Faced with cardiac emergencies, an adapted training can be proposed for the MP. Thereby, the transfer of conventional cardiac views could facilitate the advice of a cardiologist.
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Affiliation(s)
- Paul-Vincent Martin
- Emergency department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Anaïs Chataigneau
- Orthopedic and traumatology department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - François-Xavier Arnaud
- Radiology department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Faye Rozwadowski
- FAAFP, Primary Care Physician for U.S. Military Veterans, Tallahassee, Florida, 3231, USA
| | - Jean-Marie Cournac
- Internal Medecine department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Anne-Céline Martin
- Department of Cardiology, European Hospital Georges Pompidou, Paris, France
- Université de Paris, Innovative Therapy in Haemostasis, INSERM 1140, Paris, France
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Abstract
Background: Focused cardiac ultrasound (FCU) is widely used by healthcare providers to answer specific questions about cardiac structure and function at the bedside. Currently, no widely accepted FCU image acquisition checklist exists to assess learners with varying skill levels from different specialties. Objective: The primary objective of this project was to develop a consensus-based FCU image acquisition checklist using a multispecialty group of point-of-care ultrasound (POCUS) experts. Methods: The essential components of an FCU examination were identified on the basis of published recommendations from echocardiography and international ultrasound societies. A checklist of the essential components of an FCU examination was drafted. A panel of POCUS experts from different medical specialties in the United States and Canada was convened to vote on each checklist item by answering two questions: 1) Is this item important to include in a checklist of essential FCU skills applicable to any medical specialty? and 2) Should the learner be required to successfully complete this item to be considered competent? A modified Delphi approach was used to assess the level of agreement for each checklist item during four rounds of voting. Checklist items that achieved an agreement of 80% or greater were included in the final checklist. Results: Thirty-one POCUS experts from seven different medical specialties voted on sixty-five items to be included in the FCU image acquisition assessment tool. The majority of POCUS experts (61%) completed all four rounds of voting. During the first round of voting, 59 items reached consensus, and after revision and revoting, an additional 3 items achieved 80% or greater consensus. A total of 62 items were included in the final checklist, and 57 items reached consensus as a requirement for demonstration of competency. Conclusion: We have developed a multispecialty, consensus-based FCU image acquisition checklist that may be used to assess the skills of learners from different specialties. Future steps include studies to develop additional validity evidence for the use of the FCU assessment tool and to evaluate its utility for the translation of skills into clinical practice.
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Abstract
OBJECTIVE This prospective observational study evaluates the utility of expert focused cardiac ultrasound (eFCU) with spectral Doppler to inform decision making in established patients with specific, selected congenital cardiac defects in outreach clinics. Secondary objectives include determining if the addition of eFCU expands capacity in paediatric cardiology outreach clinics and if it improves the patient experience. METHODS Patients aged 2 months to 19 years old with a diagnosis of ventricular septal defect, atrial septal defect, atrioventricular septal defect, patent ductus arteriosus, aortic valve stenosis, or pulmonary valve stenosis with the need for follow-up echocardiography in an outreach clinic from August 2017 to June 2018 were studied. A novel assessment tool was used to determine the success of eFCU. RESULTS Forty-two patients from 11 clinics underwent eFCU with one unsuccessful exam making the failure rate 2.3% (95% CI 0.0006-0.1256). Addition of eFCU led to a significant increase in volume of patients able to be seen 19 versus 15.5 (p < 0.01). A majority of parents/patients reported a positive experience with eFCU. CONCLUSION Expert focused cardiac ultrasound with spectral Doppler can be used successfully for follow-up in patients with select CHD and the addition of eFCU permits increased patient capacity in outreach clinics and has the potential to improve the patient experience.
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Prada G, Fritz AV, Restrepo-Holguín M, Guru PK, Díaz-Gómez JL. Focused Cardiac Ultrasonography for Left Ventricular Systolic Function. N Engl J Med 2019; 381:e36. [PMID: 31747728 DOI: 10.1056/nejmvcm1802841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Gabriel Prada
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - Ashley V Fritz
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - Mariana Restrepo-Holguín
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - Pramod K Guru
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
| | - José L Díaz-Gómez
- From the Departments of Critical Care Medicine (G.P., P.K.G., J.L.D.-G.) and Anesthesiology and Perioperative Medicine (A.V.F., M.R.-H., J.L.D.-G.), Mayo Clinic, Jacksonville, FL
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Boretsky KR, Kantor DB, DiNardo JA, Oren-Grinberg A. Focused Cardiac Ultrasound in the Pediatric Perioperative Setting. Anesth Analg 2019; 129:925-932. [DOI: 10.1213/ane.0000000000004357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Cardiac Ultrasound in the Intensive Care Unit: A Review. Cureus 2019; 11:e4612. [PMID: 31312539 PMCID: PMC6615579 DOI: 10.7759/cureus.4612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Transthoracic echocardiography (TTE) is an incredibly valuable tool in today’s emergency rooms and intensive care units (ICUs). It has the ability to provide a complete evaluation of the structure and function of the heart, the valves, stroke volume, ejection fraction, and much more. Previous academic studies have also determined that point-of-care TTE done by non-cardiologist physicians can also provide higher accuracy in patient assessment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. The aim of this review article is to examine further these point-of-care evaluations, what they entail, their benefits, and where further research would better our own understanding.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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Luong CL, Ong K, Kaila K, Pellikka PA, Gin K, Tsang TSM. Focused Cardiac Ultrasonography: Current Applications and Future Directions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:865-876. [PMID: 30146784 DOI: 10.1002/jum.14773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.
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Affiliation(s)
- Christina L Luong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendeep Kaila
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth Gin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Pocket-Size Hand-Held Echocardiography. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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Maw A, Jalali C, Jannat-Khah D, Gudi K, Logio L, Evans A, Anderson S, Smith J. Faculty development in point of care ultrasound for internists. MEDICAL EDUCATION ONLINE 2016; 21:33287. [PMID: 27974132 PMCID: PMC5156860 DOI: 10.3402/meo.v21.33287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 05/16/2023]
Abstract
Lack of general medicine faculty expertise is a likely contributor to the slow adoption of point of care ultrasound (POCUS) by internal medicine (IM) residency training programs. We developed a 10-week faculty development program, during which 15 faculty members participated in 2 hours and 10 hours of online didactic and hands-on training, respectively. Pre-post comparisons showed that there were statistically significant improvements in faculty participants' ability to interpret images (p<0.001), perceived understanding of the capabilities and limitations of POCUS (p=0.003), comfort using POCUS to make clinical decisions (p=0.003), and perceptions regarding the extent to which POCUS can improve patient care (p=0.026). The next challenge for IM programs is to improve access to ultrasound machines and provide follow-up workshops to facilitate further development of skills and integration of POCUS into daily practice by general medicine faculty.
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Affiliation(s)
- Anna Maw
- Department of Hospital Medicine, New York Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA;
| | - Cathy Jalali
- Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Deanna Jannat-Khah
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kirana Gudi
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Lia Logio
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Arthur Evans
- Department of Hospital Medicine, New York Presbyterian Hospital, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Stacy Anderson
- Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Joshua Smith
- Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
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The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal. BIOMED RESEARCH INTERNATIONAL 2015; 2015:596451. [PMID: 26605333 PMCID: PMC4641179 DOI: 10.1155/2015/596451] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/15/2015] [Accepted: 10/18/2015] [Indexed: 01/22/2023]
Abstract
Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.
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