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Zieleskiewicz L, Lopez A, Hraiech S, Baumstarck K, Pastene B, Di Bisceglie M, Coiffard B, Duclos G, Boussuges A, Bobbia X, Einav S, Papazian L, Leone M. Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:34. [PMID: 33482873 PMCID: PMC7825196 DOI: 10.1186/s13054-021-03466-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/12/2021] [Indexed: 01/27/2023]
Abstract
Background Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809.
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Affiliation(s)
- Laurent Zieleskiewicz
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France. .,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, 13005, Marseille, France.
| | - Alexandre Lopez
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Karine Baumstarck
- Centre D'Etudes et de Recherches sur les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Bruno Pastene
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Mathieu Di Bisceglie
- Assistance Publique Hôpitaux de Marseille, Service d'Imagerie Médicale, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Benjamin Coiffard
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Gary Duclos
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Alain Boussuges
- Assistance Publique Hôpitaux de Marseille, Service des Explorations Fonctionnelles Respiratoires, Aix Marseille University, 13015, Marseille, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, 13005, Marseille, France
| | - Xavier Bobbia
- Intensive Care Unit, Department of Anesthesiology, Emergency and Critical Care Medicine, University Hospital Nîmes, 30000, Nîmes, France
| | - Sharon Einav
- Surgical Intensive Care Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
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Tavares J, Ivo R, Gonzalez F, Lamas T, Mendes JJ. Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation. Open Access Emerg Med 2019; 11:133-145. [PMID: 31372068 PMCID: PMC6628156 DOI: 10.2147/oaem.s199137] [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] [Received: 12/22/2018] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
Ultrasound technology is an essential tool in the management of critically ill patients. Point-of-care ultrasonography (POCUS) enables data collection from different anatomic areas to achieve the most probable diagnosis and administer the right therapy at the right time. Despite the increasing utilization of POCUS, there is still a lack of standards to establish how to use different bedside ultrasound protocols, and it is imperative to develop a unifying protocol. Thus, the aim of this paper is to establish a new systematized approach that can be adopted by all physicians to implement POCUS for critically ill patient management. To achieve this, we propose a new systematized approach—Global Ultrasound Check for the Critically Ill (GUCCI)—that integrates multiple protocols. This protocol is organized based on three syndromes (acute respiratory failure, shock, and cardiac arrest) and includes ultrasound-guided procedures.
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Affiliation(s)
- João Tavares
- Internal Medicine Department, Hospital da Luz, Lisbon, Portugal
| | - Rita Ivo
- Internal Medicine Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Filipe Gonzalez
- Intensive Care Unit, Hospital Garcia de Orta, Almada, Portugal
| | - Tomás Lamas
- Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal
| | - João João Mendes
- Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal
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Tarrazo Suárez JA, Morales Cano JM, Pujol Salud J, Sánchez Barrancos IM, Diaz Sánchez S, Conangla Ferrín L. [Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. Aten Primaria 2019; 51:367-379. [PMID: 31101376 PMCID: PMC6836943 DOI: 10.1016/j.aprim.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
La ecografía clínica es una herramienta que complementa a la anamnesis y a la exploración física, lo que facilita y agiliza la toma de decisiones en cualquier entorno de atención médica El médico de familia es el especialista que más se puede beneficiar del empleo de la ecografía porque debe ser competente en todos los terrenos de la enfermedad El estudio mediante ecografía, por su fiabilidad, seguridad, reproducibilidad y bajo coste debe estar accesible para su empleo en atención primaria, tanto en el ámbito de la atención normal como la urgente Esta técnica, aplicada en escenarios concretos y con una sistemática de estudio definida, confirma o descarta enfermedades, lo que orienta el diagnóstico con elevada fiabilidad, así como sustenta de modo eficaz la conducta del profesional Este artículo revisa la fiabilidad y la utilidad de la ecografía clínica en escenarios como la enfermedad cervical, y en diferentes situaciones de urgencia, como sospecha de trombosis venosa profunda en la extremidad inferior, traumatismo toracoabdominal, inestabilidad hemodinámica o parada cardiaca
La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca.
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Affiliation(s)
- José Antonio Tarrazo Suárez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Siero-Sariego, Servicio Asturiano de Salud, Pola de Siero, Asturias, España
| | - José Manuel Morales Cano
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Ciudad Real 2, Servicio de Salud de Castilla-La Mancha, Ciudad Real, España
| | - Jesús Pujol Salud
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Balaguer, Instituto Catalán de Salud, Balaguer, Lleida, España
| | - Ignacio Manuel Sánchez Barrancos
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio de Membrilla, Centro de Salud Manzanares 2, Servicio de Salud de Castilla-La Mancha, Membrilla, Ciudad Real, España.
| | - Santiago Diaz Sánchez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Pintores de Parla, Servicio Madrileño de Salud, Parla, Madrid. España
| | - Laura Conangla Ferrín
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Badalona-2, Centre Dalt la Vila, Instituto Catalán de Salud, Badalona, Barcelona, España
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Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology 2017; 283:30-48. [DOI: 10.1148/radiol.2017160107] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John R. Richards
- From the Departments of Emergency Medicine (J.R.R.) and Radiology (J.P.M.), University of California, Davis Medical Center, 4860 Y St, Sacramento, CA 95817
| | - John P. McGahan
- From the Departments of Emergency Medicine (J.R.R.) and Radiology (J.P.M.), University of California, Davis Medical Center, 4860 Y St, Sacramento, CA 95817
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Jammal M, Milano P, Cardenas R, Mailhot T, Mandavia D, Perera P. The diagnosis of right heart thrombus by focused cardiac ultrasound in a critically ill patient in compensated shock. Crit Ultrasound J 2015; 7:6. [PMID: 25995832 PMCID: PMC4437995 DOI: 10.1186/s13089-015-0023-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/19/2015] [Indexed: 02/06/2023] Open
Abstract
Right heart thrombus (RHT) is a life-threatening diagnosis that is rarely made in the emergency department (ED), but with the increasing use of focused cardiac ultrasound (FocUS), more of these cases may be identified in a timely fashion. We present a case of an ill-appearing patient who had an immediate change in management due to the visualization of RHT soon after arrival to the ED. The diagnosis was confirmed after a cardiology-performed ultrasound (US). This case illustrates the value of the recognition of RHT on FocUS and how US protocols designed for the evaluation of shock and shortness of breath may potentially be expanded to patients in a 'compensated' or 'pre-shock' state to expedite the correct diagnosis and to facilitate more timely management.
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Affiliation(s)
- Mansour Jammal
- />Division of Emergency Medicine, 300 Pasteur Drive, Alway Building, M121, Stanford, CA 94305 USA
| | - Peter Milano
- />Department of Emergency Medicine, Los Angeles County + USC Medical Center, 1200 N. State St # 1011, , Los Angeles, CA 90033 USA
| | - Renzo Cardenas
- />Department of Emergency Medicine, Los Angeles County + USC Medical Center, 1200 N. State St # 1011, , Los Angeles, CA 90033 USA
| | - Thomas Mailhot
- />Department of Emergency Medicine, Los Angeles County + USC Medical Center, 1200 N. State St # 1011, , Los Angeles, CA 90033 USA
| | - Diku Mandavia
- />Department of Emergency Medicine, Los Angeles County + USC Medical Center, 1200 N. State St # 1011, , Los Angeles, CA 90033 USA
| | - Phillips Perera
- />Division of Emergency Medicine, 300 Pasteur Drive, Alway Building, M121, Stanford, CA 94305 USA
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