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Spampinato MD, Portoraro A, Sofia SM, Luppi F, Benedetto M, D'Angelo L, Galizia G, Fabbri IS, Pagano T, Perna B, Guarino M, Passarini G, Pavasini R, Passaro A, De Giorgio R. The role of echocardiography in pulmonary embolism for the prediction of in-hospital mortality: a retrospective study. J Ultrasound 2024; 27:355-362. [PMID: 38519765 PMCID: PMC11178708 DOI: 10.1007/s40477-024-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/11/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE Pulmonary Embolism (PE) is the third leading cause of cardiovascular death, following myocardial infarction and stroke. The latest European Society of Cardiology (ESC) guidelines on PE recommend short-term prognostic stratification based on right ventricular (RV) overload detected by transthoracic echocardiography (TTE) or contrast-enhanced chest CT. The aim of the study is to find out which of the signs of right ventricular dysfunction best predicts in-hospital mortality (IHM). METHODS This is a monocentric, retrospective study including adult patients admitted from the emergency department with a c-e cCT confirmed diagnosis of PE between January 2018 and December 2022 who underwent a TTE within 48 h. RESULTS 509 patients (median age 76 years [IQR 67-84]) were included, with 7.1% IHM. At univariate analysis, RV/LV ratio > 1 (OR 2.23, 95% CI 1.1-4.5), TAPSE < 17 mm (OR 4.73, 95% CI 2.3-9.8), the D-shape (OR 3.73, 95% CI 1.71-8.14), and LVEF < 35% (OR 5.78, 95% CI 1.72-19.47) resulted significantly correlated with IHM. However, at multivariate analysis including also haemodynamic instability, PESI class > II, and abnormal hs-cTnI levels, only LVEF < 35% (OR 5.46, 95% CI 1.32-22.61) resulted an independent predictor of IHM. CONCLUSION Despite the recognised role of TTE in the early management of patients with circulatory shock and suspected PE, signs of RV dysfunction have been shown to be poor predictors of IHM, whereas severely reduced LVEF is an independent risk factor for in-hospital death.
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Affiliation(s)
- Michele Domenico Spampinato
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
- Emergency Medicine Unit, St.Anna University Hospital, Ferrara, Italy
| | - Andrea Portoraro
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Soccorsa M Sofia
- Emergency Medicine Unit, Emergency department, Maggiore Hospital Bologna, Azienda Unità Sanitaria Locale Bologna, Bologna, Italy.
| | - Francesco Luppi
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Marcello Benedetto
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Luca D'Angelo
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Giorgio Galizia
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Irma Sofia Fabbri
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Teresa Pagano
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Benedetta Perna
- School of Emergency Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
- Emergency Medicine Unit, St.Anna University Hospital, Ferrara, Italy
| | - Giulia Passarini
- Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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2
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Lee SY, Ahn JH, Kim HC, Shim TS, Kang PJ, Lee GD, Choi SH, Jung SH, Park SI, Hong SB. Outcomes of Lung Transplantation in Patients With Right Ventricular Dysfunction: A Single-Center Retrospective Analysis Comparing ECMO Configurations in a Bridge-to-Transplant Setting. Transpl Int 2024; 37:12657. [PMID: 38845757 PMCID: PMC11153757 DOI: 10.3389/ti.2024.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
This study aimed to assess the lung transplantation (LT) outcomes of patients with right ventricular dysfunction (RVD), focusing on the impact of various extracorporeal membrane oxygenation (ECMO) configurations. We included adult patients who underwent LT with ECMO as a bridge-to-transplant from 2011 to 2021 at a single center. Among patients with RVD (n = 67), veno-venous (V-V) ECMO was initially applied in 79% (53/67) and maintained until LT in 52% (35/67). Due to the worsening of RVD, the configuration was changed from V-V ECMO to veno-arterial (V-A) ECMO or a right ventricular assist device with an oxygenator (Oxy-RVAD) in 34% (18/67). They showed that lactic acid levels (2-6.1 mmol/L) and vasoactive inotropic score (6.6-22.6) increased. V-A ECMO or Oxy-RVAD was initiated and maintained until LT in 21% (14/67) of cases. There was no significant difference in the survival rates among the three configuration groups (V-V ECMO vs. configuration changed vs. V-A ECMO/Oxy-RVAD). Our findings suggest that the choice of ECMO configuration for LT candidates with RVD should be determined by the patient's current hemodynamic status. Vital sign stability supports the use of V-V ECMO, while increasing lactic acid levels and vasopressor needs may require a switch to V-A ECMO or Oxy-RVAD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sang-Bum Hong
- Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Serrano RA, Smeltz AM. The Promise of Artificial Intelligence-Assisted Point-of-Care Ultrasonography in Perioperative Care. J Cardiothorac Vasc Anesth 2024; 38:1244-1250. [PMID: 38402063 DOI: 10.1053/j.jvca.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
The role of point-of-care ultrasonography in the perioperative setting has expanded rapidly over recent years. Revolutionizing this technology further is integrating artificial intelligence to assist clinicians in optimizing images, identifying anomalies, performing automated measurements and calculations, and facilitating diagnoses. Artificial intelligence can increase point-of-care ultrasonography efficiency and accuracy, making it an even more valuable point-of-care tool. Given this topic's importance and ever-changing landscape, this review discusses the latest trends to serve as an introduction and update in this area.
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Affiliation(s)
| | - Alan M Smeltz
- University of North Carolina School of Medicine, Chapel Hill, NC
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Bronshteyn YS, Hashmi N, Privratsky JR, Barbeito A. Blood or Fat? Differentiating Hemopericardium versus Epicardial Fat Using Focused Cardiac Ultrasound. Diagnostics (Basel) 2024; 14:818. [PMID: 38667464 PMCID: PMC11049036 DOI: 10.3390/diagnostics14080818] [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: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Basic point-of-care ultrasound of the heart-also known as Focused Cardiac Ultrasound (FoCUS)-has emerged as a powerful bedside tool to narrow the differential diagnosis of causes of hypotension. The list of causes of hypotension that a FoCUS provider is expected to be able to recognize includes a compressive pericardial effusion due to hemopericardium (blood in the pericardial sac). But hemopericardium can be difficult to distinguish from a more common condition that is not immediately life-threatening: epicardial fat. This paper reviews illustrative images of both epicardial fat and hemopericardium to provide practice guidance to the FoCUS user on how to differentiate these two phenomena.
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Affiliation(s)
- Yuriy S. Bronshteyn
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
- Durham Veterans Health Administration, Durham, NC 27705, USA
| | - Nazish Hashmi
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
| | - Jamie R. Privratsky
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
| | - Atilio Barbeito
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
- Durham Veterans Health Administration, Durham, NC 27705, USA
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Inchingolo R, Zanforlin A, Buonsenso D, Perrone T, Torri E, Limoli G, Mossolani EE, Tursi F, Soldati G, Marchetti G, Carlucci P, Radovanovic D, Lohmeyer FM, Smargiassi A. Lung Ultrasound Signs: The Beginning. Part 3-An Accademia di Ecografia Toracica Comprehensive Review on Ultrasonographic Signs and Real Needs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:629-641. [PMID: 38168739 DOI: 10.1002/jum.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed-anatomical and artifactual-pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Service of Pulmonology, Health District of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziano Perrone
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Elena Torri
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | | | - Paolo Carlucci
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | | | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Musolino AM, Di Sarno L, Buonsenso D, Murciano M, Chiaretti A, Boccuzzi E, Mesturino MA, Villani A. Use of POCUS for the assessment of dehydration in pediatric patients-a narrative review. Eur J Pediatr 2024; 183:1091-1105. [PMID: 38133810 DOI: 10.1007/s00431-023-05394-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions and pleural and pericardial effusions, but less to evaluate fluid depletion. The main aim of this review is to analyze the current literature on the assessment of dehydration in pediatric patients by using POCUS. The size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for hypovolemia. A dilated IVC with decreased collapsibility (< 50%) is a sign of increased right atrial pressure. On the contrary, a collapsed IVC may be indicative of hypovolemia. The IVC collapsibility index (cIVC) reflects the decrease in the diameter upon inspiration. Altogether the IVC diameter and collapsibility index can be easily determined, but their role in children has not been fully demonstrated, and an estimation of volume status solely by assessing the IVC should thus be interpreted with caution. The inferior vena cava/abdominal aorta (IVC/AO) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS could be a valuable supplementary tool in the assessment of dehydration in several clinical scenarios, enabling rapid identification of life-threatening primary etiologies and helping physicians avoid inappropriate therapeutic interventions. Conclusion: POCUS can provide important information in the assessment of intravascular fluid status in emergency scenarios, but measurements may be confounded by a number of other clinical variables. The inclusion of lung and cardiac views may assist in better understanding the patient's physiology and etiology regarding volume status. What is Known: • In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions (like pneumonia and bronchiolitis) and pleural and pericardial effusions, but less to evaluate fluid depletion. • The size of the IVC (inferior vena cava) and its change in diameter in response to respiration have been studied as a possible screening tool to assess the volume status, predict fluid responsiveness, and assess potential intolerance to fluid loading. What is New: • The IVC diameter and collapsibility index can be easily assessed, but their role in predicting dehydration in pediatric age has not been fully demonstrated, and an estimation of volume status only by assessing the IVC should be interpreted carefully. • The IVC /AO(inferior vena cava/abdominal aorta) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS can be a valuable supplementary tool in the assessment of intravascular volume in several clinical scenarios.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenzo Di Sarno
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Manuel Murciano
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Alessia Mesturino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Bughrara NF, Neilson MR, Jones S, Workman L, Chopra A, Pustavoitau A. Is 1 Day of Focused Training in Echocardiographic Assessment Using Subxiphoid-Only (EASy) Examination Enough? A Tertiary Hospital Response to the COVID-19 Crisis and the Use of the EASy Examination to Support Unit-Wide Image Acquisition. Crit Care Explor 2024; 6:e1038. [PMID: 38415022 PMCID: PMC10898658 DOI: 10.1097/cce.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES We assessed the efficacy of 1-day training in echocardiography assessment using subxiphoid-only (EASy) followed by supervised image interpretation and decision-making during patient rounds as a novel approach to scaling up the use of point-of-care ultrasound (POCUS) in critically ill patients. DESIGN Retrospective analysis of medical records and EASy examination images. SETTING Tertiary care academic hospital. PATIENTS A total of 14 adults (> 18 yr old) with COVID-19-associated respiratory failure under the care of Albany Medical Center's surge response team from April 6-17, 2020 who received at least one EASy examination. INTERVENTIONS Residents (previously novice sonographers) were trained in EASy examination using 1 day of didactic and hands-on training, followed by independent image acquisition and supervised image interpretation, identification of hemodynamic patterns, and clinical decision-making facilitated by an echocardiography-certified physician during daily rounds. MEASUREMENTS AND MAIN RESULTS We recorded the quality of resident-obtained EASy images, scanning time, and frequency with which the supervising physician had to repeat the examination or obtain additional images. A total of 63 EASy examinations were performed; average scanning time was 4.3 minutes. Resident-obtained images were sufficient for clinical decision-making on 55 occasions (87%), in the remaining 8 (13%) the supervising physician obtained further images. CONCLUSIONS EASy examination is an efficient, valuable tool under conditions of scarce resources. The educational model of 1-day training followed by supervised image interpretation and decision-making allows rapid expansion of the pool of sonographers and implementation of bedside echocardiography into routine ICU patient management.
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Affiliation(s)
- Nibras F Bughrara
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
- Department of Surgery, Albany Medical Center, Albany, NY
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Maegan R Neilson
- Department of Anesthesiology and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Stephanie Jones
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
- Department of Surgery, Albany Medical Center, Albany, NY
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Lorna Workman
- Department of Anesthesiology and Critical Care Medicine, Wagga Wagga Base Hospital, Wagga, NSW, Australia
| | - Amit Chopra
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
- Department of Surgery, Albany Medical Center, Albany, NY
- Department of Internal Medicine, Albany Medical College, Albany Medical Center, Albany, NY
| | - Aliaksei Pustavoitau
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
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8
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Sangha V. Augmenting reality in echocardiography. Heart 2024; 110:387-388. [PMID: 37940380 DOI: 10.1136/heartjnl-2023-323443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Affiliation(s)
- Veer Sangha
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
- Department of Engineering Science, Oxford University, Oxford, UK
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Flamanc T, de Carvalho H, Le Bastard Q, Javaudin F, Pes P, Montassier E, Le Conte P. Impact of an enhanced focused cardiac ultrasound on treatment changes in a population of internal medicine patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:219-224. [PMID: 38031392 DOI: 10.1002/jcu.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Hospitalized patients with acute shortness of breath (SOB) could benefit from an enhanced focused cardiac ultrasound (eFoCUS) with Doppler measurements to reassess treatment and diagnosis. METHODS This was a retrospective observational study performed in a medical ward. Included patients were those hospitalized for acute SOB. The objectives were to assess therapeutic and diagnosis changes associated with eFoCUS. The primary endpoint of the analysis was a composite of introduction or discontinuation of diuretics, antibiotics or anticoagulation following eFoCUS. RESULTS Between January 2018 and July 2021, 119 patients were included, 67 women and 52 men, mean age 84 ± 11 years old. The eFoCUS was performed within a median time of 55 h (1st-3rd IQ: 21-107) following hospital admission. Overall, eFoCUS was associated with a change in diagnostic in 40 patients (34% [CI 95%: 25%-43%], p < 10-4 ) and a change in treatment in 53 patients (45% [CI 95%: 35%-54%], p < 10-4 ). Diuretics were prescribed in 94 patients before eFoCUS and in 56 after (p = 10-4 ), antibiotics in 34 before and 27 after and anticoagulation in 30 before and 40 after. CONCLUSION eFoCUS was associated with both therapeutic and diagnostic changes in patients with SOB. Such results should be confirmed in multicentric prospective studies.
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Affiliation(s)
| | | | - Quentin Le Bastard
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - François Javaudin
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Pes
- Service des Urgences, CHU de Nantes, Nantes, France
| | - Emmanuel Montassier
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Le Conte
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
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10
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Lee J, Lee M, Lee S, Oh CS, Kim TY. Preoperative evaluation of systolic murmur with point-of-care echocardiography before an elective thoracic surgery - A case report. Anesth Pain Med (Seoul) 2024; 19:62-67. [PMID: 38311356 PMCID: PMC10847002 DOI: 10.17085/apm.23124] [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: 10/02/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Systolic murmur suggesting the association of aortic valve (AV) stenosis or obstructive pathology in the left ventricular outflow tract (LVOT) usually requires preoperative echocardiographic evaluation for elective surgery. CASE In a 63-year-old female patient undergoing elective thoracic surgery, the systolic murmur was auscultated on the right sternal border of the second intercostal space in the preoperative patient holding area. Point-of-care (POC) transthoracic echocardiography (TTE) demonstrated a systolic jet flow in the LVOT area. The peak systolic velocity of the continuous wave Doppler tracing, aligned to the LVOT and the AV, was approximately 1.5 m/s. The peak/mean pressure gradient was 11/6 mmHg for the AV and 9/5 mmHg for the LVOT. Anesthesia was induced under continuous TTE imaging. Intraoperative transesophageal echocardiography also confirmed the absence of any cardiac pathology. CONCLUSIONS POC echocardiography offered a thorough preoperative evaluation of an unexpectedly identified systolic murmur, avoiding a potential delay in the operation schedule for conventional preoperative echocardiographic evaluation.
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Affiliation(s)
- Jaemoon Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Minki Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Sookyung Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Chung-Sik Oh
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Yop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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11
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Parra VM, Fita G, Azqueta M, González M, Aranda F, Maestre ML, Silva J, Hortal J, Morales D, Bórquez E, Adasme F, Real MI, Mercadal J, Zelada P, Riobó G, Galdames K, Domenech RJ. Student survey after ten years of continuous blended teaching of echocardiography. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:8-16. [PMID: 37683971 DOI: 10.1016/j.redare.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/25/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To analyse the impact of 10 years of blended echocardiography teaching. METHODS AND RESULTS A questionnaire was emailed to all medical doctors who graduated from the blended learning diploma in echocardiography developed by the University of Chile and taught by a team from Chile and Spain. One hundred and forty of the 210 students who graduated from the program between 2011 and 2020 completed the questionnaire: 53.57% were anaesthesiologists, and 26.42% were intensivists. More than 85% of respondents indicated that the online teaching met their expectations, and 70.2% indicated that the hands-on practice fulfilled the stated objectives. In a retrospective analysis using self-reported data, graduates reported that their use of transthoracic and transoesophageal echocardiography has increased from 24.29% to 40.71% and from 13.57% to 27.86%, repectively, after the programme compared to before the programme. They used echocardiography mainly in the perioperative period (56.7%) and during intensive care (32.3%), while only 11% of respondents used it in emergency care units. Nearly all (92.4%) respondents reported that the skills learned was very useful in their professional practice. CONCLUSIONS Ten years after its launch, the blended learning diploma in echocardiography was well rated by graduate specialists, and is associated with a significant increase in the use of echocardiography in the perioperative period and during intensive care. The main challenges are to establish a longer period of practice and achieve greater implantation in emergency medicine.
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Affiliation(s)
- Víctor M Parra
- Echocardiography Unit, Instituto Nacional del Tórax, Santiago, Chile; Faculty of Medicine, Universidad de Chile, Santiago, Chile.
| | - Guillermina Fita
- Department of Anaesthesiology, Hospital Clínic, Barcelona, Spain
| | - Manel Azqueta
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Mauricio González
- Department of Anaesthesiology and Perioperative Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Fernando Aranda
- Anaesthesia Unit and Surgical Suites, Hospital Dr. Gustavo Fricke, Universidad de Valparaíso, Chile
| | - M Luz Maestre
- Department of Anaesthesiology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Silva
- Echocardiography Unit, Instituto Nacional del Tórax, Santiago, Chile
| | - Javier Hortal
- Department of Anaesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Morales
- Echocardiography Unit, Instituto Nacional del Tórax, Santiago, Chile
| | | | - Fabián Adasme
- Cardiovascular Service, Clínica Santa María, Santiago, Chile
| | - María Isabel Real
- Department of Anaesthesiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jordi Mercadal
- Department of Anaesthesiology and Critical Care, Surgical Intensive Care Unit, Hospital Clínic, Barcelona, Spain
| | - Pamela Zelada
- Congenital Heart Diseases Unit, Instituto Nacional del Tórax, Paediatric Cardiology, Pontificia Universidad Católica de Chile and Hospital Dr. Sótero del Río, Santiago, Chile
| | - Gonzalo Riobó
- Echocardiography Unit, Instituto Nacional del Tórax, Santiago, Chile
| | - Katia Galdames
- Echocardiography Unit, Instituto Nacional del Tórax, Santiago, Chile; Cardiovascular Institute, Hospital Clínico Universidad de Chile, Santiago, Chile
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12
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Grotberg JC, McDonald RK, Co IN. Point-of-Care Echocardiography in the Difficult-to-Image Patient in the ICU: A Narrative Review. Crit Care Explor 2024; 6:e1035. [PMID: 38222871 PMCID: PMC10786596 DOI: 10.1097/cce.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES The objective of this narrative review was to address common obstacles encountered in the ICU to acquiring quality and interpretable images using point-of-care echocardiography. DATA SOURCES Detailed searches were performed using PubMed and Ovid Medline using medical subject headings and keywords on topics related to patient positioning, IV echo contrast, alternative subcostal views, right ventricular outflow tract (RVOT) hemodynamics, and point-of-care transesophageal echocardiography. Articles known to the authors were also selected based on expert opinion. STUDY SELECTION Articles specific to patient positioning, IV echo contrast, alternative subcostal views, RVOT hemodynamics, and point-of-care transesophageal echocardiography were considered. DATA EXTRACTION One author screened titles and extracted relevant data while two separate authors independently reviewed selected articles. DATA SYNTHESIS Impediments to acquiring quality and interpretable images in critically ill patients are common. Notably, body habitus, intra-abdominal hypertension, dressings or drainage tubes, postoperative sternotomies, invasive mechanical ventilation, and the presence of subcutaneous emphysema or lung hyperinflation are commonly encountered obstacles in transthoracic image acquisition in the ICU. Despite these obstacles, the bedside clinician may use obstacle-specific maneuvers to enhance image acquisition. These may include altering patient positioning, respiratory cycle timing, expanding the subcostal window to include multilevel short-axis views for use in the assessment of RV systolic function and hemodynamics, coronal transhepatic view of the inferior vena cava, and finally point-of-care transesophageal echocardiography. CONCLUSIONS Despite common obstacles to point-of-care echocardiography in critically ill patients, the beside sonographer may take an obstacle-specific stepwise approach to enhance image acquisition in difficult-to-image patients.
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Affiliation(s)
- John C Grotberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Rachel K McDonald
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Ivan N Co
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
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13
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Pergola V, Cameli M, Mattesi G, Mushtaq S, D’Andrea A, Guaricci AI, Pastore MC, Amato F, Dellino CM, Motta R, Perazzolo Marra M, Dellegrottaglie S, Pedrinelli R, Iliceto S, Nodari S, Perrone Filardi P, Pontone G. Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review. J Clin Med 2023; 12:7641. [PMID: 38137711 PMCID: PMC10743799 DOI: 10.3390/jcm12247641] [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: 11/06/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.
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Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy;
| | - Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Filippo Amato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Carlo Maria Dellino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy;
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Institute of Cardiology, University of Brescia, 25123 Brescia, Italy;
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
- Department of Biomedical, Surgical and Sciences, University of Milan, 20122 Milan, Italy
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14
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Choi W, Cho YS, Ha YR, Oh JH, Lee H, Kang BS, Kim YW, Koh CY, Lee JH, Jung E, Sohn Y, Kim HB, Kim SJ, Kim H, Suh D, Lee DH, Hong JY, Lee WW. Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective. Clin Exp Emerg Med 2023; 10:363-381. [PMID: 38225778 PMCID: PMC10790072 DOI: 10.15441/ceem.23.101] [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: 07/29/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 01/17/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.
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Affiliation(s)
- Wookjin Choi
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Rock Ha
- Department of Intensive Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Heekyung Lee
- 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
| | - Yong Won Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Chan Young Koh
- Department of Emergency Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Han Lee
- Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Euigi Jung
- Department of Emergency Medicine, VHS Medical Center, Seoul, Korea
| | - Youdong Sohn
- Department of Emergency Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Han Bit Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hohyun Kim
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hyun Lee
- Department of Intensive Care Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Woong Lee
- Department of Intensive Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - on behalf of the Society Emergency and Critical Care Imaging (SECCI)
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Department of Intensive Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
- Department of Emergency Medicine, Dankook University College of Medicine, Cheonan, Korea
- Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- Department of Emergency Medicine, VHS Medical Center, Seoul, Korea
- Department of Emergency Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Intensive Care Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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15
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Fox S, Alwakeel M, Wang X, Dugar S, Chaisson N. Diagnostic Accuracy of Cardiac Point-of-Care Ultrasound in a Tertiary Medical Intensive Care Unit. Crit Care Explor 2023; 5:e1019. [PMID: 38131017 PMCID: PMC10735065 DOI: 10.1097/cce.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Objective Critical care echocardiography (CCE) is a useful tool for managing critically ill patients in intensive care. However, concerns exist regarding the accuracy of CCE examinations because of operator dependence. We sought to evaluate the accuracy of CCE examinations compared with cardiology-performed transthoracic echocardiogram (TTE). Design Setting and Subjects We retrospectively reviewed charts of patients in a medical ICU in a large academic medical center in the United States. We compared CCE examinations performed by a fellow and reviewed by a staff physician between May 5, 2020, and December 31, 2021, to TTE obtained within 24 hours of the CCE examination. Intervention Measurements and Main Results We developed a standardized process for documentation of all CCE examinations performed in the medical ICU. We assessed agreement (kappa statistic), sensitivity and specificity of CCE examination compared with TTE. Features included left ventricle (LV) systolic function, right ventricle (RV) size, RV systolic function, pericardial effusion, mitral insufficiency, tricuspid insufficiency, and aortic insufficiency. The study analyzed 504 pairs of CCE and TTE examinations. Kappa statistics for detecting LV and RV systolic dysfunction, pericardial effusion, and RV size ranged from 0.60 to 0.74. CCE showed high sensitivity and specificity for detecting LV and RV systolic dysfunction and pericardial effusion, with values ranging from 0.85 to 0.99. The kappa statistic for detecting RV dilation was 0.59, with a sensitivity of 0.71 and a specificity of 0.85. In contrast, CCE examinations were nondiagnostic for mitral, tricuspid, or aortic insufficiency in 60-70% of cases, whereas TTE examinations were nondiagnostic in 20-30% of cases. Kappa statistics for mitral, tricuspid, and aortic insufficiency ranged from 0.32 to 0.42. Conclusions CCE is a reliable tool for assessing LV and RV systolic function, pericardial effusion, and RV size. However, CCE may be limited in its ability to detect mitral, tricuspid, or aortic insufficiency.
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Affiliation(s)
- Steven Fox
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | | | - Neal Chaisson
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
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16
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Le Bastard Q, Javaudin F, Montassier E, Pes P, Le Conte P. Diagnosis of dilated cardiomyopathy with point-of-care ultrasound in patients with unexplained shortness of breath: a case series. Eur J Emerg Med 2023; 30:448-449. [PMID: 37883240 DOI: 10.1097/mej.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Quentin Le Bastard
- Nantes Université, faculté de médecine
- Service des urgences, Centre Hospitalier Universitaire, Nantes, France
| | - François Javaudin
- Nantes Université, faculté de médecine
- Service des urgences, Centre Hospitalier Universitaire, Nantes, France
| | - Emmanuel Montassier
- Nantes Université, faculté de médecine
- Service des urgences, Centre Hospitalier Universitaire, Nantes, France
| | - Philippe Pes
- Service des urgences, Centre Hospitalier Universitaire, Nantes, France
| | - Philippe Le Conte
- Nantes Université, faculté de médecine
- Service des urgences, Centre Hospitalier Universitaire, Nantes, France
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17
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Halasz G, Capelli B, Nardecchia A, Cattaneo M, Cassina T, Biasini V, Barbieri D, Villa M, Beltrami M, Perone F, Villani M, Badini M, Gervasi F, Piepoli M, Via G. Cost-effectiveness and diagnostic accuracy of focused cardiac ultrasound in the pre-participation screening of athletes: the SPORT-FoCUS study. Eur J Prev Cardiol 2023; 30:1748-1757. [PMID: 37668353 DOI: 10.1093/eurjpc/zwad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
AIMS The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS. METHODS AND RESULTS A total of 2111 athletes (77.4% male, mean age 24.9 ± 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C. CONCLUSIONS The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.
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Affiliation(s)
- Geza Halasz
- Cardiology Department, Azienda Ospedaliera SanCamillo Forlanini, Circonvallazione Gianicolense, 87, Rome 00152, Italy
| | - Bruno Capelli
- Sport and Exercise Medicine, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alessia Nardecchia
- Italian Ministry of Education and Research, I.I.S Ceccano, Via Gaeta 105, Ceccano 03023, Italy
| | - Mattia Cattaneo
- Cardiologia, Centro Medico, Lugano, Switzerland
- Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tiziano Cassina
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Vincenzo Biasini
- Sport Medicine and Exercise Medicine, Centro di Medicina dello Sport I° Livello, L'Aquila 67100, Italy
| | - Davide Barbieri
- Department of Neuroscience and Rehabilitation, University of Ferrara, Corso Ercole I d'Este 32, Ferrara, Italy
| | - Michele Villa
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic 'Villa delle Magnolie', Castel Morrone, Caserta 81020, Italy
| | - Matteo Villani
- Intensive Care Unit, G. Da Saliceto Hospital, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Matteo Badini
- Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Federico Gervasi
- Postgraduate School of Medical Statistics and Biometry, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan 20097, Italy
- Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
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18
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Yanni E, Tsung JW, Hu K, Tay ET. Interpretation of Cardiac Standstill in Children Using Point-of-Care Ultrasound. Ann Emerg Med 2023; 82:566-572. [PMID: 37269261 DOI: 10.1016/j.annemergmed.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 06/05/2023]
Abstract
STUDY OBJECTIVE This study aimed to determine the level of agreement among pediatric emergency medicine (PEM) physicians in whether various point-of-care ultrasound (POCUS) video clips represent cardiac standstill in children and to highlight the factors that may be associated with the lack of agreement. METHODS A single, online, cross-sectional, convenience sample survey was administered to PEM attendings and fellows with variable ultrasound experience. PEM attendings with an experience of 25 cardiac POCUS scans or more were the primary subgroup based on ultrasound proficiency set by the American College of Emergency Physicians. The survey contained 11 unique, 6-second video clips of cardiac POCUS performed during pulseless arrest in pediatric patients and asked the respondent if the video clip represented a cardiac standstill. The level of interobserver agreement was determined using the Krippendorff's α (Kα) coefficient across the subgroups. RESULTS A total of 263 PEM attendings and fellows completed the survey (9.9% response rate). Of the 263 total responses, 110 responses were from the primary subgroup of experienced PEM attendings with at least 25 previously seen cardiac POCUS scans. Across all video clips, PEM attendings with 25 scans or more had an acceptable agreement (Kα=0.740; 95% CI 0.735 to 0.745). The agreement was the highest for video clips wherein the wall motion corresponded to the valve motion. However, the agreement fell to unacceptable levels (Kα=0.304; 95% CI 0.287 to 0.321) across video clips wherein the wall motion occurred without the valve motion. CONCLUSION There is an overall acceptable interobserver agreement when interpreting cardiac standstill among PEM attendings with an experience of at least 25 previously reported cardiac POCUS scans. However, factors that may influence the lack of agreement include discordances between the wall and valve motion, suboptimal views, and the lack of a formal reference standard. More specific consensus reference standards of pediatric cardiac standstill may help to improve interobserver agreement moving forward and should include more specific details regarding the wall and valve motion.
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Affiliation(s)
- Evan Yanni
- Department of Emergency Medicine, NYU Langone Medical Center, New York, NY.
| | - James W Tsung
- Department of Emergency Medicine, Mount Sinai Health System, New York, NY
| | - Kevin Hu
- Department of Emergency Medicine, Mount Sinai Health System, New York, NY
| | - Ee Tein Tay
- Department of Emergency Medicine, NYU Langone Medical Center, New York, NY
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19
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Ward JL, DeFrancesco TC. The Role of Point-of-Care Ultrasound in Managing Cardiac Emergencies. Vet Clin North Am Small Anim Pract 2023; 53:1429-1443. [PMID: 37423842 DOI: 10.1016/j.cvsm.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Point-of-care ultrasound (POCUS) is a useful imaging tool for the diagnosis and monitoring of cardiac emergencies. Unlike complete echocardiography, POCUS is a time-sensitive examination involving a subset of targeted thoracic ultrasound views to identify abnormalities of the heart, lungs, pleural space, and caudal vena cava. When integrated with other clinical information, POCUS can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension and can help clinicians monitor resolution or recurrence of these conditions.
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Affiliation(s)
- Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA 50010, USA.
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA
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20
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Lee JY, Conlon TW, Fraga MV, Bauer AJ, Soni NJ, Chen AE, Kaplan SL. Identifying commonalities in definition and governance of point-of-care ultrasound within statements from medical organizations in the United States: A scoping review for a shared understanding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1622-1630. [PMID: 37850556 DOI: 10.1002/jcu.23574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
This scoping review analyzed statements from 22 medical organizations in the United States to identify commonalities in the definition and governance of point-of-care ultrasound (POCUS). A total of 41 statements were included. The review found that the most commonly used elements in defining POCUS were "focused," "bedside," and "patient care." In terms of governance, consistent requirements included specific training programs, documentation in medical records, continuous quality assurance, and standards for credentialing and privileging. These findings suggest the existence of essential commonalities that could facilitate communication and the development of standardized POCUS programs in the future.
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Affiliation(s)
- Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria V Fraga
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nilam J Soni
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Aaron E Chen
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Richter E, Faloye A, Bhandary S, Hollon M. Pro: Does Every Anesthesiologist Need to Learn Point-of-Care Ultrasound? J Cardiothorac Vasc Anesth 2023; 37:2361-2365. [PMID: 36639259 DOI: 10.1053/j.jvca.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Ellen Richter
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
| | - Abimbola Faloye
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Sujatha Bhandary
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - McKenzie Hollon
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
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22
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Arvig MD, Lassen AT, Gæde PH, Gärtner SW, Falster C, Skov IR, Petersen HØ, Posth S, Laursen CB. Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial. Emerg Med J 2023; 40:700-707. [PMID: 37595984 PMCID: PMC10579498 DOI: 10.1136/emermed-2022-212694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone. METHODS This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021. Patients aged ≥18 years admitted with a primary complaint of dyspnoea were allocated 1:1 with block randomisation to usual care, which included a single cardiopulmonary PoCUS within 1 hour of arrival (control group) or usual care (including a PoCUS within 1 hour of arrival) plus two additional PoCUS performed at 2 hours interval from the initial PoCUS (serial ultrasound group). The primary outcome was a reduction of dyspnoea measured on a verbal dyspnoea scale (VDS) from 0 to 10 recorded at inclusion and after 2, 4 and 5 hours. RESULTS There were 206 patients recruited, 102 in the serial ultrasound group and 104 in the control group, all of whom had complete follow-up. The mean difference in VDS between patients in the serial ultrasound and the control group was -1.09 (95% CI -1.51 to -0.66) and -1.66 (95% CI -2.09 to -1.23) after 4 and 5 hours, respectively. The effect was more pronounced in patients with a presumptive diagnosis of acute heart failure (AHF). A larger proportion of patients received diuretics in the serial ultrasound group. CONCLUSION Therapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster. TRIAL REGISTRATION NUMBER NCT04091334.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Stefan Wernblad Gärtner
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
| | - Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Raadal Skov
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Ømark Petersen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Emergency Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Stefan Posth
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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23
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Bradley CA, Ma C, Hollon MM. Perioperative Point of Care Ultrasound for Hemodynamic Assessment: A Narrative Review. Semin Cardiothorac Vasc Anesth 2023; 27:208-223. [PMID: 36943777 DOI: 10.1177/10892532231165088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
While transesophageal echocardiography (TEE) has traditionally been used in perioperative care, there is growing evidence supporting point of care ultrasound (POCUS) for the anesthesiologist in guiding patient care. It is a quick way to non-invasively evaluate hemodynamically unstable patients and ascertain their state of shock, determine volume status, and guide resuscitation in cardiac arrest. In addition, through use of POCUS, the anesthesiologist is able to identify signs of chronic heart disease to provide a more tailored and safer approach to perioperative care.
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Affiliation(s)
- Caitlin A Bradley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Chris Ma
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - McKenzie M Hollon
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
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24
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Kizito PM, Bagonza KD, Odakha JA, Nalugya LG, Opejo P, Muyingo A, Chen H, Harborne D. Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda. Afr J Emerg Med 2023; 13:61-67. [PMID: 36937619 PMCID: PMC10019986 DOI: 10.1016/j.afjem.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Background Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED. Methods 49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%. Results 31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X2= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X2= 0.85, p 0.38 vs X2= 8.5, p 0.004 respectively). Conclusion Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.
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Affiliation(s)
- Prisca Mary Kizito
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
- Corresponding author.
| | - Kenneth Daniel Bagonza
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
| | - Justine Athieno Odakha
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
| | - Linda Grace Nalugya
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
| | - Pius Opejo
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
| | - Anthony Muyingo
- Faculty of Medicine, Internal Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
| | - Harry Chen
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
| | - Derek Harborne
- Faculty of Medicine, Emergency Medicine Department, Mbarara University of Science and Technology (MUST), Uganda
- Mbarara Regional Referral Hospital (MRRH), Uganda
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25
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Wong C, Vijayakumar R, Canty DJ, Royse CF, Yang Y, Royse AG, Heiberg J. Impact of focused cardiac and lung ultrasound screening performed by a junior doctor during admission to the surgical ward on patients before emergency non-cardiac surgery: A pilot prospective observational study. Australas J Ultrasound Med 2023; 26:75-84. [PMID: 37252622 PMCID: PMC10225004 DOI: 10.1002/ajum.12321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose To assess whether pre-operative focused cardiac ultrasound and lung ultrasound screening performed by a junior doctor can change diagnosis and clinical management of patients aged ≥65 years undergoing emergency, non-cardiac surgery. Method This pilot prospective observational study included patients scheduled for emergency, non-cardiac surgery. The treating team completed a diagnosis and management plan before and after focused cardiac and lung ultrasound, which was performed by a junior doctor. Changes to diagnosis and management after ultrasound were recorded. Ultrasound images were assessed for image and diagnostic interpretation by an independent expert. Results There was a total of 57 patients at age 77 ± 8 years. Cardiopulmonary pathology was suspected after clinical assessment in 28% vs. 72% after ultrasound (including abnormal haemodynamic state in 61%, valvular lesions in 32%, acute pulmonary oedema/interstitial syndrome in 9% and bilateral pleural effusions in 2%). In 67% of patients, the perioperative management was changed. The changes were in fluid therapy in 30%, cardiology consultation in 7%, formal in- or out-patient, transthoracic echocardiography in 11% and 30% respectively. Discussion The impact of pre-operative focused cardiac and lung ultrasound on diagnosis and management of patients on the hospital ward before emergency non-cardiac surgery by a junior doctor was comparable to previous studies of anaesthetists experienced in focused ultrasound. However, the ability to recognise when image quality is insufficient for diagnosis is an important consideration for novice sonographers. Conclusions Focused cardiac and lung ultrasound examination by a junior doctor is feasible and may change preoperative diagnosis and management in patients of 65 years or older, admitted for emergency non-cardiac surgery.
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Affiliation(s)
- Cliff Wong
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Rukman Vijayakumar
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - David J Canty
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Anaesthesia and Perioperative MedicineMonash HealthClaytonVictoriaAustralia
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
| | - Colin F Royse
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Outcomes Research ConsortiumCleveland ClinicClevelandOhioUSA
| | - Yang Yang
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Intensive Care UnitWestern HospitalFootscrayVictoriaAustralia
| | - Alistair G Royse
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Cardiothoracic SurgeryRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Johan Heiberg
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Anaesthesia, Centre of Head and OrthopaedicsCopenhagen University Hospital, RigshospitaletKobenhavnDenmark
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26
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Tamaki Y, Iwano H, Murayama M, Ishizaka S, Motoi K, Aoyagi H, Nakamura K, Goto M, Suzuki Y, Yokoyama S, Nishino H, Nakabachi M, Kaga S, Kamiya K, Nagai T, Anzai T. Application of an echocardiographic scoring system of left ventricular filling pressure to diagnose acute heart failure in patients complaining dyspnea. J Cardiol 2023:S0914-5087(23)00100-4. [PMID: 37119933 DOI: 10.1016/j.jjcc.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Dyspnea is a common symptom in acute heart failure (AHF) patients. Although an accurate and rapid diagnosis of AHF is essential to improve prognosis, estimation of left ventricular (LV) filling pressure (FP) remains challenging, especially for noncardiologists. We evaluated the usefulness of a recently-proposed parameter of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, to detect AHF in patients complaining of dyspnea. METHODS Echocardiography and lung ultrasonography (LUS) were performed in 121 consecutive patients (68 ± 14 years old, 75 males) presenting with dyspnea. The VMT score was determined from the atrioventricular valve opening phase (tricuspid valve first: 0, simultaneous: 1, mitral valve first: 2) and inferior vena cava dilatation (absent: 0, present: 1), and VMT ≥2 was judged as positive. LUS was performed with the 8 zones method and judged as positive if 3 or more B-lines were observed in bilateral regions. The AHF diagnosis was performed by certified cardiologists according to recent guidelines. RESULTS Of the 121 patients, 33 were diagnosed with AHF. The sensitivity and specificity for diagnosing AHF were 64 % and 84 % for LUS and 94 % and 88 % for VMT score. In logistic regression analysis, VMT score showed a significantly higher c-index than LUS (0.91 vs 0.74, p = 0.002). In multivariable analyses, VMT score was associated with AHF independently of clinically relevant covariates and LUS. In addition, serial assessment of VMT score followed by LUS provided a diagnostic flow chart to diagnose AHF (VMT 3: AHF definitive, VMT 2 and LUS positive: AHF highly suspicious; VMT 2 and LUS negative: further investigation is needed; VMT ≤ 1: AHF rejected). CONCLUSIONS VMT score showed high diagnostic accuracy in diagnosing AHF. Combined assessment of the VMT score and LUS could become a reliable strategy for diagnosis of AHF by non-cardiologists.
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Affiliation(s)
- Yoji Tamaki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Division of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan; Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan.
| | - Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan; Graduate School of Health Science, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Aoyagi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Nakamura
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mana Goto
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Yukino Suzuki
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Nakabachi
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Sanae Kaga
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan; Graduate School of Health Science, Hokkaido University, Sapporo, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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27
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Aceituno-Melgar JE, Posada-Martinez EL. Focused Cardiac Ultrasonography for Right Ventricular Size and Systolic Function. N Engl J Med 2023; 388:1150-1151. [PMID: 36947481 DOI: 10.1056/nejmc2300338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
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28
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Johri AM, Glass C, Hill B, Jensen T, Puentes W, Olusanya O, Capizzano JN, Dancel R, Reierson K, Reisinger N, Liblik K, Galen BT. The Evolution of Cardiovascular Ultrasound: A Review of Cardiac Point-of-Care Ultrasound (POCUS) Across Specialties. Am J Med 2023:S0002-9343(23)00158-4. [PMID: 36889497 DOI: 10.1016/j.amjmed.2023.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
The use of cardiac point-of-care ultrasound (POCUS) is now widespread in clinics, emergency departments, and all areas of the hospital. Users include medical trainees, advanced practice practitioners, and attending physicians in many specialties and sub-specialties. Opportunities to learn cardiac POCUS and requirements for training vary across specialties as does the scope of the cardiac POCUS examination. In this review, we describe both a brief history of how cardiac POCUS emerged from echocardiography and the state of the art across a variety of medical fields.
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Affiliation(s)
- Amer M Johri
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Casey Glass
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Trevor Jensen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wilfredo Puentes
- Department of Anesthesia, Western University, London, ON, Canada
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ria Dancel
- Departments of Internal Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Minnesota and Wisconsin, USA
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Benjamin T Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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29
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Graham JD, Grissom CK. From Pac-Man to UltraMan. Crit Care Med 2023; 51:415-418. [PMID: 36809263 DOI: 10.1097/ccm.0000000000005777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Jeffrey D Graham
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT
- Department of Pulmonary and Critical Care, Intermountain Healthcare, Salt Lake City, UT
| | - Colin K Grissom
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT
- Department of Pulmonary and Critical Care, Intermountain Healthcare, Salt Lake City, UT
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30
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Lu JC, Riley A, Conlon T, Levine JC, Kwan C, Miller-Hance WC, Soni-Patel N, Slesnick T. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:265-277. [PMID: 36697294 DOI: 10.1016/j.echo.2022.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac point-of-care ultrasound has the potential to improve patient care, but its application to children requires consideration of anatomic and physiologic differences from adult populations, and corresponding technical aspects of performance. This document is the product of an American Society of Echocardiography task force composed of representatives from pediatric cardiology, pediatric critical care medicine, pediatric emergency medicine, pediatric anesthesiology, and others, assembled to provide expert guidance. This diverse group aimed to identify common considerations across disciplines to guide evolution of indications, and to identify common requirements and infrastructure necessary for optimal performance, training, and quality assurance in the practice of cardiac point-of-care ultrasound in children. The recommendations presented are intended to facilitate collaboration among subspecialties and with pediatric echocardiography laboratories by identifying key considerations regarding (1) indications, (2) imaging recommendations, (3) training and competency assessment, and (4) quality assurance.
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Affiliation(s)
- Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
| | - Alan Riley
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Thomas Conlon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jami C Levine
- Harvard School of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Charisse Kwan
- University of Western Ontario, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | | | | | - Timothy Slesnick
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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31
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Gutowski JN, Donovan DJ, Firnberg MT, Constantinescu A, Kennedy TM. A Rare Complication of Anomalous Left Coronary Artery From the Pulmonary Artery Identified by Point-of-Care Ultrasound. Pediatr Emerg Care 2023; 39:201-203. [PMID: 36173337 DOI: 10.1097/pec.0000000000002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Point-of-care ultrasound is a valuable tool in the evaluation of undifferentiated respiratory distress in children. This case report describes a 9-month-old male infant who presented with 4 months of progressively worsening cough and was found to be tachypneic in the emergency department. Chest radiography revealed complete opacification of the left hemithorax with cardiomegaly. Point-of-care ultrasound demonstrated atelectasis of the entire left lung and severe dilation of the left ventricle with poor function. Electrocardiogram and echocardiogram findings were consistent with a diagnosis of anomalous left coronary artery from the pulmonary artery. The patient underwent successful cardiac surgery to improve myocardial perfusion. Bronchoscopy visualized the etiology of his atelectasis, pulsatile compression of the left mainstem bronchus by the dilated heart. Focused cardiac and lung ultrasound techniques, as well as pertinent sonographic findings, are reviewed.
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Affiliation(s)
| | | | - Maytal T Firnberg
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine
| | - Andrei Constantinescu
- Division of Pediatric Pulmonology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Thomas M Kennedy
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine
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32
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Raco J, Peterson B, Muallem S. Assessment of Volume Status in Hospitalized Patients With Chronic Heart Failure. Cardiol Res 2023; 14:2-11. [PMID: 36896231 PMCID: PMC9990539 DOI: 10.14740/cr1434] [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: 10/15/2022] [Accepted: 11/26/2022] [Indexed: 02/27/2023] Open
Abstract
Assessment of volume status in hospitalized patients with heart failure is a critically important diagnostic skill that clinicians utilize frequently. However, accurate assessment is challenging and there is often significant inter-provider disagreement. This review serves as an appraisal of current methods of volume assessment amongst different categories of evaluation including patient history, physical exam, laboratory analysis, imaging, and invasive procedures. Within each category, this review highlights methods that are particularly sensitive or specific, or those that carry impactful positive or negative likelihood ratios. Utilization of the information that this review provides will allow clinicians to determine volume status of hospitalized heart failure patients more accurately and more precisely in order to provide appropriate and effective therapies.
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Affiliation(s)
- Joseph Raco
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Brandon Peterson
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Samer Muallem
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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33
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Weimer J, Rolef P, Müller L, Bellhäuser H, Göbel S, Buggenhagen H, Weimer A, Waezsada E, Kirchhoff F, Weinmann-Menke J. FoCUS cardiac ultrasound training for undergraduates based on current national guidelines: a prospective, controlled, single-center study on transferability. BMC MEDICAL EDUCATION 2023; 23:80. [PMID: 36726093 PMCID: PMC9893662 DOI: 10.1186/s12909-023-04062-1] [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: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION In emergency and critical-care medicine, focused cardiac ultrasound (FoCUS) is indispensable for assessing a patient's cardiac status. The aim of this study was to establish and validate a peer-to-peer-supported ultrasound course for learning FoCUS-specific skills during undergraduate studies at a German university. METHODS A 1-day, 12 teaching units training course was developed for students in the clinical section of medical college, with content based on the current national guidelines. A total of 217 students participated in the study (97 in the course group and 120 in the control group). The course and the participants' subjective assessment of improved skills were evaluated using a questionnaire (7-point Likert scale; 7 = complete agreement and 1 = no agreement at all). Objective learning gains were assessed by tests before and after the course. These consisted of a test of figural intelligence (eight items) and a test of technical knowledge (13 items). RESULTS The course participants experienced significant improvement (P < 0.001) from before to after the course, with a large effect size of η2part = 0.26. In addition, the course group had significantly better results (P < 0.001) than the control group in the post-test, with a medium to large effect size of η2part = 0.14. No significant differences (P = 0.27) were detected in the test section on figural intelligence. The evaluations showed that the participants had a high degree of satisfaction with the course approach, teaching materials, and tutors. There was also a positive increase in their subjective assessment of their own skills, including areas such as technical knowledge, ultrasound anatomy, and performance of the examination. CONCLUSION The results of both the objective learning assessment and the subjective evaluations suggest that a FoCUS course originally intended for qualified physicians is equally suitable for students. With the development and provision of modern digital teaching media, even more students will be able to benefit from this approach in the future.
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Affiliation(s)
- Johannes Weimer
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Peter Rolef
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University of Mainz, Mainz, Germany
| | - Henrik Bellhäuser
- Institute of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Sebastian Göbel
- Department of Medicine II, Cardiology Center, Department of Medicine, University of Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Andreas Weimer
- Center for Orthopedics, Emergency Surgery, and Paraplegics, Department of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Elias Waezsada
- Department of Cardiology, Kerckhoff Hospital, Bad Nauheim, Germany
| | - Friederike Kirchhoff
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Medicine I, Nephrology Center, Department of Medicine, University of Mainz, Mainz, Germany
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Kowalczyk D, Piotrowski WJ, Rosiak O, Białas AJ. Concise, Practical Review on Transthoracic Lung Ultrasound in Prehospital Diagnosis of Dyspnea in Adults. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020224. [PMID: 36837426 PMCID: PMC9959919 DOI: 10.3390/medicina59020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
Ultrasonography is a relatively young but widely recognized method of imaging parenchymal organs, including the lungs. Our concise, practical review on transthoracic lung ultrasound (LUS) in the prehospital diagnosis of dyspnea in adults attempts to summarize current knowledge in the field. Furthermore, we discussed POCUS protocols in the analyzed context, discussing their usefulness. We concluded that bedside ultrasonography, or point of care (POCUS), is developing rapidly; however, the knowledge about the use of LUS in a pre-hospital setting is scarce, highlighting the need for further research in this field. Additionally, despite the possibility of using various ultrasound protocols in diagnosing a patient with dyspnea, there is no comprehensive and, at the same time, highly sensitive and specific protocol covering a satisfactory saccade of differential diagnosis of this symptom. It seems reasonable to conduct further targeted research to create such a dedicated solution.
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Affiliation(s)
- Damian Kowalczyk
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence:
| | | | - Oskar Rosiak
- Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, 90-419 Lodz, Poland
| | - Adam J. Białas
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Pulmonary Rehabilitation, Center for Lung Diseases and Rehabilitation, Blessed Rafal Chylinski Memorial Hospital for Lung Diseases, 90-419 Lodz, Poland
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Mauro C, Chianese S, Cocchia R, Arcopinto M, Auciello S, Capone V, Carafa M, Carbone A, Caruso G, Castaldo R, Citro R, Crisci G, D’Andrea A, D’Assante R, D’Avino M, Ferrara F, Frangiosa A, Galzerano D, Maffei V, Marra AM, Mehta RM, Mehta RH, Paladino F, Ranieri B, Franzese M, Limongelli G, Rega S, Romano L, Salzano A, Sepe C, Vriz O, Izzo R, Cademartiri F, Cittadini A, Bossone E. Acute Heart Failure: Diagnostic-Therapeutic Pathways and Preventive Strategies-A Real-World Clinician's Guide. J Clin Med 2023; 12:jcm12030846. [PMID: 36769495 PMCID: PMC9917599 DOI: 10.3390/jcm12030846] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
Acute heart failure (AHF) is the most frequent cause of unplanned hospital admission in patients of >65 years of age and it is associated with significantly increased morbidity, mortality, and healthcare costs. Different AHF classification criteria have been proposed, mainly reflecting the clinical heterogeneity of the syndrome. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of cases. Furthermore, a marked reduction in cardiac output with peripheral hypoperfusion may occur in most severe cases. Diagnosis is made on the basis of signs and symptoms, laboratory, and non-invasive tests. After exclusion of reversible causes, AHF therapeutic interventions mainly consist of intravenous (IV) diuretics and/or vasodilators, tailored according to the initial hemodynamic status with the addition of inotropes/vasopressors and mechanical circulatory support if needed. The aim of this review is to discuss current concepts on the diagnosis and management of AHF in order to guide daily clinical practice and to underline the unmet needs. Preventive strategies are also discussed.
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Affiliation(s)
- Ciro Mauro
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Salvatore Chianese
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Rosangela Cocchia
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Stefania Auciello
- First Aid—Short Intensive Observation Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Valentina Capone
- Cardiology Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Mariano Carafa
- Emergency Medicine Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Andreina Carbone
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Caruso
- Long-Term Care Division, Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Rossana Castaldo
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital Nocera Inferiore, 84014 Nocera, Italy
| | - Roberta D’Assante
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Maria D’Avino
- Long-Term Care Division, Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Francesco Ferrara
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy
| | - Antonio Frangiosa
- Post Operative Intensive Care Division, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Domenico Galzerano
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Vincenzo Maffei
- Post Operative Intensive Care Division, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Rahul M. Mehta
- ProMedica Monroe Regional Hospital, Monroe, MI 48162, USA
| | - Rajendra H. Mehta
- Duke Clinical Research Institute, 300 W Morgan St., Durham, NC 27701, USA
| | - Fiorella Paladino
- First Aid—Short Intensive Observation Division, A. Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Brigida Ranieri
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Monica Franzese
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Giuseppe Limongelli
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Salvatore Rega
- Department of Public Health University “Federico II” of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, Antonio Cardarelli Hospital, Via Cardarelli, 9, 80131 Naples, Italy
| | - Andrea Salzano
- Istituto di Ricovero e Cura a Carattere Scientifico SYNLAB SDN, Via Emanuele Gianturco, 113, 80143 Naples, Italy
| | - Chiara Sepe
- Technical Nursing and Rehabilitation Service (SITR) Department, Cardarelli Hospital, 80131 Naples, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Eduardo Bossone
- Department of Public Health University “Federico II” of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
- Correspondence:
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Haskings EM, Eissa M, Allard RV, MirGhassemi A, McFaul CM, Miller EC. Point-of-care ultrasound use in emergencies: what every anaesthetist should know. Anaesthesia 2023; 78:105-118. [PMID: 36449358 DOI: 10.1111/anae.15910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 12/05/2022]
Abstract
Point-of-care ultrasound has been embraced by anaesthetists as an invaluable tool for rapid diagnosis of haemodynamic instability, to ensure procedural safety and monitor response to treatments. Increasingly available, affordable and portable, with emerging evidence of improved patient outcomes, point-of-care ultrasound has become a valuable tool in the emergency setting. This state-of-the-art review describes the feasibility of point-of-care ultrasound practice, training and maintenance of competence. It also describes the many uses of point-of-care ultrasound for the anaesthetist and describes the most salient point-of-care ultrasound views for anaesthetic emergencies including: undifferentiated shock; hypoxemia; and trauma. Procedural safety is also discussed in addition to relevant important governance aspects. Cardiac function should be assessed using the parasternal long axis, parasternal short basal/mid-papillary/apical, apical four chamber and subcostal four chamber views, and should include a visual estimation of global left ventricular ejection fraction. Other cardiovascular conditions that can be identified using point-of-care ultrasound include: pericardial effusion; cardiac tamponade; and pulmonary embolism. Pulmonary emergency conditions that can be diagnosed using point-of-care ultrasound include pneumothorax; pleural effusion; and interstitial syndrome. The extended focused assessment with sonography for trauma examination may of value in patients who are hypotensive in order to identify intra-abdominal haemorrhage, pneumothoraces and haemothoraces.
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Affiliation(s)
- E M Haskings
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M Eissa
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - R V Allard
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - A MirGhassemi
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - C M McFaul
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - E C Miller
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
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Morello F, Bima P, Castelli M, Nazerian P. Acute aortic syndromes: An internist's guide to the galaxy. Eur J Intern Med 2022; 106:45-53. [PMID: 36229285 DOI: 10.1016/j.ejim.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/05/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022]
Abstract
Acute aortic syndromes (AASs) are severe conditions defined by dissection, hemorrhage, ulceration or rupture of the thoracic aorta. AASs share etiological and pathophysiological features, including long-term aortic tissue degeneration and mechanisms of acute aortic damage. The clinical signs and symptoms of AASs are unspecific and heterogeneous, requiring large differential diagnosis. When evaluating a patient with AAS-compatible symptoms, physicians need to integrate clinical probability assessment, bedside imaging techniques such as point-of-care ultrasound, and blood test results such as d-dimer. The natural history of AASs is dominated by engagement of ischemic, coagulative and inflammatory pathways at large, causing multiorgan damage. Medical treatment, multiorgan monitoring and outcome prognostication are therefore paramount, with internal medicine playing a key role in non-surgical management of AASs.
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Affiliation(s)
- Fulvio Morello
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Scienze Mediche, Università degli Studi di Torino, Italy
| | - Paolo Bima
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matteo Castelli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [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: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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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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Addepalli A, Guillen M, Dreyfuss A, Mantuani D, Nagdev A, Martin DA. Point-of-Care Ultrasound Diagnosis of Tetralogy of Fallot Causing Cyanosis: A Case Report. Clin Pract Cases Emerg Med 2022; 6:280-283. [PMID: 36427029 PMCID: PMC9697878 DOI: 10.5811/cpcem.2022.8.56297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Tetralogy of Fallot (TOF) is a congenital heart defect with characteristic features leading to unique physical exam and ultrasound findings. In settings where there is limited prenatal screening, TOF can present with cyanosis at any time from the neonatal period to adulthood depending on the degree of obstruction of the right ventricular outflow tract. CASE REPORT This case describes a pediatric patient who presented with undifferentiated dyspnea and cyanosis, for whom point-of-care ultrasound (POCUS) supported the diagnosis of TOF. We highlight the important role POCUS can play in a setting with limited access to formal echocardiography or consultative pediatric cardiology services. CONCLUSION This report highlights the utility of POCUS as an inflection point in the diagnostic and management pathway of this patient, which is particularly important when working in a limited-resource or rural setting.
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Affiliation(s)
- Aravind Addepalli
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Marco Guillen
- EsSalud Cusco: Hospital Nacional Adolfo Guevara Velasco, Department of Emergency Medicine, Cusco, Peru
| | - Andrea Dreyfuss
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Daniel Mantuani
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Arun Nagdev
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - David A. Martin
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California
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Hjorth-Hansen AK, Magelssen MI, Andersen GN, Graven T, Kleinau JO, Landstad B, Løvstakken L, Skjetne K, Mjølstad OC, Dalen H. Real-time automatic quantification of left ventricular function by hand-held ultrasound devices in patients with suspected heart failure: a feasibility study of a diagnostic test with data from general practitioners, nurses and cardiologists. BMJ Open 2022; 12:e063793. [PMID: 36229153 PMCID: PMC9562287 DOI: 10.1136/bmjopen-2022-063793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To evaluate the feasibility and reliability of hand-held ultrasound (HUD) examinations with real-time automatic decision-making software for ejection fraction (autoEF) and mitral annular plane systolic excursion (autoMAPSE) by novices (general practitioners), intermediate users (registered cardiac nurses) and expert users (cardiologists), respectively, compared to reference echocardiography by cardiologists in an outpatient cohort with suspected heart failure (HF). DESIGN Feasibility study of a diagnostic test. SETTING AND PARTICIPANTS 166 patients with suspected HF underwent HUD examinations with autoEF and autoMAPSE measurements by five novices, three intermediate-skilled users and five experts. HUD results were compared with a reference echocardiography by experts. A blinded cardiologist scored all HUD recordings with automatic measurements as (1) discard, (2) accept, but adjust the measurement or (3) accept the measurement as it is. PRIMARY OUTCOME MEASURE The feasibility of automatic decision-making software for quantification of left ventricular function. RESULTS The users were able to run autoEF and autoMAPSE in most patients. The feasibility for obtaining accepted images (score of ≥2) with automatic measurements ranged from 50% to 91%. The feasibility was lowest for novices and highest for experts for both autoEF and autoMAPSE (p≤0.001). Large coefficients of variation and wide coefficients of repeatability indicate moderate agreement. The corresponding intraclass correlations (ICC) were moderate to good (ICC 0.51-0.85) for intra-rater and poor (ICC 0.35-0.51) for inter-rater analyses. The findings of modest to poor agreement and reliability were not explained by the experience of the users alone. CONCLUSION Novices, intermediate and expert users were able to record four-chamber views for automatic assessment of autoEF and autoMAPSE using HUD devices. The modest feasibility, agreement and reliability suggest this should not be implemented into clinical practice without further refinement and clinical evaluation. TRIAL REGISTRATION NUMBER NCT03547076.
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Affiliation(s)
- Anna Katarina Hjorth-Hansen
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malgorzata Izabela Magelssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, St. Olavs University Hospital, Trondheim, Norway
| | - Garrett Newton Andersen
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Graven
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens Olaf Kleinau
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bodil Landstad
- Department of Research, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kyrre Skjetne
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Innherred Heart Clinic, Levanger, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, St. Olavs University Hospital, Trondheim, Norway
| | - Havard Dalen
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, St. Olavs University Hospital, Trondheim, Norway
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Jujo S, Sakka BI, Lee-Jayaram JJ, Kataoka A, Izumo M, Kusunose K, Nakahira A, Oikawa S, Kataoka Y, Berg BW. Medical student medium-term skill retention following cardiac point-of-care ultrasound training based on the American Society of Echocardiography curriculum framework. Cardiovasc Ultrasound 2022; 20:26. [PMID: 36224597 PMCID: PMC9554392 DOI: 10.1186/s12947-022-00296-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background No studies have demonstrated medium- or long-term skill retention of cardiac point-of-care ultrasound (POCUS) curriculum for medical student. Based on the American Society of Echocardiography (ASE) curriculum framework, we developed a blended-learning cardiac POCUS curriculum with competency evaluation. The objective of this study was to investigate the curriculum impact on image acquisition skill retention 8 weeks after initial training. Methods This study was a prospective, pre-post education intervention study for first- and second-year medical students, with blinded outcome assessment. The curriculum included a pre-training ASE online module and healthy volunteer hands-on training to obtain 5 views: parasternal long-axis (PLAX), parasternal short-axis (PSAX), apical 4-chamber (A4C), subcostal 4-chamber (S4C), and subcostal inferior vena cava (SIVC) views. Students took 5-view image acquisition skill tests at pre-, immediate post-, and 8-week post-training, using a healthy volunteer. Three blinded assessors rated the image quality using a validated 10-point maximum scoring system. Students used a hand-held ultrasound probe (Butterfly iQ). Results Fifty-four students completed hands-on training, and pre- and immediate post-training skill tests. Twenty-seven students completed 8-week post-training skill tests. Skill test score improvement between pre- and 8-week post-training was 2.11 points (95% CI, 1.22–3.00; effect size, 1.13). Conclusion The cardiac POCUS curriculum demonstrated medium-term skill retention. The curriculum was sufficient for S4C and SIVC skill retention, but inadequate for PLAX, PSAX, and A4C. Therefore, instructional design modifications or re-training for PLAX, PSAX, and A4C are needed to make the curriculum more effective for clinically relevant skill retention.
Supplementary Information The online version contains supplementary material available at 10.1186/s12947-022-00296-z.
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Affiliation(s)
- Satoshi Jujo
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA. .,Department of Anesthesiology, Kameda Medical Center, Chiba, Japan.
| | - Brandan I Sakka
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA
| | - Jannet J Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Atsushi Nakahira
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA.,Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Sayaka Oikawa
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA.,Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA
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Douflé G, Urner M, Dragoi L, Jain A, Brydges R, Piquette D. Evaluation of an advanced critical care echocardiography program: a mixed methods study. Can J Anaesth 2022; 69:1260-1271. [PMID: 35819631 DOI: 10.1007/s12630-022-02281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Limited data exist on advanced critical care echocardiography (CCE) training programs for intensivists. We sought to describe a longitudinal echocardiography program and investigate the effect of distributed conditional supervision vs predefined en-bloc supervision, as well as the effect of an optional echocardiography laboratory rotation, on learners' engagement. METHODS In this mixed methods study, we enrolled critical care fellows and faculty from five University of Toronto-affiliated intensive care units (ICU) between July 2015 and July 2018 in an advanced training program, comprising theoretical lectures and practical sessions. After the first year, the program was modified with changes to supervision model and inclusion of a rotation in the echo laboratory. We conducted semistructured interviews and investigated the effects of curricular changes on progress toward portfolio completion (150 transthoracic echocardiograms) using a Bayesian framework. RESULTS Sixty-five learners were enrolled and 18 were interviewed. Four (9%) learners completed the portfolio. Learners reported lack of time and supervision, and skill complexity as the main barriers to practicing independently. Conditional supervision was associated with a higher rate of submitting unsupervised echocardiograms than unconditional supervision (rate ratio, 1.11, 95% credible interval, 1.08 to 1.14). After rotation in the echocardiography laboratory, submission of unsupervised echocardiograms decreased. CONCLUSION Trainees perceived lack of time and limited access to supervision as major barriers to course completion. Nevertheless, successful portfolio completion was related to factors other than protected time in the echocardiography laboratory or unconditional direct supervision in ICU. Further research is needed to better understand the factors promoting success of CCE training programs.
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Affiliation(s)
- Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Martin Urner
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Aditi Jain
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- The Wilson Centre for Research in Healthcare Education, University of Toronto, Toronto, ON, Canada
| | - Dominique Piquette
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre for Research in Healthcare Education, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
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45
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Arvig MD, Laursen CB, Jacobsen N, Gæde PH, Lassen AT. Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review. J Ultrasound 2022; 25:547-561. [PMID: 35040102 PMCID: PMC9402857 DOI: 10.1007/s40477-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The primary aim was to investigate if treatment guided by serial ultrasound of the inferior vena cava-collapsibility index (IVC-CI) and B-lines on lung ultrasound (LUS) could reduce mortality, readmissions, and length of stay (LOS) in acutely dyspneic patients admitted to a hospital, compared to standard monitoring. The secondary aim was to determine how the changes of B-lines and IVC-CI are correlated to vitals and symptoms. METHODS A systematic search was conducted on PubMed, Embase, Cochrane, Google Scholar, Web of Science, Scopus, OpenGrey, ProQuest, and databases for ongoing trials. The risk of bias was assessed according to study design. RESULTS Of the 8258 studies identified, 50 were selected for full-text screening, and 24 studies were chosen for data extraction (19 pre-post-, two non-randomized controlled-, two randomized controlled-, and one retrospective cohort study), covering 2040 patients. Most studies were single-center and had small study populations with only heart failure patients. The risk of bias was high. No studies evaluated how the difference between two ultrasound measurements correlated with the primary outcomes. Seven studies reported that a decline in either B-lines or IVC size, or an increased IVC-CI reduced mortality, readmissions, and LOS when correlated to a single ultrasound measurement. All studies showed changes in the IVC-CI and B-lines, but these were not related to vitals or symptoms. CONCLUSION B-lines and IVC-CI are dynamic variables that change over time and with treatment. A single ultrasound measurement can influence prognostic outcomes, but it remains uncertain if repeated scans can have the same impact.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, TechSim, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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46
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Lanspa MJ, Fox SW, Sohn J, Dugar S, Klick JC, Diaz-Gomez J, Liu R, Panebianco N. Definitive Advantages of Point-of-Care Ultrasound: A Case Series. CASE (PHILADELPHIA, PA.) 2022; 6:293-298. [PMID: 36036052 PMCID: PMC9399626 DOI: 10.1016/j.case.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 4 cases where POCUS changed or aided in diagnosis. POCUS often provides useful information in patients in shock. Serial POCUS can assess changes over time in the ICU.
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Affiliation(s)
- Michael J. Lanspa
- Critical Care Echocardiography Service, Intermountain Medical Center, Murray, Utah
- Correspondence: Michael J. Lanspa, MD, FASE, Intermountain Medical Center, Shock Trauma ICU, 5121 South Cottonwood Street, Salt Lake City, Utah, 84107
| | - Steven W. Fox
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jaqueline Sohn
- Cardiovascular Anesthesia and Critical Care Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - John C. Klick
- Department of Anesthesiology, University of Vermont, Burlington, Vermont
| | - Jose Diaz-Gomez
- Cardiovascular Anesthesia and Critical Care Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas
| | - Rachel Liu
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nova Panebianco
- Department of Emergency Medicine Ultrasound, University of Pennsylvania, Philadelphia, Pennsylvania
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48
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Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, Abuhamad A, Noble V, Hussain A, Prosen G, Villen T, Via G, Nogue R, Goodmurphy C, Bastos M, Nace GS, Volpicelli G, Wakefield RJ, Wilson S, Bhagra A, Kim J, Bahner D, Fox C, Riley R, Steinmetz P, Nelson BP, Pellerito J, Nazarian LN, Wilson LB, Ma IWY, Amponsah D, Barron KR, Dversdal RK, Wagner M, Dean AJ, Tierney D, Tsung JW, Nocera P, Pazeli J, Liu R, Price S, Neri L, Piccirillo B, Osman A, Lee V, Naqvi N, Petrovic T, Bornemann P, Valois M, Lanctot JF, Haddad R, Govil D, Hurtado LA, Dinh VA, DePhilip RM, Hoffmann B, Lewiss RE, Parange NA, Nishisaki A, Doniger SJ, Dallas P, Bergman K, Barahona JO, Wortsman X, Smith RS, Sisson CA, Palma J, Mallin M, Ahmed L, Mustafa H. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14:31. [PMID: 35895165 PMCID: PMC9329507 DOI: 10.1186/s13089-022-00279-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
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Affiliation(s)
- Richard A. Hoppmann
- grid.254567.70000 0000 9075 106XInternal Medicine, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Bldg 3, Room 306, Columbia, SC 29209 USA
| | - Jeanette Mladenovic
- grid.414996.70000 0004 5902 8841Foundation for the Advancement of International Medical Education and Research, Philadelphia, USA
| | - Lawrence Melniker
- grid.413734.60000 0000 8499 1112Quality Emergency Department, NewYork-Presbyterian Health System, New York, USA
| | - Radu Badea
- grid.411040.00000 0004 0571 5814Internal Medicine and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Blaivas
- grid.254567.70000 0000 9075 106XInternal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Miguel Montorfano
- grid.414463.00000 0004 0638 1756Ultrasound and Doppler Department, Hospital de Emergencias “Dr. Clemente Alvarez”, Rosario, Argentina
| | - Alfred Abuhamad
- grid.255414.30000 0001 2182 3733Eastern Virginia School of Medicine, Norfolk, USA
| | - Vicki Noble
- grid.443867.a0000 0000 9149 4843Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Arif Hussain
- grid.415254.30000 0004 1790 7311Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gregor Prosen
- grid.412415.70000 0001 0685 1285Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Tomás Villen
- grid.449795.20000 0001 2193 453XFrancisco de Vitoria University School of Medicine, Madrid, Spain
| | - Gabriele Via
- grid.469433.f0000 0004 0514 7845Department of Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ramon Nogue
- grid.15043.330000 0001 2163 1432Emergency Medicine, University of Lleida School of Medicine, Lleida, Spain
| | - Craig Goodmurphy
- grid.240473.60000 0004 0543 9901Ultrasound Education, Penn State College of Medicine, Hershey, USA
| | - Marcus Bastos
- Ultrasound Point of Care, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, Brazil
| | - G. Stephen Nace
- grid.267301.10000 0004 0386 9246Medical Education and Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Giovanni Volpicelli
- grid.415081.90000 0004 0493 6869Internal Medicine, Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Richard J. Wakefield
- grid.9909.90000 0004 1936 8403Rheumatology, University of Leeds, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Steve Wilson
- grid.254567.70000 0000 9075 106XUniversity of South Carolina School of Medicine, Columbia, USA
| | - Anjali Bhagra
- grid.66875.3a0000 0004 0459 167XInternal Medicine, Mayo Clinic, Rochester, USA
| | - Jongyeol Kim
- grid.416992.10000 0001 2179 3554Neurology, School of Medicine Texas Tech University Health Sciences Center, Lubbock, USA
| | - David Bahner
- grid.261331.40000 0001 2285 7943Department of Emergency Medicine, The Ohio State University, Columbus, USA
| | - Chris Fox
- grid.266093.80000 0001 0668 7243Department Emergency Medicine, University of California Irvine, Irvine, USA
| | - Ruth Riley
- grid.254567.70000 0000 9075 106XLibrary Services, University of South Carolina School of Medicine, Columbia, USA
| | - Peter Steinmetz
- grid.14709.3b0000 0004 1936 8649Family Medicine, McGill University, Montreal, Canada
| | - Bret P. Nelson
- grid.59734.3c0000 0001 0670 2351Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Pellerito
- grid.512756.20000 0004 0370 4759Radiology and Science Education, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Levon N. Nazarian
- grid.265008.90000 0001 2166 5843Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - L. Britt Wilson
- grid.254567.70000 0000 9075 106XPhysiology, University of South Carolina School of Medicine, Columbia, USA
| | - Irene W. Y. Ma
- grid.22072.350000 0004 1936 7697Medicine, Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - David Amponsah
- grid.413103.40000 0001 2160 8953Department of Emergency Medicine, Henry Ford Hospital, Detroit, USA
| | - Keith R. Barron
- grid.254567.70000 0000 9075 106XDepartment of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Renee K. Dversdal
- grid.5288.70000 0000 9758 5690Internal Medicine, Oregon Health & Science University, Portland, USA
| | - Mike Wagner
- grid.254567.70000 0000 9075 106XMedicine, University of South Carolina School of Medicine-Greenville, Greenville, USA
| | - Anthony J. Dean
- grid.25879.310000 0004 1936 8972Emeritus Department of Emergency Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David Tierney
- grid.413195.b0000 0000 8795 611XInternal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
| | - James W. Tsung
- grid.59734.3c0000 0001 0670 2351Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paula Nocera
- grid.413471.40000 0000 9080 8521Anesthesiologist, Hospital Sírio Libanês, São Paulo, Brazil
| | - José Pazeli
- Nephology and Critical Care, Barbacena’s School of Medicine, Barbacena, Brazil
| | - Rachel Liu
- grid.47100.320000000419368710Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Susanna Price
- grid.439338.60000 0001 1114 4366Cardiology and Intensive Care, Royal Brompton Hospital, London, England
| | - Luca Neri
- grid.415280.a0000 0004 0402 3867Emergency and Intensive Care Medicine, King Fahad Specialist Hospital Dammam, Ad Dammām, Saudi Arabia
| | - Barbara Piccirillo
- grid.260914.80000 0001 2322 1832New York Institute of Technology, Bellmore, USA
| | - Adi Osman
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri, Ipoh, Perak Malaysia
| | - Vaughan Lee
- grid.267153.40000 0000 9552 1255Medical Education, University of South Alabama College of Medicine, Mobile, USA
| | - Nitha Naqvi
- grid.420545.20000 0004 0489 3985Royal Brompton Hospital Part of Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Paul Bornemann
- grid.254567.70000 0000 9075 106XDepartment of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Maxime Valois
- Medicine, McGill and Sherbrooke Universities, Montreal, Canada
| | | | - Robert Haddad
- grid.254567.70000 0000 9075 106XUltrasound Education - Ultrasound Institute, University of South Carolina School of Medicine, Columbia, USA
| | - Deepak Govil
- grid.429252.a0000 0004 1764 4857Critical Care Medicine, Medanta - The Medicity, Gurgaon, India
| | - Laura A. Hurtado
- grid.7345.50000 0001 0056 1981Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Vi Am Dinh
- grid.411390.e0000 0000 9340 4063Emergency Medicine and Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Robert M. DePhilip
- grid.261331.40000 0001 2285 7943Emeritus Biomedical Education and Anatomy, The Ohio State University, Columbus, USA
| | - Beatrice Hoffmann
- grid.38142.3c000000041936754XDepartment of Emergency Medicine, Harvard Medical School, Boston, USA
| | - Resa E. Lewiss
- grid.265008.90000 0001 2166 5843Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, USA
| | - Nayana A. Parange
- grid.1026.50000 0000 8994 5086Medical Sonography, University of South Australia Allied Health and Human Performance, Adelaide, Australia
| | - Akira Nishisaki
- grid.25879.310000 0004 1936 8972Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Stephanie J. Doniger
- Pediatric Emergency Medicine, Children’s Hospital in Orange California, Orange, USA
| | - Paul Dallas
- grid.438526.e0000 0001 0694 4940Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kevin Bergman
- grid.266102.10000 0001 2297 6811Family and Community Medicine, University of California - San Francisco, Martinez, USA
| | - J. Oscar Barahona
- grid.423309.f0000 0000 8901 8514Greenwich Ultrasound Services, Greenwich Ultrasound Associates, PC, Greenwich, USA
| | - Ximena Wortsman
- grid.443909.30000 0004 0385 4466Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. Stephen Smith
- grid.15276.370000 0004 1936 8091Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Craig A. Sisson
- grid.267309.90000 0001 0629 5880Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James Palma
- grid.265436.00000 0001 0421 5525Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Liju Ahmed
- King Faisal Specialist Hospital and Research Center, Madinah, Kingdom of Saudi Arabia
| | - Hassan Mustafa
- grid.21613.370000 0004 1936 9609Internal Medicine, University of Manitoba, Manitoba, Canada
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Choi YA, Jung JY, Park JW, Lee MS, Kim TK, Lee SGW, Lee YH, Kim KH. Association between focused cardiac ultrasound and time to furosemide administration in acute heart failure. Am J Emerg Med 2022; 59:156-161. [PMID: 35870373 DOI: 10.1016/j.ajem.2022.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a global health burden, and its management in the emergency department (ED) is important. This study aimed to evaluate the association between focused cardiac ultrasound (FoCUS) and early administration of diuretics in patients with acute HF admitted to the ED. METHODS This retrospective observational study was conducted at a tertiary academic hospital. Patients with acute HF patients who were admitted to the ED and receiving intravenous medication between January 2018 and December 2019 were enrolled. The main exposure was a FoCUS examination performed within 2 h of ED triage. The primary outcome was the time to furosemide administration. RESULTS Of 1154 patients with acute HF, 787 were included in the study, with 116 of them having undergone FoCUS. The time to furosemide was significantly shorter in the FoCUS group (median time (q1-q3), 112 min; range, 65-163 min) compared to the non-FoCUS group (median time, 131 min; range, 71-229 min). In the multivariable logistic regression analysis adjusting for age, sex, chief complaint, mode of arrival, triage level, shock status, and desaturation at triage, early administration of furosemide within 2 h from triage was significantly higher in the FoCUS group (adjusted odds ratio, 1.63; 95% confidence intervals, 1.04-2.55) than in the non-FoCUS group. CONCLUSIONS Early administration of intravenous furosemide was associated with FoCUS examination in patients with acute HF admitted to the ED. An early screening protocol could be useful for improving levels in clinical practice at EDs.
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Affiliation(s)
- Yun Ang Choi
- Department of Emergency Medicine, Pediatric Emergency, Seoul National University Hospital, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Pediatric Emergency, Seoul National University Hospital, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Pediatric Emergency, Seoul National University Hospital, Republic of Korea
| | - Min Sung Lee
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea
| | - Tae Kwon Kim
- Department of Emergency Medicine, Keimyung University School of Medicine, Republic of Korea
| | - Stephen Gyung Won Lee
- Department of Emergency Medicine, Keimyung University School of Medicine 1095, Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Yong Hee Lee
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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Persson JN, Kim JS, Good RJ. Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:151-173. [PMID: 36277259 PMCID: PMC9264295 DOI: 10.1007/s40746-022-00250-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 12/26/2022]
Abstract
Purpose of Review Recent Findings Summary Supplementary Information
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Affiliation(s)
- Jessica N. Persson
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
- Division of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
| | - John S. Kim
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
| | - Ryan J. Good
- Division of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
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