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Nemani L, Palmer LJ, Nabzdyk CGS. Echocardiography in Sepsis: Can One Snapshot Tell the Whole Story? J Cardiothorac Vasc Anesth 2024; 38:1620-1622. [PMID: 38839490 DOI: 10.1053/j.jvca.2024.04.021] [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: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 06/07/2024]
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2
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Parker M, Johnson L, Paquette R, Sakaguchi A, Kar R. The prevalence of ultrasound curricula in a sampling of U.S. physician assistant programs and recommendations for common ultrasound objectives: A national survey. ANATOMICAL SCIENCES EDUCATION 2024; 17:855-863. [PMID: 38197498 DOI: 10.1002/ase.2375] [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: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.
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Affiliation(s)
- Morgan Parker
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Laura Johnson
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Roland Paquette
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan Sakaguchi
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rekha Kar
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Herrera PM, Blair PW, Siddharthan T, Fong T, Pollett S, Clark DV. Implementation of an International Severe Infection Point-of-Care Ultrasound Research Network. Mil Med 2024; 189:e1246-e1252. [PMID: 37837196 DOI: 10.1093/milmed/usad393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/26/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is a rapid, readily available, and cost-effective diagnostic and prognostic modality in a range of clinical settings. However, data to support its clinical application are limited. This project's main goal was to assess the effectiveness of standardizing lung ultrasound (LUS) training for sonographers to determine if universal LUS adoption is justified. MATERIALS AND METHODS We describe the effectiveness of an implementation of a LUS research training program across eight international study sites in Asia, Africa, and North America as part of prospective Coronavirus Disease of 2019 (COVID-19) and sepsis study cohorts (Rapid Assessment of Infection with SONography research network). Within our network, point-of-care LUS was used to longitudinally evaluate radiographic markers of lung injury. POCUS operators were personnel from a variety of backgrounds ranging from research coordinators with no medical background to experienced clinicians. RESULTS Following a standardized protocol, 49 study sonographers were trained and LUS images from 486 study participants were collected. After training was completed, we compared before and after image qualities for interpretation. The proportion of acceptable images improved at each site between the first 25 scans and the second 25 scans, resulting in 80% or greater acceptance at each study site. CONCLUSIONS POCUS training and implementation proved feasible in diverse research settings among a range of providers. Standardization across ongoing cohort protocols affords opportunities for increased statistical power and generalizability of results. These results potentially support care delivery by enabling military medics to provide care at the point of injury, as well as aiding frontline clinicians in both austere and highly resourced critical care settings.
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Affiliation(s)
- Phabiola M Herrera
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL 33136, USA
| | - Paul W Blair
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Trishul Siddharthan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL 33136, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Tiffany Fong
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Simon Pollett
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Danielle V Clark
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
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4
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Ablordeppey EA, Zhao A, Ruggeri J, Hassan A, Wallace L, Agarwal M, Stickles SP, Holthaus C, Theodoro D. Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review. Emerg Med Int 2024; 2024:5675066. [PMID: 38742136 PMCID: PMC11090677 DOI: 10.1155/2024/5675066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/27/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Background Fixed, large volume resuscitation with intravenous fluids (IVFs) in septic shock can cause inadvertent hypervolemia, increased medical interventions, and death when unguided by point-of-care ultrasound (POCUS). The primary study objective was to evaluate whether total IVF volume differs for emergency department (ED) septic shock patients receiving POCUS versus no POCUS. Methods We conducted a retrospective observational cohort study from 7/1/2018 to 8/31/2021 of atraumatic adult ED patients with septic shock. We agreed upon a priori variables and defined septic shock as lactate ≥4 and hypotension (SBP <90 or MAP <65). A sample size of 300 patients would provide 85% power to detect an IVF difference of 500 milliliters between POCUS and non-POCUS cohorts. Data are reported as frequencies, median (IQR), and associations from bivariate logistic models. Results 304 patients met criteria and 26% (78/304) underwent POCUS. Cardiac POCUS demonstrated reduced ejection fraction in 15.4% of patients. Lung ultrasound showed normal findings in 53% of patients. The POCUS vs. non-POCUS cohorts had statistically significant differences for the following variables: higher median lactate (6.7 [IQR 5.2-8.7] vs. 5.6], p = 0.003), lower systolic blood pressure (77.5 [IQR 61-86] vs. 85.0, p < 0.001), more vasopressor use (51% vs. 34%, p = 0.006), and more positive pressure ventilation (38% vs. 24%, p = 0.017). However, there were no statistically significant differences between POCUS and non-POCUS cohorts in total IVF volume ml/kg (33.02 vs. 32.1, p = 0.47), new oxygen requirement (68% vs. 59%, p = 0.16), ED death (3% vs. 4%, p = 0.15), or hospital death (31% vs. 27%, p = 0.48). There were similar distributions of lactate, total fluids, and vasopressors in patients with CHF and severe renal failure. Conclusions Among ED patients with septic shock, POCUS was more likely to be used in sicker patients. Patients who had POCUS were given similar volume of crystalloids although these patients were more critically ill. There were no differences in new oxygen requirement or mortality in the POCUS group compared to the non-POCUS group.
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Affiliation(s)
- Enyo A. Ablordeppey
- Department of Anaesthesiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy Zhao
- Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffery Ruggeri
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ahmad Hassan
- Washington University School of Medicine, St. Louis, MO, USA
| | - Laura Wallace
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Mansi Agarwal
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Sean P. Stickles
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher Holthaus
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Theodoro
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Hobbs H, Millington S, Wiskar K. Multiorgan Point-of-Care Ultrasound Assessment in Critically Ill Adults. J Intensive Care Med 2024; 39:187-195. [PMID: 37552930 PMCID: PMC10845831 DOI: 10.1177/08850666231192047] [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: 04/10/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
Traditional point-of-care ultrasound (POCUS) training highlights discrete techniques, single-organ assessment, and focused protocols. More recent developments argue for a whole-body approach, where the experienced clinician-ultrasonographer crafts a personalized POCUS protocol depending on specific clinical circumstances. This article describes this problem-based approach, focusing on common acute care scenarios while highlighting practical considerations and performance characteristics.
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Affiliation(s)
- Hailey Hobbs
- Department of Critical Care Medicine, Queen's University, Kingston, Canada
| | - Scott Millington
- Critical Care Medicine, The University of Ottawa/The Ottawa Hospital, Ottawa, Canada
| | - Katie Wiskar
- Clinical Instructor, Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
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Chelikam N, Vyas A, Desai R, Khan N, Raol K, Kavarthapu A, Kamani P, Ibrahim G, Madireddy S, Pothuru S, Shah P, Patel UK. Past and Present of Point-of-Care Ultrasound (PoCUS): A Narrative Review. Cureus 2023; 15:e50155. [PMID: 38192958 PMCID: PMC10771967 DOI: 10.7759/cureus.50155] [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: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
This article aims to conduct a literature review to gain insight into point-of-care ultrasound (PoCUS). PoCUS is a rapid, accurate, non-invasive, and radiation-free imaging modality that can be used in stable and unstable patients. PoCUS can be performed parallel to physical examination, resuscitation, and stabilization; repeated exams in critical patients are essential for improving sensitivity. The review highlights how PoCUS, which was initially used to detect free intraperitoneal fluid in trauma patients, has developed into a life-saving diagnostic tool that could be utilized by treating physicians during various stages of diagnosis, resuscitation, operation, and postoperative critical care when managing sick patients. The review also notes the barriers to the widespread uptake of PoCUS in general internal medicine and the recent commercial availability of "pocket" or handheld probes that have made PoCUS more readily available. This review concludes that adopting a focused binary decision-making approach can maximize PoCUS's value in many clinical settings, including emergency departments, intensive care units, and operation theatres. Overall, the review emphasizes the importance of awareness of common indications, limitations, and strengths of this evolving and promising technology to determine its future trajectory: Providing comprehensive PoCUS training within internal medicine curriculums and supporting trainers to do so.
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Affiliation(s)
- Nikhila Chelikam
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ankit Vyas
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
| | - Rutikbhai Desai
- Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Nida Khan
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Karanrajsinh Raol
- Internal Medicine, St. Vincent's Medical Center, Bridgeport, USA
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and General Hospital, Gandhinagar, IND
| | - Anusha Kavarthapu
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | | | - Garad Ibrahim
- Internal Medicine, Hennepin County Medical Center, Minneapolis, USA
| | | | | | - Parth Shah
- Hospital Medicine, Tower Health Medical Group, Reading, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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7
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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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Corcoran E, Hopkins P, Fisher R, Wong A, Rose L. Intensive care nurse-led point of care ultrasound in the assessment and management of the critically ill COVID-19 patient: A single centre case series. Nurs Crit Care 2023; 28:781-788. [PMID: 36575807 PMCID: PMC9880746 DOI: 10.1111/nicc.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022]
Abstract
Focused ultrasound can be used to rapidly diagnose COVID-19 disease, assess disease severity, and inform management of COVID-19 and associated pathologies, reducing radiation exposure from other imaging modalities and minimizing spread of infection. Ultrasound examinations performed by trained nurses in the intensive care unit (ICU) enable more patients to receive these assessments. This case series evaluates the use of nurse-led focused cardiac and lung ultrasound for clinical management of ICU patients with COVID-19. We describe common pathophysiological findings and how findings were used to inform clinical decision-making. An ultrasound trained ICU nurse performed Focused Ultrasound in Intensive Care (FUSIC) cardiac and lung scans enabling calculation of a lung severity score on adult ICU patients with a confirmed COVID-19 diagnosis in a single-centre setting. Fifteen scans were performed on 15 patients. Thirteen (87%) patients had normal left ventricular function; 12 (80%) normal right ventricular function. All 15 (100%) scans identified abnormal lung findings including irregular thickened pleura, B-lines, sub-pleural consolidation and hepatization. Worse lung severity scores were correlated with higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (r = 0.70; p = .003). Of the 15 scans, 10 (67%) identified abnormal pathology contributing to a change in clinical management. This included targeted fluid removal (4, 27%), change in respiratory management (3, 20%) and need for formal echocardiographic assessment (3, 20%). Findings from five (33%) scans required no intervention. This case series demonstrates nurse-led ultrasound could be a useful adjunct in the management of the COVID-19 patient.
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Affiliation(s)
| | - Phil Hopkins
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Richard Fisher
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Adrian Wong
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Louise Rose
- Intensive Care Research TeamKing's College HospitalLondonUK
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Taylor JC. Mitigating Diagnostic Errors With Point-of-Care Ultrasonography: A New Framework. Tex Heart Inst J 2023; 50:e238234. [PMID: 37641910 PMCID: PMC10660645 DOI: 10.14503/thij-23-8234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Jayne Chirdo Taylor
- Department of Anesthesiology and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
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10
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Risk factors for the prognosis of patients with sepsis in intensive care units. PLoS One 2022; 17:e0273377. [PMID: 36067189 PMCID: PMC9447880 DOI: 10.1371/journal.pone.0273377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background and purpose To date, sepsis remains the main cause of mortality in intensive care units (ICU). This study aimed analyze the risk factors of the prognosis in sepsis patients. Methods In this case-control study, patients with sepsis admitted to the intensive care unit of a Chinese hospital between January and November 2020 were analyzed. Ultrasound and clinical data were analyzed and compared between non-survivors and survivors. The ROC curve analysis was also performed to determine the best indicator for predicting mortality. Results A total of 72 patients with sepsis in ICU were included for analysis. The basic characteristics between the survivals and non-survivals were similar, except for acute physiology and chronic health evaluation (APACHE) Ⅱ score, sepsis-related organ failure assessment (SOFA) score, lactate level, ultrasound parameters from superior mesenteric artery (SMA) such as peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). Univariate analysis revealed that the APACHE Ⅱ score, SOFA score, lactate, low PSV, EDV, and RI were potential risk factors for mortality in sepsis, while multivariate analysis suggested that low PSV was an independent risk factor for mortality, and the adjusted odds ratio was 0.295 (95% CI: 0.094–0.925). The ROC analysis showed that the PSV (AUC = 0.99; sensitivity and specificity were 0.99 and 0.96, respectively) had good predictive value for mortality in sepsis. Conclusion Low PSV as found to be an independent risk factor and good predictor for mortality in patients with sepsis. This study shows the promise of ultrasound in predicting mortality in patients with sepsis; however, further studies are needed to validate these results.
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11
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Valicek G. Critical Care Ultrasound: Fixer Bestandteil der ICU-Visite? ANÄSTHESIE NACHRICHTEN 2022. [PMCID: PMC8832091 DOI: 10.1007/s44179-022-00027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Gerhard Valicek
- Klinische Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum St. Pölten – Lilienfeld, Standort St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant Platz 1, 3100 St. Pölten, Österreich
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12
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The Evaluation Point-of-Care Ultrasound in the Post-Anesthesia Unit-A Multicenter Prospective Observational Study. J Clin Med 2021; 10:jcm10112389. [PMID: 34071466 PMCID: PMC8198895 DOI: 10.3390/jcm10112389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations. Methods: This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome. Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, p = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, p-values < 0.001. Conclusions: Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.
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Chiem AT, Shibata J, Lim G, Liu YT. Pick Up Your Probes: A Call for Clinically Oriented Point-of-Care Ultrasound Research in COVID-19. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:391-396. [PMID: 32686851 PMCID: PMC7405186 DOI: 10.1002/jum.15394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 05/14/2023]
Affiliation(s)
- Alan T. Chiem
- Department of Emergency MedicineOlive View–UCLA Medical CenterSylmarCaliforniaUSA
| | - Jacqueline Shibata
- Department of Emergency MedicineOlive View–UCLA Medical CenterSylmarCaliforniaUSA
| | - George Lim
- Ronald Reagan UCLA Medical CenterCaliforniaLos AngelesUSA
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Tuvali O, Sadeh R, Kobal S, Yarza S, Golan Y, Fuchs L. The long-term effect of short point of care ultrasound course on physicians' daily practice. PLoS One 2020; 15:e0242084. [PMID: 33216765 PMCID: PMC7678973 DOI: 10.1371/journal.pone.0242084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background The benefits of Point of Care Ultrasound (POCUS) are well established in the literature. As it is an operator-dependent modality, the operator is required to be skilled in obtaining and interpreting images. Physicians who are not trained in POCUS attend courses to acquire the basics in this field. The effectiveness of such short POCUS courses on daily POCUS utilization is unknown. We sought to measure the change in POCUS utilization after practicing physicians attended short POCUS courses. Methods A 13-statements questionnaire was sent to physicians who attended POCUS courses conducted at the Soroka University Medical Center between the years 2014–2018. Our primary objective was to compare pre-course and post-course POCUS utilization. Secondary objectives included understanding the course graduates’ perceived effect of POCUS on diagnosis, the frequency of ultrasound utilization and time to effective therapy. Results 212 residents and specialists received the questionnaire between 2014–2018; 116 responded (response rate of 54.7%). 72 (62.1%) participants were male, 64 (55.2%) were residents, 49 (42.3%) were specialists, 3 (2.5%) participants did not state their career status. 90 (77.6%) participants declared moderate use or multiple ultrasound use six months to four years from the POCUS course, compared to a rate of ‘no use at all’ and ‘minimal use of 84.9% before the course. 98 participants [84.4% CI 77.8%, 91.0%] agree and strongly agree that a short POCUS course may improve diagnostic skills and 76.7% [CI 69.0%, 84.3%] agree and strongly agree that the POCUS course may shorten time to diagnosis and reduce morbidity. Conclusions Our short POCUS course significantly increases bedside ultrasound utilization by physicians from different fields even 4 years from course completion. Course graduates strongly agreed that incorporating POCUS into their clinical practice improves patient care. Such courses should be offered to residents and senior physicians to close the existing gap in POCUS knowledge among practicing physicians.
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Affiliation(s)
- Ortal Tuvali
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Re'em Sadeh
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
| | - Sergio Kobal
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Cardiology Department, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shaked Yarza
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Golan
- Internal Medicine F, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Emergency Department, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ben-Baruch Golan Y, Sadeh R, Mizrakli Y, Shafat T, Sagy I, Slutsky T, Kobal SL, Novack V, Fuchs L. Early Point-of-Care Ultrasound Assessment for Medical Patients Reduces Time to Appropriate Treatment: A Pilot Randomized Controlled Trial. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1908-1915. [PMID: 32430108 DOI: 10.1016/j.ultrasmedbio.2020.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
Numerous studies emphasize the diagnostic importance of point-of-care ultrasound (POCUS), but the level of evidence remains low as most data are gathered from observational studies. We conducted a pilot, randomized controlled trial to evaluate the effect of POCUS exam on medical patient's management and clinical outcomes. Patients presenting with chest pain or dyspnea were enrolled and randomly allocated to an early POCUS scan group and a control group. POCUS assessment, within 24 h of internal ward admission, was conducted only for the intervention group. The primary outcome was time to correct diagnosis. Secondary outcomes included time to appropriate treatment, POCUS-related rate of primary diagnosis alteration and new clinically relevant findings and time to hospital discharge. Sixty patients were enrolled. Thirty patients were randomly allocated to each study arm. The POCUS exam revealed clinically relevant findings among 79% of patients and led to alteration of the primary diagnosis among 28% of patients. Time to appropriate treatment was significantly shorter among patients in the POCUS group compared with the control group (median time of 5 h [95% confidence interval: 0.5-9] vs. 24 h [95% CI: 19-29] p = 0.014). The time needed to achieve correct diagnosis by the primary team was shorter in the POCUS group compared with the control group, yet it did not reach statistical significance (median time of 24 h [95% CI: 18-30] vs. 48 h [95% CI: 20-76], p = 0.12). These results indicate that POCUS assessment conducted early among patients with dyspnea or chest pain improves diagnostic accuracy and shortens significantly the time to appropriate treatment.
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Affiliation(s)
| | - Re'em Sadeh
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuval Mizrakli
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tali Shafat
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iftach Sagy
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzachi Slutsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Emergency Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergio L Kobal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lior Fuchs
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Wilkinson JN, Saxhaug LM. Handheld ultrasound in training - The future is getting smaller! J Intensive Care Soc 2020; 22:220-229. [PMID: 34422105 DOI: 10.1177/1751143720914216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Traditional ultrasound teaching is normally delivered using large, costly and often quite advanced cart-based systems. These carts are often large systems on wheels, usually limited to the departments that own them i.e. clinics, wards or radiology. Portability has been further improved by the development of laptop style systems, which are easier to wheel in-between patients/departments. In our experience and anecdotally, many of these systems can be intimidating to the novice and can lead to early attrition or poor uptake of ultrasound into clinical practice. Carts can also restrict the amount of training deliverable to practitioners, as they are limited in number due to cost and can take quite some time to boot up, reducing convenience. This dogma is being progressively changed with the advent of smaller handheld devices, some clearly within the financial grasps of most practitioners, and even to the point of medical schools offering students their own personal device.1,2 This relative inexpensiveness can lead to the purchase of these devices for novelty and convenience, over need. Obvious caution is needed in these circumstances, but with increased ease of purchase, better availability and inbuilt simplicity, ultrasound learning can be seamlessly integrated into day-to-day practice. This review discusses how one of the most disruptive innovations in modern medicine is changing ultrasound from a classic imaging modality to become integrated as the fifth pillar of clinical examination, and how these new devices can serve as springboards to more advanced ultrasound training. In fact, within what has become a bigger area of clinical examination, things are getting smaller.
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