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Flower L, Waite A, Boulton A, Peck M, Akhtar W, Boyle AJ, Gudibande S, Ingram TE, Johnston B, Marsh S, Miller A, Nash A, Olusanya O, Parulekar P, Wagstaff D, Wilkinson J, Proudfoot AG. The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study. Intensive Care Med 2024; 50:1668-1680. [PMID: 39158704 DOI: 10.1007/s00134-024-07590-6] [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: 06/20/2024] [Accepted: 08/01/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE Echocardiography is recommended as a first-line tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. The aims of this work were to evaluate the utilisation of echocardiography in patients presenting to critical care with shock, its impact on decision making, and adherence to governance guidelines. METHODS We conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom (UK) and Crown Dependencies, led by the UK's Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 h to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making. RESULTS 1015 patients with shock were included. An echocardiogram was performed on 545 (54%) patients within 72 h and 436 (43%) within 24 h of admission. Most scans were performed by the critical care team (n = 314, 58%). Echocardiography was reported to either reduce diagnostic uncertainty or change management in 291 (54%) cases. Patients with obstructive or cardiogenic shock had their management altered numerically more often by echocardiography (n = 15 [75%] and n = 100 [58%] respectively). Twenty-five percent of echocardiograms performed adhered to current national governance and image storage guidance. CONCLUSION Use of echocardiography in the assessment of patients with shock remains heterogenous. When echocardiography is used, it improves diagnostic certainty or changes management in most patients. Future research should explore barriers to increasing use of echocardiography in assessing patients presenting with shock.
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Affiliation(s)
- Luke Flower
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- Department of Critical Care, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
- London School of Intensive Care Medicine, London, UK.
| | - Alicia Waite
- North West Deanery School of Intensive Care Medicine, Liverpool, UK
- University of Liverpool, Liverpool, UK
- Department of Critical Care, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Adam Boulton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Marcus Peck
- Department of Anaesthesia and Critical Care, Royal Hampshire County Hospital, Winchester, UK
| | - Waqas Akhtar
- Department of Critical Care, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Andrew J Boyle
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Sandeep Gudibande
- Department of Critical Care, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK
- Professional Affairs and Standards Committee, Faculty of Intensive Care Medicine, London, UK
| | - Thomas E Ingram
- Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Brian Johnston
- University of Liverpool, Liverpool, UK
- Department of Critical Care, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Sarah Marsh
- Department of Critical Care, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Ashley Miller
- Department of Critical Care, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Amy Nash
- NHS England Wessex School of Anaesthesia, Wessex, UK
| | | | | | - Daniel Wagstaff
- Wessex School of Intensive Care Medicine, NHS England, Wessex, UK
| | - Jonathan Wilkinson
- Department of Critical Care, Northampton General Hospital, Northampton, UK
| | - Alastair G Proudfoot
- Department of Critical Care, Barts Health NHS Trust, London, UK
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, London, UK
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Smith JA, Mistry R. Management change following transthoracic echocardiogram in the intensive care unit. Australas J Ultrasound Med 2024; 27:174-178. [PMID: 39328261 PMCID: PMC11423430 DOI: 10.1002/ajum.12397] [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: 09/28/2024] Open
Abstract
Introduction/Purpose The optimal utilisation of echocardiography in intensive care units (ICU) is not yet known; however, its use is becoming more frequent. Management change from transthoracic echocardiography (TTE) in ICU is quoted to be from 3% to 50%. Methods A retrospective review of clinical practice was performed over a 2-month period in a tertiary adult ICU, to explore the utilisation of formal TTEs and the findings of these. The rate of management change and critical findings were investigated, along with the indication for TTE and the patient cohort. Results Sixty-three TTEs were performed in 54 patients. A change in management occurred in 25.4% (16/63) of TTEs, with critical findings being found in 47.6% (30/63) of all TTEs. The most common indications for formal TTEs were incompletely differentiated or further evaluation of shock, and post arrest cardiac function. Discussion Almost half of the TTEs performed had critical findings, with common critical findings being severe LV dysfunction, severe RV dysfunction and regional wall motion abnormalities. Despite critical findings being seen frequently, there was only management change in 25%, suggesting that several of the critical findings were already suspected, clinically confirmed or had anticipatory management prior to TTE. Conclusion Critical findings are common in critically ill patients. However, not all critical findings will lead to a change in management. Formal TTEs in the ICU should be focussed to the clinical question being asked and a screening intensivist performed bedside TTE may be appropriate in certain situations to decrease workload of cardiology department.
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Affiliation(s)
- Jeremy A Smith
- Gold Coast University Hospital 1 Hospital Boulevard Southport Queensland 4215 Australia
| | - Ravi Mistry
- Gold Coast University Hospital 1 Hospital Boulevard Southport Queensland 4215 Australia
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3
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Taboada M, Cariñena A, Estany-Gestal A, Iglesias-Álvarez D, Veiras S, Martínez A, Eiras M, De Miguel M, Selas S, Martínez-Monzonis A, Pereira P, Bastos-Fernández M, González-Salvado V, Álvarez-Barrado M, Ferreiroa E, Caruezo V, Costa J, Naveira A, Otero P, Adrio B, Martínez-Cereijo JM, Fernández Á, González-Juanatey JR, Álvarez J, Seoane-Pillado T. Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized clinical trial. Anaesth Crit Care Pain Med 2024; 43:101346. [PMID: 38278357 DOI: 10.1016/j.accpm.2024.101346] [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: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique. METHODS In this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications. RESULTS A total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% vs. 58%; absolute difference, 32%; 95% CI 16%-48%; p < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% vs. 72%; absolute difference, 28%; 95% CI 16%-40%; p < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% vs. 52%; absolute difference, 38%; 95% CI 21%-55%; p < 0.001). CONCLUSIONS Our study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04980976.
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Affiliation(s)
- Manuel Taboada
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain.
| | - Agustín Cariñena
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Ana Estany-Gestal
- Research Methodology Unit, Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | | | - Sonia Veiras
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Adrián Martínez
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - María Eiras
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Manuela De Miguel
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Salomé Selas
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | - Pedro Pereira
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | | | | | - Esteban Ferreiroa
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Valentín Caruezo
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Jose Costa
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Alberto Naveira
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Pablo Otero
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Belén Adrio
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Jose Manuel Martínez-Cereijo
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Ángel Fernández
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | - Julián Álvarez
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Teresa Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
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Blank SP, Blank RM. Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset. Crit Care Med 2024; 52:248-257. [PMID: 38240507 DOI: 10.1097/ccm.0000000000006069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database. DESIGN Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality. SETTING Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019. PATIENTS Adults 16 years old or older with septic shock requiring vasopressor support within 48 hours of admission. Readmissions and patients admitted to the coronary care unit or cardiovascular intensive care were excluded, as well as patients with ST-elevation myocardial infarction or cardiac arrest. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Echocardiography was performed in 1,515 (27%) of 5,697 eligible admissions. The primary outcome was analyzed using a marginal structural model and rolling entry matching to adjust for baseline and time-varying confounders. Patients who underwent echocardiography showed no significant difference in 28-day mortality (adjusted hazard ratio 1.09; 95% CI, 0.95-1.25; p = 0.24). This was consistent across multiple sensitivity analyses. Secondary outcomes were changes in management instituted within 4 hours of imaging. Treatment changes occurred in 493 patients (33%) compared with 431 matched controls (29%), with the most common intervention being the administration of a fluid bolus. CONCLUSIONS Echocardiography in sepsis was not associated with a reduction in 28-day mortality based on observational data. These findings do not negate the utility of echo in cases of diagnostic uncertainty or inadequate response to initial treatment.
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Affiliation(s)
| | - Ruth M Blank
- Department of Anesthesia, Royal Darwin Hospital, Darwin, NT, Australia
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5
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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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6
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Liu Q, Tang Y, Tao W, Tang Z, Wang H, Nie S, Wang N. Early transthoracic echocardiography and long-term mortality in moderate- to-severe acute respiratory distress syndrome: An analysis of the Medical Information Mart for Intensive Care database. Sci Prog 2023; 106:368504231201229. [PMID: 37801611 PMCID: PMC10560446 DOI: 10.1177/00368504231201229] [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] [Indexed: 10/08/2023]
Abstract
BACKGROUND The clinical use of transthoracic echocardiography (TTE) in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) has dramatically increased, its impact on long-term prognosis in these patients has not been studied. This study aimed to explore the effect of early-TTE on long-term mortality in patients with moderate-to-severe ARDS in ICU. METHODS A total of 2833 patients with moderate-to-severe ARDS who had or had not received early-TTE were obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database after imputing missing values by a random forest model, patients were divided into early-TTE group and non-early-TTE group according to whether they received TTE examination in ICU. A variety of statistical methods were used to balance 41 covariates and increase the reliability of this study, including propensity score matching, inverse probability of treatment weight, covariate balancing propensity score, multivariable regression, and doubly robust estimation. Chi-Square test and t-tests were used to examine the differences between groups for categorical and continuous data, respectively. RESULTS There was a significant improvement in 90-day mortality in the early-TTE group compared to non-early-TTE group (odds ratio = 0.79, 95% CI: 0.64-0.98, p-value = 0.036), revealing a beneficial effect of early-TTE. Net-input was significantly decreased in the early-TTE group on the third day of ICU admission and throughout the ICU stay, compared with non-early-TTE group (838.57 vs. 1181.89 mL, p-value = 0.014; 4542.54 vs. 8025.25 mL, p-value = 0.05). There was a significant difference in the reduction of serum lactate between the two groups, revealing the beneficial effect of early-TTE (0.59 vs. 0.83, p-value = 0.009). Furthermore, the reduction in the proportion of acute kidney injury demonstrated a correlation between early-TTE and kidney protection (33% vs. 40%, p-value < 0.001). CONCLUSIONS Early application of TTE is beneficial to improve the long-term mortality of patients with moderate-to-severe ARDS.
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Affiliation(s)
- Qiuyu Liu
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Yingkui Tang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wu Tao
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Ze Tang
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Hongjin Wang
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Shiyu Nie
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Nian Wang
- Department of Critical Care Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
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Jordan H, Preston H, Hall DP, Gifford H, Gillies MA. Point-of-care echocardiography and thoracic ultrasound in the management of critically ill patients with COVID-19 infection: Experience in three regional UK intensive care units. J Intensive Care Soc 2023; 24:147-153. [PMID: 37255990 PMCID: PMC10225795 DOI: 10.1177/17511437211045326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) has an established role in the management of the critically ill. Information and experience of its use in those with COVID-19 disease is still evolving. We undertook a review of cardiac and thoracic ultrasound examinations in patients with COVID-19 on the intensive care unit (ICU). Our aim was to report key findings and their impact on patient management. METHODS A retrospective evaluation of critically ill patients with COVID-19 was undertaken in three adult ICUs, who received point-of-care cardiac and/or thoracic ultrasound during the 2019-2020 COVID-19 pandemic. We recorded baseline demographic data, principal findings, change in clinical management and outcome data. RESULTS A total of 55 transthoracic echocardiographic examinations scans were performed on 35 patients. 35/55 (64%) echocardiograms identified an abnormality, most commonly a dilated or impaired right ventricle (RV) and 39/55 (70%) scans resulted in a change in management. Nine patients (26%) were found to have pulmonary arterial thrombosis on CTPA or post-mortem. More than 50% of these patients showed evidence of right ventricular dilatation or impairment. Of the patients who were known to have pulmonary arterial thrombosis and died, 83% had evidence of right ventricular dilatation or impairment. 32 thoracic ultrasound scans were performed on 23 patients. Lung sliding and pleural thickening were present bilaterally in all studies. Multiple B-lines were present in all studies, and sub-pleural consolidation was present bilaterally in 72%. CONCLUSION POCUS is able to provide useful and clinically relevant information in those critically ill with COVID-19 infection, resulting in change in management in a high proportion of patients. Common findings in this group are RV dysfunction, multiple B-lines and sub-pleural consolidation.
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Affiliation(s)
- Helen Jordan
- Department of Anaesthesia, Critical Care and Pain
Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - Hannah Preston
- Department of Anaesthesia, Critical Care and Pain
Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - David P Hall
- Department of Anaesthesia, Critical Care and Pain
Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - Hugh Gifford
- Department of Anaesthesia, Critical Care and Pain
Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
| | - Michael A Gillies
- Department of Anaesthesia, Critical Care and Pain
Medicine, Royal Infirmary of
Edinburgh, Edinburgh, UK
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8
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Takagi K, Akiyama E, Paternot A, Miró Ò, Charron C, Gayat E, Deye N, Cariou A, Monnet X, Jaber S, Guidet B, Damoisel C, Barthélémy R, Azoulay E, Kimmoun A, Fournier MC, Cholley B, Edwards C, Davison BA, Cotter G, Vieillard-Baron A, Mebazaa A. Early echocardiography by treating physicians and outcome in the critically ill: An ancillary study from the prospective multicenter trial FROG-ICU. J Crit Care 2022; 69:154013. [PMID: 35278876 DOI: 10.1016/j.jcrc.2022.154013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the association between the use of early echocardiography performed by the treating physician certified in critical care ultrasound and mortality in ICU patients. MATERIALS AND METHODS FROG-ICU was a multi-center cohort designed to investigate the outcome of critically ill patients. Of the 1359 patients admitted to centers where echocardiography was available, 372 patients underwent echocardiography during the initial 3 days. RESULTS Of the ICU patients admitted for cardiac disease, 47.4% underwent echocardiography, and those patients had the lowest left ventricular ejection fraction 40 [31-58] % and the lowest cardiac output 4.2 [3.2-5.7] L/min compared to patients admitted for other causes (p < 0.001 for both). One-year mortality was 36.8% and 39.9% in patients with and without echocardiography, respectively [HR 0.92 (95% CI 0.75-1.11)]. This result was confirmed after multivariable Cox regression analysis [HR 0.88 (95% CI 0.71-1.08)]. Subgroup analyses suggest that among patients admitted to ICU for cardiac disease, those managed with echocardiography had a lower risk of one-year mortality [HR 0.65 (95% CI 0.43-0.98)]. CONCLUSIONS Early echocardiography by treating physicians was not associated with short- or long-term survival in ICU patients. In subgroups, early echocardiography improved survival in ICU patients admitted for cardiac disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01367093.
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Affiliation(s)
- Koji Takagi
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | - Eiichi Akiyama
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Alexis Paternot
- Intensive Care Unit, University hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Medical School, University of Barcelona, Barcelona, Spain
| | - Cyril Charron
- Intensive Care Unit, University hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Etienne Gayat
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Nicolas Deye
- Medical and Toxicology Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, AP-HP, Université Paris Diderot-Paris 7, Inserm U942, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Université de Paris, Paris, France
| | - Xavier Monnet
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Saclay University Hospitals, Inserm UMR_S999, Paris-Suclay University, Le Kremlin-Bicetre, France
| | - Samir Jaber
- Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Centre Hospitalier, Montpellier, France
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de réanimation, F75012 Paris, France
| | - Charles Damoisel
- Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP et Université de Paris, Paris, France
| | - Antoine Kimmoun
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Intensive Care Medicine Brabois, CHRU de Nancy, INSERM U1116, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France
| | - Marie-Céline Fournier
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Bernard Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France; Inserm UMR_S 1140, Innovations Thérapeutiques en Hémostase, Paris, France
| | | | - Beth A Davison
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | - Gad Cotter
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | | | - Alexandre Mebazaa
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France.
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9
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Chung JH, Kim N. Usefulness of Echocardiography for General Surgery Patients on Intensive Care Units: When and How? JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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10
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Gibson LE, White-Dzuro GA, Lindsay PJ, Berg SM, Bittner EA, Chang MG. Ensuring competency in focused cardiac ultrasound: a systematic review of training programs. J Intensive Care 2020; 8:93. [PMID: 33308314 PMCID: PMC7730755 DOI: 10.1186/s40560-020-00503-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a valuable skill for rapid assessment of cardiac function and volume status. Despite recent widespread adoption among physicians, there is limited data on the optimal training methods for teaching FoCUS and metrics for determining competency. We conducted a systematic review to gain insight on the optimal training strategies, including type and duration, that would allow physicians to achieve basic competency in FoCUS. METHODS Embase, PubMed, and Cochrane Library databases were searched from inception to June 2020. Included studies described standardized training programs for at least 5 medical students or physicians on adult FoCUS, followed by an assessment of competency relative to an expert. Data were extracted, and bias was assessed for each study. RESULTS Data were extracted from 23 studies on 292 learners. Existing FoCUS training programs remain varied in duration and type of training. Learners achieved near perfect agreement (κ > 0.8) with expert echocardiographers on detecting left ventricular systolic dysfunction and pericardial effusion with 6 h each of didactics and hands-on training. Substantial agreement (κ > 0.6) on could be achieved in half this time. CONCLUSION A short training program will allow most learners to achieve competency in detecting left ventricular systolic dysfunction and pericardial effusion by FoCUS. Additional training is necessary to ensure skill retention, improve efficiency in image acquisition, and detect other pathologies.
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Affiliation(s)
- Lauren E Gibson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA.
| | - Gabrielle A White-Dzuro
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Patrick J Lindsay
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Sheri M Berg
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Marvin G Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
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11
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Yastrebov K, Brunel L, Paterson HS, Williams ZA, Wise IK, Burrows CS, Bannon PG. Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography. Sci Rep 2020; 10:17485. [PMID: 33060679 PMCID: PMC7562902 DOI: 10.1038/s41598-020-74220-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/29/2020] [Indexed: 02/08/2023] Open
Abstract
Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.
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Affiliation(s)
- Konstantin Yastrebov
- Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia.
- Prince of Wales Hospital, Sydney, University of New South Wales, Barker St, Randwick, 2031, Australia.
| | - Laurencie Brunel
- Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia
| | - Hugh S Paterson
- Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia
| | - Zoe A Williams
- Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia
| | - Innes K Wise
- Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia
| | | | - Paul G Bannon
- Sydney Imaging, Core Research Facility, The University of Sydney, Sydney, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
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12
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Marbach JA, Almufleh A, Di Santo P, Simard T, Jung R, Diemer G, West FM, Millington SJ, Mathew R, Le May MR, Hibbert B. A Shifting Paradigm: The Role of Focused Cardiac Ultrasound in Bedside Patient Assessment. Chest 2020; 158:2107-2118. [PMID: 32707179 DOI: 10.1016/j.chest.2020.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
Transthoracic echocardiography is the standard of care in anatomic and functional cardiovascular assessment; however, focused cardiac ultrasound (FoCUS) performed with portable ultrasound equipment is increasingly being used as an adjunct to comprehensive history and physical examination. FoCUS assessments, unlike formal echocardiography, are intended to assist physicians in answering explicit clinical questions with a narrow differential diagnosis in real time. Over the past decade, a growing body of literature has repeatedly shown the value that FoCUS adds to clinical evaluation. Specifically, FoCUS improves point-of-care diagnostic accuracy, which in turn modifies treatment plans, decreases time to diagnosis, and reduces resource utilization. Although less robust, there is also evidence showing improvement in clinical outcomes. Based on this evidence, clinicians, training programs, and clinical societies have embraced FoCUS as a tool to complement bedside patient evaluation. Herein, we review the evidence for FoCUS in clinical practice, specifically evaluating the diagnostic accuracy, the impact on clinical decision-making, and the effect on clinical outcomes.
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Affiliation(s)
- Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Aws Almufleh
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Gretchen Diemer
- Division of Hospital Medicine, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Frances Mae West
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Scott J Millington
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michel R Le May
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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13
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Nagre AS. Focus-assessed transthoracic echocardiography: Implications in perioperative and intensive care. Ann Card Anaesth 2020; 22:302-308. [PMID: 31274494 PMCID: PMC6639886 DOI: 10.4103/aca.aca_88_18] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Transthoracic echocardiography is a potent and appealing diagnostic tool by virtue of rapidity, noninvasiveness, and repeatability. Focus-assessed transthoracic echocardiography (FATE) forms quick guidance to interpret the echocardiographic information and relates it to the clinical context. It can be applied in the perioperative period, intensive care units (ICUs), and emergency situations, in trauma and as resuscitation aids. FATE intents to assess cardiac function including contractility, chamber size and hypertrophy, valvular dysfunction, cardiac tamponade, and pericardial and pleural effusions. Thence, FATE has become a quintessential scanning tool perioperatively and in ICUs.
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Affiliation(s)
- Amarja Sachin Nagre
- Department of Anaesthesia, Kamalnayan Bajaj Hospital, Aurangabad,Maharashtra, India
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14
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Hindocha R, Garry D, Short N, Ingram TE, Steeds RP, Colebourn CL, Pearce K, Sharma V. A minimum dataset for a Level 1 echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Res Pract 2020; 7:G51-G58. [PMID: 36472200 PMCID: PMC7354713 DOI: 10.1530/erp-19-0060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/12/2020] [Indexed: 12/14/2022] Open
Abstract
The British Society of Echocardiography has previously outlined a minimum dataset for a standard transthoracic echocardiogram, and this remains the basis on which an echocardiographic study should be performed. The importance of ultrasound in excluding critical conditions that may require urgent treatment is well known. Several point-of-care echo protocols have been developed for use by non-echocardiography specialists. However, these protocols are often only used in specific circumstances and are usually limited to 2D echocardiography. Furthermore, although the uptake in training for these protocols has been reasonable, there is little in the way of structured support available from accredited sonographers in the ongoing training and re-accreditation of those undertaking these point-of-care scans. In addition, it is well recognised that the provision of echocardiography on a 24/7 basis is extremely challenging, particularly outside of tertiary cardiac centres. Consequently, following discussions with NHS England, the British Society of Echocardiography has developed the Level 1 echocardiogram in order to support the rapid identification of critical cardiac pathology that may require emergency treatment. It is intended that these scans will be performed by non-specialists in echocardiography and crucially are not designed to replace a full standard transthoracic echocardiogram. Indeed, it is expected that a significant number of patients, in whom a Level 1 echocardiogram is required, will need to have a full echocardiogram performed as soon as is practically possible. This document outlines the minimum dataset for a Level 1 echocardiogram. The accreditation process for Level 1 echo is described separately.
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Affiliation(s)
- Rakhee Hindocha
- Brighton and Sussex University Hospitals, Brighton, UK,Correspondence should be addressed to R Hindocha:
| | - David Garry
- Oxford University Hospitals Trust, Oxford, UK
| | | | - Tom E Ingram
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Richard P Steeds
- Universty Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Vishal Sharma
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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15
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Vallabhajosyula S, Ahmed AM, Sundaragiri PR. Role of echocardiography in sepsis and septic shock. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:150. [PMID: 32309299 PMCID: PMC7154469 DOI: 10.21037/atm.2020.01.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abdelrahman M Ahmed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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16
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Arican Ş, Dertli R, Dağli Ç, Hacibeyoğlu G, Koyuncu M, Topal A, Tuncer Uzun S, Asil M. The role of right ventricular volumes and inferior vena cava diameters in the evaluation
of volume status before colonoscopy. Turk J Med Sci 2019; 49:1606-1613. [PMID: 31655506 PMCID: PMC7518660 DOI: 10.3906/sag-1903-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/18/2019] [Indexed: 11/03/2022] Open
Abstract
Background/aim Ultrasonographic measurements of inferior vena cava (IVC) diameters and right ventricle (RV) volumes are important tools for the evaluation of intravascular volume. The current study investigates the association of IVC diameters and RV volumes before colonoscopy in prediction of postanesthesia hypotension. Materials and methods Seventy patients scheduled for colonoscopy were included in the study. Preoperatively, expirium (dIVC max) and inspirium (dIVC min) IVC diameters were measured using M-mode ultrasonography and the collapsibility index (IVC-CI) was calculated. Ventricular volumes and areas were also measured using transthoracic echocardiography. Postanesthesia hypotension was defined as mean arterial blood pressure of <60 mmHg or a decrease of >30% in the mean arterial pressure after sedation. Results Minimum and maximum IVC diameters were significantly lower (P = 0.005 and P < 0.001, respectively) and IVC-CI was significantly higher (P < 0.001) in patients who developed hypotension. Similarly, right ventricular end-diastolic area (RV-EDA), right ventricular end-systolic area (RV-ESA), right ventricular end-diastolic volume (RV-EDV), right ventricular end-systolic volume (RVESV), and left ventricular end-systolic volume (LV-ESV) values were significantly lower in patients with hypotension (P < 0.05). Logistic regression analysis showed that dIVC min and RV-ESA were independent predictors of hypotension. Conclusion IVC diameters and RV-ESA, RV-EDA, RV-ESV, and RV-EDV are good indicators of preoperative volume status and can be used to predict the patients at risk of developing hypotension.
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17
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Lan P, Wang TT, Li HY, Yan RS, Liao WC, Yu BW, Wang QQ, Lin L, Pan KH, Yu YS, Zhou JC. Utilization of echocardiography during septic shock was associated with a decreased 28-day mortality: a propensity score-matched analysis of the MIMIC-III database. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:662. [PMID: 31930063 DOI: 10.21037/atm.2019.10.79] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Hemodynamic management is of paramount importance in patients with septic shock. Echocardiography has been increasingly used in assessing volume status and cardiac function. However, whether the utilization of echocardiography has an impact on prognosis is unknown. Thus, we intended to explore its effect on the outcomes of patients with septic shock. Methods The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. Septic shock patients were divided into two groups according to the usage of echocardiography during the onset of septic shock. The primary outcome was 28-day mortality. Secondary outcomes included the usage of inotropes, ventilation-free and norepinephrine-free time, and fluids input. Propensity-score matching was used to reduce the imbalance. Results Among 3,291 eligible patients, 1,289 patients who underwent echocardiography (Echo), and 1,289 who did not receive the Echo, had similar propensity scores and were included in the analyses. After matching, the Echo group had a significantly lower 28-day mortality (33.2% vs. 37.7%, P=0.019). More patients in the Echo group received pulmonary artery catheter (PAC) (4.2% vs. 0.2%, P<0.001) and inotropes (17.8% vs. 7.1%, P<0.001). In the survival analysis, Echo utilization was associated with improved 28-day mortality [hazard ratio (HR): 0.83; 95% confidence interval (CI), 0.73-0.95, P=0.005]. A reduced likelihood of 28-day mortality in patients with Echo vs. those without Echo was maintained either when excluding patients receiving multiple echocardiography scans (HR, 0.82; 95% CI, 0.72-0.94; P=0.004) or when excluding patients undergoing PAC or pulse index continuous cardiac output (PiCCO) (HR, 0.87; 95% CI, 0.76-0.99; P=0.034). Conclusions Utilization of echocardiography was associated with improved 28-day outcomes in patients with septic shock.
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Affiliation(s)
- Peng Lan
- Department of Infectious Diseases Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China.,Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Ting-Ting Wang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Hang-Yang Li
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Ru-Shuang Yan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Wei-Chao Liao
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Bu-Wen Yu
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Qian-Qian Wang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Ling Lin
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Kong-Han Pan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Yun-Song Yu
- Department of Infectious Diseases Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Jian-Cang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
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18
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Pontet J, Yic C, Díaz-Gómez JL, Rodriguez P, Sviridenko I, Méndez D, Noveri S, Soca A, Cancela M. Impact of an ultrasound-driven diagnostic protocol at early intensive-care stay: a randomized-controlled trial. Ultrasound J 2019; 11:24. [PMID: 31595353 PMCID: PMC6783485 DOI: 10.1186/s13089-019-0139-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is a tool in increasing use, but there is still a lack of basics for its routine use and evidence of its impact in intensive care. Objective To measure the impact of POCUS on resource utilization, diagnostic accuracy, and clinical management in medical-surgical intensive care units (ICUs). Methods Prospective, controlled study, in two polyvalent ICUs. The patients were randomly assigned to POCUS or control group. Interventions POCUS patients received systematic ultrasound examination of optic nerve, lung/pleura, heart, abdomen, and venous system, performed at the bedside by trained intensivists. Control patients were treated by critical care specialists who do not perform ultrasound in their clinical practice. Results We included 80 patients, 40 per group. There were no significant differences in age, sex, APACHE II score, or admission diagnosis. POCUS group used fewer resources per patient in the first 5 days of hospitalization: chest radiography (2.6 ± 2.0 vs 4.1 ± 3.5, P = 0.01), additional ultrasound evaluations performed by a radiology specialist (0.6 ± 0.7 vs 1.1 ± 0.7, P = 0.002), and computed tomography studies (0.5 ± 0.6 vs 0.9 ± 0.7, P = 0.007). Time to perform any requested ultrasound evaluation after ICU admission was 2.1 ± 1.6 h versus 7.7 ± 6.7 h (P = 0.001). Systematic ultrasound evaluation led to better characterization of ICU admission diagnosis in 14 (35%) patients and change in clinical management in 24 (60%). POCUS group had lower fluid balance at 48 and 96 h after admission (P = 0.01) and spent less time mechanically ventilated (5.1 ± 5.7 days vs 8.8 ± 9.4, P = 0.03). Conclusions Systematic application of POCUS may decrease utilization of conventional diagnostic imaging resources and time of mechanical ventilation, and facilitate meticulous intravenous fluid administration in critically ill patients during the first week of stay in the ICU. Trial registration ClinicalTrials.gov Identifier: NCT03608202.
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Affiliation(s)
- Julio Pontet
- Intensive Care Unit, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay. .,Intensive Care Unit, Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay. .,, Larravide 2458, Montevideo, Uruguay.
| | - Christian Yic
- Intensive Care Unit, Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay
| | - José L Díaz-Gómez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, USA
| | - Pablo Rodriguez
- Intensive Care Unit, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Igor Sviridenko
- Intensive Care Unit, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Diego Méndez
- Intensive Care Unit, Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay
| | - Sylvia Noveri
- Intensive Care Unit, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Ana Soca
- Intensive Care Unit, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Mario Cancela
- Intensive Care Unit, Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay
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19
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Moreno O, Ochagavía A, Artigas A, Barbadillo S, Tomás R, Bosque MD, Fortia C, Baigorri F. Impact of goal directed basic echocardiography on diagnostic and therapeutic management in an ICU of cardiac surgery. Med Intensiva 2019; 44:534-541. [PMID: 31474457 DOI: 10.1016/j.medin.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Few studies have evaluated the impact in diagnosis and therapeutic management of basic transthoracic echocardiography in postoperated cardiac surgery. The aim of our study was to evaluate the impact of basic transthoracic echocardiography in the management of this kind of patients. DESIGN Over an 18-month period, we prospectively studied all patients admitted to a university hospital Intensive Care Unit following heart surgery. We evaluated clinically all of them to establish a diagnosis and an initial treatment. We performed basic transthoracic echocardiography for a diagnosis evaluation that was compared with clinical diagnosis. If they differed, we assessed to change treatment and evaluate the therapeutic response. We performed a descriptive analysis. RESULTS We included 136 patients and performed 203 echocardiographies. Transthoracic echocardiography differed of initial diagnosis in 101 (49.8%) echocardiographies. In 56 of these echocardiographies (55.44%), we could give an alternative diagnosis with a change in the treatment in 30patients (53,6%). We found clinical improvement in 26 patients (86.76%) in the following 30-60minutes. CONCLUSIONS Basic transthoracic echocardiography is useful in diagnostic and therapeutic management of postoperative cardiac surgery patients. We could not confirm the clinical diagnosis in half of the performed echocardiographies. In most patients in whom we observe a change in the diagnosis due to echocardiography, we observed a clinical improvement after changing the treatment.
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Affiliation(s)
- O Moreno
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Ochagavía
- Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Madrid, España
| | - A Artigas
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Madrid, España; Servicio de Medicina Intensiva, Hospital Universitari Sagrat Cor, Barcelona, España
| | - S Barbadillo
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - R Tomás
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - M D Bosque
- Servicio de Medicina Intensiva, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - C Fortia
- Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España
| | - F Baigorri
- Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Medicina Intensiva, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, España
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20
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Ramalingam G, Choi S, Agarwal S, Kunst G, Gill R, Fletcher SN, Klein AA, Shashidaran P, Waghmare K, Kadayam R, Flynn F, Gavin N, Mairead‐Machugh U, Bell M, Hawthorn A, Sajgalik P, Burri N, Meraglia A. Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care. Anaesthesia 2019; 75:21-26. [DOI: 10.1111/anae.14734] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/26/2022]
Affiliation(s)
- G. Ramalingam
- Department of Anaesthesia and Intensive Care Royal Papworth Hospital CambridgeUK
| | - S.‐W. Choi
- Department of Anaesthesiology Faculty of Medicine The University of Hong Kong HongKongHKSAR
| | - S. Agarwal
- Department of Cardiothoracic Anaesthesia Manchester Royal Infirmary ManchesterUK
| | - G. Kunst
- Department of Cardiothoracic Anaesthesia Kings College Hospital LondonUK
| | - R. Gill
- Department of Cardiothoracic Anaesthesia University Hospital Southampton UK
| | - S. N. Fletcher
- Department of Cardiothoracic Anaesthesia St Georges University Hospitals London UK
| | - A. A. Klein
- Department of Anaesthesia and Intensive Care Royal Papworth Hospital CambridgeUK
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21
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22
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Denault A, Canty D, Azzam M, Amir A, Gebhard CE. Whole body ultrasound in the operating room and intensive care unit. Korean J Anesthesiol 2019; 72:413-428. [PMID: 31159535 PMCID: PMC6781205 DOI: 10.4097/kja.19186] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022] Open
Abstract
Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.
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Affiliation(s)
- André Denault
- Department of Anesthesiology and Critical Care Medicine, Faculté de Médecine, Université de Montréal, Institut de Cardiologie de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David Canty
- Department of Surgery, University of Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Clayton, Melbourne, and Department of Anesthesia, Monash Medical Centre and Royal Melbourne Hospital, Victoria, Australia
| | - Milène Azzam
- Department of Anesthesiology, Jewish General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Alexander Amir
- Department of Anesthesiology, Montreal General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Caroline E Gebhard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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A practical approach to critical care ultrasound. J Crit Care 2019; 51:156-164. [DOI: 10.1016/j.jcrc.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
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Schwarz S, Kalbitz M, Hummler HD, Mendler MR. Transthoracic Echocardiography of the Neonatal Laboratory Piglet. Front Pediatr 2019; 7:318. [PMID: 31417887 PMCID: PMC6684740 DOI: 10.3389/fped.2019.00318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Newborn piglets are commonly used in biomedical research. However, cardiovascular imaging of this species is quite challenging. For point of care diagnostics of heart function transthoracic echocardiography may be used, which appears to differ comparing newborn piglets with adult pigs. To date, there are few data or studies on the feasibility and quality of measurement of functional echocardiographic parameters in very small neonatal piglets. Objectives: To study the feasibility of transthoracic echocardiography in very small newborn piglets in supine position. Methods: In 44 anesthetized and intubated newborn piglets, positioned in supine position [age 32 h (12-44 h), weight 1,220 g (1,060-1,495 g), median (IQR)] transthoracic echocardiography was performed using a point of care ultrasound device (M-Turbo©, FujiFilm SonoSite BV, Amsterdam, Netherlands), and a standard ultrasound transducer. Results: Using 2D- and M-mode-imaging left- and right-sided heart structures were accessible to transthoracic echocardiography in neonatal piglets. Diameters of the interventricular septum, the left ventricle, and the posterior wall were measured and ejection fraction and shortening fraction was calculated. Both left and right ventricular outflow tract could be imaged, and ventricular filling and systolic function could be evaluated. Furthermore, we were able to assess shunts of fetal circulation, such as patent ductus arteriosus, structure of the heart valves and congenital heart defects including ventricular septal defect. Conclusions: In summary, transthoracic echocardiography is feasible for assessment of cardiovascular function even in very small newborn laboratory piglets in supine position.
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Affiliation(s)
- Stephan Schwarz
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, Ulm University, Ulm, Germany
| | - Helmut D Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.,Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | - Marc R Mendler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
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Lau V, Priestap F, Landry Y, Ball I, Arntfield R. Diagnostic Accuracy of Critical Care Transesophageal Echocardiography vs Cardiology-Led Echocardiography in ICU Patients. Chest 2018; 155:491-501. [PMID: 30543807 DOI: 10.1016/j.chest.2018.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Critical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardiorespiratory failure in the ICU. Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. The goal of this study was to characterize the diagnostic accuracy of ccTEE. METHODS This study was a two-center, retrospective comparison between TEE studies performed and interpreted by intensivists and cardiology-led TEE or transthoracic echocardiography (TTE) performed and/or interpreted by cardiologists. The study period was December 2012 to December 2016 for all consecutive ICU patients who received an initial ccTEE and either a cardiology TEE or TTE within 72 h. Using the cardiology-conducted examination as the gold standard, we reported sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ccTEE. RESULTS Comparisons between ccTEE and cardiology TEE/TTE performed yielded 56 patients (five ccTEE vs cardiology TEE and 51 ccTEE vs cardiology TTE). The comparison between ccTEE and cardiology TEE showed 100% sensitivity, specificity, PPV, NPV, and accuracy for the primary diagnosis and other major findings. For the combined ccTEE and cardiology TEE/TTE comparison, there was a high sensitivity/specificity/PPV/NPV/accuracy for the primary diagnosis (90%-100% range), as well as other major diagnoses (88%-100% range). CONCLUSIONS This study showed that ccTEE has a high sensitivity, specificity, PPV, NPV, and accuracy compared with the gold standard cardiology TEE or TTEs in critically ill patients, when performed by advanced echocardiogram-trained/experienced intensivists.
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Affiliation(s)
- Vincent Lau
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Fran Priestap
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Yves Landry
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ian Ball
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Robert Arntfield
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Royse C, Canty D, Sessler D. Perioperative ultrasound-assisted clinical evaluation - A case based review. Australas J Ultrasound Med 2018; 21:204-218. [PMID: 34760525 PMCID: PMC8409857 DOI: 10.1002/ajum.12113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Ultrasound is increasingly being adopted into anaesthesia and intensive care practice. The range of ultrasound examination has also increased from transoesophageal echocardiography in cardiac surgery and ultrasound-guided nerve blocks and vascular access, to examination of the heart, lungs, abdomen and deep veins. Typically, the use of ultrasound is focused or basic, designed to be performed by the anaesthetist at the patient's bedside in real time to answer clinical questions and to direct therapy. Ultrasound is not performed in isolation, but used to complement clinical evaluation, and accordingly can be considered as 'ultrasound-assisted perioperative evaluation'. Whilst there is good evidence that ultrasound improves diagnostic accuracy and in turn alters management, there are few data examining whether ultrasound leads to improved clinical outcomes. This review will examine multiple uses of perioperative ultrasound with case studies to illustrate potential utility.
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Affiliation(s)
- Colin Royse
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
| | - David Canty
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
- Department of MedicineMonash UniversityScenic Blvd & Wellington RoadClaytonVictoria3050Australia
- Department of Anaesthesia and Perioperative Medicine3rd FloorMonash Medical Centre246 Clayton RoadMelbourneVictoria3168Australia
| | - Daniel Sessler
- Department of Outcomes ResearchAnesthesiology InstituteCleveland ClinicClevelandOhioUSA
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Moreno O, Ochagavía A, Artigas A, Espinal C, Tomás R, Bosque MD, Fortià C, Baigorri F. Evaluation of intensivist basic training in transthoracic echocardiography in the postoperative period of heart surgery. Med Intensiva 2018; 43:538-545. [PMID: 30072143 DOI: 10.1016/j.medin.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/19/2018] [Accepted: 06/03/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery. METHODS Over an 8-month period we prospectively studied 148 patients within 24h after admission to a university hospital ICU following heart surgery. We performed basic transthoracic echocardiography to evaluate ventricular function, pericardial effusion, hypovolemia and mitral regurgitation. Cohen's Kappa was used to compare transthoracic echocardiograms obtained by intensivists with basic versus advanced training. Concordance on image acquisition and interpretation was evaluated. RESULTS We analyzed data of adequate transthoracic echocardiograms in 148 patients (92.5%). Apical four-chamber view and advanced trainees obtained better quality images. Concordance was good for right and left ventricular function (kappa=0.7±0.14 and 0.87±0.05, respectively), and moderate for the remaining parameters. Interpretation concordance between basic and advanced training intensivists was good (kappa=0.73±0.05). CONCLUSIONS Intensivists with basic training in echocardiography are capable of performing and interpreting echocardiograms in most patients during the postoperative period of heart surgery.
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Affiliation(s)
- O Moreno
- Critical Care Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - A Ochagavía
- Critical Care Department, Parc Taulí Hospital Universitari, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - A Artigas
- Critical Care Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain; Critical Care Department, Parc Taulí Hospital Universitari, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Critical Care Department, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - C Espinal
- Critical Care Department, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - R Tomás
- Critical Care Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - M D Bosque
- Critical Care Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - C Fortià
- Critical Care Department, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - F Baigorri
- Universidad Autónoma de Barcelona, Barcelona, Spain; Critical Care Department, Parc Taulí Hospital Universitari, Sabadell, Spain
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Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73:1265-1279. [DOI: 10.1111/anae.14354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix Marseille university C2VN France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care Medicine Hospices Civils de Lyon Hôpital Femme Mère Enfant Bron France
| | - S. Einav
- General Intensive Care Shaare Zedek Medical Centre Hebrew University Faculty of Medicine Jerusalem Israel
| | - G. Duclos
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
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Abstract
PURPOSE OF REVIEW The objective was to define the role of ultrasound in the diagnosis and the management of circulatory shock by critical appraisal of the literature. RECENT FINDINGS Assessment of any patient's hemodynamic profile based on clinical examination can be sufficient in several cases, but many times unclarities remain. Arterial catheters and central venous lines are commonly used in critically ill patients for practical reasons, and offer an opportunity for advanced hemodynamic monitoring. Critical care ultrasonography may add to the understanding of the hemodynamic profile at hand. Improvements in ultrasound techniques, for example, smaller devices and improved image quality, may reduce limitations and increase its value as a complementary tool. Critical care ultrasonography has great potential to guide decisions in the management of shock, but operators should be aware of limitations and pitfalls as well. Current evidence comes from cohort studies with heterogeneous design and outcomes. SUMMARY Use of ultrasonography for hemodynamic monitoring in critical care expands, probably because of absence of procedure-related adverse events. Easy applicability and the capacity of distinguishing different types of shock add to its increasing role, further supported by consensus statements promoting ultrasound as the preferred tool for diagnostics in circulatory shock.
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Nazerian P, Volpicelli G, Gigli C, Lamorte A, Grifoni S, Vanni S. Diagnostic accuracy of focused cardiac and venous ultrasound examinations in patients with shock and suspected pulmonary embolism. Intern Emerg Med 2018; 13:567-574. [PMID: 28540661 DOI: 10.1007/s11739-017-1681-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/18/2017] [Indexed: 12/22/2022]
Abstract
Evaluating the diagnostic performance of focused cardiac ultrasound (US) alone and combination with venous US in patients with shock and suspected pulmonary embolism (PE). Consecutive adult patients with shock and suspected PE, presenting to two Italian emergency departments, were included. Patients underwent cardiac and venous US at presentation with the aim of detecting right ventricular (RV) dilatation and proximal deep venous thrombosis (DVT). Final diagnosis of PE was based on a second level diagnostic test or autopsy. Among the 105 patients included in the study, 43 (40.9%) had a final diagnosis of PE. Forty-seven (44.8%) patients showed RV dilatation and 27 (25.7%) DVT. Sensitivity and specificity of cardiac US were 91% (95% CI 80-97%) and 87% (95% CI 80-91%), respectively. Venous US showed a lower sensitivity (56%, 95% CI 45-60%) but higher specificity (95%, 95% CI 88-99%) than cardiac US (both p < 0.05). When cardiac and venous US were both positive (22 out of 105 patients, 21%) the specificity increased to 100% (p < 0.01 vs cardiac US), whereas when at least one was positive (54 out of 105 patients, 51%) the sensitivity increased to 95% (p = 0.06 vs cardiac US). Focused cardiac US showed good but not optimal sensitivity and specificity for the diagnosis of PE in patients presenting with shock. Venous US significantly increased specificity of cardiac US, and the diagnosis of PE can be certain when both tests are positive or reasonably excluded when negative.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Chiara Gigli
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandro Lamorte
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database. Intensive Care Med 2018; 44:884-892. [DOI: 10.1007/s00134-018-5208-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/05/2018] [Indexed: 10/14/2022]
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Betcher J, Majkrzak A, Cranford J, Kessler R, Theyyunni N, Huang R. Feasibility study of advanced focused cardiac measurements within the emergency department. Crit Ultrasound J 2018; 10:10. [PMID: 29797105 PMCID: PMC5968017 DOI: 10.1186/s13089-018-0093-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/02/2018] [Indexed: 01/01/2023] Open
Abstract
Background This study aims to compare the increased time needed to perform advanced focused cardiac measurements in the emergency department, including diastolic heart failure evaluation via E/E′, and cardiac output with LVOT/VTI. Patients with pertinent cardiopulmonary symptoms in the emergency department had a focused cardiac ultrasound performed by the emergency department ultrasound team. The ability to obtain basic cardiac windows, evaluate for effusion, systolic ejection fraction, and right-sided heart pressures were recorded. Advanced measurements, along with time to obtain all images and the training level of the provider, were recorded. Results Fifty-three patients were enrolled. Basic focused cardiac windows were able to be obtained in 80% of patients. The average 4-window focused cardiac ultrasound took 4 min and 49 s to perform. Diastolic measurements were able to be obtained in 51% of patients, taking an average of 3 min and 17 s. Cardiac output measurements were able to be obtained in 53% of patients, taking an average of 3 min and 8 s. Conclusion The ability to obtain these images improved with increasing level of training. Performing both cardiac output and diastolic measurements increased the time with bedside ultrasound by 6 min and 25 s, and were able to be obtained in slightly over half of all ED patients.
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Affiliation(s)
- Joe Betcher
- Department of Emergency Medicine, Lake Michigan Emergency Specialists, Mercy Health Muskegon, Muskegon, USA.
| | - Al Majkrzak
- Department of Emergency Medicine, Emergency Physicians Medical Group, St. Joseph Mercy Ann Arbor, Ann Arbor, USA
| | - Jim Cranford
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ross Kessler
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nik Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rob Huang
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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McCormick TJ, Miller EC, Chen R, Naik VN. Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists. Can J Anaesth 2018; 65:427-436. [DOI: 10.1007/s12630-018-1049-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/16/2023] Open
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Blans MJ, Bosch FH. Ultrasound in acute internal medicine; time to set a European standard. Eur J Intern Med 2017; 45:51-53. [PMID: 28986154 DOI: 10.1016/j.ejim.2017.09.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
Nowadays point-of-care ultrasound (POCUS) is considered indispensable for critical care and emergency physicians. POCUS is a noninvasive tool, can be done at the bedside, leads to instant diagnostic information and is safe in terms of radiation. POCUS could also be very suitable for internists in the field of acute internal medicine. There are differences between European internists in the use of POCUS from no use at all to more outlined educational programs. In literature there are examples of comprehensive POCUS guidelines which could serve as an example for the European Federation of Internal Medicine (EFIM). In this review some aspects of POCUS are highlighted and the authors encourage EFIM to set European standards for this important development.
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Affiliation(s)
- Michael Justinus Blans
- Department of Internal Medicine and Intensive Care, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
| | - Frank Hendrik Bosch
- Department of Internal Medicine and Intensive Care, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
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Younan D, Griffin R, Reiff D, Richey J, Schinnerer E, Pittet JF, Zaky A. Echocardiographic correlates are associated with in-hospital mortality in trauma and burn patients. Am J Surg 2017; 214:798-803. [DOI: 10.1016/j.amjsurg.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/27/2017] [Accepted: 02/05/2017] [Indexed: 11/17/2022]
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Mongodi S, Roldi EM, Orlando A, Civardi L, Iotti GA, Mojoli F. A 70-Year-Old Develops Refractory Hypotension in the ICU. Chest 2017; 152:e61-e63. [DOI: 10.1016/j.chest.2017.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/05/2017] [Accepted: 03/16/2017] [Indexed: 11/28/2022] Open
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Yin W, Li Y, Zeng X, Qin Y, Wang D, Zou T, Su L, Kang Y. The utilization of critical care ultrasound to assess hemodynamics and lung pathology on ICU admission and the potential for predicting outcome. PLoS One 2017; 12:e0182881. [PMID: 28806783 PMCID: PMC5555697 DOI: 10.1371/journal.pone.0182881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/26/2017] [Indexed: 02/05/2023] Open
Abstract
Aim Critical care ultrasound (CCUS) has been used by many Intensive Care Units(ICUs) worldwide, so as to guiding the diagnosis and the treatment. However, none of the publications currently systematically describe the utilization of CCUS to analyze the characteristics of hemodynamics and lung pathology upon the new admission to ICU and its potential role in patients’ prognosis prediction. In this retrospective clinical study, we have demonstrated and analyzed the characteristics of hemodynamics and lung pathology assessed by CCUS and investigated its potential to predict patient outcome. Methods We have described and analyzed the epidemic characteristics of hemodynamics and lung pathology assessed by CCUS on ICU admission, which based on our database of 451 cases from the biggest medical center in Western China, between November 2014 and October 2015. The patients’ demographics, clinical characteristics, prognosis and ultrasonic pattern of hemodynamics and lung pathology had been analyzed. A bivariate logistic regression model was established to identify the correlation between the ultrasonic variables on admission and the ICU mortality. Results The mean age of the 451 patients was 56.7±18.7 years; the mean APACHE II score was 19.0±7.9, the ICU mortality was 30.6%. Patients received CCUS examination of pericardial, right ventricle (RV) wall motion, left ventricle (LV) wall motion, LV systolic function, LV diastolic function, lung and volume of inferior vena cava (IVC) were 423(93.8%), 418(92.7%), 392(86.9%), 389(86.3%), 383(84.9%), 440(97.6%), 336(74.5%), respectively; The univariate analysis revealed that length of mechanical ventilation was significantly correlated with the diameter of IVC, tricuspid annular plane systolic excursion(TAPSE), mitral annular plane systolic excursion(MAPSE), early diastolic transmitral velocity to early mitral annulus diastolic velocity(E/e’) (p = 0.016, 0.011, 0.000, 0.049, respectively); The TAPSE, ejection fraction(EF), MAPSE, lung ultrasound score (LUS score) (p = 0.000, 0.028, 0.000, 0.011, respectively) were significantly related to ICU mortality. The multivariate analysis demonstrated that APACHE II, age, TAPSE, E/e’ are the independent risk factors for ICU mortality in our study. Conclusion CCUS examination on ICU admission which performed by the experienced physician provide valuable information to assist the caregivers in understanding the comprehensive outlook of the characteristics of hemodynamics and lung pathology. Those key variables obtained by CCUS predict the possible prognosis of patients, hence deserve more attention in clinical decision making.
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Affiliation(s)
- Wanhong Yin
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yi Li
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xueying Zeng
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yao Qin
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Dong Wang
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ling Su
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- * E-mail:
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Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study. Anatol J Cardiol 2017. [PMID: 28639944 PMCID: PMC5731263 DOI: 10.14744/anatoljcardiol.2017.7659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children. Methods: A total of 140 children, including 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) children, who were admitted consecutively from March to August 2013 were evaluated prospectively. Data regarding the indication for echocardiography and therapeutic approaches used were documented. For evaluating disease severity, the Pediatric Risk of Mortality Score III (PRISM) was ascertained. The correlation between PRISM score and the requirement of echocardiographic evaluations were analyzed. Results: Patients ages were between 45 days to 18 years. The male-to-female ratio was 1.33. In 35.4% patients who underwent echocardiographic evaluation, no definitive alteration occurred in treatment approach, whereas in the remaining 64.6% patients, decisive or supplemental information was gathered. Echocardiography was indicated in 88% MV children and 46.2% SB children. Echocardiographic evaluation was necessary in MV children and there was a positive correlation between the PRISM score and the requirement of echocardiographic assessment (p<0.001). Conclusion: Echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. Basic training for intensivists in this procedure is crucial and needs to be improved and supported in critically ill.
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Focused Critical Care Echocardiography: Development and Evaluation of an Image Acquisition Assessment Tool. Crit Care Med 2017; 44:e329-35. [PMID: 26825858 DOI: 10.1097/ccm.0000000000001620] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Little attention has been placed on assessment tools to evaluate image acquisition quality for focused critical care echocardiography. We designed a novel assessment tool to objectively evaluate the image acquisition skills of critical care trainees learning focused critical care echocardiography and examined the tool for evidence of validity. DESIGN Prospective observational study. SETTING Medical-surgical ICUs at a tertiary care teaching hospital. SUBJECTS Trainees in our critical care medicine fellowship program. INTERVENTIONS Six trainees completed a focused critical care echocardiography training curriculum followed by performing 20 transthoracic echocardiograms on patients receiving invasive mechanical ventilation. At three assessment intervals (the 1st and 2nd examinations, 10th and 11th examinations, and 19th and 20th examinations), echocardiograms performed by trainees were compared with those of critical care physicians certified in echocardiography and scored according to the focused critical care echocardiography assessment tool. The primary outcome was an efficiency score (overall assessment tool score divided by examination time). Differences in mean efficiency scores between echocardiographers of differing skill levels and changes in trainees' mean efficiency scores with increasing focused critical care echocardiography experience were compared by using t tests. MEASUREMENTS AND MAIN RESULTS On the initial assessment, mean efficiency scores (SD) for trainees and experienced physicians were 1.55 (0.95) versus 2.78 (1.38), respectively (p = 0.02), and for the second and third assessments, the corresponding efficiency ratings for trainees and experienced physicians were 2.48 (0.97) versus 4.55 (1.32) (p < 0.01) and 2.61 (1.37) versus 4.17 (2.12) (p = 0.04), respectively. CONCLUSIONS Trainees' efficiency in focused critical care echocardiography image acquisition improved quickly in the first 10 studies, yet, it could not match with the performance of experienced physicians after 20 focused critical care echocardiography studies. The focused critical care echocardiography assessment tool demonstrated evidence of validity and could discern changes in trainees' image acquisition performance with increasing experience.
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Kratz T, Steinfeldt T, Exner M, Dell´Orto MC, Timmesfeld N, Kratz C, Skrodzki M, Wulf H, Zoremba M. Impact of Focused Intraoperative Transthoracic Echocardiography by Anesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients. J Cardiothorac Vasc Anesth 2017; 31:602-609. [DOI: 10.1053/j.jvca.2016.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 11/11/2022]
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Hall DP, Jordan H, Alam S, Gillies MA. The impact of focused echocardiography using the Focused Intensive Care Echo protocol on the management of critically ill patients, and comparison with full echocardiographic studies by BSE-accredited sonographers. J Intensive Care Soc 2017; 18:206-211. [PMID: 29118832 DOI: 10.1177/1751143717700911] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction Focused echocardiography is widely used to assist clinical decision-making in critically ill patients. In the UK, the Focused Intensive Care Echo protocol is recommended by the Intensive Care Society to ensure consistency of approach and guarantee training standards. Concerns remain about the reliability of information attained by non-expert clinicians in focused echocardiography, particularly when this is used to alter clinical management. Methods A prospective, observational evaluation of 60 consecutive patients undergoing Focused Intensive Care Echo studies in a single ICU. Results A complete Focused Intensive Care Echo study was possible in 43/60 scans (72%) and new diagnostic information obtained following 41/60 scans (68%), which lead to a change of clinical management in 28/60 (47%) of cases. In 24/60 (40%) of cases, a full transthoracic study was subsequently undertaken by a fully accredited sonographer. There were no cases where the results from the full study contradicted those from the limited Focused Intensive Care Echo study; additional diagnostic information was attained following 68% of full studies. Conclusion Focused echocardiography using the Focused Intensive Care Echo protocol is feasible and clinically useful in a high proportion of ICU patients. However, many still require additional expert echocardiographic assessment. Focused echocardiography delivered by non-experts is clinically useful in this setting but its limitations must be understood and access to expert assessment should be available.
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Affiliation(s)
- David P Hall
- Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine ICT Centre, Birmingham, UK
| | - Helen Jordan
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shirjel Alam
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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Focused cardiac ultrasound in the early resuscitation of severe sepsis and septic shock: a prospective pilot study. J Anesth 2017; 31:487-493. [PMID: 28144779 DOI: 10.1007/s00540-017-2312-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/20/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Point-of-care ultrasonography has been increasingly used in the care of critically ill patients; however, reports on its use during active resuscitation are limited. The aim of this study was to investigate the true impact of focused cardiac ultrasound (FCU) during the management of sepsis with early (6-h) resuscitation. METHODS A prospective pilot observational study was conducted at an academic medical center from March 2011 through July 2012. Patients undergoing resuscitation for severe sepsis or septic shock were prospectively enrolled at medical and combined medical-surgical intensive care units. Patients underwent a 10-min FCU examination when echocardiography was not part of their care plan. FCU was performed by sonographers and interpreted by cardiologists to minimize risks of inadequate image acquisition and misinterpretation. Intensivists completed surveys on their diagnostic and therapeutic plans before and after receiving FCU information. RESULTS Of the 30 patients enrolled, 18 (60%) were male and the median age was 61 years [interquartile range (IQR) 50-71 years]. Median central venous oxygen saturation and lactate levels were 59.6% (IQR 53.1-66.2%) and 2.7 mmol/L (IQR 1.2-4.1 mmol/L), respectively. Clinical assessment by intensivists before FCU commonly failed to correctly estimate ventricular function; specifically, left ventricular in 12 patients [40%, 95% confidence interval (CI) 25-58%] and right ventricular function in 15 patients (50%, 95% CI 33-67%). Intensivists' therapeutic plans changed in eight cases (27%, 95% CI 14-44%) after FCU information became available. The most common changes were fluid management and imaging tests. Intensivists' confidence in their therapeutic plans improved for 11 patients (37%, 95% CI 22-55%). CONCLUSION FCU is a valuable examination tool during early resuscitation of severe sepsis and septic shock.
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Nazarnia S, Subramaniam K. Role of Simulation in Perioperative Echocardiography Training. Semin Cardiothorac Vasc Anesth 2016; 21:81-94. [PMID: 27381621 DOI: 10.1177/1089253216655874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Echocardiography plays a major role in the diagnosis and management of hemodynamic compromise during the perioperative period. Both transthoracic and transesophageal echocardiography have been shown to improve outcomes after cardiac and noncardiac surgery. Teaching basic echocardiographic skills to perioperative physicians remains a challenging task. Thus far, simulation-based medical education has been proven useful in teaching specific procedural skills and management of infrequent catastrophic events. Simulation-based echocardiography education has the potential to facilitate clinical training in echocardiography. Several small studies have shown the benefits of echocardiographic simulation on developing psychomotor and cognitive echocardiography skills. Future research should focus on the impact of simulation on actual clinical echocardiographic performance in the operating room and ultimately, patient outcomes.
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Bernier-Jean A, Albert M, Shiloh AL, Eisen LA, Williamson D, Beaulieu Y. The Diagnostic and Therapeutic Impact of Point-of-Care Ultrasonography in the Intensive Care Unit. J Intensive Care Med 2016; 32:197-203. [PMID: 26423745 DOI: 10.1177/0885066615606682] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE In light of point-of-care ultrasonography's (POCUS) recent rise in popularity, assessment of its impact on diagnosis and treatment in the intensive care unit (ICU) is of key importance. METHODS Ultrasound examinations were collected through an ultrasound reporting software in 6 multidisciplinary ICU units from 3 university hospitals in Canada and the United States. This database included a self-reporting questionnaire to assess the impact of the ultrasound findings on diagnosis and treatment. We retrieved the results of these questionnaires and analyzed them in relation to which organs were assessed during the ultrasound examination. RESULTS One thousand two hundred and fifteen ultrasound studies were performed on 968 patients. Intensivists considered the image quality of cardiac ultrasound to be adequate in 94.7% compared to 99.7% for general ultrasound ( P < .001). The median duration of a cardiac examination was 10 (interquartile range [IQR] 10) minutes compared to 5 (IQR 8) minutes for a general examination ( P < .001). Overall, ultrasound findings led to a change in diagnosis in 302 studies (24.9%) and to a change in management in 534 studies (44.0%). A change in diagnosis or management was reported more frequently for cardiac ultrasound than for general ultrasound (108 [37.1%] vs 127 [16.5%], P < .001) and (170 [58.4%] vs 270 [35.1%], P < .001). Assessment of the inferior vena cava for fluid status emerged as the critical care ultrasound application associated with the greatest impact on management. CONCLUSION Point-of-care ultrasonography has the potential to optimize care of the critically ill patients when added to the clinical armamentarium of the intensive care physician.
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Affiliation(s)
- Amélie Bernier-Jean
- 1 Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada
| | - Martin Albert
- 2 Hôpital du Sacré-Coeur de Montréal Research Center, University of Montreal, Montreal, Canada
| | - Ariel L Shiloh
- 3 Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, J.B. Langner Critical Care Service, Montefiore Medical Center, New York, NY, USA
| | - Lewis A Eisen
- 3 Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, J.B. Langner Critical Care Service, Montefiore Medical Center, New York, NY, USA
| | - David Williamson
- 4 Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, Faculty de Pharmacy, University of Montreal, Montreal, Canada
| | - Yanick Beaulieu
- 1 Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada
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Heiberg J, El-Ansary D, Canty DJ, Royse AG, Royse CF. Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care. Anaesthesia 2016; 71:1091-100. [DOI: 10.1111/anae.13525] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 01/15/2023]
Affiliation(s)
- J. Heiberg
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - D. El-Ansary
- Department of Physiotherapy; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - D. J. Canty
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. G. Royse
- Department of Surgery; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - C. F. Royse
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Melbourne Victoria Australia
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Kratz T, Exner M, Campo dell'Orto M, Timmesfeld N, Schüttler K, Efe T, Zoremba M, Wulf H, Steinfeldt T. A pocket-sized hand held ultrasound system for intraoperative transthoracic echocardiography by anaesthesiologists: A feasibility study. Technol Health Care 2016; 24:309-15. [DOI: 10.3233/thc-161131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T. Kratz
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
- Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France
| | - M. Exner
- Department of Anaesthesia, Intensive Care Medicin and Pain Therapy, Unfallkrankenhaus, Berlin, Germany
| | - M. Campo dell'Orto
- Department of Cardiology and Medecine, Sportklinik Bad Nauheim, Bad Nauheim, Germany
| | - N. Timmesfeld
- Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Bunsenstr, Marburg, Germany
| | - K.F. Schüttler
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - T. Efe
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - M. Zoremba
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
| | - H. Wulf
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
| | - T. Steinfeldt
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
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Mojoli F, Orlando A, Mongodi S, Braschi A. A 44-Year-Old Woman Presents to the ED With Agitation, Dyspnea, and Hypotension. Chest 2016; 149:e137-9. [DOI: 10.1016/j.chest.2015.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022] Open
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Évaluation hémodynamique par échographie en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fagley RE, Haney MF, Beraud AS, Comfere T, Kohl BA, Merkel MJ, Pustavoitau A, von Homeyer P, Wagner CE, Wall MH. Critical Care Basic Ultrasound Learning Goals for American Anesthesiology Critical Care Trainees: Recommendations from an Expert Group. Anesth Analg 2016; 120:1041-1053. [PMID: 25899271 DOI: 10.1213/ane.0000000000000652] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE In this review, we define learning goals and recommend competencies concerning focused basic critical care ultrasound (CCUS) for critical care specialists in training. DESIGN The narrative review is, and the recommendations contained herein are, sponsored by the Society of Critical Care Anesthesiologists. Our recommendations are based on a structured literature review by an expert panel of anesthesiology intensivists and cardiologists with formal training in ultrasound. Published descriptions of learning and training routines from anesthesia-critical care and other specialties were identified and considered. Sections were written by groups with special expertise, with dissent included in the text. RESULTS Learning goals and objectives were identified for achieving competence in the use of CCUS at a specialist level (critical care fellowship training) for diagnosis and monitoring of vital organ dysfunction in the critical care environment. The ultrasound examination was divided into vascular, abdominal, thoracic, and cardiac components. For each component, learning goals and specific skills were presented. Suggestions for teaching and training methods were described. DISCUSSION Immediate bedside availability of ultrasound resources can dramatically improve the ability of critical care physicians to care for critically ill patients. Anesthesia--critical care medicine training should have definitive expectations and performance standards for basic CCUS interpretation by anesthesiology--critical care specialists. The learning goals in this review reflect current trends in the multispecialty critical care environment where ultrasound-based diagnostic strategies are already frequently applied. These competencies should be formally taught as part of an established anesthesiology-critical care medicine graduate medical education programs.
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Affiliation(s)
- R Eliot Fagley
- From the *Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington; †Umeå University Anesthesiology and Intensive Care Medicine, Umeå, Sweden; ‡Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California; §Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; ∥Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ¶Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon; #Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland; **Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; ††Department of Anesthesiology and Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee; and ‡‡Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
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