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Buz Yaşar A, Tarhan M, Atalay B, Kabaalioğlu A, Girit S. Investigation of Childhood Pneumonia With Thoracic Ultrasound: A Comparison Between X-ray and Ultrasound. Ultrasound Q 2023; 39:216-222. [PMID: 37543750 DOI: 10.1097/ruq.0000000000000651] [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: 08/07/2023]
Abstract
ABSTRACT Childhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q 1 : 8 and Q 3 : 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different ( P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment ( κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia.
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Affiliation(s)
| | - Merve Tarhan
- Department of Radiology, Derince Research and Training Hospital, Kocaeli
| | - Basak Atalay
- Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University
| | | | - Saniye Girit
- Department of Pediatric Pulmonology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Tognon C, Pulvirenti R, Pizzi S, Zuliani M, Cortese G, Esposito C, Gamba P. Lung Ultrasound to Assess One Lung Ventilation: A Pediatric Case Series. J Laparoendosc Adv Surg Tech A 2022; 32:566-570. [PMID: 35353608 DOI: 10.1089/lap.2021.0839] [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: 11/12/2022] Open
Abstract
Objectives: One lung ventilation (OLV) is the preferred ventilation technique for thoracoscopy as it provides a better exposure of the operative field and grants the protection of the healthy lung. Preoperative evaluation of lung exclusion is necessary and different methods are available. In recent years lung ultrasound (US) gained popularity and its use for monitoring the endotracheal tube position is widely reported. The existing evidence on adults addresses lung US as effective, yet only few data are available in children. Therefore, we present our experience with lung US as verification method for pediatric OLV. Methods: All patients undergoing OLV for video-assisted thoracoscopic surgery from January 2019 to May 2021 and for whom lung exclusion was confirmed through lung US were involved. Lung exclusion was considered effective when absence of lung motion and presence of lung pulse were encountered. When lung US did not match these criteria, repositioning of the endobronchial device followed by US verification was performed. When lung US met the exclusion criteria surgery was started and direct thoracoscopic observation was used to verify lung exclusion. Results: A total of 20 patients, accounting for 22 procedures, were involved. Absence of lung motion and presence of lung pulse were assessed in the operative-side lung for all patients. Lung exclusion was confirmed through thoracoscopy. Postoperative lung US proved the reappearance of lung motion in the previously excluded lung. Conclusions: In our center experience lung US resulted to be a safe, effective, and time-saving verification method for OLV. Further studies are needed to define its sensitivity and specificity.
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Affiliation(s)
- Costanza Tognon
- Anesthesiology Pediatric Unit, Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Rebecca Pulvirenti
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Simone Pizzi
- Anesthesiology Pediatric Unit, Mother and Child Department, G. Salesi Hospital, Ancona, Italy
| | - Monica Zuliani
- Department of Medicine, Pediatric Radiology Unit-Radiology Institute Hospital, University of Padova, Padova, Italy
| | - Giuseppe Cortese
- Unit of Anesthesia, Intensive Care and Pain Therapy, Department of General and Specialistic Surgery, Kidney Transplantation, Nephrology, Intensive Care and Pain Therapy, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padova, Padova, Italy
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Koshy V, Patel K, Yadav D, Saxena P, George RA, Gangadharan V, Koshy G. Descriptive study of the role of ultrasound in the evaluation of patients with interstitial lung disease associated with autoimmune connective tissue disorders. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_159_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Scialanga B, Buonsenso D, Scateni S, Valentini P, Schingo PMS, Boccuzzi E, Mesturino MA, Ferro V, Chiaretti A, Villani A, Supino MC, Musolino AM. Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study. Front Pediatr 2022; 10:812246. [PMID: 35372158 PMCID: PMC8965612 DOI: 10.3389/fped.2022.812246] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax is a relatively uncommon and poorly studied condition in children. While several protocols have been developed to evaluate the use of lung ultrasound for dyspneic adult patients in the emergency department, no specific guidelines are present for pediatric emergency physicians. OBJECTIVES We prospectively analyzed children with acute chest pain and clinical suspicion of pneumothorax evaluated at the pediatric emergency department. METHODS We consecutively enrolled children aged 5-17 years presenting to the pediatric emergency department with clinically suspected pneumothorax based on sudden onset of acute chest pain. After clinical examination, all children underwent lung ultrasound followed by chest X-ray (reference standard). We enrolled 77 children, of which 13 (16.9%) received a final diagnosis of pneumothorax. RESULTS The lung point had a sensitivity of 92.3% (95% CI 77.8-100) and a specificity of 100% (95% CI 94.4-100) for the detection of pneumothorax. The "barcode sign" had a sensitivity of 100% (95% CI 75.3-100) and a specificity of 100% (95% CI 94.4-100) for the detection of pneumothorax. CONCLUSION Lung ultrasound is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department. If pneumothorax is suspected, but the lung point is not visible, the barcode sign should always be sought as it could be a form of massive pneumothorax.
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Affiliation(s)
- Barbara Scialanga
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, Institute for Research and Health Care (IRCCS), Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Scateni
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Paolo Maria Salvatore Schingo
- Department of Diagnostic Imaging, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Elena Boccuzzi
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Alessia Mesturino
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Valentina Ferro
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Institute for Research and Health Care (IRCCS), Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Chiara Supino
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
| | - Anna Maria Musolino
- Department of Emergency, Acceptance and General Pediatrics, Institute for Research and Health Care (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy
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Point-of-Care Lung Ultrasonography: A Clinical Update for the Emergency Nurse Practitioner. Adv Emerg Nurs J 2021; 43:279-292. [PMID: 34699417 DOI: 10.1097/tme.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the introduction of ultrasonography, clinicians have discovered different uses for embedding this technology in the clinical setting. The use of point-of-care ultrasonography has gained a lot of interest in the emergency department. It is a procedure that a clinician can rapidly utilize to triage, risk stratify, evaluate, and monitor the patient's condition. The COVID-19 pandemic has highlighted the significance and application of ultrasonography in identifying and managing patients presenting with lung pathology in the emergency setting.
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Wang L, Zhang F, Li J, Liu Z, Kou Y, Song Y, Xu H, Wang H, Wang Y. Using pulmonary artery acceleration time to evaluate pulmonary hemodynamic changes on preterm infants with respiratory distress syndrome. Transl Pediatr 2021; 10:2287-2297. [PMID: 34733669 PMCID: PMC8506067 DOI: 10.21037/tp-21-341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary artery acceleration time (PAAT) is a reliable and non-invasive method for assessing pulmonary hemodynamics. To date, few studies have used PAAT to assess preterm infants, especially those with respiratory distress syndrome (RDS). This study aimed to assess changes in PAAT among preterm infants with RDS undergoing pulmonary surfactant (PS) therapy or not, and determine its potential effects on the pulmonary vascular disease (PVD) outcomes of preterm infants with RDS in the late postnatal period. METHODS The risk of RDS was reviewed in 62 preterm infants with a gestational age of 26-31 weeks. The infants receiving PS therapy were allocated to the PS group, and the others were allocated to the control group. PAAT, right ventricular ejection time (RVET), and other ultrasonic parameters at 3 different time points after birth were studied and compared. RESULTS Infants in the PS group had a significantly lower PAAT (52.7±5.9 vs. 59.6±8.7; P=0.001) and PAAT/RVET (0.30±0.03 vs. 0.33±0.03; P=0.001) than those in the control group at 36 weeks postmenstrual age (PMA). No significant increases in PAAT/RVET were detected at 3 different times for the PS group (P=0.117), but both PAAT and PAAT/RVET increased significantly with time after birth in the control group (P<0.001). CONCLUSIONS Preterm infants with RDS might still have PVD in the late postnatal period and thus require long-term follow-up observation. PAAT appears to be a reliable non-invasive screening measure for evaluating pulmonary hemodynamics in preterm infants with RDS and late PVD.
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Affiliation(s)
- Liling Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fengjuan Zhang
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiahui Li
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhijie Liu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yan Kou
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanting Song
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Xu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yulin Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Melton MS, Li YJ, Pollard R, Chen Z, Hunting J, Hopkins T, Buhrman W, Taicher B, Aronson S, Stafford-Smith M, Raghunathan K. Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study. Can J Anaesth 2021. [PMID: 33058058 DOI: 10.1007/s12630-020-01822-1/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
PURPOSE We estimated the rate of unplanned hospital and intensive care unit (ICU) admissions following ambulatory surgery centre (ASC) procedures, and identified factors associated with their occurrence. METHODS This retrospective cohort included adult patients who underwent ASC procedures within a large community practice from January 2010 to December 2014. Patients were categorized into two groups: unplanned postoperative hospital/ICU admission within 24 hr of procedure or uneventful discharge. Demographics, comorbidities, anesthesia type, procedure type, procedure group, and ASC facility were assessed. RESULTS Of the 211,389 patients included, there were 211,147 uneventful discharges (99.89%) and 242 unplanned hospital admissions (0.11%), of which 75 were ICU admissions (0.04%). The multivariable logistic regression model for hospital admission showed an increased risk associated with age > 50 yr (odds ratio [OR], 1.53); American Society of Anesthesiologists (ASA) physical status (III vs II: OR, 1.45; IV vs II: OR, 1.88), comorbidity (chronic obstructive pulmonary disease: OR, 2.63; diabetes mellitus: OR, 1.62; transient ischemic attack: OR, 2.48) procedure (respiratory: OR, 2.92; digestive: OR, 2.66; musculoskeletal system: OR, 2.53), anesthetic management (general anesthesia [GA] and peripheral nerve block vs GA: OR, 1.79), and ASC facility (189BB: OR, 2.29; 30E9A: OR, 7.41; and BD21F: OR, 1.69). The multivariable logistic regression model for ICU admission showed increased risk of unplanned ICU admission associated with ASA physical status (ASA III vs II: OR, 3.0; ASA IV vs II: OR, 8.52), procedure (musculoskeletal system: OR, 2.45), and ASC facility (00E6C: OR, 3.14; 189BB: OR, 2.77; 30E9A: OR, 2.59; and BD21F: OR, 3.71). CONCLUSION While a small percentage of adult patients who underwent ASC procedures required unplanned hospital admission (0.07%), approximately one-third of these admissions were to the ICU (0.04%). Facility was at least as strong a predictor of hospital admission as the patient- and/or procedure-specific variables.
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Affiliation(s)
- M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA.
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Zhengxi Chen
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - John Hunting
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Thomas Hopkins
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - William Buhrman
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Brad Taicher
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Solomon Aronson
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
- CAPER Unit, Duke Anesthesiology, Durham, NC, USA
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Melton MS, Li YJ, Pollard R, Chen Z, Hunting J, Hopkins T, Buhrman W, Taicher B, Aronson S, Stafford-Smith M, Raghunathan K. Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study. Can J Anaesth 2021; 68:30-41. [PMID: 33058058 DOI: 10.1007/s12630-020-01822-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We estimated the rate of unplanned hospital and intensive care unit (ICU) admissions following ambulatory surgery centre (ASC) procedures, and identified factors associated with their occurrence. METHODS This retrospective cohort included adult patients who underwent ASC procedures within a large community practice from January 2010 to December 2014. Patients were categorized into two groups: unplanned postoperative hospital/ICU admission within 24 hr of procedure or uneventful discharge. Demographics, comorbidities, anesthesia type, procedure type, procedure group, and ASC facility were assessed. RESULTS Of the 211,389 patients included, there were 211,147 uneventful discharges (99.89%) and 242 unplanned hospital admissions (0.11%), of which 75 were ICU admissions (0.04%). The multivariable logistic regression model for hospital admission showed an increased risk associated with age > 50 yr (odds ratio [OR], 1.53); American Society of Anesthesiologists (ASA) physical status (III vs II: OR, 1.45; IV vs II: OR, 1.88), comorbidity (chronic obstructive pulmonary disease: OR, 2.63; diabetes mellitus: OR, 1.62; transient ischemic attack: OR, 2.48) procedure (respiratory: OR, 2.92; digestive: OR, 2.66; musculoskeletal system: OR, 2.53), anesthetic management (general anesthesia [GA] and peripheral nerve block vs GA: OR, 1.79), and ASC facility (189BB: OR, 2.29; 30E9A: OR, 7.41; and BD21F: OR, 1.69). The multivariable logistic regression model for ICU admission showed increased risk of unplanned ICU admission associated with ASA physical status (ASA III vs II: OR, 3.0; ASA IV vs II: OR, 8.52), procedure (musculoskeletal system: OR, 2.45), and ASC facility (00E6C: OR, 3.14; 189BB: OR, 2.77; 30E9A: OR, 2.59; and BD21F: OR, 3.71). CONCLUSION While a small percentage of adult patients who underwent ASC procedures required unplanned hospital admission (0.07%), approximately one-third of these admissions were to the ICU (0.04%). Facility was at least as strong a predictor of hospital admission as the patient- and/or procedure-specific variables.
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Affiliation(s)
- M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA.
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Zhengxi Chen
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - John Hunting
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Thomas Hopkins
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - William Buhrman
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Brad Taicher
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Solomon Aronson
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
- CAPER Unit, Duke Anesthesiology, Durham, NC, USA
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Dahl AB. The POCUS Paradigm. J Cardiothorac Vasc Anesth 2020; 34:3158-3159. [DOI: 10.1053/j.jvca.2020.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022]
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Martins SR, Nogué R. Vertical displacement of pleura: a new method for bronchospasm evaluation? Ultrasound J 2020; 12:42. [PMID: 32839914 PMCID: PMC7445216 DOI: 10.1186/s13089-020-00184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Lung ultrasonography has been increasingly recognized has a valuable diagnostic tool. In adult patients with asthma/chronic obstructive pulmonary disease and wheezing, LUS usually presents as an A/nude profile (normal profile, with sliding and A-lines, and without any abnormal findings) or at most reveals a decrease/absence of lung sliding. Therefore, until now simple point-of-care ultrasonography appeared to be unable to assess the severity of airflow limitation. Case presentation We report the case of a woman presenting to the emergency department with an asthma exacerbation. Bedside ultrasound showed the usual A/normal profile, but also an associated vertical pleural displacement, probably secondary to hyperinflation and accessory muscle recruitment. We evaluated the described movement with M-mode and established a comparison index between end-inspiration and end-expiration, using the skin as reference. This index showed improvement and complete normalization during treatment. Conclusions Pleural vertical displacement appears to be a sonographic alteration associated to bronchospasm and accessory muscle recruitment. It is easily identifiable and measurable on LUS, thus possibly representing a new method to evaluate bronchospasm and monitoring treatment response. Further research is needed to confirm or refute this finding.
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Ghany MFA. Transthoracic ultrasound in the diagnosis of bronchiectasis: is it valuable? THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_2_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The lung point, still a sign specific to pneumothorax. Intensive Care Med 2019; 45:1327-1328. [PMID: 31399778 DOI: 10.1007/s00134-019-05677-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
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Denault A, Shaaban Ali M, Couture EJ, Beaubien-Souligny W, Bouabdallaoui N, Brassard P, Mailhot T, Jacquet-Lagrèze M, Lamarche Y, Deschamps A. A Practical Approach to Cerebro-Somatic Near-Infrared Spectroscopy and Whole-Body Ultrasound. J Cardiothorac Vasc Anesth 2019; 33 Suppl 1:S11-S37. [DOI: 10.1053/j.jvca.2019.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Abd ElvFatah SR, Elhefny RA, Ahmed RI, Abd ElTawab DM. Fayoum experience in the ultrasonographic evaluation of diffuse parenchymal lung disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_54_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raymond M, Grønlykke L, Couture EJ, Desjardins G, Cogan J, Cloutier J, Lamarche Y, L'Allier PL, Ravn HB, Couture P, Deschamps A, Chamberland ME, Ayoub C, Lebon JS, Julien M, Taillefer J, Rochon A, Denault AY. Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:1090-1104. [DOI: 10.1053/j.jvca.2018.08.198] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 11/11/2022]
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[Guideline on lung ultrasound to diagnose pulmonary diseases in newborn infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:105-113. [PMID: 30782270 PMCID: PMC7389823 DOI: 10.7499/j.issn.1008-8830.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Zuin M, Rigatelli G, Roncon L. Bedside local thrombolysis in patients with massive pulmonary embolism and no access to fluoroscopy: a new tool in the intensivist's arsenal? Br J Anaesth 2018; 122:e17-e19. [PMID: 30686319 DOI: 10.1016/j.bja.2018.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Zuin
- Ferrara, Italy; Rovigo, Italy
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Hwang TS, Yoon YM, Jung DI, Yeon SC, Lee HC. Usefulness of transthoracic lung ultrasound for the diagnosis of mild pneumothorax. J Vet Sci 2018; 19:660-666. [PMID: 30041286 PMCID: PMC6167337 DOI: 10.4142/jvs.2018.19.5.660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/29/2018] [Accepted: 07/02/2018] [Indexed: 01/23/2023] Open
Abstract
The aim of the present study was to investigate the diagnostic accuracy of ultrasonography in the detection of mild pneumothorax using computed tomography (CT) in dogs. Nine adult healthy beagles were included in the study. A thoracic tube was inserted into pleural space at the left thoracic wall, and each dog underwent the examinations in the order of CT, lung ultrasonography, and radiography before the infusion of room air into the pleural space. Two, 3, and 5 mL/kg infusions of room air were sequentially introduced into the pleural space and CT, lung ultrasound, and radiography examinations were performed. Sonographic signs included A-lines, stratosphere, lung sliding, lung point, lung pulse, and reverse sliding signs. Radiographs were evaluated for the absence or presence of a pneumothorax. Lung ultrasound results were more accurate than radiography results for the detection of mild pneumothorax. The overall sensitivity of the sonographic reverse sliding sign was higher than that of other sonographic signs, and its specificity was 100% for detection of mild pneumothorax. Thus, the reverse sliding sign is useful when using lung ultrasonography for diagnosis of mild pneumothorax.
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Affiliation(s)
- Tae Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Young Min Yoon
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Dong In Jung
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Seong Chan Yeon
- College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
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Affiliation(s)
- In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Denault AY, Langevin S, Lessard MR, Courval JF, Desjardins G. Transthoracic echocardiographic evaluation of the heart and great vessels. Can J Anaesth 2018; 65:449-472. [DOI: 10.1007/s12630-018-1068-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/06/2017] [Accepted: 12/16/2017] [Indexed: 12/26/2022] Open
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Beaubien-Souligny W, Rhéaume M, Blondin MC, El-Barnachawy S, Fortier A, Éthier J, Legault L, Denault A. A Simplified Approach to Extravascular Lung Water Assessment Using Point-of-Care Ultrasound in Patients with End-Stage Chronic Renal Failure Undergoing Hemodialysis. Blood Purif 2017; 45:79-87. [DOI: 10.1159/000481768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/23/2017] [Indexed: 12/17/2022]
Abstract
Background: Fluid overload leading to pulmonary congestion is an important issue in patients undergoing hemodialysis. This study aimed to determine if a simplified method of extravascular lung water assessment using ultrasound provided clinically relevant information. Methods: This prospective study recruited 47 patients from a single hemodialysis center. Pulmonary ultrasound was performed before and after 2 hemodialysis sessions in 28 regions on the thorax. The B-line score was defined as the percentage regions where B-lines were present. Results: When B-lines were detected before hemodialysis, a significant relationship was found between fluid removal and the change in B-line score. Patients with a B-line score of ≥21.4% (4th quartile) after the second hemodialysis session were more likely to be hospitalized for pulmonary edema or acute coronary syndrome. Conclusions: A simplified pulmonary assessment using ultrasound provides relevant information about pulmonary congestion in hemodialysis patients and identifies patients at risk of hospitalization for heart-related problems.
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Ren XL, Fu W, Liu J, Liu Y, Xia RM. Lung ultrasonography to diagnose pulmonary hemorrhage of the newborn. J Matern Fetal Neonatal Med 2017; 30:2601-2606. [PMID: 27809611 DOI: 10.1080/14767058.2016.1256997] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study was aimed to investigate the application of lung ultrasound for the diagnosis of pulmonary hemorrhage of the newborn (PHN). METHODS From July 2013 to June 2016, 157 neonates were enrolled in the study. They were divided into two groups: a study group of 57 neonates, who were diagnosed with PHN according to their medical history, clinical manifestations and chest X-ray findings, and a control group of 100 neonates with no lung disease. All subjects underwent bedside lung ultrasound in a quiet state in a supine, lateral or prone position, performed by a single expert physician. The ultrasound findings were compared between the two groups. RESULTS The lung ultrasound main findings associated with PHN included lung consolidation with air bronchograms with an incidence of 82.5%, a shred sign with an incidence of 91.2%, pleural effusion with an incidence of 84.2% (pleurocentesis confirmed the fluid was really bleeding), atelectasis with a incidence of 33.3%, pleural line abnormalities, as well as disappearing A-lines with an incidence of 100%, and 11.9% of these patients had the main manifestations of alveolar-interstitial syndrome (AIS). The shred sign exhibited a sensitivity of 91.2% and a specificity of 100% in diagnosing PHN. CONCLUSIONS Lung ultrasonography is useful and reliable for diagnosing PHN, which is suitable for routine application in the neonatal intensive care unit.
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Affiliation(s)
- Xiao-Ling Ren
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
- b Department of Neonatology and NICU of Bayi Children's Hospital , the Army General Hospital of the Chinese PLA , Beijing , China
| | - Wei Fu
- b Department of Neonatology and NICU of Bayi Children's Hospital , the Army General Hospital of the Chinese PLA , Beijing , China
| | - Jing Liu
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
- b Department of Neonatology and NICU of Bayi Children's Hospital , the Army General Hospital of the Chinese PLA , Beijing , China
| | - Ying Liu
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
| | - Rong-Ming Xia
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
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Head to toe ultrasound: Current opinion on its role in hemodynamic instability, hypoxemia, oligoanuria and the patient with altered neurological status☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Denault AY, Casas C, Puentes W, Eljaiek R, Iglesias I. Head to toe ultrasound: Current opinion on its role in hemodynamic instability, hypoxemia, oligoanuria and the patient with altered neurological status. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Denault AY, Casas C, Puentes W, Eljaiek R, Iglesias I. Ultrasonido de la cabeza a los pies: opinión actual sobre su utilidad en inestabilidad hemodinámica, hipoxemia, oligoanuria y en el paciente con estado neurológico alterado. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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La ecografía pulmonar como herramienta para guiar la surfactación en neonatos prematuros. An Pediatr (Barc) 2016; 84:249-53. [DOI: 10.1016/j.anpedi.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/02/2015] [Accepted: 09/07/2015] [Indexed: 01/25/2023] Open
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Rodríguez-Fanjul J, Balcells Esponera C, Moreno Hernando J, Sarquella-Brugada G. Lung ultrasound as a tool to guide the administration of surfactant in premature neonates. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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30
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Stafrace S, Engelhardt T, Teoh WH, Kristensen MS. Essential ultrasound techniques of the pediatric airway. Paediatr Anaesth 2016; 26:122-31. [PMID: 26681484 DOI: 10.1111/pan.12787] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
Abstract
Ultrasound of the airways is a technique which has been described in a number of recent articles and reviews highlighting the diagnostic possibilities and simple methodology. However, there is a paucity of information focusing specifically on such methods in children where equipment, technique, and challenges are different. This review article gives a general overview of the equipment considerations, scanning protocols, and clinical applications in children.
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Affiliation(s)
- Samuel Stafrace
- Department of Radiology, Sidra Medical and Research Center, Doha, Qatar
| | - Thomas Engelhardt
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Wendy H Teoh
- Visiting Consultant, KK Women's & Children's Hospital, Singapore, Singapore
| | - Michael S Kristensen
- Department of Anaesthesia, Center of Head and Orthopaedics, Section for Anaesthesia for ENT-, Head-, Neck- and Maxillofacial Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Ecografía al lado de la cama del paciente para anestesiólogos. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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32
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Arzola C. Point-of-care ultrasonography for anesthesiologists. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Moreno-Aguilar G, Lichtenstein D. Lung ultrasound in the critically ill (LUCI) and the lung point: a sign specific to pneumothorax which cannot be mimicked. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:311. [PMID: 26345706 PMCID: PMC4562120 DOI: 10.1186/s13054-015-1030-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Daniel Lichtenstein
- Medical Intensive Care Unit, Hôpital Ambroise-Paré, Paris-West University, Nanterre, France.
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Zheng XZ, Zheng Q, Zhou J, Yang B. B-Lines in Assessment of Pulmonary Hypertension in Patients With Interstitial Lung Diseases: Feasibility of Transthoracic Lung Sonographic Signs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1669-1675. [PMID: 26283756 DOI: 10.7863/ultra.15.14.10055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study was conducted to evaluate the value of sonographic B-lines (previously called "comet tail artifacts") in assessment of pulmonary hypertension in patients with interstitial lung diseases. METHODS One hundred thirty-four patients with clinically diagnosed interstitial lung diseases complicated by pulmonary hypertension underwent transthoracic lung sonography and Doppler echocardiography for assessment of the presence of B-lines, the distance between them, and the pulmonary artery (PA) systolic pressure. A correlation analysis and a receiver operating characteristic curve analysis were performed. RESULTS All patients had diffuse bilateral B-lines. The maximum number of B-lines seen in any positive zone (not a summation) was significantly correlated with the severity of PA systolic pressure (r= 0.812; P< .0001), and a linear regression equation could be demonstrated: that is, y = 6.06 x + 17.57, where x and y represent the number of B-lines and PA systolic pressure, respectively. A cutoff of more than 4 B-lines seen in any positive zone had 89.5% sensitivity, 85.0% specificity, and 87.2% accuracy in predicting elevated PA pressure (>30 mm Hg). CONCLUSIONS The number of B-lines is useful in assessment of pulmonary hypertension, especially when tricuspid regurgitation and pulmonary valve regurgitation do not exist or cannot be satisfactorily measured by Doppler echocardiography.
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Affiliation(s)
- Xiao-Zhi Zheng
- Departments of Ultrasound (X.-Z.Z.) and Cardiology (Q.Z.), First People's Hospital of Yancheng, Yancheng, China; Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (X.-Z.Z., B.Y.); and Department of Ultrasound, Third People's Hospital of Yancheng, Yancheng, China (J.Z.)
| | - Quan Zheng
- Departments of Ultrasound (X.-Z.Z.) and Cardiology (Q.Z.), First People's Hospital of Yancheng, Yancheng, China; Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (X.-Z.Z., B.Y.); and Department of Ultrasound, Third People's Hospital of Yancheng, Yancheng, China (J.Z.)
| | - Jing Zhou
- Departments of Ultrasound (X.-Z.Z.) and Cardiology (Q.Z.), First People's Hospital of Yancheng, Yancheng, China; Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (X.-Z.Z., B.Y.); and Department of Ultrasound, Third People's Hospital of Yancheng, Yancheng, China (J.Z.)
| | - Bin Yang
- Departments of Ultrasound (X.-Z.Z.) and Cardiology (Q.Z.), First People's Hospital of Yancheng, Yancheng, China; Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (X.-Z.Z., B.Y.); and Department of Ultrasound, Third People's Hospital of Yancheng, Yancheng, China (J.Z.).
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Nam JS, Park I, Seo H, Min HG. The use of lung ultrasonography to confirm lung isolation in an infant who underwent emergent video-assisted thoracoscopic surgery: a case report. Korean J Anesthesiol 2015; 68:411-4. [PMID: 26257857 PMCID: PMC4524943 DOI: 10.4097/kjae.2015.68.4.411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/22/2013] [Accepted: 11/28/2013] [Indexed: 11/11/2022] Open
Abstract
Video-assisted thoracoscopic surgery for pediatric patients has gained popularity due to better outcomes than open surgery. For this procedure, one-lung ventilation may be necessary to provide an adequate surgical field. Confirming lung isolation is crucial when one-lung ventilation is required. Recently, we experienced a case in which one-lung ventilation was confirmed by ultrasonography using the lung sliding sign and the lung pulse in an infant. Since lung ultrasonography can be performed easily and quickly, it may be a useful method to confirm lung isolation, particularly in emergency surgeries with limited time, devices, and experienced anesthesiologists.
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Affiliation(s)
- Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Inkyung Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungseok Seo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Gi Min
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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36
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Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. Resuscitation 2015; 87:1-6. [DOI: 10.1016/j.resuscitation.2014.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 11/20/2022]
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Point-of-care ultrasonography for anesthesiologists☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543040-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liu J, Wang Y, Fu W, Yang CS, Huang JJ. Diagnosis of neonatal transient tachypnea and its differentiation from respiratory distress syndrome using lung ultrasound. Medicine (Baltimore) 2014; 93:e197. [PMID: 25501071 PMCID: PMC4602774 DOI: 10.1097/md.0000000000000197] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Transient tachypnea of the newborn (TTN) is one of the most common causes of perinatal dyspnea and is traditionally diagnosed by chest x-ray. This study aimed to explore the diagnostic value of lung ultrasonography (LUS) for TTN as well as differentiate it from respiratory distress syndrome (RDS) by using LUS. From January 2013 to February 2014, 60 infants who were diagnosed with TTN based on medical history, clinical manifestations, arterial blood gas analysis, and chest radiography were recruited to the study group. During the same period, 40 hospitalized neonates with nonlung diseases and 20 patients with RDS were recruited to the control group. In a quiet state, infants were placed in the supine, lateral, or prone position for the examination. Each lung of every infant was divided into 3 regions: the anterior, lateral, and posterior regions as bordered by the anterior axillary and posterior axillary lines. The probe was placed perpendicular to the ribs. Each region of both the lungs was carefully scanned.The common ultrasonographic manifestations of TTN were double-lung point (DLP), interstitial syndromes or white lungs, pleural line abnormalities, and A-line disappearance. A small number of infants (20%) with TTN exhibited pleural effusions, whereas the main ultrasonographic manifestation of RDS was lung consolidation with air bronchograms, which does not occur in TTN. The sensitivity and specificity of DLP for the diagnosis of TTN were 76.7% and 100%, respectively. LUS can accurately and reliably diagnose TTN. The DLP and lung consolidation possess great value in the diagnosis and differential diagnosis of TTN with RDS. Thus, we believe that LUS can be widely used in neonatal intensive care units.
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Affiliation(s)
- Jing Liu
- From the Department of Neonatology and NICU of Bayi Children's Hospital (JL, YW, WF, C-SY, J-JH), Beijing Military General Hospital, Beijing; and Graduate School of Southern Medical University (YW, WF), Guangzhou, China
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Wu CY, Lin FS, Wang YC, Chou WH, Lin WY, Sun WZ, Lin CP. Fast Track ultrasound protocol to detect acute complications after totally implantable venous access device placement. Ann Surg Oncol 2014; 22:1943-9. [PMID: 25404473 DOI: 10.1245/s10434-014-4222-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization. METHODS Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared. RESULTS Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p < 0.001). CONCLUSIONS Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.
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Affiliation(s)
- Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Denault A, Lamarche Y, Rochon A, Cogan J, Liszkowski M, Lebon JS, Ayoub C, Taillefer J, Blain R, Viens C, Couture P, Deschamps A. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol 2014; 30:S459-77. [PMID: 25432139 DOI: 10.1016/j.cjca.2014.09.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 02/07/2023] Open
Abstract
Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest. Herein, we discuss the reasons that each of these components are particularly important in improving perioperative care, describe how they can be addressed, and their impact in the care of patients who undergo cardiac surgery.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Critical Care Program, Montreal Heart Institute, and Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
| | - Yoan Lamarche
- Department of Cardiac Surgery and Critical Care Program, Montreal Heart Institute, and Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mark Liszkowski
- Department of Medicine, Cardiology and Critical Care Program, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Taillefer
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Blain
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Claudia Viens
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Vegas A, Denault A, Royse C. A bedside clinical and ultrasound-based approach to hemodynamic instability - Part II: bedside ultrasound in hemodynamic shock: continuing professional development. Can J Anaesth 2014; 61:1008-27. [PMID: 25274122 DOI: 10.1007/s12630-014-0231-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/19/2014] [Indexed: 01/29/2023] Open
Abstract
UNLABELLED Shock is defined as a situation where oxygen transport and delivery is inadequate to meet oxygen demand. The patient in shock is evaluated through medical history, physical examination, and careful observation of the hemodynamic and respiratory monitors. The patient is initially managed with basic resuscitation measures, however bedside ultrasound should be performed if hemodynamic instability persists. We propose to use ultrasound of the inferior vena cava (IVC), and the concept of venous return, as the initial step in order to identify the mechanism of shock. Doppler examination of the hepatic venous flow can also be added. Further ultrasound examination of the patient's heart, thorax, and abdomen can then be performed in order to determine the etiology of shock. In patients with reduced mean systemic venous pressure, an examination of the patient's thoracic and abdominal cavities to detect free fluid, pneumonia, or empyema can be considered. In patients with increased right atrial pressure, transthoracic echocardiography will allow identification of left or right ventricular dysfunction. Finally, in the presence of increased resistance to venous return, thoracic examination for pneumothorax or cardiac tamponade and abdominal examination for signs of abdominal compartment syndrome or IVC occlusion can be considered. Subsequent treatment can then be tailored to the etiology of shock. Elements of bedside ultrasound examination are currently taught in many anesthesia training programs. PURPOSE To develop an approach to the patient in shock that incorporates bedside ultrasound examination.
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Affiliation(s)
- Annette Vegas
- Department of Anesthesiology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Abstract
There is increasing interest in the use of ultrasound to assess and guide the management of critically ill patients. The ability to carry out quick examinations by the bedside to answer specific clinical queries as well as repeatability are clear advantages in an acute care setting. In addition, delays associated with transfer of patients out of the Intensive Care Unit (ICU) and exposure to ionizing radiation may also be avoided. Ultrasonographic imaging looks set to evolve and complement clinical examination of acutely ill patients, offering quick answers by the bedside. In this two-part narrative review, we describe the applications of ultrasonography with a special focus on the management of the critically ill. Part I explores the utility of echocardiography in the ICU, with emphasis on its usefulness in the management of hemodynamically unstable patients. We also discuss lung ultrasonography - a vastly underutilized technology for several years, until intensivists began to realize its usefulness, and obvious advantages over chest radiography. Ultrasonography is rapidly emerging as an important tool in the hands of intensive care physicians.
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Affiliation(s)
- Jose Chacko
- Multidisciplinary Intensive Care Unit, Manipal Hospital, Bengaluru, Karnataka, India
| | - Gagan Brar
- Multidisciplinary Intensive Care Unit, Manipal Hospital, Bengaluru, Karnataka, India
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Hasan AA, Makhlouf HA. B-lines: Transthoracic chest ultrasound signs useful in assessment of interstitial lung diseases. Ann Thorac Med 2014; 9:99-103. [PMID: 24791173 PMCID: PMC4005169 DOI: 10.4103/1817-1737.128856] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/11/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This prospective study was conducted to evaluate the value of sonographic B-lines (previously called "comet tail artifacts"), which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases (ILD) and compare them with the findings of chest high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs). MATERIALS AND METHODS Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT (ground glass, reticular, nodular or honey combing) and PFT as forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO) and partial arterial oxygen pressure (PaO2). RESULTS All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 (the distance was 3 mm) correlated with ground glass opacity and B7 (the distance was 7 mm) correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC (r = -0.848, P < 0.001), TLC (r = -0.664, P < 0.001), DLCO (r = -0.817, P < 0.001) and PaO2 (r = -0.902, P < 0.001). CONCLUSION B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD.
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Affiliation(s)
- Ali A Hasan
- Department of Chest, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Hoda A Makhlouf
- Department of Chest, Assiut University Hospital, Assiut University, Assiut, Egypt
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Denault AY, Couture P. Practical diastology. World J Anesthesiol 2014; 3:96-104. [DOI: 10.5313/wja.v3.i1.96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 02/07/2023] Open
Abstract
Left ventricular (LV) diastolic dysfunction is being recognized as an important part in the pre-operative evaluation. Pre-operative LV diastolic dysfunction has been associated with increased risk of post-operative complications. Furthermore guidelines have been published on the assessment of LV diastolic function. However LV diastolic function is significantly influenced by loading conditions which are typically altered during cardiac and non-cardiac surgery. In addition, waveform analysis from the pulmonary artery catheter tend to correlate with diastolic function and loading conditions. The advantage of hemodynamic monitoring being that they are continuously displayed as opposed to intermittent diastolic parameters. Finally if the importance of diastolic function assessment is to estimate filling pressure, the presence of B lines with the use of lung ultrasound is a simpler method in detecting pulmonary edema. Another indirect evidence of either LV systolic or diastolic dysfunction is an abnormal near-infrared spectroscopy value. Finally it might be more important to evaluate right ventricular (RV) diastolic dysfunction as RV dysfunction is significantly associated with pulmonary hypertension and consequently mortality. Such assessment of RV diastolic dysfunction can be obtained continuously with the use of RV pressure waveform monitoring.
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Merenkov VV, Monahov YE, Kovalev AN, Ustinov AA. Pneumothorax After Pacemaker Implantation: A Diagnostic Value of Sonography. J Cardiothorac Vasc Anesth 2013; 27:e73-5. [DOI: 10.1053/j.jvca.2013.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Indexed: 11/11/2022]
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Hemodynamic instability and fluid responsiveness. Can J Anaesth 2013; 60:1240-7. [PMID: 24114743 DOI: 10.1007/s12630-013-0036-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/13/2013] [Indexed: 01/12/2023] Open
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Denault A, Fayad A, Chen R. Focused ultrasound is the next step in perioperative care. Can J Anaesth 2013; 60:741-7. [DOI: 10.1007/s12630-013-9966-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/07/2013] [Indexed: 12/26/2022] Open
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