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Keegan MT, Harman AE, McLoughlin TM, Macario A, Deiner SG, Gaiser RR, Warner DO, Suresh S, Sun H. Administration of the American Board of Anesthesiology's virtual APPLIED Examination: successes, challenges, and lessons learned. BMC MEDICAL EDUCATION 2024; 24:749. [PMID: 38992662 PMCID: PMC11241991 DOI: 10.1186/s12909-024-05694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024]
Abstract
In response to the COVID-19 pandemic, the American Board of Anesthesiology transitioned from in-person to virtual administration of its APPLIED Examination, assessing more than 3000 candidates for certification purposes remotely in 2021. Four hundred examiners were involved in delivering and scoring Standardized Oral Examinations (SOEs) and Objective Structured Clinical Examinations (OSCEs). More than 80% of candidates started their exams on time and stayed connected throughout the exam without any problems. Only 74 (2.5%) SOE and 45 (1.5%) OSCE candidates required rescheduling due to technical difficulties. Of those who experienced "significant issues", concerns with OSCE technical stations (interpretation of monitors and interpretation of echocardiograms) were reported most frequently (6% of candidates). In contrast, 23% of examiners "sometimes" lost connectivity during their multiple exam sessions, on a continuum from minor inconvenience to inability to continue. 84% of SOE candidates and 89% of OSCE candidates described "smooth" interactions with examiners and standardized patients/standardized clinicians, respectively. However, only 71% of SOE candidates and 75% of OSCE candidates considered themselves to be able to demonstrate their knowledge and skills without obstacles. When compared with their in-person experiences, approximately 40% of SOE examiners considered virtual evaluation to be more difficult than in-person evaluation and believed the remote format negatively affected their development as an examiner. The virtual format was considered to be less secure by 56% and 40% of SOE and OSCE examiners, respectively. The retirement of exam materials used virtually due to concern for compromise had implications for subsequent exam development. The return to in-person exams in 2022 was prompted by multiple factors, especially concerns regarding standardization and security. The technology is not yet perfect, especially for testing in-person communication skills and displaying dynamic exam materials. Nevertheless, the American Board of Anesthesiology's experience demonstrated the feasibility of conducting large-scale, high-stakes oral and performance exams in a virtual format and highlighted the adaptability and dedication of candidates, examiners, and administering board staff.
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Affiliation(s)
- Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ann E Harman
- The American Board of Anesthesiology, 4200 Six Forks Rd, Suite 1100, Raleigh, NC, 27609, USA
| | - Thomas M McLoughlin
- Department of Anesthesiology, Lehigh Valley Health Network, Allentown, PA, 18103, USA
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Robert R Gaiser
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Santhanam Suresh
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Huaping Sun
- The American Board of Anesthesiology, 4200 Six Forks Rd, Suite 1100, Raleigh, NC, 27609, USA.
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Martis WR, Oughton C, Traer E, Ismail H, Riedel B. Reassessing perioperative cardiopulmonary exercise testing: point-of-care cardiac ultrasound and end-tidal pressure of carbon dioxide measurement for scalable individualised risk assessment. Br J Anaesth 2024; 133:199-202. [PMID: 38670894 DOI: 10.1016/j.bja.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Walston R Martis
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthetics, Monash Health, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Chad Oughton
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Northern Health, Melbourne, VIC, Australia
| | - Emily Traer
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Hilmy Ismail
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Bernhard Riedel
- Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
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O'Brien EM, Guris RD, Quarshie W, Lin EE. The state of point-of-care ultrasound training in pediatric anesthesia fellowship programs in the United States: A survey assessment. Paediatr Anaesth 2024; 34:544-550. [PMID: 38358309 DOI: 10.1111/pan.14851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Point-of-care ultrasound is an invaluable bedside tool for anesthesiologists and has been integrated into anesthesiology residency training and board certification in the United States. Little is known about point-of-care ultrasound training practices in pediatric anesthesia fellowship programs. AIMS To describe the current state of point-of-care ultrasound education in pediatric anesthesia fellowship programs in the United States. METHODS We conducted a cross-sectional survey study distributed to 60 American Accreditation Council for Graduate Medical Education-accredited pediatric anesthesia fellowship programs. Two programs were in their initial accreditation period and were excluded due to lack of historical data. Program directors or associate program directors were invited to complete this 23-item survey. RESULTS Thirty-three of fifty-eight programs (57%) completed the survey. Of those, 15 programs (45%) reported having a point-of-care ultrasound curriculum. Programs with ≤3 fellows per year were less likely to have an ultrasound curriculum compared to programs with ≥4 fellows per year (30% programs 0-3 fellows/year vs. 69% programs ≥4 fellows/year, odds ratio 0.19 [95% confidence intervals 0.04-0.87]; p = .03). Program directors and associate program directors rated point-of-care ultrasound training as highly valuable to fellows' education. Barriers to use most commonly included lack of experience (64%), lack of oversight/interpretive guidance (58%), and lack of time (45%). Programs without point-of-care ultrasound training had significantly higher odds of listing lack of ultrasound access as a primary barrier (50% programs without vs. 13% programs with, odds ratio 6.5, [95% confidence intervals 1.3-50]; p = .04). CONCLUSIONS This observational survey-based study suggests that fewer than half of pediatric anesthesia training programs in the United States offer point-of-care ultrasound education. Additional research is needed to optimize this education and training in pediatric anesthesia fellowship programs.
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Affiliation(s)
- Elizabeth M O'Brien
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Associate Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rodrigo Daly Guris
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William Quarshie
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elaina E Lin
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Müller-Wirtz LM, Patterson WM, Ott S, Brauchle A, Meiser A, Volk T, Berwanger U, Conrad D. Teaching Medical Students Rapid Ultrasound for shock and hypotension (RUSH): learning outcomes and clinical performance in a proof-of-concept study. BMC MEDICAL EDUCATION 2024; 24:360. [PMID: 38566149 PMCID: PMC10988853 DOI: 10.1186/s12909-024-05331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a critical diagnostic tool in various medical settings, yet its instruction in medical education is inconsistent. The Rapid Ultrasound for Shock and Hypotension (RUSH) protocol is a comprehensive diagnostic tool, but its complexity poses challenges for teaching and learning. This study evaluates the effectiveness of a single-day training in RUSH for medical students by assessing their performance in clinical scenarios. METHODS In this prospective single-center observational proof-of-concept study, 16 medical students from Saarland University Medical Center underwent a single-day training in RUSH, followed by evaluations in clinical settings and on a high-fidelity simulator. Performance was assessed using a standardized scoring tool and time to complete the RUSH exam. Knowledge gain was measured with pre- and post-training written exams, and diagnostic performance was evaluated with an objective structured clinical examination (OSCE). RESULTS Students demonstrated high performance in RUSH exam views across patients (median performance: 85-87%) and improved scanning times, although not statistically significant. They performed better on simulators than on live patients. Written exam scores significantly improved post-training, suggesting a gain in theoretical knowledge. However, more than a third of students could not complete the RUSH exam within five minutes on live patients. CONCLUSIONS Single-day RUSH training improved medical students' theoretical knowledge and simulator performance but translating these skills to clinical settings proved challenging. The findings suggest that while short-term training can be beneficial, it may not suffice for clinical proficiency. This study underscores the need for structured and possibly longitudinal training programs to ensure skill retention and clinical applicability.
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Affiliation(s)
- Lukas Martin Müller-Wirtz
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany.
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany.
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA.
| | - William M Patterson
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Sascha Ott
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Annika Brauchle
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - Andreas Meiser
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - Thomas Volk
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Ulrich Berwanger
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - David Conrad
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
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Bianchini A, Susi F, Laici C, Zangheri E, Gollinucci B, Siniscalchi A. Preoperative point-of-care neck ultrasound: beyond the airway. J Ultrasound 2024; 27:185-190. [PMID: 38040941 PMCID: PMC10908738 DOI: 10.1007/s40477-023-00840-1] [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: 03/02/2023] [Accepted: 08/02/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE A preoperative point-of-care neck ultrasound, carried out during preoperative airway evaluation by extending the scans to the regions close to the larynx and trachea, can allow for the rapid identification of unknown pathologies or abnormalities in a cost-effective and non-invasive manner. This prospective, observational study examines a series of ultrasound findings in structures close to the airway, made through preoperative point-of-care neck ultrasound in a cohort of 230 patients. METHODS We conducted a prospective observational study, enrolling 230 adult patients selected for elective abdominal surgery. The primary goal was to verify the predictive role of airway ultrasound in identifying difficult airways, while the secondary goal was to evaluate structures close to the airway such as jugular veins, carotid arteries, thyroid gland and soft tissues. RESULTS Overall, preoperative point-of-care neck ultrasound proved to be an effective and reliable method of obtaining details about local or systemic pathologies, which could affect perioperative care. For example, the exam consistently revealed the presence of carotid plaques or venous congestion, which could be used to best determine the patient's cardiovascular risk or to instigate further investigations. It also allowed for more accurate central venous catheter placement planning and better airway management and it warned about possible thyroid or neoplastic pathologies that would have otherwise remained unknown. In some cases, information from preoperative point-of-care neck ultrasound has even led to modifications in perioperative therapy. CONCLUSION Preoperative point-of-care neck ultrasound is fast, inexpensive, and non-invasive, and it can be easily performed by a properly trained professional during the preoperative airway ultrasound evaluation. It can be considered as a new preoperative assessment tool.
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Affiliation(s)
- Amedeo Bianchini
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Susi
- Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy.
| | - Cristiana Laici
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Zangheri
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Gollinucci
- Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Sun H, Deiner SG, Harman AE, Isaak RS, Keegan MT. A comparison of the American Board of Anesthesiology's in-person and virtual objective structured clinical examinations. J Clin Anesth 2023; 91:111258. [PMID: 37734196 DOI: 10.1016/j.jclinane.2023.111258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The American Board of Anesthesiology's Objective Structured Clinical Examination (OSCE), as a component of its initial certification process, had been administered in-person in a dedicated assessment center since its launch in 2018 until March 2020. Due to the COVID-19 pandemic, a virtual format of the exam was piloted in December 2020 and was administered in 2021. This study aimed to compare candidate performance, examiner grading severity, and scenario difficulty between these two formats of the OSCE. METHODS The Many-Facet Rasch Model was utilized to estimate candidate performance, examiner grading severity, and scenario difficulty for the in-person and virtual OSCEs separately. The virtual OSCE was equated to the in-person OSCE by common examiners and common scenarios. Independent-samples t-test was used to compare candidate performance, and partially overlapping samples t-tests were applied to compare examiner grading severity and scenario difficulty between the in-person and virtual OSCEs. RESULTS The in-person (n = 3235) and virtual (n = 2934) first-time candidates were comparable in age, sex, race/ethnicity, and whether U.S. medical school graduates. The virtual scenarios (n = 35, mean [0.21] ± SD [0.38] in logits) were more difficult than the in-person scenarios (n = 93, 0.00 ± 0.69, Welch's partially overlapping samples t-test, p = 0.01); there were no statistically significant differences in examiner severity (n = 390, -0.01 ± 0.82 vs. n = 304, -0.02 ± 0.93, Welch's partially overlapping samples t-test, p = 0.81) or candidate performance (2.19 ± 0.93 vs. 2.18 ± 0.92, Welch's independent samples t-test, p = 0.83) between the in-person and virtual OSCEs. CONCLUSIONS Our retrospective analyses of first-time OSCEs found comparable candidate performance and examiner grading severity between the in-person and virtual formats, despite the virtual scenarios being more difficult than the in-person scenarios. These results provided assurance that the virtual OSCE functioned reasonably well in a high-stakes setting.
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Affiliation(s)
- Huaping Sun
- The American Board of Anesthesiology, Raleigh, NC, USA.
| | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | - Ann E Harman
- The American Board of Anesthesiology, Raleigh, NC, USA.
| | - Robert S Isaak
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Yastrebov K, Costello C, Taylor B, Torda A. Point-of-care ultrasonography-An essential skill for medical graduates? Australas J Ultrasound Med 2023; 26:272-274. [PMID: 38098619 PMCID: PMC10716562 DOI: 10.1002/ajum.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
The recent proliferation of point-of-care ultrasonography (POCUS) in the clinical practice of many medical specialties has exposed persistent barriers to education, training and standardisation. Specialist training curriculums are already overwhelming, having grossly insufficient time available for the specialist trainees and for the small number of available trainers alike to incorporate POCUS into postgraduate education. The logical solution to overcome these barriers could be to incorporate basic POCUS education and training into the undergraduate university curriculums, introducing longitudinal integration with other relevant medical sciences. The Australasian Society of Ultrasound in Medicine already has well-established educational programmes in POCUS with standardised assessment of competency, which could potentially offer the basis for symbiosis with the Australian and New Zealand medical schools.
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Affiliation(s)
| | - Cartan Costello
- College of Intensive Care Medicine of Australia and New ZealandPrahranVictoriaAustralia
| | - Ben Taylor
- University of New South WalesSydneyNew South WalesAustralia
| | - Adrienne Torda
- University of New South WalesSydneyNew South WalesAustralia
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Hughey S, Daugherty L, Nicholson A, DeYoung H. Point-of-Care Ultrasound in Austere Environments. Wilderness Environ Med 2023; 34:260-262. [PMID: 36934029 DOI: 10.1016/j.wem.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Scott Hughey
- Department of Anesthesiology and Pain Medicine, Naval Hospital Okinawa, Okinawa, Japan; Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA
| | | | - Ashton Nicholson
- Department of Anesthesiology and Pain Medicine, Naval Hospital Okinawa, Okinawa, Japan
| | - Henry DeYoung
- Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA; Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA
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Remskar MH, Theophanous R, Bowman A, Simonson LE, Koehler J, Basrai Z, Manohar CM, Mader MJ, Nathanson R, Soni NJ. Current Use, Training, and Barriers of Point-of-Care Ultrasound in Anesthesiology: A National Survey of Veterans Affairs Hospitals. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00229-X. [PMID: 37120325 DOI: 10.1053/j.jvca.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine current use, training needs, and barriers to point-of-care ultrasound (POCUS) use among anesthesiologists in practice. DESIGN Multicenter, prospective, observational study. SETTING Anesthesiology departments in the Veterans Affairs Healthcare System in the United States. PARTICIPANTS Chiefs of staff and chiefs of anesthesiology departments. INTERVENTIONS A web-based survey was conducted between June 2019 and March 2020. Chiefs of staff answered questions about facility-level POCUS use, training, competency, and policies. Anesthesiology chiefs responded to a follow-up survey with specialty-specific POCUS questions. The results of the 2020 survey were compared with a similar survey conducted by the authors' group in 2015. MEASUREMENTS AND MAIN RESULTS All chiefs of staff (n = 130) and 77% of anesthesiology chiefs (n = 96) completed the survey. The most common POCUS applications used were central and peripheral vascular access (69%-72%), peripheral nerve blocks (66%), and evaluation of cardiac function (29%-31%). Compared with 2015, there was a statistically significant increase in desire for training (p = 0.00015), but no significant change in POCUS use (p = 0.31). Training was most desired for volume-status assessment (52%), left ventricular function (47%), pneumothorax (47%), central line placement (40%), peripheral nerve blocks (40%), and pleural effusion (40%). The most common barriers to POCUS use were lack of funding for training (35%), trained providers (33%), and training opportunities (28%). CONCLUSIONS A significant increase in desire for POCUS training was seen among anesthesiologists practicing in the Veterans Affairs healthcare system since 2015, and lack of training continues to be a top barrier for POCUS use among anesthesiologists.
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Affiliation(s)
- Mojca H Remskar
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN; Anesthesiology Service, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
| | - Rebecca Theophanous
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Emergency Medicine, Durham VA Healthcare System, Durham, NC
| | - Amber Bowman
- Department of Medicine, Duke University School of Medicine, Durham, NC; Medicine Service, Durham VA Healthcare System, Durham, NC
| | | | - Jessica Koehler
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Emergency Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Crystal M Manohar
- Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, TX; Department of Anesthesiology Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
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Bronshteyn YS, Blitz J, Hashmi N, Krishnan S. Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing. Int Anesthesiol Clin 2022; 60:1-7. [PMID: 35582953 DOI: 10.1097/aia.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yuriy S Bronshteyn
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Health Administration, Durham, North Carolina
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nazish Hashmi
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sundar Krishnan
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
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Adams AJ, Songster JC, Harig JP, Markin NW. Perioperative gastric ultrasound: utility and limitations. Int Anesthesiol Clin 2022; 60:45-54. [PMID: 35499911 DOI: 10.1097/aia.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Austin J Adams
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey C Songster
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jason P Harig
- Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
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12
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New applications of perioperative POCUS: beyond the Big 4. Int Anesthesiol Clin 2022; 60:65-73. [PMID: 35670237 DOI: 10.1097/aia.0000000000000364] [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]
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13
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Aissaoui Y, Jozwiak M, Bahi M, Belhadj A, Alaoui H, Qamous Y, Serghini I, Seddiki R. Prediction of post-induction hypotension by point-of-care echocardiography: A prospective observational study. Anaesth Crit Care Pain Med 2022; 41:101090. [PMID: 35508291 DOI: 10.1016/j.accpm.2022.101090] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Post-induction hypotension (PIH) is a common side effect of general anaesthesia and is associated with poor perioperative outcomes. We assessed the ability of two point-of-care echocardiographic variables to predict the occurrence of PIH: the passive leg raising-induced changes in the velocity-time integral of the left ventricular outflow tract (ΔVTI-PLR) and the inferior vena cava collapsibility index (IVC-CI). METHODS We studied 64 patients > 50 years scheduled for elective abdominal surgery. ΔVTI-PLR and IVC-CI were prospectively obtained before general anaesthesia induction. PIH was defined by a systolic arterial pressure < 90 mmHg or a mean arterial pressure < 65 mmHg or by a decrease in systolic or mean arterial pressure > 30% from pre-induction level. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of echocardiographic measurements. Receiver operating characteristic (ROC) curves with 95% confidence intervals (CIs) were generated to test the ability of ΔVTI-PLR and IVC-CI to predict the occurrence of PIH. RESULTS PIH occurred in 33 (51%) patients. The ICCs for VTI and IVC measurements showed excellent reproducibility. The occurrence of PIH was accurately predicted by ΔVTI-PLR with an area under the ROC curve (AUROC) of 0.89 (95% CI: 0.80-0.97), a threshold value of 18% with a sensitivity of 88% (95% CI: 71-97%) and a specificity of 84% (95% CI: 66-94%). The occurrence of PIH was poorly predicted by IVC-CI with an AUROC of 0.68 (95% CI: 0.54-0.80) and a threshold value of 42%. CONCLUSIONS ΔVTI-PLR, unlike IVC-CI, could reliably predict the occurrence of PIH. The use of ΔVTI-PLR could help individualise anaesthesia management to prevent PIH.
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Affiliation(s)
- Younes Aissaoui
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco.
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, 151 route saint Antoine de Ginestière, 06200, Nice, France; UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Mohammed Bahi
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco
| | - Ayoub Belhadj
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Hassan Alaoui
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Youssef Qamous
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Issam Serghini
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Rachid Seddiki
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
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A Study on the Role of Intelligent Medical Simulation Systems in Teaching First Aid Competence in Anesthesiology. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8163546. [PMID: 35494522 PMCID: PMC9050259 DOI: 10.1155/2022/8163546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
Anesthesiology is a subject with strong practicality and application. Undergraduate anesthesiology teaching needs to strike a balance between theoretical knowledge, clinical skill training, and clinical thinking development. Clinical probation and practice are an important part of undergraduate anesthesia teaching. Traditional clinical teaching uses real patients for demonstration and training, but as patients become more self-protective and less cooperative, there are not enough patients for clinical skill training. Simulation is to teach medical scenes in real life under the control of standardized technical guidelines and parameters. Since then, with the rapid development of computer technology, simulation technology and simulation teaching have been greatly developed and are more and more used in clinical teaching, skill evaluation, and scientific research. This study explores the effective methods of clinical teaching in anesthesiology by comparing the effectiveness of traditional teaching methods and simulation teaching methods in undergraduate clinical teaching. It is difficult to combine theory and practice in first aid, which does not allow them to directly receive and deal with emergency medical treatment and resuscitation. In China's current medical environment and patients' high demand for medical services, it is imperative to vigorously carry out simulated medical education. In the eastern part of Inner Mongolia, according to the advantages of teaching hospitals, our hospital took the lead in carrying out the simulation education project, which is still in the exploratory stage and not systematic enough. This study will help us to better carry out simulation teaching and improve the clinical skills of medical students in the future. Methods. The student group and class took the advanced simulator training as the experimental group, applied the advanced integrated simulator and other systems of the Norwegian company, referred to the international guidelines for cardiopulmonary resuscitation and cardiovascular first aid in 2005, and practiced in the emergency department during the clinical internship and “emergency clinical simulation training” course. The course includes basic life support, advanced life support, and comprehensive training of CPR (cardiopulmonary resuscitation) and endotracheal intubation. Results. The passing rate of simulated first aid practice was 94.4%; 100% of the students think it is necessary to set up the course, 91% of the students think it is practical, 91% of the students think the course content is reasonable and perfect, and 77%–100% of the students think the course has improved their first aid operation ability, comprehensive application of knowledge, and clinical thinking ability. Conclusion. Carrying out the course of “clinical simulated first aid training” through the advanced simulator system can effectively improve the interns' clinical first aid operation ability, teamwork ability, and self-confidence, improve the students' clinical thinking and judgment ability, and improve the service level to patients.
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15
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Khoche S, Choi C, Kothari P, Hamm K, Poorsattar SP, Maus TM. The Year in Perioperative Echocardiography: Selected Highlights from 2021. J Cardiothorac Vasc Anesth 2022; 36:3459-3468. [DOI: 10.1053/j.jvca.2022.04.002] [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: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/11/2022]
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16
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Tankul R, Halilamien P, Tangwiwat S, Dejarkom S, Pangthipampai P. Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists. BMC Anesthesiol 2022; 22:5. [PMID: 34979932 PMCID: PMC8722139 DOI: 10.1186/s12871-021-01550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers. METHODS This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106). RESULTS Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: -0.125 to 0.931), 0.669 (95% CI: -0.254 to 0.920), 0.362 (95% CI: -0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05). CONCLUSION Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training. TRIAL REGISTRATION ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.
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Affiliation(s)
- Rattanaporn Tankul
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pathom Halilamien
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sukanya Dejarkom
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Airway ultrasonography - Need for structured training curriculum, quality standards, and competencies assessment. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Mehdiratta L, Kumar N, Bajwa SJS. Advancing, strengthening and reshaping obstetric critical care with Point-of-Care Ultrasound (POCUS). Indian J Anaesth 2021; 65:711-715. [PMID: 34898697 PMCID: PMC8607862 DOI: 10.4103/ija.ija_924_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Nishant Kumar
- Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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20
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Moharir A, Tobias JD. The Role of a Handheld Ultrasound Device to Facilitate Remote Learning for a Point-of-Care Ultrasound Certificate Program. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1043-1048. [PMID: 34584478 PMCID: PMC8462468 DOI: 10.2147/amep.s328625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Point-of-care ultrasound is a growing field within anesthesiology as well as several other medical and surgical specialties. The recent development of handheld ultrasound devices has the potential to expand the use or this technology by decreasing the cost and increasing accessibility for the healthcare provider. These handheld devices may be used to assist with education, training, and even direct patient care. We outline our process for using a handheld ultrasound device, the Lumify, to assist in the completion of a point-of-care ultrasound certificate program offered by the American Society of Anesthesiologists. We outline the unique advantages of this device as it relates to cost, portability, and applicability of its web-based technology compared to a traditional standalone ultrasound machine for the completion of this course.
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Affiliation(s)
- Alok Moharir
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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21
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Kalagara H, Manson W, Townsley MM. Point-of-Care Ultrasound (POCUS) Training for Anesthesiologists: Is it Time to Embrace and Attain Competency? J Cardiothorac Vasc Anesth 2021; 36:30-32. [PMID: 34521580 DOI: 10.1053/j.jvca.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - William Manson
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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22
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Subramaniam K, Subramanian H, Knight J, Mandell D, McHugh SM. An Approach to Standard Perioperative Transthoracic Echocardiography Practice for Anesthesiologists-Perioperative Transthoracic Echocardiography Protocols. J Cardiothorac Vasc Anesth 2021; 36:367-386. [PMID: 34629240 DOI: 10.1053/j.jvca.2021.08.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/10/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
The use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists' training and practice. While a special "certification in Critical Care Echocardiography" was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists. In this review, the authors describe the categories, indications and applications of perioperative TTE and provide a recommended sequence for performing an examination tailored to the evaluation of perioperative patients. Although the authors describe a protocol utilized at their institution, there are no standards described in the literature for PTTE. Cardiac anesthesiologists and cardiac anesthesia societies (Society of Cardiovascular Anesthesiologists, European Association of Cardiothoracic Anesthesiologists) must come forward to establish standards working in collaboration with echocardiography societies (American Society of Echocardiography, European Society of Cardiology).
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Affiliation(s)
- Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel Mandell
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Stephen M McHugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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23
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A Comparison of Lung Ultrasound and Computed Tomography in the Diagnosis of Patients with COVID-19: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11081351. [PMID: 34441286 PMCID: PMC8394642 DOI: 10.3390/diagnostics11081351] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Lung ultrasound (LUS) and computed tomography (CT) can both be used for diagnosis of interstitial pneumonia caused by coronavirus disease 2019 (COVID-19), but the agreement between LUS and CT is unknown. Purpose to compare the agreement of LUS and CT in the diagnosis of interstitial pneumonia caused by COVID-19. Materials and Methods We searched PubMed, Cochrane library, Embase, Chinese Biomedicine Literature, and WHO COVID-19 databases to identify studies that compared LUS with CT in the diagnosis of interstitial pneumonia caused by COVID-19. We calculated the pooled overall, positive and negative percent agreements, diagnostic odds ratio (DOR) and the area under the standard receiver operating curve (SROC) for LUS in the diagnosis of COVID-19 compared with CT. Results We identified 1896 records, of which nine studies involving 531 patients were finally included. The pooled overall, positive and negative percentage agreements of LUS for the diagnosis of interstitial pneumonia caused by COVID-19 compared with CT were 81% (95% confidence interval [CI] 43–99%), 96% (95% CI, 80–99%, I2 = 92.15%) and 80% (95%CI, 60–92%, I2 = 92.85%), respectively. DOR was 37.41 (95% CI, 9.43–148.49, I2 = 63.9%), and the area under the SROC curve was 0.94 (95% CI, 0.92–0.96). The quality of evidence for both specificity and sensitivity was low because of heterogeneity and risk of bias. Conclusion The level of diagnostic agreement between LUS and CT in the diagnosis of interstitial pneumonia caused by COVID-19 is high. LUS can be therefore considered as an equally accurate alternative for CT in situations where molecular tests are not available.
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Vetrugno L, Boero E, Bignami E, Cortegiani A, Raineri SM, Spadaro S, Moro F, D’Incà S, D’Orlando L, Agrò FE, Bernardinetti M, Forfori F, Corradi F, Pregnolato S, Mosconi M, Bellini V, Franchi F, Mongelli P, Leonardi S, Giuffrida C, Tescione M, Bruni A, Garofalo E, Longhini F, Cammarota G, De Robertis E, Giglio G, Urso F, Bove T. Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP). Ultrasound J 2021; 13:30. [PMID: 34100124 PMCID: PMC8184059 DOI: 10.1186/s13089-021-00230-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs. METHODS LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns-each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. CONCLUSIONS Lung ultrasound (LU), as a tool within the anesthesiologist's armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Savino Spadaro
- Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Federico Moro
- Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Stefano D’Incà
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
| | - Loris D’Orlando
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
| | - Felice Eugenio Agrò
- Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Mattia Bernardinetti
- Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Sandro Pregnolato
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Mosconi
- Orthopedics and Traumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy
| | - Pierpaolo Mongelli
- Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy
| | | | | | - Marco Tescione
- Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Giglio
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
| | - Felice Urso
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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The Evaluation Point-of-Care Ultrasound in the Post-Anesthesia Unit-A Multicenter Prospective Observational Study. J Clin Med 2021; 10:jcm10112389. [PMID: 34071466 PMCID: PMC8198895 DOI: 10.3390/jcm10112389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations. Methods: This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome. Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, p = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, p-values < 0.001. Conclusions: Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.
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Salik I, Rodhouse HB, Mehta B, Villion A. Preoperative cardiac POCUS for urgent surgery in a patient with Maroteaux-Lamy syndrome. J Clin Anesth 2021; 72:110296. [PMID: 33915412 DOI: 10.1016/j.jclinane.2021.110296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 09/30/2022]
Affiliation(s)
- Irim Salik
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
| | - Heather Brosnan Rodhouse
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
| | - Bhupen Mehta
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
| | - Andrew Villion
- Department of Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
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28
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Fatima H, Amador Y, Walsh DP, Qureshi NQ, Chaudhary O, Mufarrih SH, Bose RR, Mahmood F, Matyal R. Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach Proposal. J Cardiothorac Vasc Anesth 2021; 35:2273-2282. [PMID: 34006466 DOI: 10.1053/j.jvca.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 01/17/2023]
Abstract
Despite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. However, there is a lack of consensus on the formal role of ultrasound during evaluation of perioperative hypoxia or hypotension. The previous ultrasound algorithms have adopted a complex technique that possibly ignore the pathophysiologic mechanisms underlying the conditions presenting in a similar fashion. The authors here propose a simple, sequential and focused multiorgan approach, applicable for the evaluation of perioperative hypotension and hypoxia in emergency scenarios. The authors believe this approach will enhance the care provided in the postanesthesia care unit, operating room, and intensive care unit.
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Affiliation(s)
- Huma Fatima
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Yannis Amador
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Daniel P Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Nada Qaisar Qureshi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Omar Chaudhary
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Syed Hamza Mufarrih
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Ruma R Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA.
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29
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Bronshteyn YS, Anderson TA, Badakhsh O, Boublik J, Brady MBW, Charnin JE, Coker BJ, Deriy LB, Hardman HD, Haskins SC, Hollon M, Hsia HLJ, Neelankavil JP, Panzer OPF, Perlas A, Ramsingh D, Sharma A, Shore-Lesserson LJ, Zimmerman JM. Diagnostic Point-of-Care Ultrasound: Recommendations From an Expert Panel. J Cardiothorac Vasc Anesth 2021; 36:22-29. [PMID: 34059438 DOI: 10.1053/j.jvca.2021.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/28/2021] [Accepted: 04/10/2021] [Indexed: 12/31/2022]
Abstract
Diagnostic point-of-care ultrasound (PoCUS) has emerged as a powerful tool to help anesthesiologists guide patient care in both the perioperative setting and the subspecialty arenas. Although anesthesiologists can turn to guideline statements pertaining to other aspects of ultrasound use, to date there remains little in the way of published guidance regarding diagnostic PoCUS. To this end, in 2018, the American Society of Anesthesiologists chartered an ad hoc committee consisting of 23 American Society of Anesthesiologists members to provide recommendations on this topic. The ad hoc committee convened and developed a committee work product. This work product was updated in 2021 by an expert panel of the ad hoc committee to produce the document presented herein. The document, which represents the consensus opinion of a group of practicing anesthesiologists with established expertise in diagnostic ultrasound, addresses the following issues: (1) affirms the practice of diagnostic PoCUS by adequately trained anesthesiologists, (2) identifies the scope of practice of diagnostic PoCUS relevant to anesthesiologists, (3) suggests the minimum level of training needed to achieve competence, (4) provides recommendations for how diagnostic PoCUS can be used safely and ethically, and (5) provides broad guidance about diagnostic ultrasound billing.
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Affiliation(s)
- Yuriy S Bronshteyn
- Duke University School of Medicine, Duke University Health System, Durham Veterans Health Administration, Durham, NC.
| | | | - Orode Badakhsh
- University of California Davis Medical Center, Sacramento, CA
| | - Jan Boublik
- Stanford University School of Medicine, Stanford, CA
| | | | - Jonathan E Charnin
- Mayo Clinic, Rochester, MN, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley J Coker
- Mayo Clinic, Rochester, MN, University of Alabama at Birmingham, Birmingham, AL
| | - Lev B Deriy
- Department of Anesthesiology and Critical Care, University of New Mexico, Albuquerque, NM
| | - H David Hardman
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen C Haskins
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY; Department of Anesthesiology, Weill-Cornell Medical College, New York, NY
| | - McKenzie Hollon
- Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA
| | - Hung-Lun John Hsia
- Duke University School of Medicine, Duke University Health System, Durham Veterans Health Administration, Durham, NC
| | | | - Oliver P F Panzer
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Anahi Perlas
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
| | - Archit Sharma
- University of Iowa Carver College of Medicine, Iowa City, IA
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30
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Haskins SC, Bronshteyn Y, Perlas A, El-Boghdadly K, Zimmerman J, Silva M, Boretsky K, Chan V, Kruisselbrink R, Byrne M, Hernandez N, Boublik J, Manson WC, Hogg R, Wilkinson JN, Kalagara H, Nejim J, Ramsingh D, Shankar H, Nader A, Souza D, Narouze S. American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: clinical indications. Reg Anesth Pain Med 2021; 46:1031-1047. [PMID: 33632778 DOI: 10.1136/rapm-2021-102560] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/20/2022]
Abstract
Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine (ASRA) commissioned this narrative review to provide recommendations for POCUS. The guidelines were written by content and educational experts and approved by the Guidelines Committee and the Board of Directors of the ASRA. In part I of this two-part series, clinical indications for POCUS in the perioperative and chronic pain setting are described. The clinical review addresses airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma examination and focused cardiac ultrasound for the regional anesthesiologist and pain physician. It also provides foundational knowledge regarding ultrasound physics, discusses the impact of handheld devices and finally, offers insight into the role of POCUS in the pediatric population.
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Affiliation(s)
- Stephen C Haskins
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Yuriy Bronshteyn
- Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anahi Perlas
- Anesthesiology and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Joshua Zimmerman
- Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Marcos Silva
- Anesthesiology and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vincent Chan
- Anesthesiology and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Melissa Byrne
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nadia Hernandez
- Anesthesiology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jan Boublik
- Anesthesiology, Stanford Hospital and Clinics, Stanford, California, USA
| | - William Clark Manson
- Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rosemary Hogg
- Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Jonathan N Wilkinson
- Intensive Care and Anaesthesia, Northampton General Hospital, Northampton, Northamptonshire, UK
| | | | - Jemiel Nejim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Davinder Ramsingh
- Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Hariharan Shankar
- Anesthesiology, Clement Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Antoun Nader
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dmitri Souza
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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31
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Kalagara H, Coker B, Gerstein NS, Kukreja P, Deriy L, Pierce A, Townsley MM. Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:1132-1147. [PMID: 33563532 DOI: 10.1053/j.jvca.2021.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022]
Abstract
Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.
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Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley Coker
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Albert Pierce
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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32
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Kars MS, Gomez Morad A, Haskins SC, Boublik J, Boretsky K. Point-of-care ultrasound for the pediatric regional anesthesiologist and pain specialist: a technique review. Reg Anesth Pain Med 2020; 45:985-992. [DOI: 10.1136/rapm-2020-101341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/04/2020] [Accepted: 08/08/2020] [Indexed: 01/11/2023]
Abstract
Point-of-care ultrasound (PoCUS) has been well described for adult perioperative patients; however, the literature on children remains limited. Regional anesthesiologists have gained interest in expanding their clinical repertoire of PoCUS from regional anesthesia to increasing numbers of applications. This manuscript reviews and highlights emerging PoCUS applications that may improve the quality and safety of pediatric care.In infants and children, lung and airway PoCUS can be used to identify esophageal intubation, size airway devices such as endotracheal tubes, and rule in or out a pulmonary etiology for clinical decompensation. Gastric ultrasound can be used to stratify aspiration risk when nil-per-os compliance and gastric emptying are uncertain. Cardiac PoCUS imaging is useful to triage causes of undifferentiated hypotension or tachycardia and to determine reversible causes of cardiac arrest. Cardiac PoCUS can assess for pericardial effusion, gross ventricular systolic function, cardiac volume and filling, and gross valvular pathology. When PoCUS is used, a more rapid institution of problem-specific therapy with improved patient outcomes is demonstrated in the pediatric emergency medicine and critical care literature.Overall, PoCUS saves time, expedites the differential diagnosis, and helps direct therapy when used in infants and children. PoCUS is low risk and should be readily accessible to pediatric anesthesiologists in the operating room.
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33
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Kiefer JJ, Gold AK, Feinman JW, Raiten J. Critical Care and Perioperative Echocardiography Certification: Challenges Ahead. J Cardiothorac Vasc Anesth 2020; 35:248-250. [PMID: 32888794 DOI: 10.1053/j.jvca.2020.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Jesse J Kiefer
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Andrew K Gold
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jesse Raiten
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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