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Mohsen N, Yeung T, Fadel NB, Abdul Wahab MG, Elsayed Y, Nasef N, Mohamed A. Current perception and barriers to implementing lung ultrasound in Canadian neonatal intensive care units: a national survey. Eur J Pediatr 2024; 183:3499-3508. [PMID: 38787415 DOI: 10.1007/s00431-024-05591-7] [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: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs. A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Telford Yeung
- Section of Neonatology, Windsor Regional Hospital, University of Windsor, Windsor, Canada
| | - Nadya Ben Fadel
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Yasser Elsayed
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Pai VV, Noh CY, Dasani R, Vallandingham S, Manipon C, Haileselassie B, Profit J, Balasundaram M, Davis AS, Bhombal S. Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e76-e84. [PMID: 35691294 DOI: 10.1055/s-0042-1750118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In the adult and pediatric critical care population, point-of-care ultrasound (POCUS) can aid in diagnosis, patient management, and procedural accuracy. For neonatal providers, training in ultrasound and the use of ultrasound for diagnosis and management is increasing, but use in the neonatal intensive care unit (NICU) is still uncommon compared with other critical care fields. Our objective was to describe the process of implementing a POCUS program in a large academic NICU and evaluate the role of ultrasound in neonatal care during early adaption of this program. STUDY DESIGN A POCUS program established in December 2018 included regular bedside scanning, educational sessions, and quality assurance, in collaboration with members of the cardiology, radiology, and pediatric critical care divisions. Core applications were determined, and protocols outlined guidelines for image acquisition. An online database included images and descriptive logs for each ultrasound. RESULTS A total of 508 bedside ultrasounds (76.8% diagnostic and 23.2% procedural) were performed by 23 providers from December 2018 to December 2020 in five core diagnostic applications: umbilical line visualization, cardiac, lung, abdomen (including bladder), and cranial as well as procedural applications. POCUS guided therapy and influenced clinical management in all applications: umbilical line assessment (26%), cardiac (33%), lung (14%), abdomen (53%), and cranial (43%). With regard to procedural ultrasound, 74% of ultrasound-guided arterial access and 89% of ultrasound-guided lumbar punctures were successful. CONCLUSIONS Implementation of a POCUS program is feasible in a large academic NICU and can benefit from a team approach. Establishing a program in any NICU requires didactic opportunities, a defined scope of practice, and imaging review with quality assurance. Bedside clinician performed ultrasound findings can provide valuable information in the NICU and impact clinical management. KEY POINTS · Use of point-of-care ultrasound is increasing in neonatology and has been shown to improve patient care.. · Implementation of a point-of-care ultrasound program requires the definition of scope of practice and can benefit from the support of other critical care and imaging departments and providers.. · Opportunities for point-of-care ultrasound didactics, imaging review, and quality assurance can enhance the utilization of bedside ultrasound..
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Affiliation(s)
- Vidya V Pai
- Division of Neonatology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Caroline Y Noh
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Reedhi Dasani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shelby Vallandingham
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Christine Manipon
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Bereketeab Haileselassie
- Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Malathi Balasundaram
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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董 文, 邓 博, 悦 光, Elsayed Y, 巨 容, 王 建, 史 源. [Interpretation of the clinical guideline for point-of-care ultrasonography in the neonatal intensive care unit in the United States]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:672-677. [PMID: 37529947 PMCID: PMC10414167 DOI: 10.7499/j.issn.1008-8830.2302004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/06/2023] [Indexed: 08/03/2023]
Abstract
In December 2022, the American Academy of Pediatrics released a clinical guideline for point-of-care ultrasonography (POCUS) in the neonatal intensive care unit (NICU). The guideline outlined the development and current status of POCUS in the NICU, and summarized the key elements and implementation guidelines for successful implementation of POCUS in the NICU. This article provides an overview of the key points of the clinical guideline and analyzes the current status of POCUS in China, providing a reference for the implementation of POCUS in neonatal care in China.
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Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes. Pediatrics 2022; 150:190110. [PMID: 37154781 DOI: 10.1542/peds.2022-060053] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
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Affiliation(s)
- Dan L Stewart
- Department of Pediatrics and International Pediatrics, Norton Children's Neonatology Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yasser Elsayed
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba-Canada, Health Sciences Centre-Winnipeg, Winnipeg, Manitoba, Canada
| | - María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian D Coley
- Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aparna Annam
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Sarah Sarvis Milla
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Abstract
The dramatic technologic advancements seen in ultrasound have accelerated the growth of point-of-care ultrasound (POCUS) in medicine. Neonatology has lagged behind other pediatric and adult specialties in incorporating POCUS into clinical practice despite there being numerous applications in cardiac and non-cardiac arenas. Widely available training programs are aiding in improving this situation but significantly more structure and orchestration for neonatal POCUS dissemination will be needed to fully actualize the potential for POCUS to augment its widespread clinical application.
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Goldsmith JP, Keels E. Recognition and Management of Cardiovascular Insufficiency in the Very Low Birth Weight Newborn. Pediatrics 2022; 149:184900. [PMID: 35224636 DOI: 10.1542/peds.2021-056051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The measurement of blood pressure in the very low birth weight newborn infant is not simple and may be erroneous because of numerous factors. Assessment of cardiovascular insufficiency in this population should be based on multiple parameters and not only on numeric blood pressure readings. The decision to treat cardiovascular insufficiency should be made after considering the potential complications of such treatment. There are numerous potential strategies to avoid or mitigate hypoperfusion states in the very low birth weight infant.
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Affiliation(s)
- Jay P Goldsmith
- Department of Pediatrics, Division of Newborn Medicine, Tulane University, New Orleans, Louisiana
| | - Erin Keels
- Neonatal Practitioner Program, Neonatal Services, Nationwide Children's Hospital, Columbus, Ohio
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Zheng Y, Gandhi A, Sewell K, Tumin D, Bear K. Point-of-care ultrasound educational interventions in the neonatal intensive care unit: A systematic review. J Neonatal Perinatal Med 2022; 15:511-520. [PMID: 35491808 DOI: 10.3233/npm-210925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The benefits of point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) have been widely recognized, but education on this area of practice remains variable. We reviewed published educational interventions regarding POCUS use in the NICU and whether they have led to sustainable increases in POCUS use. METHODS A systematic search of 6 databases was performed for publications from January 2000 to March 2021. Studies with quantitative data related to POCUS educational interventions in the NICU were included. Data on number of participants and roles, educational intervention, curriculum description, and project outcome measures (including sustainability) was extracted. RESULTS The search resulted in 686 articles, of which nine studies met the inclusion criteria. Educational interventions included didactic sessions, simulation practice, animal practice, and practice in real patients. The most common assessment was based on the quality and accuracy of the images. At the participant level, the average time to reach proficiency ranged from eight hours and thirty-six minutes to five months, and none of the studies evaluated sustainability of POCUS use after the intervention. CONCLUSION There is a lack of standardized training modules and assessments for POCUS use in the NICU. Given that none of the studies addressed sustainability or standardized training, we recommend that a standardized training protocol and assessment tool is developed and studied longitudinally; and that barriers to sustainable POCUS use in the NICU (such as billing issues and a lack of POCUS machines and instructors) be systematically addressed as part of this work.
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Affiliation(s)
- Y Zheng
- Department of Pediatrics, East Carolina University and Vidant Medical Center, Greenville, NC, USA
| | - A Gandhi
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Sewell
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - D Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Bear
- Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
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Kurepa D, Boyar V, Zaghloul N, Beachy J, Zaytseva A, Teng D, Cooper R, Klewer S, Amodio J. Structured Neonatal Point-of-Care Ultrasound Training Program. Am J Perinatol 2021; 38:e284-e291. [PMID: 32344442 DOI: 10.1055/s-0040-1709667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Point-of-care ultrasound (POC US) has been increasingly used by intensive care physicians. Growing use of POC US necessitates defining distinct clinical indications for its application, as well as structured POC US training programs. Homogeneous approach to POC US education combined with rigorous quality assurance should further enable POC US to become standard-of-care clinical tool. This study aimed to present the first, innovative, and structured POC US program in neonatal-perinatal medicine field. In addition, we reviewed the availability of the POC US training programs across different medical specialties. STUDY DESIGN Available English-language publications on POC US training programs in general and neonatal-perinatal medicine were reviewed in this study. DISCUSSION Mounting body of evidence suggests improved procedural completion rates, as well as clinical decision making with the use of POC US. However, limited research supported the existence of structured, comprehensive POC US programs. It was recognized that medical institutions need to develop syllabuses, teach, and credential increasing number of health care professionals in the use of POC US. We defined intuitive educational strategy that encompasses POC US clinical indications, educational curriculum, scanning protocols, competence evaluation, and finally credentialing process. In addition, we offered description of the imaging quality assurance, as well as POC US coding, and reimbursement. CONCLUSION Future efforts need to be dedicated to the ongoing development of neonatal POC US as a clinical instrument. It should allow for eventual paradigm change and improved effectiveness in management of critically ill neonates.
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Affiliation(s)
- Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Vitalya Boyar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Nahla Zaghloul
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Joanna Beachy
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Alla Zaytseva
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - David Teng
- Division of Emergency Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Rubin Cooper
- Division of Cardiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Scott Klewer
- Division of Cardiology, Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - John Amodio
- Division of Radiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
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Polonio PL, Tumin D, Zheng Y, Gandhi A, Bear K. Implementation of point of care ultrasound to assess umbilical venous catheter position in the neonatal intensive care unit. J Matern Fetal Neonatal Med 2021; 35:7207-7209. [PMID: 34219599 DOI: 10.1080/14767058.2021.1946508] [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: 10/20/2022]
Abstract
Point of care ultrasound (POCUS) is an emerging method for assessing umbilical venous catheter (UVC) position. We implemented a training module for neonatal providers geared toward POCUS proficiency in assessing UVC position in our neonatal intensive care unit. Over 14 months, the percentage of providers qualified to use POCUS for UVC placement increased from 0 to 33%. The median time to achieve proficiency was 5 months (interquartile range: 3-14 months). Additionally, we discovered that a minimum of two views were required to correctly assess catheter tip location. The two views in which it was easiest to correctly identify the catheter tip were the subcostal and parasternal short view using the cardiac ultrasound windows, and the phased array ultrasound probe.
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Affiliation(s)
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Yingying Zheng
- Department of Pediatrics, East Carolina University and Vidant Medical Center, Greenville, NC, USA
| | - Anita Gandhi
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Kelly Bear
- Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
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Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center. Diagnostics (Basel) 2021; 11:diagnostics11071172. [PMID: 34203357 PMCID: PMC8305030 DOI: 10.3390/diagnostics11071172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022] Open
Abstract
There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.
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