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Gomes da Silva DA, D'Ambrosio PD, Minamoto FEN, Pessoa BMDL, Rocha Junior E, Lauricella LL, Terra RM, Pêgo-Fernandes PM, Mariani AW. Resident physician training in bedside pleural procedures: A one-year experience at a teaching hospital. Clinics (Sao Paulo) 2024; 79:100399. [PMID: 38834010 PMCID: PMC11178978 DOI: 10.1016/j.clinsp.2024.100399] [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: 09/24/2023] [Revised: 04/08/2024] [Accepted: 05/18/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVE This study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects. MATERIALS AND METHODS The authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023. RESULTS 463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications. CONCLUSION Bedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety.
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Affiliation(s)
- Diego Arley Gomes da Silva
- Divisao Cirurgia Toracica, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Paula Duarte D'Ambrosio
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Fabio Eiti Nishibe Minamoto
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Bernardo Mulinari de Lacerda Pessoa
- Divisao Cirurgia Toracica, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eserval Rocha Junior
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Leticia Leone Lauricella
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ricardo Mingarini Terra
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Divisao Cirurgia Toracica, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alessandro Wasum Mariani
- Divisao Cirurgia Toracica, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 2021; 90:524-531. [PMID: 30127522 PMCID: PMC7094915 DOI: 10.1038/s41390-018-0114-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 01/29/2023]
Abstract
Lung ultrasound (LUS) is the latest amongst imaging techniques: it is a radiation-free, inexpensive, point-of-care tool that the clinician can use at the bedside. This review summarises the rapidly growing scientific evidence on LUS in neonatology, dividing it into descriptive and functional applications. We report the description of the main ultrasound features of neonatal respiratory disorders and functional applications of LUS aiming to help a clinical decision (such as surfactant administration, chest drainage etc). Amongst the functional applications, we propose SAFE (Sonographic Algorithm for liFe threatening Emergencies) as a standardised protocol for emergency functional LUS in critical neonates. SAFE has been funded by a specific grant issued by the European Society for Paediatric Research. Future potential development of LUS in neonatology might be linked to its quantitative evaluation: we also discuss available data and research directions using computer-aided diagnostic techniques. Finally, tools and opportunities to teach LUS and expand the research network are briefly presented.
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Rodriguez Lima DR, Yepes AF, Birchenall Jiménez CI, Mercado Díaz MA, Pinilla Rojas DI. Real-time ultrasound-guided thoracentesis in the intensive care unit: prevalence of mechanical complications. Ultrasound J 2020; 12:25. [PMID: 32337606 PMCID: PMC7184066 DOI: 10.1186/s13089-020-00172-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background The use of thoracic ultrasound during thoracentesis reduces complications. The aim of this study was to determine the prevalence of complications for real-time ultrasound-guided thoracentesis performed by intensivists. As a secondary objective, the change in oxygenation before and after the procedure was evaluated. Patients and methods An observational prospective study was conducted. A total of 81 cases of real-time ultrasound-guided thoracentesis performed by intensivists in the intensive care unit (ICU) of Méderi Major University Hospital, Bogotá, Colombia, between August 2018 and August 2019 were analyzed. Thoracentesis performed by interventional radiologists and using techniques different from the focus of this study were excluded from the analysis. Results There was one pneumothorax, for a prevalence rate of mechanical complications in this population of 1.2%. The mean partial oxygen pressure to inspired oxygen fraction ratio (PaO2/FiO2) prior to the procedure was 198.1 (95% CI 184.75–211.45), with a PaO2/FiO2 after the procedure of 224.6 (95% CI 213.08–226.12) (p < 0.05). Conclusions Real-time ultrasound-guided thoracentesis performed by intensivists is a safe procedure and leads to a significant improvement in oxygenation rates. Future studies are required to determine the impact of these results on other outcomes, such as mortality, ICU stay, and days of mechanical ventilation.
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Affiliation(s)
- David Rene Rodriguez Lima
- Emergency Medicine and Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia.
| | - Andrés Felipe Yepes
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
| | | | - Mario Andrés Mercado Díaz
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
| | - Darío Isaías Pinilla Rojas
- Critical and Intensive Care Medicine, Hospital Universitario Mayor Méderi-Universidad del Rosario, Bogotá, Colombia
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Vetrugno L, Dogareschi T, Sassanelli R, Orso D, Seremet L, Mattuzzi L, Scapol S, Spasiano A, Cagnacci A, Bove T. Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia. Ultrasound J 2020; 12:10. [PMID: 32140875 PMCID: PMC7058737 DOI: 10.1186/s13089-020-00158-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Pregnancy-induced changes in cardiovascular status make women more susceptible to pulmonary edema. During cesarean section, to counterbalance the effect of hypotension caused by spinal anesthesia, anesthesiologists must choose between two fundamental approaches to maintain the hemodynamic state—intravenous fluids or vasopressors—and this choice will depend upon their particular opinions and experience. We aim to assess for any correlations between thoracic ultrasound A- and B-line artifacts, brain natriuretic peptide (BNP) levels, and the amount of intraoperative fluids administered. Results From December 2016 to August 2018, at the University-Hospital of Udine, we enrolled 80 consecutive pregnant women undergoing cesarean section. We observed a statistically significant difference in the volume of fluids administered in the first 24 h (p = 0.035) between the patients presenting B-lines in at least one basal area of their thoracic ultrasound and patients with no evident B-lines (AUC 66.4%; IC 0.49–0.83). Dividing the population on whether their BNP levels were higher or less than 20 pg/mL, no statistically significant difference was revealed with regard to fluids administered in the first 24 h (p = 0.537). Conclusions Thoracic ultrasound is a non-invasive and easy-to-use tool for detecting fluid intolerance in pregnant women undergoing cesarean section. BNP levels were slow to rise following the cesarean section and did not show any clear correlation with fluid volumes administered.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy. .,University-Hospital of S. M. Misericordia, Udine, Italy, 33100, P.le S. Maria della Misericordia n 15, Udine, Italy.
| | - Teresa Dogareschi
- University-Hospital of S. M. Misericordia, Udine, Italy, 33100, P.le S. Maria della Misericordia n 15, Udine, Italy
| | - Rossella Sassanelli
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Ludmilla Seremet
- Hospital S. Vito al Tagliamento, Pordenone, Italy, Via della Vecchia Ceramica 1, 33170, Pordenone, Italy
| | - Lisa Mattuzzi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Sara Scapol
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Alessandra Spasiano
- University-Hospital of S. M. Misericordia, Udine, Italy, 33100, P.le S. Maria della Misericordia n 15, Udine, Italy
| | - Angelo Cagnacci
- Gynecologic and Obstetric, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy.,University-Hospital of S. M. Misericordia, Udine, Italy, 33100, P.le S. Maria della Misericordia n 15, Udine, Italy
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Vetrugno L, Guadagnin GM, Barbariol F, D'Incà S, Delrio S, Orso D, Girometti R, Volpicelli G, Bove T. Assessment of Pleural Effusion and Small Pleural Drain Insertion by Resident Doctors in an Intensive Care Unit: An Observational Study. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2019; 13:1179548419871527. [PMID: 31516312 PMCID: PMC6724497 DOI: 10.1177/1179548419871527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022]
Abstract
Small-bore pleural drainage device insertion has become a first-line therapy for the treatment of pleural effusions (PLEFF) in the intensive care unit; however, no data are available regarding the performance of resident doctors in the execution of this procedure. Our aim was to assess the prevalence of complications related to ultrasound-guided percutaneous small-bore pleural drain insertion by resident doctors. In this single-center observational study, the primary outcome was the occurrence of complications. Secondary outcomes studied were as follows: estimation of PLEFF size by ultrasound and postprocedure changes in PaO2/FiO2 ratio. In all, 87 pleural drains were inserted in 88 attempts. Of these, 16 were positioned by the senior intensivist following a failed attempt by the resident, giving a total of 71 successful placements performed by residents. In 13 cases (14.8%), difficulties were encountered in advancing the catheter over the guidewire. In 16 cases (18.4%), the drain was positioned by a senior intensivist after a failed attempt by a resident. In 8 cases (9.2%), the final chest X-ray revealed a kink in the catheter. A pneumothorax was identified in 21.8% of cases with a mean size (±SD) of just 10 mm (±6; maximum size: 20 mm). The mean size of PLEFF was 57.4 mm (±19.9), corresponding to 1148 mL (±430) according to Balik’s formula. Ultrasound-guided placement of a small-bore pleural drain by resident doctors is a safe procedure, although it is associated with a rather high incidence of irrelevant pneumothoraces.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni M Guadagnin
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Anesthesiology and Intensive Care 1, Department of Anesthesia and Intensive Care Medicine, University Hospital of Udine, Udine, Italy
| | - Stefano D'Incà
- Anesthesiology and Intensive Care, A.A.S. n. 3 Alto Friuli-Collinare-Medio Friuli, Sant'Antonio Abate Hospital, Tolmezzo, Italy
| | - Silvia Delrio
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Daniele Orso
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
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Abstract
PURPOSE OF REVIEW Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present. RECENT FINDINGS AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives. The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.
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Heraganahally S, Mehra S, Veitch D, Sajkov D, Falhammar H, Morton S. New cost-effective pleural procedure training: manikin-based model to increase the confidence and competency in trainee medical officers. Postgrad Med J 2019; 95:245-250. [PMID: 30992415 DOI: 10.1136/postgradmedj-2018-136380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/21/2019] [Accepted: 03/16/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY Pleural diseases are common in clinical practice. Doctors in training often encounter these patients and are expected to perform diagnostic and therapeutic pleural procedures with confidence and safely. However, pleural procedures can be associated with significant complications, especially when performed by less experienced. Structured training such as use of training manikin and procedural skills workshop may help trainee doctors to achieve competence. However, high costs involved in acquiring simulation technology or attending a workshop may be a hurdle. We hereby describe a training model using a simple manikin developed in our institution and provide an effective way to document skill acquisition and assessment among trainee medical officers. STUDY DESIGN This was a prospective observational study. The need for training, competence and confidence of trainees in performing pleural procedures was assessed through an online survey. Trainees underwent structured simulation training through a simple manikin developed at our institute. Follow-up survey after the training was then performed to access confidence and competence in performing pleural procedures. RESULTS Forty-seven trainees responded to an online survey and 91% of those expressed that they would like further training in pleural procedure skills. 81% and 85% of responders, respectively, indicated preferred method of training is either practising on manikin or performing the procedure under supervision. Follow-up survey showed improvement in the confidence and competence. CONCLUSION Our pleural procedure training manikin model is a reliable, novel and cost-effective method for acquiring competences in pleural procedures.
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Affiliation(s)
- Subash Heraganahally
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia .,Respiratory and Sleep Medicine, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Sumit Mehra
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Daisy Veitch
- SHARP Dummies Pty Ltd, Adelaide, South Australia, Australia.,Industrial Design Engineering, Delft University of Technology, TU Delft, The Netherlands
| | - Dimitar Sajkov
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Medicine, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Sharon Morton
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
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Vetrugno L, Bignami E, Orso D, Vargas M, Guadagnin GM, Saglietti F, Servillo G, Volpicelli G, Navalesi P, Bove T. Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis. J Crit Care 2019; 52:22-32. [PMID: 30951925 DOI: 10.1016/j.jcrc.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The effects on the respiratory or hemodynamic function of drainage of pleural effusion on critically ill patients are not completely understood. First outcome was to evaluate the PiO2/FiO2 (P/F) ratio before and after pleural drainage. SECONDARY OUTCOMES evaluation of A-a gradient, End-Expiratory lung volume (EELV), heart rate (HR), mean arterial pressure (mAP), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and E/A waves ratio (E/A). A tertiary outcome: evaluation of pneumothorax and hemothorax complications. MATERIALS AND METHODS Searches were performed on MEDLINE, EMBASE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases from inception to June 2018 (PROSPERO CRD42018105794). RESULTS We included 31 studies (2265 patients). Pleural drainage improved the P/F ratio (SMD: -0.668; CI: -0.947-0.389; p < .001), EELV (SMD: -0.615; CI: -1.102-0.219; p = .013), but not A-a gradient (SMD: 0.218; CI: -0.273-0.710; p = .384). HR, mAP, LVEDV, SV, CO, E/A and EF were not affected. The risks of pneumothorax (proportion: 0.008; CI: 0.002-0.014; p = .138) and hemothorax (proportion: 0.006; CI: 0.001-0.011; p = .962) were negligible. CONCLUSIONS Pleural effusion drainage improves oxygenation of critically ill patients. It is a safe procedure. Further studies are needed to assess the hemodynamic effects of pleural drainage.
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Affiliation(s)
- Luigi Vetrugno
- Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy.
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Daniele Orso
- Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giovanni M Guadagnin
- Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Francesco Saglietti
- University of Milan-Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Tiziana Bove
- Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
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Gustavsen PH, Nielsen DG, Paltved C, Konge L, Nayahangan LJ. A national needs assessment study to determine procedures for simulation-based training in cardiology in Denmark. SCAND CARDIOVASC J 2019; 53:35-41. [PMID: 30649966 DOI: 10.1080/14017431.2019.1569716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES New training methods such as simulation have been introduced in cardiology as in other specialties; however, the development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The objective of this study was to perform a nationwide general needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum for cardiology residency in Denmark. DESIGN We completed a needs assessment using the Delphi method among key opinion leaders in cardiology. Brainstorming in round 1 identified technical procedures that future cardiologists should learn. Round 2 was a survey to examine frequency of procedure, number of cardiologists performing the procedure, operator-related risk and/or discomfort for patients and feasibility for simulation. Round 3 was final elimination and prioritization of procedures. RESULTS Ninety-four key opinion leaders were included, and the response rates were 77% (round 1), 62% (Round 2), and 68% (Round 3). Twenty-four technical procedures were identified in Round 1 and pre-prioritized in Round 2. In round 3, 13 procedures were included in the final prioritized list. The five highly prioritized procedures eligible for simulation-based training were advanced life support, pleurocentesis, transesophageal echocardiography, coronary angiography, and pericardiocentesis. CONCLUSION The general needs assessment following the Delphi process identified and prioritized 13 technical procedures in cardiology that should be integrated in a simulation-based curriculum. The final list provides educators a guide when developing simulation-based training programmes for cardiology residents.
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Affiliation(s)
- Pia Helene Gustavsen
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark, Copenhagen , Denmark.,b Department of Cardiology, Herlev Gentofte Hospital , Copenhagen University Hospital , Copenhagen , Denmark
| | | | - Charlotte Paltved
- d MidtSim - Centre for Human Resources , Central Region of Denmark and Aarhus University , Aarhus , Denmark
| | - Lars Konge
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark, Copenhagen , Denmark.,e Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Leizl Joy Nayahangan
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark, Copenhagen , Denmark
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Rasmussen KMB, Hertz P, Laursen CB, Arshad A, Saghir Z, Clementsen PF, Konge L. Ensuring Basic Competence in Thoracentesis. Respiration 2019; 97:463-471. [PMID: 30625480 DOI: 10.1159/000495686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trocar pigtail catheter thoracentesis (TPCT) is a common procedure often performed by junior physicians. Simulation-based training may effectively train physicians in the procedure prior to performing it on patients. An assessment tool with solid validity evidence is necessary to ensure sufficient procedural competence. OBJECTIVES Our study objectives were (1) to collect evidence of validity for a newly developed pigtail catheter assessment tool (Thoracentesis Assessment Tool [ThorAT]) developed for the evaluation of TPCT performance and (2) to establish a pass/fail score for summative assessment. METHODS We assessed the validity evidence for the ThorAT using the recommended framework for validity by Messick. Thirty-four participants completed two consecutive procedures and their performance was assessed by two blinded, independent raters using the ThorAT. We compared performance scores to test whether the assessment tool was able to discern between the two groups, and a pass/fail score was established. RESULTS The assessment tool was able to discriminate between the two groups in terms of competence level. Experienced physicians received significantly higher test scores than novices in both the first and second procedure. A pass/fail score of 25.2 points was established, resulting in 4 (17%) passing novices and 1 (9%) failing experienced participant in the first procedure. In the second procedure 9 (39%) novices passed and 2 (18%) experienced participants failed. CONCLUSIONS This study provides a tool for summative assessment of competence in TPCT. Strong validity evidence was gathered from five sources of evidence. A simulation-based training program using the ThorAT could ensure competence before performing thoracentesis on patients.
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Affiliation(s)
| | - Peter Hertz
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Christian B Laursen
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Arman Arshad
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Zaigham Saghir
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
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13
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Evison M, Blyth KG, Bhatnagar R, Corcoran J, Saba T, Duncan T, Hallifax R, Ahmed L, West A, Pepperell JCT, Roberts M, Sivasothy P, Psallidas I, Clive AO, Latham J, Stanton AE, Maskell N, Rahman N. Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians. BMJ Open Respir Res 2018; 5:e000307. [PMID: 30116537 PMCID: PMC6089266 DOI: 10.1136/bmjresp-2018-000307] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/30/2022] Open
Abstract
Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this has been tempered by the resulting loss of procedural experience in general medical teams tasked with managing acute pleural disease. This review aims to define a framework though which a minimum standard of care might be implemented. This review has been written by pleural clinicians from across the UK representing all types of secondary care hospital. Its content has been formed on the basis of literature review, national guidelines, National Health Service England policy and consensus opinion following a round table discussion. Recommendations have been provided in the broad themes of procedural training, out-of-hours management and pleural service specification. Procedural competences have been defined into descriptive categories: emergency, basic, intermediate and advanced. Provision of emergency level operators at all times in all trusts is the cornerstone of out-of-hours recommendations, alongside readily available escalation pathways. A proposal for minimum standards to ensure the safe delivery of pleural medicine have been described with the aim of driving local conversations and providing a framework for service development, review and risk assessment.
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Affiliation(s)
- Matthew Evison
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth Hospital, Glasgow, UK.,Institute of Infection, Immunity of Inflammation, University of Glasgow, Glasgow, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Corcoran
- Interventional Pulmonology Service, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Tarek Saba
- Respiratory Medicine, Blackpool Victoria Hospital, Blackpool, UK
| | - Tracy Duncan
- Pleural Service, North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
| | - Liju Ahmed
- Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK.,Respiratory Medicine, Kings College School of Medicine, London, UK
| | - Alex West
- Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK
| | | | - Mark Roberts
- Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
| | - Amelia O Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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14
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Vetrugno L, Guadagnin GM, Orso D, Boero E, Bignami E, Bove T. An easier and safe affair, pleural drainage with ultrasound in critical patient: a technical note. Crit Ultrasound J 2018; 10:18. [PMID: 30066098 PMCID: PMC6068051 DOI: 10.1186/s13089-018-0098-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/25/2018] [Indexed: 01/02/2023] Open
Abstract
Thoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultrasound, paying particular attention to indications, contraindications, ultrasound guidance, preparation/equipment, procedure and complications.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
| | - Giovanni Maria Guadagnin
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy.
| | - Daniele Orso
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
| | - Enrico Boero
- Anesthesiology and Intensive Care, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tiziana Bove
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
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15
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Nayahangan LJ, Nielsen KR, Albrecht-Beste E, Bachmann Nielsen M, Paltved C, Lindorff-Larsen KG, Nielsen BU, Konge L. Determining procedures for simulation-based training in radiology: a nationwide needs assessment. Eur Radiol 2018; 28:2319-2327. [PMID: 29318426 DOI: 10.1007/s00330-017-5244-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/03/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum. METHODS A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures. RESULTS Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound. CONCLUSION A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs. KEY POINTS • Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.
| | - Kristina Rue Nielsen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Paltved
- MidtSim - Centre for Human Resources, Central Region of Denmark and Aarhus University, Aarhus, Denmark
| | | | - Bjørn Ulrik Nielsen
- Sim-C - the Simulation Centre of Odense University Hospital, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Brogi E, Gargani L, Bignami E, Barbariol F, Marra A, Forfori F, Vetrugno L. Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:325. [PMID: 29282107 PMCID: PMC5745967 DOI: 10.1186/s13054-017-1897-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Pleural effusion (PLEFF), mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. Thoracic ultrasound (TUS) helps clinicians not only to visualize pleural effusion, but also to distinguish between the different types. Furthermore, TUS is essential during thoracentesis and chest tube drainage as it increases safety and decreases life-threatening complications. It is crucial not only during needle or tube drainage insertion, but also to monitor the volume of the drained PLEFF. Moreover, TUS can help diagnose co-existing lung diseases, often with a higher specificity and sensitivity than chest radiography and without the need for X-ray exposure. We review data regarding the diagnosis and management of pleural effusion, paying particular attention to the impact of ultrasound. Technical data concerning thoracentesis and chest tube drainage are also provided.
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Affiliation(s)
- E Brogi
- Department of Anaesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - E Bignami
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Barbariol
- Department of Medicine, University of Udine, Udine, Italy
| | - A Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - F Forfori
- Department of Anaesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Vetrugno
- Department of Medicine, University of Udine, Udine, Italy
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17
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Williamson JP, Grainge C, Parameswaran A, Twaddell SH. Thoracic Ultrasound: What Non-radiologists Need to Know. CURRENT PULMONOLOGY REPORTS 2017; 6:39-47. [PMID: 28435782 PMCID: PMC5381550 DOI: 10.1007/s13665-017-0164-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of review The aim of this review is to provide the theoretical and practical
knowledge essential for non-radiologists to develop the skills necessary to apply
thoracic ultrasound as an extension of clinical assessment and
intervention. Recent findings Issues relating to training and competence are discussed and a
library of thoracic ultrasound videos is provided to illustrate artefacts,
pleural, parenchymal and pneumothorax pathology as well as important pitfalls to
consider. Novel and future diagnostic applications of thoracic ultrasound in the
setting of acute cardiorespiratory pathology including consolidation, acute
interstitial syndromes and pulmonary embolism are explored. Summary Thoracic ultrasound requires an understanding of imaging artefact
specific to lung and pleura and a working knowledge of machine knobology for image
optimisation and interpretation. Ultrasound is a valuable tool for the practicing
chest clinician providing diagnostic information for the assessment of pleural and
parenchymal disease and increased safety and cost effectiveness of thoracic
interventions. Electronic supplementary material The online version of this article (doi:10.1007/s13665-017-0164-1) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Jonathan P Williamson
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia.,Respiratory, Sleep and Environmental Health Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | - Chris Grainge
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW Australia
| | - Ahilan Parameswaran
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - Scott H Twaddell
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW Australia
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