1
|
Ahmed RM, Moussa BS, Ali MA, Abo El Sood AISA, Labban GME. Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital. BMC Emerg Med 2024; 24:119. [PMID: 39014307 PMCID: PMC11251130 DOI: 10.1186/s12873-024-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. AIMOF THIS STUDY The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. PATIENTS & METHODS The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure < 90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate > 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). RESULTS Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value < 0.05) and DIVC Max (on arrival) (after 1 h) (p-value < 0.001). There is no statistically significant difference (p-value = 0.075) between repleted and non-repleted cases regarding DIVC Max (after 24 h).In our study, we found that IVCci0 at a cut-off point > 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 - 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 - 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). CONCLUSION Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.
Collapse
|
2
|
Sabogal RC. Exploring the Applicability of Pre-Anesthetic Cardiac POCUS in Unexpected Conditions: Could it be Helpful? POCUS JOURNAL 2023; 8:237-242. [PMID: 38099178 PMCID: PMC10721308 DOI: 10.24908/pocus.v8i2.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Formal preoperative echocardiography has traditionally been recommended when there is substantial cardiovascular disease without recent follow up, unexplained dyspnea, a functional class less than 4 METS or a Duke Activity Status Index less than 34. However, it is important to note that certain patients may present with a variety of cardiac abnormalities due to their preexisting condition or multiple treatments, and these individuals warrant consideration. The objective of pre-anesthetic cardiac POCUS is to provide clinical information in a timely manner. Although it does not aim to replace conventional echocardiography, cardiac POCUS can undoubtedly assist anesthesia practitioners in identifying asymptomatic and potentially hazardous conditions, allowing for more accurate risk allocation and individualized patient care.
Collapse
Affiliation(s)
- Rodolfo C Sabogal
- Department of Anesthesiology and Critical Care, Universidad de Cartagena, Universidad de AntioquiaCartagenaColombia
| |
Collapse
|
3
|
Komanek T, Rabis M, Omer S, Peters J, Frey UH. Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients. BMC Anesthesiol 2023; 23:65. [PMID: 36855077 PMCID: PMC9972694 DOI: 10.1186/s12871-023-02025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Echocardiographic quantification of ejection fraction (EF) by manual endocardial tracing requires training, is time-consuming and potentially user-dependent, whereas determination of cardiac output by pulmonary artery catheterization (PAC) is invasive and carries a risk of complications. Recently, a novel software for semi-automated EF and CO assessment (AutoEF) using transthoracic echocardiography (TTE) has been introduced. We hypothesized that AutoEF would provide EF values different from those obtained by the modified Simpson's method in transoesophageal echocardiography (TOE) and that AutoEF CO measurements would not agree with those obtained via VTILVOT in TOE and by thermodilution using PAC. METHODS In 167 patients undergoing coronary artery bypass graft surgery (CABG), TTE cine loops of apical 4- and 2-chamber views were recorded after anaesthesia induction under steady-state conditions. Subsequently, TOE was performed following a standardized protocol, and CO was determined by thermodilution. EF and CO were assessed by TTE AutoEF as well as TOE, using the modified Simpson's method, and Doppler measurements via velocity time integral in the LV outflow tract (VTILVOT). We determined Pearson's correlation coefficients r and carried out Bland-Altman analyses. The primary endpoints were differences in EF and CO. The secondary endpoints were differences in left ventricular volumes at end diastole (LVEDV) and end systole (LVESV). RESULTS AutoEF and the modified Simpson's method in TOE showed moderate EF correlation (r = 0.38, p < 0.01) with a bias of -12.6% (95% limits of agreement (95%LOA): -36.6 - 11.3%). AutoEF CO correlated poorly both with VTILVOT in TOE (r = 0.19, p < 0.01) and thermodilution (r = 0.28, p < 0.01). The CO bias between AutoEF and VTILVOT was 1.33 l min-1 (95%LOA: -1.72 - 4.38 l min-1) and 1.39 l min-1 (95%LOA -1.34 - 4.12 l min-1) between AutoEF and thermodilution, respectively. AutoEF yielded both significantly lower EF (EFAutoEF: 42.0% (IQR 29.0 - 55.0%) vs. EFTOE Simpson: 55.2% (IQR 40.1 - 70.3%), p < 0.01) and CO values than the reference methods (COAutoEF biplane: 2.30 l min-1 (IQR 1.30 - 3.30 l min-1) vs. COVTI LVOT: 3.64 l min-1 (IQR 2.05 - 5.23 l min-1) and COPAC: 3.90 l min-1 (IQR 2.30 - 5.50 l min-1), p < 0.01)). CONCLUSIONS AutoEF correlated moderately with TOE EF determined by the modified Simpson's method but poorly both with VTILVOT and thermodilution CO. A systematic bias was detected overestimating LV volumes and underestimating both EF and CO compared to the reference methods. TRIAL REGISTRATION German Register for Clinical Trials (DRKS-ID DRKS00010666, date of registration: 08/07/2016).
Collapse
Affiliation(s)
- Thomas Komanek
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Marco Rabis
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Saed Omer
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Jürgen Peters
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Ulrich H Frey
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany. .,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany.
| |
Collapse
|
4
|
Allocca M, Kucharzik T, Rubin DT. Intestinal Ultrasound in the Assessment and Management of Inflammatory Bowel Disease: Is It Ready for Standard Practice? Gastroenterology 2023; 164:851-855. [PMID: 36708790 DOI: 10.1053/j.gastro.2023.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 01/30/2023]
Affiliation(s)
- Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
| |
Collapse
|
5
|
Douflé G, Urner M, Dragoi L, Jain A, Brydges R, Piquette D. Evaluation of an advanced critical care echocardiography program: a mixed methods study. Can J Anaesth 2022; 69:1260-1271. [PMID: 35819631 DOI: 10.1007/s12630-022-02281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Limited data exist on advanced critical care echocardiography (CCE) training programs for intensivists. We sought to describe a longitudinal echocardiography program and investigate the effect of distributed conditional supervision vs predefined en-bloc supervision, as well as the effect of an optional echocardiography laboratory rotation, on learners' engagement. METHODS In this mixed methods study, we enrolled critical care fellows and faculty from five University of Toronto-affiliated intensive care units (ICU) between July 2015 and July 2018 in an advanced training program, comprising theoretical lectures and practical sessions. After the first year, the program was modified with changes to supervision model and inclusion of a rotation in the echo laboratory. We conducted semistructured interviews and investigated the effects of curricular changes on progress toward portfolio completion (150 transthoracic echocardiograms) using a Bayesian framework. RESULTS Sixty-five learners were enrolled and 18 were interviewed. Four (9%) learners completed the portfolio. Learners reported lack of time and supervision, and skill complexity as the main barriers to practicing independently. Conditional supervision was associated with a higher rate of submitting unsupervised echocardiograms than unconditional supervision (rate ratio, 1.11, 95% credible interval, 1.08 to 1.14). After rotation in the echocardiography laboratory, submission of unsupervised echocardiograms decreased. CONCLUSION Trainees perceived lack of time and limited access to supervision as major barriers to course completion. Nevertheless, successful portfolio completion was related to factors other than protected time in the echocardiography laboratory or unconditional direct supervision in ICU. Further research is needed to better understand the factors promoting success of CCE training programs.
Collapse
Affiliation(s)
- Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Martin Urner
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Aditi Jain
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- The Wilson Centre for Research in Healthcare Education, University of Toronto, Toronto, ON, Canada
| | - Dominique Piquette
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre for Research in Healthcare Education, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
6
|
Zisblatt L, Byrne M, Chen F, Caldwell M. Graduate Medical Education Can Be an Impetus for Behavior Changes in Physicians in Practice: Point-Of-Care Ultrasound Faculty Development Intervention in Anesthesiology. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:90-96. [PMID: 35180744 DOI: 10.1097/ceh.0000000000000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION While there is growing evidence to suggest that point-of-care ultrasound (POCUS) may aid in clinical decision-making in the perioperative setting and there are new requirements that anesthesiology residents must be trained in POCUS, few practicing anesthesiologists use POCUS in their practice. The goal of this investigation is to determine whether a multifaceted faculty development program helps a group of faculty members incorporate POCUS into their practice. METHODS This intervention had five parts: (1) online prework, (2) 2-day workshop, (3) follow-up hands-on sessions, (4) regular communication, and (5) equipment acquisition. This is a pretest/posttest, single group, observational study where the main outcome measure is the number of POCUS examinations documented and the number of providers who performed at least one examination. In addition, presurveys and postsurveys were administered to determine whether there was a change in confidence and self-reported use of POCUS. RESULTS The number of examinations completed and the number of providers completing examinations by month both seemed to increase over time between May 2017 and October 2018. Between August 2017 and October 2018, the number of examinations completed per month increased by a rate of approximately one examination per month (starting with one examination in May 2017) and the number of providers completing examinations increased by a rate of approximately 0.61 providers per month (staring with one provider in May 2017). DISCUSSION This study shows that an intervention that targets interested faculty can increase the use of POCUS in practice and residents' perceptions of teaching.
Collapse
Affiliation(s)
- Lara Zisblatt
- Dr. Zisblatt: Education Specialist, Department of Anesthesiology at University of Michigan Health System, Ann Arbor, MI. Dr. Byrne: Assistant Professor, Department of Anesthesiology at University of Michigan Health System, Ann Arbor, MI. Dr. Chen: Assistant Professor, Medical Education, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Caldwell: Assistant Professor, Department of Anesthesiology at University of Michigan Health System, Ann Arbor, MI
| | | | | | | |
Collapse
|
7
|
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]
|
8
|
Smith B, Dennis A, Davies K, Cramp P, Gregory K, Sturgess D. The use of transthoracic echocardiography in caesarean section surgical patients in the intensive care unit: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2021; 62:155-159. [PMID: 34370303 DOI: 10.1111/ajo.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
Data regarding transthoracic echocardiography (TTE) application to obstetric patients are scant. Often, anaesthetists preparing for caesarean section are unaware of the proportion of obstetric patients who have relevant cardiac disease. This audit aimed at undertaking a retrospective analysis of TTE performed in intensive care unit patients after caesarean section. Over five years, 56 women were eligible. Echocardiographic abnormalities were deemed relevant if graded as of moderate severity. The most common reason was dyspnoea (41%). Echocardiography demonstrated structural abnormality in 29% or functional abnormality in 38%. It may be appropriate to undertake preoperative echocardiography more commonly in high-risk obstetric patients.
Collapse
Affiliation(s)
- Bradley Smith
- Mater Hospital Brisbane, South Brisbane, Qld, Australia
| | - Alicia Dennis
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Kathy Davies
- Mater Hospital Brisbane, South Brisbane, Qld, Australia
| | - Peter Cramp
- Mater Hospital Brisbane, South Brisbane, Qld, Australia
| | - Kye Gregory
- Mater Research Institute, University of Queensland, St Lucia, Queensland, Australia
| | - David Sturgess
- Mater Research Institute, University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
9
|
Horvath B, Diab R, Prielipp RC, Kloesel B. Transthoracic utilization of the transesophageal echocardiography probe-a novel window to non-invasive hemodynamic monitoring for the pediatric anesthesiologist. Can J Anaesth 2021; 68:1090-1092. [PMID: 33751458 DOI: 10.1007/s12630-021-01976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Balazs Horvath
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
| | - Rami Diab
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Richard C Prielipp
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Kloesel
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
10
|
van Dyk S, Khaw P, Lin MY, Chang D, Bernshaw D. Ultrasound-guided Brachytherapy for Cervix Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e403-e411. [PMID: 33715936 DOI: 10.1016/j.clon.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.
Collapse
Affiliation(s)
- S van Dyk
- Radiation Therapy Services, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - P Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - M-Y Lin
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - D Chang
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - D Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| |
Collapse
|
11
|
Navas-Blanco JR, Louro J, Reynolds J, Epstein RH, Dudaryk R. Intraoperative Focused Cardiac Ultrasound for Assessment of Hypotension: A Systematic Review. Anesth Analg 2020; 133:852-859. [PMID: 33346986 DOI: 10.1213/ane.0000000000005336] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Focused cardiac ultrasound (FoCUS) has become a valuable tool to assess unexplained hypotension in critically ill patients. Due to increasing availability of transthoracic echocardiography (TTE) equipment in the operating room, there is a widespread interest in its usefulness for intraoperative diagnosis of hypotension as an alternative to transesophageal echocardiography (TEE). The objective of this systematic review is to evaluate the utility of intraoperative FoCUS to assess patients experiencing unexplained hypotension while undergoing noncardiac surgery. We performed a systematic literature search of multiple publication databases for studies that evaluated the utility of intraoperative FoCUS for assessment and management of unexplained hypotension in patients undergoing noncardiac surgery, including retro- and prospective clinical studies. A summary of the study findings, study quality, and assessment of level of evidence is presented. We identified 2227 unique articles from the literature search, of which 27 were potentially relevant, and 9 were included in this review. The number of patients pooled from these studies was 255, of whom 228 had intraoperative diagnoses with the aid of intraoperative FoCUS. The level of evidence of all studies included was very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. This systematic review has demonstrated that FoCUS may be a useful, noninvasive method to differentiate causes of intraoperative hypotension and guide correcting interventions, although the quality of evidence is very low. Further prospective high-quality studies are needed to investigate whether intraoperative FoCUS has a diagnostic utility that is associated with improved outcomes.
Collapse
Affiliation(s)
- Jose R Navas-Blanco
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Jack Louro
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - John Reynolds
- Department of Health Informatics, The Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida
| | - Richard H Epstein
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Roman Dudaryk
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| |
Collapse
|
12
|
Tuvali O, Sadeh R, Kobal S, Yarza S, Golan Y, Fuchs L. The long-term effect of short point of care ultrasound course on physicians' daily practice. PLoS One 2020; 15:e0242084. [PMID: 33216765 PMCID: PMC7678973 DOI: 10.1371/journal.pone.0242084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background The benefits of Point of Care Ultrasound (POCUS) are well established in the literature. As it is an operator-dependent modality, the operator is required to be skilled in obtaining and interpreting images. Physicians who are not trained in POCUS attend courses to acquire the basics in this field. The effectiveness of such short POCUS courses on daily POCUS utilization is unknown. We sought to measure the change in POCUS utilization after practicing physicians attended short POCUS courses. Methods A 13-statements questionnaire was sent to physicians who attended POCUS courses conducted at the Soroka University Medical Center between the years 2014–2018. Our primary objective was to compare pre-course and post-course POCUS utilization. Secondary objectives included understanding the course graduates’ perceived effect of POCUS on diagnosis, the frequency of ultrasound utilization and time to effective therapy. Results 212 residents and specialists received the questionnaire between 2014–2018; 116 responded (response rate of 54.7%). 72 (62.1%) participants were male, 64 (55.2%) were residents, 49 (42.3%) were specialists, 3 (2.5%) participants did not state their career status. 90 (77.6%) participants declared moderate use or multiple ultrasound use six months to four years from the POCUS course, compared to a rate of ‘no use at all’ and ‘minimal use of 84.9% before the course. 98 participants [84.4% CI 77.8%, 91.0%] agree and strongly agree that a short POCUS course may improve diagnostic skills and 76.7% [CI 69.0%, 84.3%] agree and strongly agree that the POCUS course may shorten time to diagnosis and reduce morbidity. Conclusions Our short POCUS course significantly increases bedside ultrasound utilization by physicians from different fields even 4 years from course completion. Course graduates strongly agreed that incorporating POCUS into their clinical practice improves patient care. Such courses should be offered to residents and senior physicians to close the existing gap in POCUS knowledge among practicing physicians.
Collapse
Affiliation(s)
- Ortal Tuvali
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Re'em Sadeh
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
| | - Sergio Kobal
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Cardiology Department, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shaked Yarza
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Golan
- Internal Medicine F, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Joyce and Irwing Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Emergency Department, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
13
|
Qian X, Wodnicki R, Kang H, Zhang J, Tchelepi H, Zhou Q. Current Ultrasound Technologies and Instrumentation in the Assessment and Monitoring of COVID-19 Positive Patients. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2230-2240. [PMID: 32857693 PMCID: PMC7654715 DOI: 10.1109/tuffc.2020.3020055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/23/2020] [Indexed: 05/04/2023]
Abstract
Since the emergence of the COVID-19 pandemic in December of 2019, clinicians and scientists all over the world have faced overwhelming new challenges that not only threaten their own communities and countries but also the world at large. These challenges have been enormous and debilitating, as the infrastructure of many countries, including developing ones, had little or no resources to deal with the crisis. Even in developed countries, such as Italy, health systems have been so inundated by cases that health care facilities became oversaturated and could not accommodate the unexpected influx of patients to be tested. Initially, resources were focused on testing to identify those who were infected. When it became clear that the virus mainly attacks the lungs by causing parenchymal changes in the form of multifocal pneumonia of different levels of severity, imaging became paramount in the assessment of disease severity, progression, and even response to treatment. As a result, there was a need to establish protocols for imaging of the lungs in these patients. In North America, the focus was on chest X-ray and computed tomography (CT) as these are widely available and accessible at most health facilities. However, in Europe and China, this was not the case, and a cost-effective and relatively fast imaging modality was needed to scan a large number of sick patients promptly. Hence, ultrasound (US) found its way into the hands of Chinese and European physicians and has since become an important imaging modality in those locations. US is a highly versatile, portable, and inexpensive imaging modality that has application across a broad spectrum of conditions and, in this way, is ideally suited to assess the lungs of COVID-19 patients in the intensive care unit (ICU). This bedside test can be done with little to no movement of the patients from the unit that keeps them in their isolated rooms, thereby limiting further exposure to other health personnel. This article presents a basic introduction to COVID-19 and the use of the US for lung imaging. It further provides a high-level overview of the existing US technologies that are driving development in current and potential future US imaging systems for lung, with a specific emphasis on portable and 3-D systems.
Collapse
Affiliation(s)
- Xuejun Qian
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
- NIH Resource Center forMedical Ultrasonic Transducer TechnologyUniversity of Southern CaliforniaLos AngelesCA90089USA
- Keck School of MedicineRoski Eye Institute, University of Southern CaliforniaLos AngelesCA90033USA
| | - Robert Wodnicki
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
- NIH Resource Center forMedical Ultrasonic Transducer TechnologyUniversity of Southern CaliforniaLos AngelesCA90089USA
| | - Haochen Kang
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
- NIH Resource Center forMedical Ultrasonic Transducer TechnologyUniversity of Southern CaliforniaLos AngelesCA90089USA
| | - Junhang Zhang
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
- NIH Resource Center forMedical Ultrasonic Transducer TechnologyUniversity of Southern CaliforniaLos AngelesCA90089USA
| | - Hisham Tchelepi
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA90033USA
| | - Qifa Zhou
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCA90089USA
- NIH Resource Center forMedical Ultrasonic Transducer TechnologyUniversity of Southern CaliforniaLos AngelesCA90089USA
- Keck School of MedicineRoski Eye Institute, University of Southern CaliforniaLos AngelesCA90033USA
| |
Collapse
|
14
|
Ong AML. Utility of gastrointestinal ultrasound in functional gastrointestinal disorders: A narrative review. World J Meta-Anal 2020; 8:109-118. [DOI: 10.13105/wjma.v8.i2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal (GI) ultrasound (GIUS) is valuable in the evaluation of GI diseases such as inflammatory bowel disease, but its use in functional GI disorders (FGIDs) is largely unknown although promising. In order to review the current knowledge on current and potential uses of GIUS in FGIDs, information was obtained via a structured literature search through PubMed, EMBASE and Google Scholar databases with a combination of MESH and keyword search terms: “ultrasound”, “functional GI disorders”, “irritable bowel syndrome”, “functional dyspepsia”, “intestinal ultrasound”, “point of care ultrasonography”, “transabdominal sonography”, “motility”, “faecal loading”, “constipation”. GIUS is currently used for various settings involving upper and lower GI tracts, including excluding organic diseases, evaluating physiology, guiding treatment options and building rapport with patients. GIUS can be potentially used to correlate mechanisms with symptoms, evaluate mechanisms behind treatment efficacy, and investigate further the origin of symptoms in real-time. In conclusion, GIUS is unique in its real-time, interactive and non-invasive nature, with the ability of evaluating several physiological mechanisms with one test, thus making it attractive in the evaluation and management of FGIDs. However, there are still limitations and concerns of operator dependence and lack of validation data for widespread implementation of GIUS in FGIDs.
Collapse
Affiliation(s)
- Andrew Ming-Liang Ong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169856, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| |
Collapse
|
15
|
Critical Care Ultrasound Should Not Be a Priority First-Line Assessment Tool in the Management of Neurocritically Ill Patients. Crit Care Med 2020; 47:837-839. [PMID: 30889021 DOI: 10.1097/ccm.0000000000003736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Khoury M, Fotsing S, Jalali A, Chagnon N, Malherbe S, Youssef N. Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943615. [PMID: 32754649 PMCID: PMC7378712 DOI: 10.1177/2382120520943615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. METHODS Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. RESULTS For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. CONCLUSION The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.
Collapse
Affiliation(s)
- Michel Khoury
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Salomon Fotsing
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Alireza Jalali
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Nicolas Chagnon
- Department of Emergency Medicine,
Montfort Hospital, Ottawa, ON, Canada
| | | | - Nermine Youssef
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| |
Collapse
|
17
|
Miles DA, Levi CS, Uhanova J, Cuvelier S, Hawkins K, Minuk GY. Pocket-Sized Versus Conventional Ultrasound for Detecting Fatty Infiltration of the Liver. Dig Dis Sci 2020; 65:82-85. [PMID: 31376083 DOI: 10.1007/s10620-019-05752-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS The high prevalence of nonalcoholic fatty liver disease (NAFLD) in the general population warrants determining whether pocket-sized ultrasound devices (PoCUS) might serve as point-of-care screening for NAFLD in busy office practices. METHODS One hundred adult subjects undergoing conventional abdominal ultrasound (US) examinations for various indications were screened by PoCUS immediately prior to the conventional US procedure. The PoCUS examination only assessed the presence or absence of excess fat. Assessment of other liver pathology was not performed. Investigators (conventional US: an experienced radiologist and PoCUS: a general internist recently trained in the use of PoCUS) were blinded to the results of the alternative imaging. RESULTS Forty patients (40%) had fatty infiltration of the liver on both conventional US and PoCUS, and 49 (49%) were negative by both modalities. A consensus was reached in two of the 11 remaining subjects with initially discrepant results. The overall sensitivity and specificity of PoCUS relative to conventional US were 91% and 88%, respectively. CONCLUSIONS These findings support the use of PoCUS by a trained physician for point-of-care screening of patients at risk for NAFLD.
Collapse
Affiliation(s)
- D A Miles
- Morberg Family Chair in Hepatology, Section of Hepatology, Department of Medicine, Rady College of Medicine, John Buhler Research Centre, University of Manitoba, 715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada
| | - C S Levi
- Section of Ultrasound, Department of Radiology, Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J Uhanova
- Morberg Family Chair in Hepatology, Section of Hepatology, Department of Medicine, Rady College of Medicine, John Buhler Research Centre, University of Manitoba, 715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada
| | - S Cuvelier
- Morberg Family Chair in Hepatology, Section of Hepatology, Department of Medicine, Rady College of Medicine, John Buhler Research Centre, University of Manitoba, 715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada
| | - K Hawkins
- Morberg Family Chair in Hepatology, Section of Hepatology, Department of Medicine, Rady College of Medicine, John Buhler Research Centre, University of Manitoba, 715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada
| | - G Y Minuk
- Morberg Family Chair in Hepatology, Section of Hepatology, Department of Medicine, Rady College of Medicine, John Buhler Research Centre, University of Manitoba, 715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada. .,Section of Ultrasound, Department of Radiology, Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| |
Collapse
|
18
|
Lenk T, Whittle J, Miller TE, Williams DGA, Bronshteyn YS. Focused cardiac ultrasound in preoperative assessment: the perioperative provider's new stethoscope? Perioper Med (Lond) 2019; 8:16. [PMID: 31832180 PMCID: PMC6873469 DOI: 10.1186/s13741-019-0129-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
Focused cardiac ultrasound (FoCUS)—a simplified, qualitative version of echocardiography—is a well-established tool in the armamentarium of critical care and emergency medicine. This review explores the extent to which FoCUS could also be used to enhance the preoperative physical examination to better utilise resources and identify those who would benefit most from detailed echocardiography prior to surgery. Among the range of pathologies that FoCUS can screen for, the conditions it provides the most utility in the preoperative setting are left ventricular systolic dysfunction (LVSD) and, in certain circumstances, significant aortic stenosis (AS). Thus, FoCUS could help answer two common preoperative diagnostic questions. First, in a patient with high cardiovascular risk who subjectively reports a good functional status, is there evidence of LVSD? Second, does an asymptomatic patient with a systolic murmur have significant aortic stenosis? Importantly, many cardiac pathologies of relevance to perioperative care fall outside the scope of FoCUS, including regional wall motion abnormalities, diastolic dysfunction, left ventricular outflow obstruction, and pulmonary hypertension. Current evidence suggests that after structured training in FoCUS and performance of 20–30 supervised examinations, clinicians can achieve competence in basic cardiac ultrasound image acquisition. However, it is not known precisely how many training exams are necessary to achieve competence in FoCUS image interpretation. Given the short history of FoCUS use in preoperative evaluation, further research is needed to determine what additional questions FoCUS is suited to answer in the pre-operative setting.
Collapse
Affiliation(s)
- Tara Lenk
- 1Department of Anesthesiology, Mission Hospital, 509 Biltmore Ave, Asheville, NC 28801 USA
| | - John Whittle
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| | - Timothy E Miller
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| | - David G A Williams
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| | - Yuriy S Bronshteyn
- 2Division of General, Vascular, and Transplant, Department of Anesthesiology, Duke University, Durham, NC USA
| |
Collapse
|
19
|
Abstract
Ultrasound (US) is an important imaging tool and the most commonly used imaging modality worldwide. Although US requires expertise to be performed at the highest quality levels, basic US exams can be learned by most physicians and medical technologists with knowledge of human anatomy and with physical examination skills. The full potential of US is achieved when it is more than a pure “imaging modality”, but instead an integrated clinical, physical, and imaging assessment in which the examiner interacts directly and personally with the patient. Specific diagnostic US knowledge is strongly encouraged for specialist training in clinical disciplines.
Collapse
|
20
|
Royer DF. Seeing with Sound: How Ultrasound Is Changing the Way We Look at Anatomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1138:47-56. [PMID: 31313257 DOI: 10.1007/978-3-030-14227-8_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ultrasound uses high frequency sound waves and their rebounding echoes to capture live images of the structures beneath the skin. Thanks to recent technological advances, contemporary ultrasound machines offer excellent image resolution packaged in smaller, highly portable devices, which has allowed ultrasound to expand into new areas, both within the hospital as well as across non-traditional settings. Ultrasound is an incredibly powerful visualization tool in medicine, allowing physicians to safely see and interrogate the most relevant parts of their patient's internal anatomy instantly. Point-of-care ultrasound, a focused ultrasound evaluation performed at the patient's bedside, is now common across medical specialties, encompassing a vast array of diagnostic, procedural and screening applications. The impressive expansion of point-of-care ultrasound has resulted in an increased demand for ultrasound training earlier during medical school. As a non-invasive and non-destructive way to see inside the living body, ultrasound is an ideal tool to teach anatomy. It allows both medical and non-medical students the ability to improve their understanding and retention of anatomical form and function. The widespread and still expanding use of ultrasound in healthcare today, as well as its adoption into the anatomy classroom, is a testament to the power of ultrasound for achieving real-time visualization of the hidden aspects of our bodies.
Collapse
Affiliation(s)
- Danielle F Royer
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
21
|
Soeding PF, Steel A, Wong J, Hoy GA. Focused cardiac echocardiography in beach-chair position surgery: A case study. Anaesth Intensive Care 2019; 47:385-388. [PMID: 31299864 DOI: 10.1177/0310057x19863067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The haemodynamic response to the beach-chair position may be affected by the presence of left ventricular hypertrophy where remodelling of cardiac chambers can potentially lead to left ventricular outflow tract obstruction. We present a case report of severe hypotension in the beach-chair position, where focused cardiac ultrasound identified left ventricular hypertrophy and geometric features that contributed to the hypotensive response. This case illustrates that focused cardiac ultrasound has the potential to alert the clinician preoperatively to left ventricular outflow tract obstruction susceptibility during surgery in the beach-chair position, and intraoperatively to direct management should sudden decreases in blood pressure occur.
Collapse
Affiliation(s)
- Paul F Soeding
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
| | - Amelia Steel
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - James Wong
- The University of Melbourne, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Gregory A Hoy
- Melbourne Orthopaedic Group, The Avenue Hospital, Windsor, Australia.,Monash University, Melbourne, Australia
| |
Collapse
|
22
|
Zawadka M, Graczyńska A, Janiszewska A, Ostrowski A, Michałowski M, Rykowski M, Andruszkiewicz P. Lessons Learned from a Study of the Integration of a Point-of-Care Ultrasound Course into the Undergraduate Medical School Curriculum. Med Sci Monit 2019; 25:4104-4109. [PMID: 31154454 PMCID: PMC6561147 DOI: 10.12659/msm.914781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Point-of-care ultrasound (POCUS) diagnosis, performed by a physician at the patient bedside, is routinely used in emergency medicine and critical care. Although training in ultrasonography has become part of the medical school curriculum, POCUS can be challenging for medical students. This study aimed to assess the effectiveness of a one-day POCUS course in a group of final-year medical students by pre-course and post-course assessment of both diagnostic ability and changes in student confidence levels in making a diagnosis. Material/Methods A prospective study recruited 57 final-year medical students who participated in a one-day POCUS course. Improvement in making decisions and levels of confidence were evaluated before and two weeks after the course, using image-based testing and a self- evaluation questionnaire. Results All 57 final-year medical students attended the course and completed the tests and surveys. The pre-training and post-training test scores of medical students improved from 41.78±12% to 58±13%. Student confidence scores in the post-training assessment significantly increased. The post-training confidence scores were significantly increased compared with the pre-training scores regardless of whether or not the questions were answered correctly (p<0.001). The Dunning-Kruger effect, or cognitive bias, might partially explain this phenomenon. Conclusions One day of POCUS training integrated into anesthesia curriculum for final-year medical students improved performance in the post-training test scores and improved their confidence scores. Further studies are needed to evaluate this effect and to develop adequate tools to assess medical students.
Collapse
Affiliation(s)
- Mateusz Zawadka
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Agata Graczyńska
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Anna Janiszewska
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Ostrowski
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Michałowski
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Michał Rykowski
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Andruszkiewicz
- Second Department of Anesthesiology and Intensive Care, Central Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
23
|
Mizubuti GB, Allard RV, Ho AMH, Wang L, Beesley T, Hopman WM, Egan R, Sydor D, Engen D, Saha T, Tanzola RC. [Knowledge retention after focused cardiac ultrasound training: a prospective cohort pilot study]. Rev Bras Anestesiol 2019; 69:177-183. [PMID: 30665672 DOI: 10.1016/j.bjan.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 09/13/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Focused Cardiac Ultrasound (FoCUS) has proven instrumental in guiding anesthesiologists' clinical decision-making process. Training residents to perform and interpret FoCUS is both feasible and effective. However, the degree of knowledge retention after FoCUS training remains a subject of debate. We sought to provide a description of our 4-week FoCUS curriculum, and to assess the knowledge retention among anesthesia residents at 6 months after FoCUS rotation. METHODS A prospective analysis involving eleven senior anesthesia residents was carried out. At end of FoCUS Rotation (EOR) participants completed a questionnaire (evaluating the number of scans completed and residents' self-rated knowledge and comfort level with FoCUS), and a multiple-choice FoCUS exam comprised of written- and video-based questions. Six months later, participants completed a follow-up questionnaire and a similar exam. Self-rated knowledge and exam scores were compared at EOR and after 6 months. Spearman correlations were conducted to test the relationship between number of scans completed and exam scores, perceived knowledge and exam scores, and number of scans and perceived knowledge. RESULTS Mean exam scores (out of 50) were 44.1 at EOR and 43 at the 6-month follow-up. Residents had significantly higher perceived knowledge (out of 10) at EOR (8.0) than at the 6-month follow-up (5.5), p=0.003. At the EOR, all trainees felt comfortable using FoCUS, and at 6 months 10/11 still felt comfortable. All the trainees had used FoCUS in their clinical practice after EOR, and the most cited reason for not using FoCUS more frequently was the lack of perceived clinical need. A strong and statistically significant (rho=0.804, p=0.005) correlation between number of scans completed during the FoCUS rotation and 6-month follow-up perceived knowledge was observed. CONCLUSION Four weeks of intensive FoCUS training results in adequate knowledge acquisition and 6-month knowledge retention.
Collapse
Affiliation(s)
- Glenio B Mizubuti
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Rene V Allard
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Anthony M-H Ho
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Louie Wang
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | | | - Wilma M Hopman
- Queen's University, Kingston Sciences Centre Research Institute and Public Health Sciences, Kingston, Canadá
| | - Rylan Egan
- Queen's University, Healthcare Quality Graduate Programs, Kingston, Canadá
| | - Devin Sydor
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Dale Engen
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Tarit Saha
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Robert C Tanzola
- Queen's University, Kingston General Hospital, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá.
| |
Collapse
|
24
|
Royse C, Canty D, Sessler D. Perioperative ultrasound-assisted clinical evaluation - A case based review. Australas J Ultrasound Med 2018; 21:204-218. [PMID: 34760525 PMCID: PMC8409857 DOI: 10.1002/ajum.12113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Ultrasound is increasingly being adopted into anaesthesia and intensive care practice. The range of ultrasound examination has also increased from transoesophageal echocardiography in cardiac surgery and ultrasound-guided nerve blocks and vascular access, to examination of the heart, lungs, abdomen and deep veins. Typically, the use of ultrasound is focused or basic, designed to be performed by the anaesthetist at the patient's bedside in real time to answer clinical questions and to direct therapy. Ultrasound is not performed in isolation, but used to complement clinical evaluation, and accordingly can be considered as 'ultrasound-assisted perioperative evaluation'. Whilst there is good evidence that ultrasound improves diagnostic accuracy and in turn alters management, there are few data examining whether ultrasound leads to improved clinical outcomes. This review will examine multiple uses of perioperative ultrasound with case studies to illustrate potential utility.
Collapse
Affiliation(s)
- Colin Royse
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
| | - David Canty
- Department of SurgeryLevel 6, Centre for Medical ResearchUniversity of Melbourne300 Grattan StreetParkvilleVictoria3050Australia
- Department of Anaesthesia and Pain ManagementWard 3 NorthRoyal Melbourne Hospital300 Grattan StreetParkvilleVictoria3050Australia
- Department of MedicineMonash UniversityScenic Blvd & Wellington RoadClaytonVictoria3050Australia
- Department of Anaesthesia and Perioperative Medicine3rd FloorMonash Medical Centre246 Clayton RoadMelbourneVictoria3168Australia
| | - Daniel Sessler
- Department of Outcomes ResearchAnesthesiology InstituteCleveland ClinicClevelandOhioUSA
| |
Collapse
|
25
|
Si X, Xu H, Liu Z, Wu J, Cao D, Chen J, Chen M, Liu Y, Guan X. Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis. Anesth Analg 2018; 127:1157-1164. [DOI: 10.1213/ane.0000000000003459] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
26
|
|
27
|
Valencia JA, Romero DJ, Arango E, Cubillos JE, Mantilla HA, García-Herreros LG. Ultrasound-Guided Percutaneous Dilatational Tracheostomies in 2 Difficult Airways. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1043-1048. [PMID: 29027675 DOI: 10.1002/jum.14433] [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: 04/11/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
Ultrasound has become a rapid, safe, and easy-to-use tool for anesthesiologists. It reduces complications, morbidity, and mortality, especially in patients with anatomic abnormalities in whom a traditional approach may be both difficult and risky. We report 2 cases of symptomatic patients with a difficult airway due to displacement of the trachea by a neck mass. Real-time ultrasound imaging was performed for percutaneous dilatational tracheostomies, identifying important structures, without any complications.
Collapse
Affiliation(s)
- José A Valencia
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - David J Romero
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Enrique Arango
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Javier E Cubillos
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo A Mantilla
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luis G García-Herreros
- Department of Surger, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| |
Collapse
|
28
|
McCormick TJ, Miller EC, Chen R, Naik VN. Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists. Can J Anaesth 2018; 65:427-436. [DOI: 10.1007/s12630-018-1049-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/16/2023] Open
|
29
|
Conlin F, Connelly NR, Eaton MP, Broderick PJ, Friderici J, Adler AC. Perioperative Use of Focused Transthoracic Cardiac Ultrasound. Anesth Analg 2017; 125:1878-1882. [DOI: 10.1213/ane.0000000000002089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
30
|
Krause C, Krause R, Krause R, Gomez N, Jafry Z, Dinh VA. Effectiveness of a 1-Hour Extended Focused Assessment With Sonography in Trauma Session in the Medical Student Surgery Clerkship. JOURNAL OF SURGICAL EDUCATION 2017; 74:968-974. [PMID: 28479071 DOI: 10.1016/j.jsurg.2017.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/15/2017] [Accepted: 03/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended focused assessment with sonography in trauma (eFAST) into the year-3 medical student surgical clerkship. DESIGN A prospective cohort study where participants served as self-controls. One hour of instruction in the eFAST examination, along with 3 required observed examinations, was incorporated into the year-3 surgery clerkship. Effectiveness of the training was evaluated by a preliminary and posttraining assessment. An online survey was used assessing comfort based on a 5-point Likert scale. An online quiz was used assessing knowledge, and a 2-part objective structured clinical examination (OSCE) was used assessing skill and speed. Participants also logged 3 eFAST examinations during the 10-week clerkship where they reported their comfort in performing and interpreting the eFAST on a 5-point Likert scale. Postassessment was held during the last week of the clerkship and included the same online quiz, survey, and 2-part OSCE. SETTING The study was performed at Loma Linda University and affiliated hospitals where surgical clerkship students rotate. PARTICIPANTS A total of 148 year-3 medical students completed the study. RESULTS All testing modalities showed improvement. The mean average of the OSCE improved from 46% ± 27% to 81% ± 18%. The percentage of participants able to perform the examination in less than 6 minutes increased from 18% ± 27% to 84% ± 36%. Participants' comfort level in recognizing eFAST pathology increased from a mean of 2.40 ± 0.94 to 3.55 ± 0.87 out of 5. Comfort in performing the eFAST examination improved from 2.81 ± 0.79 to 3.77 ± 0.68. Comfort in interpreting the eFAST examination improved from 2.88 ± 0.87 to 3.65 ± 0.72. CONCLUSIONS This study demonstrates that incorporating 1 hour of eFAST training into the general surgery clerkship is feasible and may lead to improved competency in performing and interpreting the eFAST examination.
Collapse
Affiliation(s)
- Cassandra Krause
- Department of Surgery, Loma Linda University, Loma Linda School of Medicine, Loma Linda, California.
| | - Reed Krause
- Department of Surgery, Loma Linda University, Loma Linda School of Medicine, Loma Linda, California
| | - Raymond Krause
- Department of Surgery, Loma Linda University, Loma Linda School of Medicine, Loma Linda, California
| | - Nephtali Gomez
- Department of Surgery, Loma Linda University, Loma Linda, California
| | - Zan Jafry
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California
| | - Vi Am Dinh
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California; Department of Medicine, Loma Linda University, Loma Linda, California
| |
Collapse
|
31
|
|
32
|
Head to toe ultrasound: Current opinion on its role in hemodynamic instability, hypoxemia, oligoanuria and the patient with altered neurological status☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
33
|
Denault AY, Casas C, Puentes W, Eljaiek R, Iglesias I. Head to toe ultrasound: Current opinion on its role in hemodynamic instability, hypoxemia, oligoanuria and the patient with altered neurological status. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
34
|
Denault AY, Casas C, Puentes W, Eljaiek R, Iglesias I. Ultrasonido de la cabeza a los pies: opinión actual sobre su utilidad en inestabilidad hemodinámica, hipoxemia, oligoanuria y en el paciente con estado neurológico alterado. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
35
|
Mongodi S, Roldi EM, Orlando A, Civardi L, Iotti GA, Mojoli F. A 70-Year-Old Develops Refractory Hypotension in the ICU. Chest 2017; 152:e61-e63. [DOI: 10.1016/j.chest.2017.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/05/2017] [Accepted: 03/16/2017] [Indexed: 11/28/2022] Open
|
36
|
Ultrasonography training and utilization in surgical critical care fellowships: a program director's survey. J Surg Res 2017; 218:292-297. [PMID: 28985864 DOI: 10.1016/j.jss.2017.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intensivist-performed ultrasound (IPUS) is an adjunctive tool used to assist in resuscitation and management of critically ill patients. It allows clinicians real-time information through noninvasive methods. We aimed to evaluate the types of IPUS performed and the methods surgical critical care (SCC) fellows are trained along with challenges in training. METHODS One hundred SCC fellowship directors were successfully sent an email inviting them to participate in a short Web-based survey. We inquired about program characteristics including hospital type, fellowship size, faculty size and training, dedicated surgical critical care beds, and ultrasound equipment availability. The survey contained questions regarding the program directors' perception on importance on cost effectiveness of IPUS, types of IPUS examinations performed, fellows experience with IPUS, challenges to training, and presence and methods of quality assurance (QA) programs. RESULTS A total of 38 (38.0%) program directors completed the survey. Using a 100-point Likert scale, the majority of the respondents indicated that IPUS is important to patient care in the SICU and is cost-effective (mean score 85.5 and 84.6, respectively). Most (34, 89.5%) utilize IPUS and conduct a mean of 5.1 different examination types with FAST being the most prevalent examination (33, 86.8%). Thirty-three (86.8%) programs include IPUS in their SCC training with varying amounts of time spent training. Of these programs, 19 (57.6%) have a specific curriculum. The most frequently used modalities for training fellows were informal bedside teaching (28, 84.8%), hands-on lectures (20, 60.6%) and formal lectures (19, 57.6%). The top three challenges program directors cited for IPUS education was time (23, 69.7%), followed by concerns for ongoing QA (19, 57.6%) and lack of faculty trained in IPUS (18, 53.9%). Only 20 (60.6%) programs review images as a part of QA/quality improvement. CONCLUSIONS Utilization and training of IPUS is common in SCC fellowships. There is varied education type and training time devoted to IPUS which could lead to gaps in knowledge and care. Development of a standard curriculum for SCC fellowships could assist surgical intensivists in achieving a base of knowledge in IPUS to create a more homogenously trained workforce and standards of care.
Collapse
|
37
|
Royer DF, Kessler R, Stowell JR. Evaluation of an innovative hands-on anatomy-centered ultrasound curriculum to supplement graduate gross anatomy education. ANATOMICAL SCIENCES EDUCATION 2017; 10:348-362. [PMID: 27870531 DOI: 10.1002/ase.1670] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/17/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
Ultrasound (US) can enhance anatomy education, yet is incorporated into few non-medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non-medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy-centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre- and post-course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post-course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre-course versus post-course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End-of-semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy-centered ultrasound curriculum significantly increased confidence with and knowledge of US among non-medical anatomy students with limited prior training. Non-medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348-362. © 2016 American Association of Anatomists.
Collapse
Affiliation(s)
- Danielle F Royer
- Department of Cell and Developmental Biology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ross Kessler
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jeffrey R Stowell
- Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, Arizona
| |
Collapse
|
38
|
Rojas-Gómez MF, Blanco-Dávila R, Tobar Roa V, Gómez González AM, Ortiz Zableh AM, Ortiz Azuero A. Regional anesthesia guided by ultrasound in the pudendal nerve territory. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
39
|
Anestesia regional guiada por ultrasonido en territorio del nervio pudendo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
40
|
Regional anesthesia guided by ultrasound in the pudendal nerve territory☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
41
|
Abstract
Ultrasonography is a first-line diagnostic tool when evaluating volume status in the critical care patient population. Ultrasonography leads to a prompt diagnosis and more appropriate management plan, while decreasing health care costs, time to diagnosis, hospital length of stay, time to definitive operation, and mortality. It is recommended that critical care providers treating critically ill patients be skilled and competent in critical care ultrasonography. As the critical care population and the shortage of critical care physicians increases, advanced practice providers are becoming more prevalent in critical care areas and should be competent in this skill as well.
Collapse
|
42
|
Coker BJ, Zimmerman JM. Why Anesthesiologists Must Incorporate Focused Cardiac Ultrasound Into Daily Practice. Anesth Analg 2017; 124:761-765. [DOI: 10.1213/ane.0000000000001854] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
43
|
Yeh L, Montealegre-Gallegos M, Mahmood F, Hess PE, Shnider M, Mitchell JD, Jones SB, Mashari A, Wong V, Matyal R. Assessment of Perioperative Ultrasound Workflow Understanding: A Consensus. J Cardiothorac Vasc Anesth 2017; 31:197-202. [DOI: 10.1053/j.jvca.2016.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 11/11/2022]
|
44
|
Farsoni S, Astolfi L, Bonfe M, Spadaro S, Volta CA. A Versatile Ultrasound Simulation System for Education and Training in High-Fidelity Emergency Scenarios. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2017; 5:1800109. [PMID: 29018630 PMCID: PMC5477762 DOI: 10.1109/jtehm.2016.2635635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/19/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
Point of care ultrasonography and the related focused assessment with sonography for trauma protocol, if performed by experienced physicians, is a highly sensitive examination, and specific for the detection of free fluids. Different systems and methods have been proposed for training, including simulation as one of the most efficient. This paper presents an ultrasound training system, specifically designed to be used during bedside high fidelity simulation scenarios, that could facilitate the learning process. The development of the proposed system exploited novel rapid prototyping electronic boards as a means to obtain good performances with a low cost. Moreover, the design of the data structure permits the construction of a library that caters for individual needs, with the possibility of adding emergency scenarios, collecting pictures or videos, as well as 3-D volumes. The device has been compared with currently commercial ultrasound simulators and its innovative aspects have been highlighted. Finally, it has been tested during a training session in order to evaluate features, such as realism and user-friendliness.
Collapse
Affiliation(s)
| | - Luca Astolfi
- Department of Morphology, Surgery and Experimental MedicineInstitution of Anesthesia and Intensive CareUniversity of Ferrara
| | | | - Savino Spadaro
- Department of Morphology, Surgery and Experimental MedicineInstitution of Anesthesia and Intensive CareUniversity of Ferrara
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental MedicineInstitution of Anesthesia and Intensive CareUniversity of Ferrara
| |
Collapse
|
45
|
Point-of-Care Ultrasound for the Regional Anesthesiologist and Pain Specialist. Reg Anesth Pain Med 2017; 42:281-282. [DOI: 10.1097/aap.0000000000000570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Dietrich CF, Goudie A, Chiorean L, Cui XW, Gilja OH, Dong Y, Abramowicz JS, Vinayak S, Westerway SC, Nolsøe CP, Chou YH, Blaivas M. Point of Care Ultrasound: A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:49-58. [PMID: 27472989 DOI: 10.1016/j.ultrasmedbio.2016.06.021] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, "ultrasound performed at the bedside and interpreted directly by the treating clinician." PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice. However, its use and teaching are different from continent to continent and from country to country. This World Federation for Ultrasound in Medicine and Biology position paper discusses the current status and future perspectives of PoC-US. Particular attention is given to the different uses of PoC-US and its clinical significance, including within emergency and critical care medicine, cardiology, anesthesiology, rheumatology, obstetrics, neonatology, gynecology, gastroenterology and many other applications. In the future, PoC-US will be more diverse than ever and be included in medical student training.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China.
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
| | - Liliana Chiorean
- Département d'imagerie médicale, Clinique des Cévennes 07100 Annonay, France
| | - Xin Wu Cui
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yi Dong
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jacques S Abramowicz
- Section of Ultrasound, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Sudhir Vinayak
- Department of Imaging & Diagnostic Radiology, WFUMB COE, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Christian Pállson Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
| |
Collapse
|
47
|
Kobayashi T, Kato H. Development of Pocket-sized Hand-held Ultrasound Devices Enhancing People's Abilities and Need for Education on Them. J Gen Fam Med 2016. [DOI: 10.14442/jgfm.17.4_276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
48
|
Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nolsøe C, Nürnberg D, Dietrich CF. WFUMB Position Paper. Learning Gastrointestinal Ultrasound: Theory and Practice. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2732-2742. [PMID: 27742140 DOI: 10.1016/j.ultrasmedbio.2016.08.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gastrointestinal ultrasound (GIUS) is an ultrasound application that has been practiced for more than 30 years. Recently, GIUS has enjoyed a resurgence of interest, and there is now strong evidence of its utility and accuracy as a diagnostic tool for multiple indications. The method of learning GIUS is not standardised and may incorporate mentorship, didactic teaching and e-learning. Simulation, using either low- or high-fidelity models, can also play a key role in practicing and honing novice GIUS skills. A course for training as well as establishing and evaluating competency in GIUS is proposed in the manuscript, based on established learning theory practice. We describe the broad utility of GIUS in clinical medicine, including a review of the literature and existing meta-analyses. Further, the manuscript calls for agreement on international standards regarding education, training and indications.
Collapse
Affiliation(s)
- Nathan S S Atkinson
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert V Bryant
- School of Medicine, University of Adelaide, Adelaide, South Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Torsten Kucharzik
- Stadtisches Klinikum Luneburg gGmbH, Department of Gastroenterology, Lüneburg, Germany
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy
| | - Anil K Asthana
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Medicine. Department of Emergency Medicine, Piedmont Hospital Newnan, Georgia, USA
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | | | | |
Collapse
|
49
|
Point-of-Care Thoracic Ultrasonography in the Diagnosis and Management of Kaposiform Lymphangiomatosis. Pediatr Emerg Care 2016; 32:888-891. [PMID: 27898632 DOI: 10.1097/pec.0000000000000968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Kaposiform lymphangiomatosis is a generalized lymphatic disorder complicated by consumptive coagulopathy and pericardial and pleural effusions. We present the case of a 13-year-old female adolescent given a diagnosis of a large pleural effusion by point-of-care thoracic ultrasonography, which led to further evaluation and diagnosis of this rare disorder. We review the use of point-of-care thoracic ultrasonography for the diagnosis of pleural effusion.
Collapse
|
50
|
Abstract
PURPOSE OF REVIEW A need for further assessment of patients in the perioperative setting and an increasing availability of ultrasonography equipment have facilitated the diffusion of ultrasonography and lately focused transthoracic echocardiography (TTE) in anesthesiology practice. This review will discuss the possible use of focused TTE in the perioperative setting and provides an update on present and future perspectives. RECENT FINDINGS Several studies focusing on patient management and diagnostic accuracy of perioperative, focused TTE, have been published recently. Several multidisciplinary guidelines addressing use and educational aspects of focused ultrasonography are available, yet guidelines focusing solely on the use in the perioperative setting are lacking. SUMMARY Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.
Collapse
|