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Nair P, Chen-Tournoux A, Almufleh AS, Blissett S, Ducas R, Fine NM, Johri AM, Kushneriuk D, Ramer S, Sanfilippo A, Thibodeau-Jarry N, Yu E, Bewick D, Burwash IG, Chow CM, Cooley H, De S, Douflé G, Fagan SM, Henri C, Jassal DS, Jelic T, Lee D, Leipsic J, Leong-Poi H, Luksun W, Mulloy AJ, Mulvagh S, Nesbitt G, Promislow S, Sebag IA, Tran DTT, Tsang TSM. 2023 CCS/CSE Standards for Physician Training and Maintenance of Competence in Adult Echocardiography: Executive Summary. Can J Cardiol 2023; 39:1302-1306. [PMID: 37355231 DOI: 10.1016/j.cjca.2023.06.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023] Open
Affiliation(s)
- Parvathy Nair
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Annabel Chen-Tournoux
- Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Aws S Almufleh
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sarah Blissett
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Robin Ducas
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amer M Johri
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dominique Kushneriuk
- Division of Cardiology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Ramer
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony Sanfilippo
- Division of Cardiology, Kingston Health Science Centre, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicolas Thibodeau-Jarry
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Eric Yu
- Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Bewick
- Division of Cardiology, Department of Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Ian G Burwash
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Heather Cooley
- Echocardiography, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | - Ghislaine Douflé
- Interdepartmental Division of Critical Care Medicine and Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan M Fagan
- Division of Cardiology, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Henri
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Davinder S Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tom Jelic
- Emergency Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dana Lee
- Surrey Memorial Hospital and University of British Columbia, Division of Cardiology, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- St Paul's Hospital and University of British Columbia, Department of Radiology and Department of Medicine, Vancouver, British Columbia, Canada
| | - Howard Leong-Poi
- Division of Cardiology, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Warren Luksun
- Department of Critical Care Medicine and Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Andrew J Mulloy
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sharon Mulvagh
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Dalhousie, University, Halifax, Nova Scotia, Canada, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gillian Nesbitt
- Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Steven Promislow
- Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Igal A Sebag
- Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Diem T T Tran
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Lau VI, Mah GD, Wang X, Byker L, Robinson A, Milovanovic L, Alherbish A, Odenbach J, Vadeanu C, Lu D, Smyth L, Rohatensky M, Whiteside B, Gregoire P, Luksun W, van Diepen S, Anderson D, Verma S, Slemko J, Brindley P, Kustogiannis DJ, Jacka M, Shaw A, Wheatley M, Windram J, Opgenorth D, Baig N, Rewa OG, Bagshaw SM, Buchanan BM. Intrapulmonary and Intracardiac Shunts in Adult COVID-19 Versus Non-COVID Acute Respiratory Distress Syndrome ICU Patients Using Echocardiography and Contrast Bubble Studies (COVID-Shunt Study): A Prospective, Observational Cohort Study. Crit Care Med 2023; 51:1023-1032. [PMID: 36971440 PMCID: PMC10335602 DOI: 10.1097/ccm.0000000000005848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES Studies have suggested intrapulmonary shunts may contribute to hypoxemia in COVID-19 acute respiratory distress syndrome (ARDS) with worse associated outcomes. We evaluated the presence of right-to-left (R-L) shunts in COVID-19 and non-COVID ARDS patients using a comprehensive hypoxemia workup for shunt etiology and associations with mortality. DESIGN Prospective, observational cohort study. SETTING Four tertiary hospitals in Edmonton, Alberta, Canada. PATIENTS Adult critically ill, mechanically ventilated, ICU patients admitted with COVID-19 or non-COVID (November 16, 2020, to September 1, 2021). INTERVENTIONS Agitated-saline bubble studies with transthoracic echocardiography/transcranial Doppler ± transesophageal echocardiography assessed for R-L shunts presence. MEASUREMENTS AND MAIN RESULTS Primary outcomes were shunt frequency and association with hospital mortality. Logistic regression analysis was used for adjustment. The study enrolled 226 patients (182 COVID-19 vs 42 non-COVID). Median age was 58 years (interquartile range [IQR], 47-67 yr) and Acute Physiology and Chronic Health Evaluation II scores of 30 (IQR, 21-36). In COVID-19 patients, the frequency of R-L shunt was 31 of 182 COVID patients (17.0%) versus 10 of 44 non-COVID patients (22.7%), with no difference detected in shunt rates (risk difference [RD], -5.7%; 95% CI, -18.4 to 7.0; p = 0.38). In the COVID-19 group, hospital mortality was higher for those with R-L shunt compared with those without (54.8% vs 35.8%; RD, 19.0%; 95% CI, 0.1-37.9; p = 0.05). This did not persist at 90-day mortality nor after adjustment with regression. CONCLUSIONS There was no evidence of increased R-L shunt rates in COVID-19 compared with non-COVID controls. R-L shunt was associated with increased in-hospital mortality for COVID-19 patients, but this did not persist at 90-day mortality or after adjusting using logistic regression.
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Affiliation(s)
- Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Graham D Mah
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Xiaoming Wang
- Health Services Statistical and Analytic Methods, Alberta Health Services, Edmonton, AB, Canada
| | - Leon Byker
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Andrea Robinson
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Lazar Milovanovic
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Aws Alherbish
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Alberta Health Services, Edmonton, AB, Canada
| | - Jeffrey Odenbach
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cristian Vadeanu
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David Lu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Leo Smyth
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mitchell Rohatensky
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian Whiteside
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phillip Gregoire
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Warren Luksun
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Department of Anesthesiology & Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Alberta Health Services, Edmonton, AB, Canada
| | - Dustin Anderson
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sanam Verma
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Alberta Health Services, Edmonton, AB, Canada
| | - Jocelyn Slemko
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Peter Brindley
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Demetrios J Kustogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Michael Jacka
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Andrew Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH
| | - Matt Wheatley
- Department of Neurosurgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jonathan Windram
- Division of Cardiology, Department of Medicine, Faculty of Medicine, and Alberta Health Services, Edmonton, AB, Canada
| | - Dawn Opgenorth
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Nadia Baig
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Brian M Buchanan
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
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Kiamanesh O, Harper L, Wiskar K, Luksun W, McDonald M, Ross H, Woo A, Granton J. Lung Ultrasound for Cardiologists in the Time of COVID-19. Can J Cardiol 2020; 36:1144-1147. [PMID: 32416318 PMCID: PMC7235628 DOI: 10.1016/j.cjca.2020.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
Abstract
Lung ultrasound (LUS) is a point-of-care ultrasound technique used for its portability, widespread availability, and ability to provide real-time diagnostic information and procedural guidance. LUS outperforms lung auscultation and chest X-ray, and it is an alternative to chest computed tomography in selected cases. Cardiologists may enhance their physical and echocardiographic examination with the addition of LUS. We present a practical guide to LUS, including device selection, scanning, findings, and interpretation. We outline a 3-point scanning protocol using 2-dimensional and M-mode imaging to evaluate the pleural line, pleural space, and parenchyma. We describe LUS findings and interpretation for common causes of respiratory failure. We provide guidance specific of COVID-19, which at the time of writing is a global pandemic. In this context, LUS emerges as a particularly useful tool for the diagnosis and management of patients with cardiopulmonary disease.
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Affiliation(s)
- Omid Kiamanesh
- Echocardiography Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Lea Harper
- Division of Respirology, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Katie Wiskar
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Warren Luksun
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Anna Woo
- Echocardiography Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - John Granton
- Division of Respirology, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Wąsowicz M, Jerath A, Luksun W, Sharma V, Mitsakakis N, Meineri M, Katznelson R, Yau T, Rao V, Beattie WS. Comparison of propofol-based versus volatile-based anaesthesia and postoperative sedation in cardiac surgical patients: a prospective, randomized, study. Anaesthesiol Intensive Ther 2018; 50:200-209. [PMID: 29913033 DOI: 10.5603/ait.a2018.0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 06/18/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Clinical trials have shown conflicting results regarding the use of volatile anaesthesia before or after an ischaemic insult in cardiac surgical patients and its effect on myocardial injury. This may be attributable to the failure of continuing volatile agents into the early postoperative period. We hypothesised that combined volatilebased anaesthesia and postoperative sedation would decrease the extent of myocardial injury after coronary artery bypass grafting (CABG) when compared with an intravenous, propofol-based approach. This study aimed to assess the feasibility of the perioperative protocol and investigate whether volatile anaesthesia provides cardioprotection in patients undergoing CABG. METHODS Randomized, controlled trial enrolling 157 patients with preserved left ventricular function scheduled for elective or urgent on-pump CABG. Patients received either volatile- or propofol-based anaesthesia and postoperative sedation. Volatile sedation in the ICU was provided with the use of the AnaConDa® device (Sedana Medical, Uppsala, Sweden). The primary outcome was myocardial injury measured by serial troponin measurement at the beginning of surgery, 2, 4 and 12-16 h after ICU admission. The secondary outcome was cardiac performance expressed as cardiac index (CI) and the need for inotropic and vasopressor drug support. The peak postoperative troponin level was defined as the highest level at any time in the first 16 h after surgery. RESULTS 127 patients completed the study protocol, 60 patients in the volatile group and 67 patients in the propofol group. Troponin levels were similar between groups at all of the measured time points. There were no differences in cardiac index or vasoactive drug support except for the immediate post- cardiopulmonary bypass (CPB) period when patients in the volatile group had low systemic vascular resistance, high CI and required more vasopressors. There was no difference in postoperative kidney function, intensive care unit discharge or hospital discharge time. CONCLUSIONS The use of volatile-based anaesthesia and postoperative sedation did not confer any cardioprotection compared with propofol-based anaesthesia and sedation in patients who had good left ventricular function and were undergoing CABG.
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Affiliation(s)
- Marcin Wąsowicz
- Deaprtment of Anesthesia, Faculty of Medicine, University of Toronto; Department of Anesthesia and Pain Management, Toronto Genaral Hospital/University Health Network, Toronto, Ontario, Canada.
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Luksun W, Wąsowicz M. Evidence-Based Critical Care. Anesth Analg 2018. [DOI: 10.1213/ane.0000000000002816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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