Detecting Ventilator‐Induced Diaphragmatic Dysfunction Using Point‐of‐Care Ultrasound in Children With Long‐term Mechanical Ventilation

Ventricular septal rupture is a rare and potentially fatal complication of transmural myocardial infarction. Early identification utilising transthoracic echocardiography significantly improves long term outcomes in these patients. We report on a case of a 77-year-old male who presented with signs and symptoms of cardiac failure and a loud systolic murmur. The patient underwent an initial point-of-care ultrasound which revealed evidence of a transmural myocardial infarction and a high suspicion of an apical ventricular septal rupture. A complete transthoracic echocardiogram confirmed the septal rupture diagnosis and the patient subsequently underwent surgical repair of the ventricular rupture. This case highlights the role of echocardiography in decreasing adverse outcomes in patients with ventricular septal rupture.

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Intensive point-of-care ultrasound training with long-term follow-up in a cohort of Rwandan physicians

Tropical Medicine & International Health ◽

10.1111/tmi.12780 ◽

2016 ◽

Vol 21 (12) ◽

pp. 1531-1538 ◽

Cited By ~ 18

Author(s):

Patricia C. Henwood ◽

David C. Mackenzie ◽

Joshua S. Rempell ◽

Emily Douglass ◽

Damas Dukundane ◽

...

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Long Term Follow Up

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Point-of-Care Respiratory Muscle Ultrasound in a Child with Medical Complexity

10.22541/au.163251751.13767591/v1 ◽

2021 ◽

Author(s):

Sigmund Kharasch ◽

LAUREN SELAME ◽

Helene Dumas ◽

Hamid Shokoohi ◽

Andrew Liteplo ◽

...

Keyword(s):

Mechanical Ventilation ◽

Adverse Effects ◽

Point Of Care ◽

Spontaneous Breathing Trial ◽

Point Of Care Ultrasound ◽

Lateral Abdominal Wall ◽

High Resource ◽

Weaning Failure ◽

Medical Complexity ◽

Expiratory Muscles

Point-of-care ultrasound of the diaphragm is a simple, noninvasive, dynamic bedside evaluation of diaphragm function that involves no ionizing radiation, does not require patient transport, and enables the serial evaluation of diaphragmatic function over time. Adverse effects on the diaphragm attributed to ventilator-induced diaphragm dysfunction include longer weaning times, ventilation time and weaning failure. Recent investigations of point-of-care ultrasound evaluating the expiratory muscles of the lateral abdominal wall have found similar adverse effects of mechanical ventilation on these important respiratory muscles resulting in weaning difficulty as well as impaired airway clearance. Children with medical complexity have significant chronic health conditions that may involve multisystem disease (congenital or acquired), high medical fragility, functional and psychosocial impairment, technology dependence (tracheostomies, mechanical ventilation, feeding tubes) and high resource utilization (frequent and/or prolonged hospitalizations). Weaning children dependent on mechanical ventilation is a common rehabilitation goal that has beneficial effects on the quality of life, ease of care, and functionality for transitioning to home care. We present a case of weaning difficulty in a child with medical complexity and the important role of point-of-care ultrasound in the evaluation of the diaphragm and expiratory muscles during a spontaneous breathing trial.

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Point-of-Care Ultrasound Measurement of Diaphragm Thickening Fraction as a Predictor of Successful Extubation in Critically Ill Children

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1730931 ◽

2021 ◽

Author(s):

Swathy Subhash ◽

Vasanth Kumar

Keyword(s):

Mechanical Ventilation ◽

Point Of Care ◽

Neuromuscular Disorders ◽

Spontaneous Breathing Trial ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Critically Ill Children ◽

Ultrasound Measurement ◽

Point Of Care Ultrasound ◽

Diaphragm Function

AbstractVentilation-induced diaphragm dysfunction can delay weaning from mechanical ventilation. Identifying the optimal time for extubation has always been a challenge for intensivists. Diaphragm ultrasound is gaining immense popularity as a surrogate to measure diaphragm function. We attempted to assess the utility of diaphragm function in predicting extubation success using point-of-care ultrasound examination. We conducted a prospective observational study in a single-center tertiary care pediatric intensive care unit (PICU). All children aged between 1 month and 16 years admitted to the PICU and who underwent invasive mechanical ventilation for more than 24 hours were included in the study. Children who died during mechanical ventilation and those with conditions affecting diaphragm function like neuromuscular disorders, pneumothorax, chronic respiratory diseases, and intraabdominal hypertension were excluded from the study. Diaphragm thickening fraction (DTf) was measured during spontaneous breathing trial and correlated to predict extubation success. We found that DTf is an independent predictor of extubation success. DTf more than or equal to 20% was associated with extubation success with a positive predictive value of 85%. The area under the curve for DTf showed good accuracy.

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Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery

Anesthesiology ◽

10.1097/aln.0000000000002774 ◽

2019 ◽

Vol 131 (2) ◽

pp. 266-278 ◽

Cited By ~ 6

Author(s):

S. Spadaro ◽

S. Grasso ◽

M. Dres ◽

A. Fogagnolo ◽

F. Dalla Corte ◽

...

Keyword(s):

Odds Ratio ◽

Thoracoscopic Surgery ◽

Point Of Care ◽

Pulmonary Complications ◽

Point Of Care Ultrasound ◽

Postoperative Pulmonary Complications ◽

Diaphragmatic Dysfunction ◽

Video Assisted ◽

Diaphragmatic Function ◽

Video Assisted Thoracoscopic Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative diaphragmatic dysfunction after thoracic surgery is underestimated due to the lack of reproducible bedside diagnostic methods. We used point of care ultrasound to assess diaphragmatic function bedside in patients undergoing video-assisted thoracoscopic or thoracotomic lung resection. Our main hypothesis was that the thoracoscopic approach may be associated with lower incidence of postoperative diaphragm dysfunction as compared to thoracotomy. Furthermore, we assessed the association between postoperative diaphragmatic dysfunction and postoperative pulmonary complications. Methods This was a prospective observational cohort study. Two cohorts of patients were evaluated: those undergoing video-assisted thoracoscopic surgery versus those undergoing thoracotomy. Diaphragmatic dysfunction was defined as a diaphragmatic excursion less than 10 mm. The ultrasound evaluations were carried out before (preoperative) and after (i.e., 2 h and 24 h postoperatively) surgery. The occurrence of postoperative pulmonary complications was assessed up to 7 days after surgery. Results Among the 75 patients enrolled, the incidence of postoperative diaphragmatic dysfunction at 24 h was higher in the thoracotomy group as compared to video-assisted thoracoscopic surgery group (29 of 35, 83% vs. 22 of 40, 55%, respectively; odds ratio = 3.95 [95% CI, 1.5 to 10.3]; P = 0.005). Patients with diaphragmatic dysfunction on the first day after surgery had higher percentage of postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.001). Radiologically assessed atelectasis was 46% (16 of 35) in the thoracotomy group versus 13% (5 of 40) in the video-assisted thoracoscopic surgery group (P = 0.040). Univariate logistic regression analysis indicated postoperative diaphragmatic dysfunction as a risk factor for postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.002). Conclusions Point of care ultrasound can be used to evaluate postoperative diaphragmatic function. On the first postoperative day, diaphragmatic dysfunction was less common after video-assisted than after the thoracotomic surgery and is associated with postoperative pulmonary complications.

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Implementation of a point-of-care ultrasound skills practicum for hospitalists

Ultrasound ◽

10.1177/1742271x18791317 ◽

2018 ◽

Vol 27 (1) ◽

pp. 38-44

Author(s):

Emily Cochard ◽

Zachary Fulkerson ◽

W Graham Carlos

Keyword(s):

Point Of Care ◽

Ultrasound Image ◽

Point Of Care Ultrasound ◽

Short Term ◽

Assessment Scores ◽

Ultrasound Field ◽

Hands On ◽

Inpatient Medicine ◽

The Mean

Introduction Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results The mean pre- vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 ± 1.66 vs. 6.33 ± 1.63, p < 0.0001), but decreased at six months (6.33 ± 1.63 vs. 4.10 ± 2.22, p < 0.0001). The greatest limitations to usage pre-course and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) ( p = 0.28). Conclusion Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists’ confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access.

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Expanding Point-of-Care Ultrasound Training in a Low- and Middle-Income Country: Experiences From a Collaborative Short-Training Workshop in Kenya

Family Medicine ◽

10.22454/fammed.2020.986896 ◽

2020 ◽

Vol 52 (1) ◽

pp. 38-42 ◽

Cited By ~ 4

Author(s):

Leanne Jones ◽

Catherine Gathu ◽

Daria Szkwarko ◽

Sam Mucheru ◽

Naushad Amin ◽

...

Keyword(s):

Family Medicine ◽

Point Of Care ◽

Rank Test ◽

P Value ◽

Point Of Care Ultrasound ◽

Self Assessment ◽

Middle Income ◽

Skill Scores ◽

Signed Rank Test

Background and Objectives: In Kenya, little data exists on point-of-care ultrasound (POCUS) training and use for family medicine physicians. In 2017, a 3-day POCUS workshop assembled most of the family medicine physicians in Kenya. Through surveys, we assessed how this workshop could affect the level of POCUS use, skill, and confidence in family medicine practitioners in the long term. Methods: Structured surveys, distributed before, after, and 10 months postworkshop assessed demographics, POCUS use, barriers, comfort, and skills based on attendee self-assessment. We compared data from the preworkshop surveys to postsurveys and post-postsurveys to assess immediate and long-term differences. Wilcoxon signed-rank test was used to evaluate continuous data, and significance was based on a P value of <.05. Results: The proportion of participants who self-reported using POCUS increased significantly between presurvey and post-postsurvey (29.7% to 63.2%, P=.0161). Mean confidence scores increased significantly from presurvey to postsurvey and post-postsurvey. For all body systems, self-reported mean skill scores increased significantly from presurvey to postsurvey and post-postsurvey. Lack of access to machines and mentorship are substantial barriers to increasing POCUS use. Conclusions: This study highlights the utility of one-time POCUS training in increasing long-term POCUS uptake by participants. While encouraging, our findings also show barriers to increasing POCUS use. These barriers must be addressed, potentially through intradepartmental and interorganizational exchanges of resources to ensure that future POCUS workshops are successful in supporting POCUS use in Kenya.

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