scholarly journals Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Keith Killu ◽  
Victor Coba ◽  
Michael Mendez ◽  
Subhash Reddy ◽  
Tanja Adrzejewski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Patient Management ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Fellowship Program ◽  
Icu Patients ◽  
Surgical Icu ◽  
New Diagnosis

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care.Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year.Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435).Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

Point-of-Care Ultrasound in the Intensive Care Unit

2018 ◽  
Vol 39 (1) ◽  
pp. 79-97 ◽  
Author(s):  
Steven J. Campbell ◽  
Rabih Bechara ◽  
Shaheen Islam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound

Governance in point-of-care ultrasound

2019 ◽  
pp. 273-278
Author(s):  
Peter Macnaughton ◽  
Marcus Peck
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Ultrasound Examination ◽  
Point Of Care ◽  
Good Practice ◽  
Point Of Care Ultrasound ◽  
Equipment Management ◽  
Image Storage ◽  
Ensure Patient Safety

The performance and interpretation of ultrasound examination are very user-dependent that require significant training and experience. This chapter details the processes that should be adopted within an intensive care unit using point-of-care ultrasound to ensure that practitioners are appropriately trained and are able to maintain and develop their skills. The chapter also outlines recommendations regarding good practice in reporting and image storage, together with guidance regarding equipment management, to ensure patient safety.

Point-of-care ultrasound in the neonatal intensive care unit: international perspectives

2011 ◽  
Vol 16 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Nick Evans ◽  
Veronique Gournay ◽  
Fernando Cabanas ◽  
Martin Kluckow ◽  
Tina Leone ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
International Perspectives

1150: A FINANCIAL MODEL FOR POINT-OF-CARE ULTRASOUND IN A PEDIATRIC INTENSIVE CARE UNIT

2016 ◽  
Vol 44 (12) ◽  
pp. 363-363
Author(s):  
Nathan Wiedemann ◽  
Russell Horowitz ◽  
Zena Harris ◽  
Michael Ruppe ◽  
Alexander Thai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Point Of Care ◽  
Pediatric Intensive Care ◽  
Point Of Care Ultrasound ◽  
Financial Model

scholarly journals The role of lung ultrasound in preterm neonates with respiratory distress in neonatal intensive care unit

2021 ◽  
Vol 8 (8) ◽  
pp. 284-288
Author(s):  
Sidhant Swarup ◽  
Rakesh Panigrahi ◽  
Suryakanta Swain ◽  
Hemant Agrawal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Preterm Neonates ◽  
Point Of Care Ultrasound

Introduction: Up to 29% of late preterm babies suffer from respiratory distress due to which they need to be admitted to neonatal intensive care unit (NICU). Point-of-care ultrasound is a useful tool in critical neonate care, providing valuable information without any risk of ionizing radiation to the newborn. Materials and Method: This mono-centric, descriptive, and prospective study was conducted in NICU. Preterm newborns of less than 36 weeks with respiratory distress at birth on non-invasive ventilation were recruited. A lung ultrasound was performed at first 12 h of life and followed till their discharge. Main outcomes need for surfactant treatment. Results: Sixty preterm infants (median gestational age: 29 weeks) were recruited. Newborn in the surfactant group requiring ultrasound and intervention was significantly higher than in no surfactant group (p<0.0001). In 15 newborns who received surfactant, the first dose was administered at a median age of 4.5 h. In 13 of these 15 newborns, the lung ultrasound scan was subsequently repeated an average of 2 h (Standard deviation or SD: 2) On average, the second dose of surfactant was administered at 24 h of life (SD: 9). Conclusion: Early lung ultrasound in preterm infants with respiratory distress appears to be a useful tool with no adverse effects for the patient. It allows a better assessment of respiratory distress by detecting patients with a greater risk of requiring surfactant or mechanical ventilation, even before oxygenation criteria.

scholarly journals Utility of point-of-care ultrasound in the pediatric intensive care unit

2019 ◽  
Author(s):  
Reagan Lyman ◽  
Yoshikazu Yamaguchi ◽  
Alok Moharir ◽  
Alok Moharir ◽  
Joseph D. Tobias
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Point Of Care ◽  
Pediatric Intensive Care ◽  
Therapeutic Interventions ◽  
Point Of Care Ultrasound ◽  
Critical Care Units ◽  
Clinical Scenarios

For critically ill patients, point-of-care ultrasound (POCUS) has been rapidly adopted for use in emergency departments and critical care units for diagnostic purposes and to guide decision making. We present two unique clinical scenarios in the Pediatric Intensive Care Unit (PICU), one in which ultrasound was used as a diagnostic tool to identify pulmonary edema, and the other in which ultrasound was used to facilitate placement of a naso-duodenal tube for enteral feeding. The potential role of POCUS in the PICU is presented and its utility in these two unique clinical scenarios discussed. Although, many cases will still require further radiological tests, The success of POCUS lies in immediate diagnosis allowing at the spot therapeutic interventions without wasting precious time.Citation: Lyman R, Yamaguchi Y, Moharir A, Tobias JD. Utility of point-of-care ultrasound in the pediatric intensive care unit. Anaesth pain & intensive care 2019;23(3):314-317

The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

2021 ◽  
pp. 088506662110478
Author(s):  
Laura A. Watkins ◽  
Sharon P. Dial ◽  
Seth J. Koenig ◽  
Dalibor N. Kurepa ◽  
Paul H. Mayo
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Point Of Care ◽  
Pediatric Intensive Care ◽  
Pediatric Care ◽  
Point Of Care Ultrasound ◽  
Pediatric Critical Care ◽  
New Therapy

Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.

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