scholarly journals Feasibility of cardiac output measurements in critically ill patients by medical students

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Geert Koster ◽  
Thomas Kaufmann ◽  
Bart Hiemstra ◽  
Renske Wiersema ◽  
Madelon E. Vos ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critical Care ◽  
Medical Students ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Left Ventricular ◽  
Percentage Error ◽  
Poor Agreement ◽  
Cardiac Output Measurements

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

scholarly journals Current use of inotropes in circulatory shock

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thomas W. L. Scheeren ◽  
Jan Bakker ◽  
Thomas Kaufmann ◽  
Djillali Annane ◽  
Pierre Asfar ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Additional Treatment ◽  
Circulatory Shock ◽  
Left Ventricular Ejection ◽  
First Line ◽  
Ventricular Ejection Fraction

Abstract Background Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81–90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.

scholarly journals Back to Basics: Changes to the Residency Curriculum During a Pandemic

2020 ◽  
Vol 15 (3) ◽  
Author(s):  
Alecsa Mackinnon Blair ◽  
Sagar Rohailla ◽  
Alberto Goffi ◽  
Malika Sharma
Keyword(s):  
Critical Care ◽  
Medical Students ◽  
Patient Care ◽  
Critically Ill ◽  
Emotional Support ◽  
Critically Ill Patients ◽  
Medical Systems ◽  
Residency Programs ◽  
Soins Intensifs ◽  
Residency Curriculum

In the height of the COVID-19 pandemic, prompt changes are required from medical systems. Within Canadian academic institutions, this will mean a restructuring of residency programs of all specialties and at all levels of training. Rapid training in critical care procedures and models of patient care will be paramount to contend with the increasing numbers of critically-ill patients. Flexibility from staff physicians, residents, and medical students will be required to fill gaps in patient care. Finally, compassion for our co-workers throughout illness and isolation will be necessary to provide emotional support for one another. ResumeAu plus fort de la pandémie COVID-19, des changements rapides sont nécessaires de la part des systèmes médicaux. Au sein des institutions universitaires canadiennes, cela signifiera la restructuration des programmes de résidence de toutes les spécialités et à tous les niveaux de formation. Une formation rapide aux procédures de soins intensifs et aux modèles de soins aux patients sera primordiale pour faire face au nombre croissant de patients gravement malades. La flexibilité des médecins du personnel, des résidents et des étudiants en médecine sera nécessaire pour combler les lacunes dans les soins aux patients. Enfin, la compassion envers nos collègues tout au long de la maladie et de l’isolement sera nécessaire pour se soutenir mutuellement sur le plan émotionnel.

Transesophageal Echocardiography Performed by Intensivist and Emergency Physicians—A 5-Year, Single-Center Experience

2021 ◽  
pp. 088506662110425
Author(s):  
Trenton C. Wray ◽  
Molly Johnson ◽  
Shelby Cluff ◽  
Fiona T. Nguyen ◽  
Isaac Tawil ◽  
...  
Keyword(s):  
Critical Care ◽  
Transesophageal Echocardiography ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Chart Review ◽  
The United States ◽  
Left Ventricular ◽  
Emergency Physicians ◽  
Single Center ◽  
Common Diagnosis

Purpose: Data on the use of transesophageal echocardiography (TEE) by intensivist physicians (IP) and emergency physicians (EP) are limited. This study aims to characterize the use of TEE by IPs and EPs in critically ill patients at a single center in the United States. Materials and Methods: Retrospective chart review of all critical care TEEs performed from January 1, 2016 to January 31, 2021. The personnel performing the exams, location of the exams, characteristics of exams, complications, and outcome of the patients were reviewed. Results: A total of 396 examinations was reviewed. TEE was performed by IPs (92%) and EPs (9%). The location of TEE included: intensive care unit (87%), emergency department (11%), and prehospital (2%) settings. The most common indications for TEE were: hemodynamic instability/shock (44%), cardiac arrest (23%), and extracorporeal membrane oxygenation (ECMO) facilitation, adjustment, or weaning (21%). The most common diagnosis based on TEE were: normal TEE (25%), left ventricular dysfunction (19%), and vasodilatory shock (15%). A management change resulted from 89% of exams performed. Complications occurred in 2% of critical care TEEs. Conclusion: TEE can be successfully performed by IPs and EPs on critically ill patients in multiple clinical settings. TEE frequently informed management changes with few complications.

A COMPARISON OF TRANSESOPHAGEAL DOPPLER, THERMODILUTION AND FICK CARDIAC OUTPUT MEASUREMENTS IN CRITICALLY ILL PATIENTS

1998 ◽  
Vol 26 (Supplement) ◽  
pp. 62A ◽  
Author(s):  
Joseph Cuschieri ◽  
Emanuel Rivers ◽  
James Caruso ◽  
Gregory Hays ◽  
Barry Dereczyk ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Transesophageal Doppler ◽  
Cardiac Output Measurements

scholarly journals Agreement between continuous and intermittent pulmonary artery thermodilution for cardiac output measurement in perioperative and intensive care medicine: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Karim Kouz ◽  
Frederic Michard ◽  
Alina Bergholz ◽  
Christina Vokuhl ◽  
Luisa Briesenick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Output ◽  
Confidence Interval ◽  
Pulmonary Artery ◽  
Critically Ill Patients ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Percentage Error ◽  
Limits Of Agreement ◽  
Cardiac Output Measurements

Abstract Background Pulmonary artery thermodilution is the clinical reference method for cardiac output monitoring. Because both continuous and intermittent pulmonary artery thermodilution are used in clinical practice it is important to know whether cardiac output measurements by the two methods are clinically interchangeable. Methods We performed a systematic review and meta-analysis of clinical studies comparing cardiac output measurements assessed using continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients. 54 studies with 1522 patients were included in the analysis. Results The heterogeneity across the studies was high. The overall random effects model-derived pooled estimate of the mean of the differences was 0.08 (95%-confidence interval 0.01 to 0.16) L/min with pooled 95%-limits of agreement of − 1.68 to 1.85 L/min and a pooled percentage error of 29.7 (95%-confidence interval 20.5 to 38.9)%. Conclusion The heterogeneity across clinical studies comparing continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients is high. The overall trueness/accuracy of continuous pulmonary artery thermodilution in comparison with intermittent pulmonary artery thermodilution is good (indicated by a pooled mean of the differences < 0.1 L/min). Pooled 95%-limits of agreement of − 1.68 to 1.85 L/min and a pooled percentage error of 29.7% suggest that continuous pulmonary artery thermodilution barely passes interchangeability criteria with intermittent pulmonary artery thermodilution. PROSPERO registration number CRD42020159730.

scholarly journals Knowledge and Confidence of Final-Year Medical Students Regarding Critical Care Core-Concepts, a Comparison between Problem-Based Learning and a Traditional Curriculum

2021 ◽  
Vol 8 ◽  
pp. 238212052199966
Author(s):  
Mariam Al Ansari ◽  
Ali Al Bshabshe ◽  
Hadil Al Otair ◽  
Layla Layqah ◽  
Abdullah Al-Roqi ◽  
...  
Keyword(s):  
Critical Care ◽  
Medical Students ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Problem Based Learning ◽  
Assessment Tools ◽  
Care Education ◽  
Future Career ◽  
Care Assessment ◽  
Medical Undergraduates

Background: Medical undergraduates should be prepared to recognize life threating critical conditions. Undergraduate medical curriculum development to incorporate more critical care education is an essential requirement. Problem Based Learning curriculum has a potential advantage in providing more focused critical care education to medical undergraduate. Objectives: We aimed to evaluate the final year medical students’ knowledge and confidence in key critical care concepts in Problem Based Learning (PBL) curriculum compared to those in Traditional (Lecture) Based Learning curriculum. We also aimed to evaluate undergraduate’s level of satisfaction with the exposure to critical care education during medical education and training. Materials and methods: This is a cross-sectional anonymous self-administered survey questionnaire completed by two groups of final-year medical students (PBL and TBL) from three Saudi medical schools to assess the degree of undergraduate exposure to critical care and their knowledge of key critical care assessment parameters. Results: The responses of 279 final year medical students was analyzed (70% response rate). The majority (53%) was male and the mean age 23.9 ± 1.4 years. Only 13% of students felt confident to manage hypovolemic shock and 15% could recognize the signs of a threatened airway. One third of the students (29%) correctly identified the critical level of lactic acid in shock and less than 2% of the sample responded correctly to all the questions related to the formal assessment of critically ill patients. Lectures were the main source of information in acute care. More than two-thirds (46%) of the sample indicated that they received tuition in critical care, however the total duration spent in a critical care rotation or teaching was 1 day or less. The medical students, who completed their training with a Problem-Based Learning curriculum, had a higher knowledge base and were more confident in many critical care concepts. Only 6.5% choose critical care as their likely future career. Conclusion: Medical undergraduates in PBL have an overall better knowledge on key concepts and assessment tools applicable to evaluating and managing critically ill patients compared to students in TBL. However the gap in knowledge and confidence in assessing ill patients in both groups is evident. Critical care was not chosen as a preferred future career in all surveyed students. There is a need for institutional support and endorsement of undergraduate critical care exposure and education in Saudi Universities both to better prepare medical students for their imminent post-graduates exposure to ill patients and to help in closing the gap in critical care physicians through promoting the specialty.

scholarly journals Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

2020 ◽  
Author(s):  
Yi Fang ◽  
Di Lv ◽  
Haidong Zhou ◽  
Xiaoxiao Sun ◽  
Yuanzhuo Chen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Cardiac Output ◽  
Critically Ill ◽  
Clinical Efficacy ◽  
Critically Ill Patients ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Continuous Cardiac Output ◽  
Female Ratio ◽  
Significant Difference

Abstract Background: To compare safety and clinical efficacy of artificial intelligence (AI)-powered ultrasound with pulse index continuous cardiac output (PiCCO) for monitoring critically ill patients.Methods: Patients who were admitted to our hospital from April to June 2020 were recruited. PiCCO was employed to monitor cardiac output (CO) and extravascular lung water index (ELWI). Simultaneously, an AI-powered ultrasound was used to automatically monitor CO and the left ventricular outflow tract velocity time integral (LVOT-VTI), and Lung ultrasound B line.Results: A total of 41 patients were enrolled, the male/female ratio was 26:15, and the patients’ median age was 73.6±8.85 years old. There was no significant difference between PiCCO and AI-powered ultrasound in monitoring of CO (t = 1.01, P = 0.316), and the correlation between these two techniques was significant (r=0.911; 95% confidence interval (CI): [0.82; 0.96]; P < 0.001). Similarly, the correlation between lung ultrasound and ELWI was significant r=0.770 (95%CI: [0.58; 0.88]; P < 0.001). Conclusions: Clinical management of critically ill patients can be achieved via monitoring techniques, such as PICCO and AI-powered ultrasound.

scholarly journals Emergency and critical care services in Malawi: Findings from a nationwide survey of health facilities

2020 ◽  
Vol 32 (1) ◽  
pp. 19-23
Author(s):  
Raphael Kayambankadzanja
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Low Income ◽  
Resource Availability ◽  
Critically Ill Patients ◽  
Support Services ◽  
Nationwide Survey ◽  
Health Facilities ◽  
Low Income Countries

BackgroundGlobally, critical illness causes up to 45 million deaths every year. The burden is highest in low-income countries such as Malawi. Critically ill patients require good quality, essential care in emergency departments and in hospital wards to avoid negative outcomes such as death. Little is known about the quality of care or the availability of necessary resources for emergency and critical care in Malawi. The aim of this study was to assess the availability of resources for emergency and critical care in Malawi using data from the Service Provision Assessment (SPA).MethodsWe conducted a secondary data analysis of the SPA – a nationwide survey of all health facilities. We assessed the availability of resources for emergency and critical care using previously developed standards for hospitals in low-income countries. Each health facility received an availability score, calculated as the proportion of resources that were present. Resource availability was sub-divided into the seven a-priori defined categories of drugs, equipment, support services, emergency guidelines, infrastructure, training and routines.ResultsOf the 254 indicators in the standards necessary for assessing the quality of emergency and critical care, SPA collected data for 102 (40.6%). Hospitals had a median resource availability score of 51.6% IQR (42.2-67.2) and smaller health facilities had a median of 37.5% (IQR 28.1-45.3). For the category of drugs, the hospitals’ median score was 62.0% IQR (52.4-81.0), for equipment 51.9% IQR (40.7-66.7), support services 33.3% IQR (22.2-77.8) and emergency guidelines 33.3% IQR (0-66.7). SPA did not collect any data for resources in the categories of infrastructure, training or routines. ConclusionHospitals in Malawi lack resources for providing emergency and critical care. Increasing data about the availability of resources for emergency and critical care and improving the hospital systems for the care of critically ill patients in Malawi should be prioritized.

Sign in / Sign up

Export Citation Format

Share Document