scholarly journals Relationship between Evaluations of Tracheal Tube Position Using Ultrasound and Fluoroscopy in an Infant and Pediatric Population

2020 ◽  
Vol 9 (6) ◽  
pp. 1707
Author(s):  
Davinder Ramsingh ◽  
Elizabeth Ghazal ◽  
Brent Gordon ◽  
Philip Ross ◽  
Darren Goltiao ◽  
...  
Keyword(s):  
Image Quality ◽  
Tracheal Tube ◽  
Strong Correlation ◽  
Point Of Care ◽  
Pediatric Population ◽  
Cricoid Cartilage ◽  
Pediatric Care ◽  
Point Of Care Ultrasound ◽  
Linear Probe ◽  
Age Range

Introduction: A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. After adjusting for the subjects’ height and TT size, ultrasound measurements of the TT cuff location were compared with fluoroscopy measurements of the TT tip location. Methods: Perioperative pediatric patients (<10 years) requiring a cuffed TT were enrolled. After routine TT placement, ultrasound and fluoroscopy images were obtained. Measurements from the TT cuff to the cricoid cartilage were obtained from the POCUS examination. Chest fluoroscopy was reviewed to measure the TT’s distance from the carina. Both measurements were then compared after scaling for patient height. The duration of the ultrasound examination and image quality scores were also recorded. Results: Forty-one patients were enrolled, with a median age of 3 (25th/75th percentile: 1.50/7.00) years. The POCUS examination identified the TT cuff in all cases with the highest image quality score. The median POCUS exam time was 112 (25th/75th percentile: 80.00/156.00) seconds. There was a strong correlation between the POCUS measurements and the fluoroscopy measurements, r = −0.7575, 95% CI [−0.8638, −0.5866 ], p < 0.001). Conclusions: Our results demonstrate a strong correlation between POCUS TT localization measurements and traditional measurements via fluoroscopy. This study further supports the utility of POCUS for pediatric care.

scholarly journals Wireless point-of-care ultrasound: First experiences with a new generation handheld device

2021 ◽  
pp. 1-12
Author(s):  
E.M. Jung ◽  
J. Dinkel ◽  
N. Verloh ◽  
M. Brandenstein ◽  
C. Stroszczynski ◽  
...  
Keyword(s):  
Image Quality ◽  
Mobile Device ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Imaging Method ◽  
Diagnostic Reliability ◽  
Handheld Device ◽  
Ultrasound Device ◽  
Linear Probe ◽  
New Generation

AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 –80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2–5 MHz (convex probe) and 3–12 MHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality (0–4, from not assessable = 0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions. Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD –0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD –0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations.

“To Do or Not To Do?” Clinical Integration of Point-Of-Care Ultrasound After Training: A Prospective Study

2020 ◽  
Author(s):  
Wan-Ching Lien ◽  
Chih-Heng Chang ◽  
Kah-Meng Chong ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
...  
Keyword(s):  
Image Quality ◽  
Prospective Study ◽  
Patient Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Global Rating ◽  
Clinical Integration ◽  
Valuable Adjunct ◽  
Global Ratings ◽  
Group 1

Abstract Background: Point-of-care ultrasound (PoCUS) can serve as a valuable adjunct for patient care. This study aimed to investigate the clinical integration of PoCUS of the first post-graduate year (PGY-1) residents after a PoCUS curriculum.Methods: The prospective study was conducted at the emergency department (ED) of the National Taiwan University Hospital between July 2015 and October 2017. Every PGY-1 resident had one-month ED training and a PoCUS curriculum was implemented during the first week. The post-training objective structured clinical examination global ratings were obtained, as well as the sonographic examinations the residents performed on shifts. Four groups could be identified: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations.Results: 239 residents participated. The median global rating was 4 (interquartile ranges, 4-5). After the curriculum, an increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality. No differences existed in the global ratings between 4 groups, however, nearly 30% of residents did not use PoCUS during their shifts. Group 1 performed more cases with better image quality and using ≥2 US applications (8/100 vs. 82/359, p=0.0009), compared with those before the curriculum. Comparing with those in groups 1 and 2, group 1 performed more cases (p<0.0001) with better image quality (p=0.03). “No suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks in groups 3 and 4.Conclusions: A short focused US training had an immediate positive impact on OSCE global ratings and integration of PoCUS of PGY-1 residents in the ED. The global ratings could not predict whether to use PoCUS in the ED practice. Although the working climate was designated to be friendly for utilizing US, a substantial percentage of residents did not use PoCUS. Further longitudinal studies would be needed for the sustained effects of the curriculum.Trial registration: NCT03738033.

Single-access ultrasound-guided tunneled femoral lines in critically ill pediatric patients

2020 ◽  
Vol 21 (6) ◽  
pp. 1034-1041 ◽  
Author(s):  
Andrew Woerner ◽  
Jesse L Wenger ◽  
Eric J Monroe
Keyword(s):  
Critically Ill ◽  
Pediatric Patients ◽  
Point Of Care ◽  
Pediatric Population ◽  
Central Venous Access ◽  
Venous Access ◽  
Point Of Care Ultrasound ◽  
Ultrasound Guided ◽  
Patient Transport ◽  
Neonates And Infants

Central venous access is an essential aspect of critical care for pediatric patients. In the critically ill pediatric population, image-guided procedures performed at the bedside expedite care and may reduce risks and logistical challenges associated with patient transport to a remote procedure suite such as interventional radiology. We describe our institutional technique for ultrasound-guided tunneled femoral venous access in neonates and infants and provide technical pearls from our experience, with an intended audience including specialists performing point-of-care ultrasound–guided procedures as well as interventional radiologist making their services available in the intensive care unit.

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.

scholarly journals P068: Patient satisfaction following educational ultrasounds in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S101
Author(s):  
P. Kapur ◽  
M. Betz ◽  
J. Chenkin ◽  
C. Brick
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Negative Experiences ◽  
Patient Demographics ◽  
Included Patient ◽  
Survey Results ◽  
Age Range ◽  
Do So

Introduction: Development of point-of-care ultrasound (POCUS) image-generating skills requires residents to practice on patients awaiting care in the emergency department (ED) for unrelated reasons. While patients are almost universally agreeable to the scans, there is the possibility that they feel pressured to do so and may have negative experiences that go unreported. The objective of this study was to determine the self-reported patient satisfaction and identify any concerns after educational ultrasounds performed in the ED. Methods: We conducted a survey of patients at a single academic ED. Patients were eligible for enrollment if they had volunteered for an ultrasound when study personnel were available. The survey was administered by a representative from the Patient Affairs Department who advised the patients that the results would remain anonymous and would have no impact on their care. The survey included patient demographics, questions about the consent process, communication by the trainee, adverse reactions and patient satisfaction. The primary outcome was the overall satisfaction level reported by the volunteer patients on a 5-point Likert scale. Secondary outcomes included identification of any discomfort or concerns about the process as expressed by patients. Simple descriptive statistics were used to report survey results. Results: Ninety-nine patients fully completed the questionnaire. Fifty (50%) were women. The age range was 18 to 99 years. Satisfaction among volunteers was high, with 94% of respondents giving a rating of 4 or 5 (five being an excellent experience). No patients gave a negative rating (1 or 2). Three (3%) patients felt “somewhat” pressured to volunteer. A majority of patients (72%) experienced no discomfort during the scan however 16% experienced some physical discomfort. Comments indicated that too much pressure applied with the ultrasound probe or cold ultrasound gel were the main sources of discomfort. Despite some discomfort 95 (95%) patients stated they would likely volunteer again if asked in the future. Conclusion: ED patients volunteering as models for residents learning POCUS expressed generally positive perceptions of their experience. While only a small minority of patients experienced some discomfort or felt pressured into participating, it is important to ensure that patients have a process to communicate any concerns about educational ultrasounds in the ED.

scholarly journals Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Vigil James ◽  
John Samuel ◽  
Chor Yek Kee ◽  
Gene Yong-Kwang Ong
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Department ◽  
Wall Calcification

Abstract Background The presence of intra-abdominal calcification in the pediatric population can be due to a wide range of conditions. Calcification in the abdomen can be seen in normal or abnormal anatomical structures. In some patients, abnormal calcification points towards the pathology; whereas in others, calcification itself is the pathology. After a thorough history and clinical examination, point-of-care ultrasound (POCUS) would complement the assessment of acute abdominal pain, based on the list of differentials generated as per the abdominal region. The main objective of this article is to review commonly encountered causes of intra-abdominal calcifications in the pediatric population and help in clinical decision-making in a Pediatric Emergency Department. Case presentation We describe a series of pediatric patients who presented to the Pediatric Emergency Department with acute abdominal pain, in whom point-of-care ultrasound helped expedite the diagnosis by identifying varying types of calcification and associated sonological findings. For children who present to the Pediatric Emergency Department with significant abdominal pain, a rapid distinction between emergencies and non-emergencies is vital to decrease morbidity and mortality. Conclusions In a child presenting to the Pediatric Emergency Department with abdominal pain, POCUS and the findings of calcifications can narrow or expand the differential diagnosis when integrated with history and physical exam, to a specific anatomic structure. Integrating these findings with additional sonological findings of an underlying pathology might raise sufficient concerns in the emergency physicians to warrant further investigations for the patient in the form of a formal radiological ultrasound and assist in the patient's early disposition. The use of POCUS might also help to categorize the type of calcification to one of the four main categories of intra-abdominal calcifications, namely concretions, conduit wall calcification, cyst wall calcification, and solid mass-type calcification. POCUS used thoughtfully can give a diagnosis and expand differential diagnosis, reduce cognitive bias, and reduce physician mental load. By integrating the use of POCUS with the history and clinical findings, it will be possible to expedite the management in children who present to the Pediatric Emergency Department with acute abdominal pain.

scholarly journals Evaluation of a novel handheld point-of-care ultrasound device in an African emergency department

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Samuel L. Burleson ◽  
Jonathan F. Swanson ◽  
Erin F. Shufflebarger ◽  
Douglas W. Wallace ◽  
Matthew A. Heimann ◽  
...  
Keyword(s):  
Emergency Department ◽  
Image Quality ◽  
Point Of Care ◽  
Low Cost ◽  
Clinical Care ◽  
Point Of Care Ultrasound ◽  
Emergency Setting ◽  
Low Resource ◽  
Ultrasound Device ◽  
High Acuity

Abstract Background Many point-of-care ultrasound devices are now “pocket-sized” or handheld, allowing easy transport during travel and facilitating use in crowded spaces or in austere low-resource settings. Concerns remain about their durability, image quality, and clinical utility in those environments. Method Five emergency physicians with training in point-of-care ultrasound employed the Butterfly iQ, a novel handheld ultrasound device, in routine clinical care in a busy, high-acuity African emergency department over a period of 10 weeks. We retrospectively evaluated the performance of the Butterfly iQ from the perspectives of both the clinicians using the device and expert ultrasound faculty reviewing the images. Results We found advantages of the Butterfly iQ in a high-acuity African emergency department include its use of a single probe for multiple functions, small size, ease of transport, relatively low cost, and good image quality in most functions. Disadvantages include large probe footprint, lower, though still adequate, cardiac imaging quality, frequent overheating, and reliance on internet-based cloud storage, but these were surmountable. We also report a wide variety of patient presentations, pathology, and procedures to which the device was used. Conclusion We conclude the Butterfly iQ is an effective, though imperfect, point-of-care ultrasound device in a low-resource emergency setting. We will continue to employ the device in clinical emergency care and teaching in this setting.

P0304POINT OF CARE ULTRASOUND IN NEPHROLOGY: THE SOONER THE BETTER!

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mirela Liana Gliga ◽  
Mihail Gheorghe Gliga ◽  
Cristian Chirila ◽  
Raluca-Maria Lie-Ungurean ◽  
Paula Chirila
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Ct Scan ◽  
Point Of Care ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Portable Device ◽  
Diagnostic Tools ◽  
Point Of Care Ultrasound ◽  
Linear Probe

Abstract Background and Aims Point of care ultrasound (POCUS) is performed at the bedsite of the patient by de treating clinician. In nephrology a particular situation is related to severly ill patients, immobilized with elevated creatinine, which can not be deffered to imaging investigations such as CT scan or MRI. Using a small portable device, important clinical problems can be solved in no time. Method We examined 360 out of 670 patients admitted to the nephrology departament in a period of one year. They were severely ill due to following pathologies: 35 severe sepsis with hypotension, 53 decompensated heart failure, 24 stroke, 248 with renal failure and acido-basic or electrolitic disturbances. Evaluation was made using a portable US device with a 10 MHz linear probe and 3.5 MHz convexe probe with abdomen and thoracic software. Diameter of inferior vena cava (IVC), respiratory collapse of IVC, effusions in pleura, pericardium or peritoneum, liver dimensions, kidneys and spleen were described. Results 31 out of 35 patients with hypotension had collapsed IVC, diameter less than 1cm, PPV 88.5%; 48 from 53 heart failure had enlarged IVC with reduced respiratory collapse, PPV 90.6% and 201 from 248 renal failure patients had kidney changes, 81.04%. As compared with standard diagnostic tools (echocardiography, native CT scan and clinical examination, Sensitivity was over 98% in all cases. Conclusion POCUS is a very usefull test for the rapid bed-site examination of kidney patients, were a rapid decision has to be made using a portable device. Sensitivity of the method proved to be comparable as with standard diagnostic tools.

Is Bigger Really Better? Comparison of Ultraportable Handheld Ultrasound with Standard Point-of-Care Ultrasound for Evaluating Safe Site Identification and Image Quality prior to Pleurocentesis

Respiration ◽  
2020 ◽  
Vol 99 (4) ◽  
pp. 325-332
Author(s):  
Sarah M. Newhouse ◽  
Tanja W. Effing ◽  
Brendan D. Dougherty ◽  
Jason A. D&apos;Costa ◽  
Anand R. Rose
Keyword(s):  
Image Quality ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Safe Site ◽  
Handheld Ultrasound ◽  
Site Identification

scholarly journals The role of PoCUS in the assessment of COVID-19 patients

2021 ◽  
Author(s):  
John Karp ◽  
Karina Burke ◽  
Sarah-Marie Daubaras ◽  
Cian McDermott
Keyword(s):  
Ultrasound Imaging ◽  
Imaging Technique ◽  
Imaging Techniques ◽  
Point Of Care ◽  
Pediatric Population ◽  
Point Of Care Ultrasound ◽  
Alara Principle ◽  
Clinical Questions ◽  
Effective Use

AbstractThe Coronavirus disease 19 (COVID-19) pandemic has increased the burden of stress on the global healthcare system in 2020. Point of care ultrasound (PoCUS) is used effectively in the management of pulmonary, cardiac and vascular pathologies. POCUS is the use of traditional ultrasound imaging techniques in a focused binary manner to answer a specific set of clinical questions. This is an imaging technique that delivers no radiation, is inexpensive, ultraportable and provides results instantaneously to the physician operator at the bedside. In regard to the pandemic, PoCUS has played a significant adjunctive role in the diagnosis and management of co-morbidities associated with COVID-19. PoCUS also offers an alternative method to image obstetric patients and the pediatric population safely in accordance with the ALARA principle. Finally, there have been numerous PoCUS protocols describing the effective use of this technology during the COVID-19 pandemic.

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