Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment

The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-Care Ultrasonography (POCUS) is emerging as a valuable non-invasive bedside diagnostic tool for objective evaluation of physiological and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function as well as quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography provides additional quantitative information including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function, pulmonary and venous congestion using POCUS and review relevant literature.

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Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department

10.21203/rs.3.rs-27350/v1 ◽

2020 ◽

Author(s):

Wei-Lung Chen ◽

Chan-Peng Hsu ◽

Po-Han Wu ◽

Jiann-Hwa Chen ◽

Chien-Cheng Huang ◽

...

Keyword(s):

Emergency Department ◽

Soft Tissue ◽

Training Program ◽

Test Score ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Ultrasound Studies ◽

Training Course ◽

Hemodynamic Assessment ◽

Procedural Guidance

Abstract Background: Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). It has contributed to improvements in patient treatment quality, procedural safety, timeliness of care, diagnostic accuracy, and cost reduction. We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.Methods: We conducted a retrospective cohort study in the ED of a university-affiliated medical center, evaluating a centralized residency-based POCUS training course from July 2017 to June 2018 for ED residents that included 12 core ultrasound applications: trauma, intrauterine pregnancy, abdominal aortic aneurysm, echocardiography and hemodynamic assessment, hepatobiliary system, urinary tract, deep vein thrombosis, soft tissue and musculoskeletal, thoracic-airway, ocular, bowel, and procedural guidance. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. Utilization of POCUS among ED residents before and after the POCUS training course (July 2016–June 2017 and July 2018–June 2019) was calculated and analyzed using the Wilcoxon signed-rank test.Results: In total, 16 residents participated and completed the entire training course. The post-test score improved significantly compared to the pre-test score by a median of 12 points (p = 0.04). Utilization of POCUS among the ED residents increased significantly from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (p < 0.01) after completion of the entire training course. Increased POCUS scanning percentages over the cardiac, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conclusions: There was a significant increase in POCUS utilization among ED residents after a comprehensive residency-based POCUS training program.

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Extra-cardiac Doppler Hemodynamic Assessment Using Point-of-Care Ultrasound

10.1007/978-3-030-73387-2_26 ◽

2021 ◽

pp. 385-404

Author(s):

William Beaubien-Souligny ◽

André Denault

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Hemodynamic Assessment ◽

Cardiac Doppler

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Transcranial duplex doppler ultrasonography in dogs with hydrocephalus

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/s0102-09352010000100008 ◽

2010 ◽

Vol 62 (1) ◽

pp. 57-63 ◽

Cited By ~ 1

Author(s):

C.F. Carvalho ◽

M.C. Chammas ◽

J.P. Andrade Neto ◽

C.D. Jimenez ◽

S.A. Diniz ◽

...

Keyword(s):

Doppler Ultrasound ◽

Cerebral Arteries ◽

Resistive Index ◽

Logistic Regression Models ◽

Neurological Signs ◽

Duplex Doppler Ultrasound ◽

Hemodynamic Assessment ◽

Significant Difference ◽

The Mean ◽

Duplex Doppler

Transcranial duplex Doppler ultrasound was performed in 32 conscious dogs presenting ventriculomegaly detected in B-mode, obtaining measures of lateral ventricles and resistance parameters of main cerebral arteries before and after 30 days of clinical treatment. The animals were distributed divided in two groups: group 1, dogs that presented remission or decrease of the neurological signs of the disease after clinical therapy; and group 2, dogs that displayed worsening of the neurological signs or clinical stability. The data were all presented in tables and were submitted to paired t test and to logistic regression models to evaluate the influence of the RI reduction on both groups. There was no significant influence of the variables in the B-mode. After the treatment, the mean resistive index (RI) was significantly lower for the group that presented clinical improvement. There was no significant difference of the mean RI reduction for the same artery when the right and left sides were compared. It could be concluded that transcranial duplex Doppler ultrasound is a method of cerebral hemodynamic assessment able to monitor more precisely the treatment of hydrocephalus in dogs and verify the responses.

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Basic Ultrasound Physics, Doppler Ultrasound, and Hemodynamic Assessment

Essential Echocardiography ◽

10.1007/978-3-319-34124-8_3 ◽

2016 ◽

pp. 45-58

Author(s):

Gerard R. Manecke

Keyword(s):

Doppler Ultrasound ◽

Hemodynamic Assessment

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Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report

The Ultrasound Journal ◽

10.1186/s13089-019-0147-2 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Christian Boßelmann ◽

Sven Poli

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Point Of Care ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Carotid Ultrasound ◽

Case Presentation ◽

Retrosternal Pain ◽

Hemodynamic Assessment

Abstract Background Carotid artery dissection due to extension of aortic dissection (CAEAD) is a severe complication of acute aortic dissection. The risk of ischemic stroke is increased. Early sonographic detection and repeat evaluation are necessary to guide clinical management. Case presentation A 58-year-old male patient presents with sudden, tearing retrosternal pain. Point-of-care carotid ultrasound is used to establish the diagnosis of CAEAD. We describe a number of sonographic features and compare ultrasound to other imaging modalities. Conclusions Bedside carotid ultrasound enables rapid, sensitive and safe hemodynamic assessment, especially in critically ill patients.

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