Critical Care Ultrasonography Research Articles

Critical care ultrasound among Tunisian intensive care residents: A Cross-sectional Survey.

Critical Care ultrasound (CCUS) is more and more used in Tunisian critical care units. An objective assessment of this training has not yet been performed. To assess the theoretical and practical knowledge about CCUS among Intensive Care Unit (ICU) residents. This is a cross-sectional study conducted during the period from January to June 2021. Data were collected using a French language questionnaire distributed on the day of the selection of the residents' posts for the next training period (at the end of June 2021). Out of 75 residents, 37 accepted to answer to the survey (Participation rate =49 %). The majority were female (66.4%). The mean age was 29±12.36 years. Only 5.4% of participants (n=2) had previously received training concerning echocardiography and only 8.1% of the participants have received dedicated training for lung ultrasound (LU). Among the participants, 80.1% of residents (n=30) had never performed a transthoracic echocardiography (TTE). Competence in performing echocardiography was self-assessed quite good and bad by 5.4% and 43.2% of responders respectively. Most of the residents (86%) did not insert before ultrasound-guided central venous catheters. Views known by the participants using TTE were mainly parasternal long axis section (56.8%) and apical 4/5 chambers section (52.8%). All participants (100%) thought that teaching CCU is a necessary part of the training of intensivists. Our study highlighted the lack of training of Tunisian ICU residents regarding CCUS learning. Therefore, it is crucial to integrate such learning and training into their training programs.

Cardiac Point-of-Care Ultrasound in Critical Care: Evolution, Current State, and Future Prospects

Cardiac Point-of-Care Ultrasound in Critical Care: Evolution, Current State, and Future Prospects

Expert consensus on the application of critical care ultrasonography in invasive procedures

The evolution of critical care medicine is inextricably linked to the development of critical care procedures. These procedures not only facilitate diagnosis and treatment of critically ill patients, but also provide valuable insights into disease pathophysiology. While critical care interventions offer undeniable benefits, the potential for iatrogenic complications necessitates careful consideration. The recent surge in critical care ultrasound (US) utilization is a testament to its unique advantages: non-invasiveness, real-time bedside availability, direct visualization of internal structures, elimination of ionizing radiation exposure, repeatability, and relative ease of learning. Recognizing the need to optimize procedures and minimize complications, critical care utrasound study group of Beijing critical care ultrasound research assocition convened a panel of critical care experts to generate this consensus statement. This document serves as a guide for healthcare providers, aiming to ensure patient safety and best practices in critical care.

Training and Education in Point of Care Ultrasound in Critical Care: An Update

Training and Education in Point of Care Ultrasound in Critical Care: An Update

Assessment of Pulmonary Circulation of Critically Ill Patients Based on Critical Care Ultrasound

Pulmonary circulation is crucial in the human circulatory system, facilitating the oxygenation of blood as it moves from the right heart to the lungs and then to the left heart. However, during critical illness, pulmonary microcirculation can be vulnerable to both intrapulmonary and extrapulmonary injuries. To assess these potential injuries in critically ill patients, critical point-of-care ultrasound can be used to quantitatively and qualitatively evaluate the right atrium, right ventricle, pulmonary artery, lung, pulmonary vein, and left atrium along the direction of blood flow. This assessment is particularly valuable for common ICU diseases such as acute respiratory distress syndrome (ARDS), sepsis, pulmonary hypertension, and cardiogenic pulmonary edema. It has significant potential for diagnosing and treating these conditions in critical care medicine.

Critical Care Ultrasound Competency of Fellows and Faculty in Pulmonary and Critical Care Medicine: A Nationwide Survey

Purpose: Competency assessment standards for Critical Care Ultrasonography (CCUS) for Graduate Medical Education (GME) trainees in pulmonary/critical care medicine (PCCM) fellowship programs are lacking. We sought to answer the following research questions: How are PCCM fellows and teaching faculty assessed for CCUS competency? Which CCUS teaching methods are perceived as most effective by program directors (PDs) and fellows. Methods: Cross-sectional, nationwide, electronic survey of PCCM PDs and fellows in accredited GME training programs. Results: PDs and fellows both reported the highest rates of fellow competence to use CCUS for invasive procedural guidance, but lower rates for assessment of deep vein thrombosis and abdominal organs. 54% and 90% of PDs reported never assessing fellows or teaching faculty for CCUS competency, respectively. PDs and fellows perceived hands-on workshops and directly supervised CCUS exams as more effective learning methods than unsupervised CCUS archival with subsequent review and self-directed learning. Conclusions: There is substantial variation in CCUS competency assessment among PCCM fellows and teaching faculty nationwide. The majority of training programs do not formally assess fellows or teaching faculty for CCUS competence. Guidelines are needed to formulate standardized competency assessment tools for PCCM fellowship programs.

Book Review: Point of Care Ultrasound in Critical Care by Luke Flower and Pradeep Madhivathanan

Book Review: <i>Point of Care Ultrasound in Critical Care</i> by Luke Flower and Pradeep Madhivathanan

Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review.

Lung ultrasound has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures; among point-of-care ultrasound techniques, the lung ultrasound saw the greatest spread in the last decade. The COVID-19 pandemic has given a boost to the use of ultrasound since it allows to obtain a wide range of clinical information with a bedside, not harmful, repeatable examination that is reliable. This led to the remarkable growth of publications on lung ultrasounds. The first part of this narrative review aims to discuss basic aspects of lung ultrasounds, from the machine setting, probe choice, and standard examination to signs and semiotics for qualitative and quantitative lung ultrasound interpretation. The second part focuses on how to use lung ultrasound to answer specific clinical questions in critical care units and in emergency departments.

Use of pulmonary ultrasound to predict in-hospital mortality in patients with COVID-19 infection.

Lung ultrasound (LUS) implementation in patients with COVID-19 can help to establish the degree of pulmonary involvement, evaluate treatment response and estimate in-hospital outcome. To evaluate the application of a LUS protocol in patients with COVID-19 infection to predict in-hospital mortality. The study was carried out from April 1 to August 1, 2020 in patients with COVID-19 infection admitted to the Intensive Care Unit. Lung evaluation was carried out by physicians trained in critical care ultrasonography. Most patients were males, median age was 56 years, and 59 % required mechanical ventilation. In-hospital mortality was 39.4 %, and in those with a LUS score ≥ 19, mortality was higher (50 %). The multiple logistic regression model showed that a LUS score ≥ 19 was significantly associated with mortality (hazard ratio = 2.55, p = 0.01). LUS is a safe and fast clinical tool that can be applied at bedside in patients with COVID-19 infection to establish the degree of parenchymal involvement and predict mortality.

Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure.

Lung ultrasound when used in isolation, usually misses out metabolic causes of dyspnoea and differentiating acute exacerbation of COPD from pneumonia and pulmonary embolism is difficult, hence we thought of combining critical care ultrasonography (CCUS) with arterial blood gas analysis (ABG). The objective of this study was to estimate accuracy of Critical Care Ultrasonography (CCUS) plus Arterial blood gas (ABG) based algorithm in diagnosing aetiology of dyspnoea. Accuracy of traditional Chest X-ray (CxR) based algorithm was also validated in the following setting. It was a facility based comparative study, where 174 dyspneic patients were subjected to CCUS plus ABG and CxR based algorithms on admission to ICU. The patients were classified into one of five pathophysiological diagnosis 1) Alveolar( Lung-pneumonia)disorder ; 2) Alveolar (Cardiac-pulmonary edema) disorder; 3) Ventilation with Alveolar defect (COPD) disorder ;4) Perfusion disorder; and 5) Metabolic disorder. We calculated diagnostic test properties of CCUS plus ABG and CXR based algorithm in relation to composite diagnosis and correlated these algorithms for each of the defined pathophysiological diagnosis. The sensitivity of CCUS and ABG based algorithm was 0.85 (95% CI-75.03-92.03) for alveolar (lung) ; 0.94 (95% CI-85.15-98.13) for alveolar (cardiac); 0.83 (95% CI-60.78-94.16) for ventilation with alveolar defect; 0.66 (95% CI-30-90.32) for perfusion defect; 0.63 (95% CI-45.25-77.07) for metabolic disorders.Cohn's kappa correlation coefficient of CCUS plus ABG based algorithm in relation to composite diagnosis was 0.7 for alveolar (lung), 0.85 for alveolar (cardiac), 0.78 for ventilation with alveolar defect, 0.79 for perfusion defect and 0.69 for metabolic disorders. CCUS plus ABG algorithm is highly sensitive and it's agreement with composite diagnosis is far superior. It is a first of it's kind study, where authors have attempted combining two point of care tests and creating an algorithmic approach for timely diagnosis and intervention.

A Tool to Assess Competence in Critical Care Ultrasound Based on Entrustable Professional Activities.

Existing assessment tools for competence in critical care ultrasound (CCUS) have limited scope and interrupt clinical workflow. The framework of entrustable professional activities (EPAs) is well suited to developing an assessment tool that is comprehensive and readily integrated into the intensive care unit (ICU) training environment. This study sought to design an EPA-based tool to assess competence in CCUS for pulmonary and critical care fellows and to assess the validity and reliability of the tool. Eight experts in CCUS met to define the core EPAs for CCUS. A nominal group technique was used to reach consensus. An assessment tool was created based on the EPAs with a modified Ottawa entrustability scale. Trained faculty evaluated pulmonary and critical care fellows using this tool in the ICU over a 6-month study period at a single institution. An assessment of validity of the EPA-based tool is made with four sources of validity evidence: content, response process, reliability, and relation to other variables. Reliability and response process data were generated using generalizability theory analysis to estimate sources of variance in entrustment scores. Analysis of response process validity and validity by relation to other variables was performed using regression models. Fifty-four assessments were recorded during the study period, conducted on 23 trainees by 13 faculty. Content validity of the tool was demonstrated using expert consensus and published guidelines from critical care societies to define the EPAs. Response process validity was demonstrated by the low variance in entrustment scores due to evaluators (0.086 or 6%) and high agreement between score and trainee self-assessment (regression coefficient, 0.82; P < 0.0001). Reliability was demonstrated by the high "true" variance in entrustment score attributable to the trainee: 0.674 or 45%. Validity by relation to other variables was demonstrated using regression analysis to show correlation between entrustment score and the number of times a fellow has performed an EPA (regression coefficient, 0.023; P < 0.0001). An EPA-based assessment tool for competence in CCUS was created. We obtained sufficient validity evidence on three of the diagnostic EPAs. Procedural EPAs were infrequently assessed, limiting generalizability in this subgroup.

Use of critical care ultrasound in Saudi Arabia: Questionnaire analysis

Basic skills and knowledge of critical care ultrasonography (CCUS) are considered mandatory in intensive care unit (ICU) practice. A link for the survey questionnaire [Appendix 1] was distributed to attendees of critical care meetings from different regions in Saudi Arabia about the topics of CCUS availability, use for diagnosis, and intervention. Responses were recorded for 48 h from launching on 1st day. We received 172 full responses, 95% of responders claimed that they have their own ultrasound machines in their units. In the opinion of 85.5% of the responders, the need for CCUS in ICU is mandatory and 14% of responders see it as optional. A significant positive association was found between responders' years of experience and obstacles to use CCUS (P < 0.001), while there was no significant association regarding responders' specialties, work region in Saudi Arabia and type of hospital they are working in (P = 0.509, 0.081, and 0.122, respectively).

A prospective randomized study to compare standard versus intensive training strategies on long-term improvement in critical care ultrasonography proficiency

BackgroundCritical care ultrasonography (CCUS) has become a daily diagnostic tool for intensivists. While the effective training measures for ultrasound novices are discussed widely, the best curriculum for the novices to retain a long-term proficiency is yet to be determined.MethodsCritical care medicine fellows who underwent an introductory CCUS workshop were randomly allocated into the standard training (ST) or the intensive training (IT) group. The IT group received an 8-h training besides the standardized fellowship education that the ST group received. Participant improvement in CCUS proficiency tests (maximum score, 200) after a 6-month training intervention was compared between the groups. CCUS examinations performed in patient care were observed over 2 years.ResultsTwenty-one fellows were allocated into the ST (n = 10) or the IT (n = 11) group. No statistically significant difference was observed in the median (interquartile range [IQR]) improvement in CCUS proficiency tests between the ST group and the IT group: 18 (3.8–38) versus 31 (21–46) (P = .09). Median (IQR) test scores were significantly higher in postintervention than preintervention for both groups: ST, 103 (87–116) versus 124 (111–143) (P = .02), and IT, 100 (87–113) versus 143 (121–149) (P < .01). Participating fellows performed 226 examinations over the 2 years of observation.ConclusionsFellows improved their CCUS proficiency significantly after 6-month training intervention. However, an additional 8-h training did not provide further benefits.

Machines that save lives in the intensive care unit: the ultrasonography machine.

This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.

Role of critical care ultrasonography in acute respiratory distress

Introduction: Acute Respiratory Distress and/or Failure (ARF), is a common and serious presentation of patients admitted to intensive care unit (ICU) and traditional diagnosis has a low accuracy except CT chest which may inappropriate to all patient. Bedside ultrasound (US) is now emerging as a valuable tool in dynamic assessment of lungs, heart, vessels and hemodynamic status. Aim of the work: Our aim in this study was to evaluate the diagnostic utility of combined cardiac and thoracic critical care ultrasonography in identifying causes of Acute Respiratory Distress and/or Failure in the early course of critical illness. Patients and method: This prospective observational study was conducted on adult patient admitted to Medical Intensive Care Unit (MICU), Department of Internal medicine, Al Hussein university hospital, Al Azhar University. All included patients underwent bedside CPUS including lung ultrasound (US) and transthoracic echocardiography plus targeted venous US by single investigator, blinded to clinical data. The US diagnosis of ARF etiology was shared with treating intensivist. Initial clinicaldiagnosis (ICD) of each patient were compared with post US clinical diagnosis.

Assessing a novel critical care ultrasonography training program for intensive care unit nurses in China.

Assessing a novel critical care ultrasonography training program for intensive care unit nurses in China.

Implementation of a Longitudinal Critical Care Fellowship Ultrasound Curriculum.

BackgroundThe use of point-of-care ultrasound as a diagnostic and interventional tool is rapidly becoming standard of care in critical care medicine; a standardized training curriculum is needed to ensure provider proficiency.ObjectiveThis study aimed to describe a longitudinal critical care ultrasound (CCUS) curriculum in a pulmonary critical care medicine (PCCM) fellowship training program. It evaluated the curriculum’s impact on fellows’ knowledge, skills, and self-reported confidence and retention of these attributes.MethodsWe conducted a prospective observational study of a longitudinal CCUS training program within a single PCCM fellowship training program. Knowledge, skills, and confidence of 22 fellows were assessed at baseline; after initial training; and at 6, 12, and 18 months in five domains (ultrasound basics, vascular, lung/pleural, abdomen, and cardiac). We quantified changes in CCUS knowledge, confidence, and skills by fellowship class and assessed for longitudinal retention of these three attributes. The difference in scores between new first-year fellows undergoing formal training and second-year fellows with previous informal training was compared at matched time points.ResultsAfter the initial formal training, there was a significant increase in knowledge, skills, and confidence scores, which were maintained or continued to increase up to 18 months. Fellows with 1 year of formal training also had a higher level of knowledge and skills than fellows with 1 year of informal training, although they had similar levels of self-reported confidence in their skills.ConclusionA formal, longitudinal CCUS curriculum implemented in a PCCM fellowship program improves trainees’ knowledge and skills in various ultrasound domains in addition to their confidence in using ultrasound for patient care. A longitudinal curriculum results in retention of all three attributes and appeared to be more effective than an informal training program based on teaching during rounds, but this needs to be replicated in a larger cohort.

Shock Resuscitation - the Necessity and Priority of Renal Blood Perfusion Assessment.

Improving organ perfusion is the aim of shock resuscitation; therefore, improving organ blood perfusion is a direct indicator for shock resuscitation. During shock, different organs have different capacities for blood flow autoregulation. The kidney is an important organ with excellent ability to autoregulate the blood flow and with vulnerability to poor organ perfusion, which places kidney perfusion in a position of necessity and priority relative to that of other organs in shock. Critical-care ultrasonography provides the best evaluation of renal perfusion.

Critical care Ultrasonography as a Decision Support and Therapeutic Assist Tool in the Intensive Care Unit: A Single Center Retrospective Survey in a District General Hospital, Sri Lanka.

Official journal of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.Interested in submitting to this journal? We recommend that you review the About the Journal page for the journal's section policies, as well as the Author Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

TOWARDS UNIVERSAL BASIC FLUENCY: A PILOT CURRICULUM IN CRITICAL CARE ULTRASOUND

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Critical care ultrasound (CCUS) continues to revolutionize how critically ill patients are cared for. CCUS refers to focused ultrasound performed by a treating practitioner to help detect and/or monitor life-threatening illnesses and to improve the safety of life-saving procedures. Although most critical care medicine (CCM) practitioners should have, at least, basic fluency in CCUS, academic institutions may find themselves ill-equipped to deliver comprehensive CCUS education to CCM trainees and practitioners. Challenges include a paucity of skilled faculty and lack of a standardized curriculum. In this study, we implement and evaluate a novel CCUS curriculum to resolve such concerns. METHODS: This is a pilot prospective study of implementation and evaluation of a longitudinal CCUS curriculum for CCM attendings, trainees, and nurse practitioners working across five medical-surgical intensive care units in Edmonton, Alberta (Canada). The curriculum was comprised of a custom online flipped-classroom learning environment, a one-day workshop, eight two-hour expert-led hands-on sessions, an image interpretation session, and longitudinal image/report-archiving with feedback. We used Kirkpatrick's Model of Evaluation to examine for pre/post-changes in perception (survey, Likert-scale 1-5), evidence of learning (30 question MCQ / psychomotor skill assessment), and behaviour change (survey). RESULTS: Fourteen CCM practitioners participated in the curriculum (7 attendings, 3 trainees, 4 nurse practitioners). The curriculum was halted at the end of the third month because of the COVID-19 pandemic. Participants reported increases in overall perceived performance and interpretation in CCUS (p=0.001) with a moderate effect size (Cohen's d=0.63). A comparison of mean exam scores (±SD) pre- and post-curriculum were 69% (± 15%) and 78% (± 11%) with a large effect size (p=0.007, d=0.86). Psychomotor skill assessment with a standardized entrustment scale demonstrated large effect sizes across all modalities (cardiac, lung, thoracic, abdominal, vascular) with effect sizes between 0.95 and 1.28. Thirteen of the fourteen participants reported an increase use of CCUS across all modalities. While participant feedback was overwhelmingly positive, some participants wanted a longer curriculum and others reported difficulty completing CCUS exam reports while caring for the critically ill. CONCLUSIONS: A longitudinal curriculum in CCUS delivered across five medical-surgical intensive care units resulted in increases in knowledge and skill with strong effect sizes. Feedback from participants emphasized the need to lengthen the curriculum, improve workflow for CCUS exam reporting, and further increase access to direct bedside mentorship. CLINICAL IMPLICATIONS: This curriculum provides a strong foundation for local CCUS education, a path to universal basic fluency, and a template with potential for national expansion. DISCLOSURES: No relevant relationships by Aws Alherbish, source=Web Response No relevant relationships by Brian Buchanan, source=Web Response No relevant relationships by Vijay Daniels, source=Web Response No relevant relationships by Jean Deschamps, source=Web Response no disclosure on file for Sean McAleer