Role Of Point-of-care Ultrasound Research Articles

An [illustrative] update on pediatric emergency ultrasound: part 3 - cerebral, musculoskeletal and other applications.

Point-of-care ultrasound (POCUS) plays an essential role in pediatric emergency medicine by improving diagnostics and procedural safety. The role of POCUS in the care of pediatric patients in the emergency department has expanded considerably in recent years. Cranial and musculoskeletal imaging has significant potential, yet POCUS has also become a vital tool for common procedures, such as central and difficult peripheral intravenous access. The purpose of this article is to provide an overview of pediatric POCUS applications for cranial, small parts (head, eyes, nose, throat, and soft tissue), musculoskeletal, and common procedural applications, forming the third part of the series.

An [illustrative] update on pediatric emergency medicine ultrasound: part 1 - trauma and thoracic applications.

Point-of-care ultrasound (POCUS) plays an essential role in emergency medicine, providing a range of diagnostic and procedural modalities. It does not involve any ionizing radiation and can improve procedural accuracy and safety. The role of POCUS in the care of pediatric patients differs somewhat from that of adult patients, as there are a range of conditions specific to infants and children. The technical background of pediatric POCUS and its current applications for trauma and thoracic scanning are reviewed and illustrated in this first article of this series.

Role of POCUS in Assessing an Acute Aortic Thrombus

A 67-year-old female patient presented with abdominal pain with a recent diagnosis of paroxysmal atrial fibrillation. Computed tomography (CT) of the abdomen demonstrated a filling defect concerning for an aortic thrombus. Point of care ultrasound (POCUS) confirmed a mobile thrombus in the proximal abdominal aorta in close proximity to several major arterial branches, leading to urgent surgical consultation due to a concern for mesenteric and end-organ ischemia. POCUS played a role in determining patient management in this novel case, and the patient was anticoagulated and ultimately discharged from the hospital.

Point-of-care ultrasound (POCUS) in acute hospitalized older patients focused on hydration.

Acutely ill older patients frequently suffer not only from their acute disease, but also polymorbidity and frailty. Dehydration is another typical symptom, usually occurring in its both forms: low-intake dehydration and volume depletion. POCUS is goal-directed bedside ultrasound examination and several studies refer to its positive impact on hydration assessment. The aim of our study was to determine whether POCUS might influence (de)hydration diagnostics and/or treatments in older patients with acute illness. We randomized 120 acutely ill patients, aged ≥65 years, into POCUS and non-POCUS groups. All participants underwent routine laboratory tests, including haematocrit, serum and urine osmolality, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio, and C-reactive protein (CRP). POCUS was performed twice during the first two days to determine chest and abdominal status, with inferior vena cava (IVC) measurements. Length of hospital stay (HL) and consumption of infused fluids (CIF) was evaluated too. Data were analysed with exploratory methods and appropriate statistics. Among all participants, the serum osmolality significantly correlated with age, BUN, creatinine and CIF. HL correlated with CRP and CIF. No significant correlations between IVC and other followed parameters were found. The POCUS group consumed significantly less infused fluids than the non-POCUS group, what could be influenced by POCUS examination of defined body compartments. Dehydration is a common feature in older individuals and its diagnostics is rather complicated. The role of POCUS in assessing hydration status remains unclear. However, our study showed, that ultrasound assessment provides next important information for comprehensive understanding of clinical status in older patients and can be beneficial for optimizing the treatment strategy, including fluid management decisions.

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

How to assess, detect, and manage joint involvement in the era of transformational therapies: Role of point-of-care ultrasound.

Patients with haemophilia experience recurring hemarthroses, mainly involving knees, elbows and ankles, which lead to haemophilic arthropathy, the major chronic complication of haemophilia. With new approaches to haemophilia treatment leading to fewer joint bleeds and, in some cases, no bleeding events, assessing whether current outcome assessment tools provide adequate sensitivity and specificity for management and care of patients with haemophilia is needed. An overview of current imaging tools for monitoring joint health, novel osteochondral damage and synovial proliferation biomarkers, and the relationship between assessments for functionality and imaging modalities is provided. Usefulness and sensitivity of point-of-care ultrasound (POCUS) to complement other assessments and use of ultrasound to monitor haemophilic arthropathy are also examined. This review provides rationale for haemophilia teams to move beyond traditional outcomes in joint imaging, as well as guidance and evidence on assessment of joint health for potential new treatment modalities, such as gene therapy. The role of POCUS in the existing paradigm for haemophilia care and management along with the use of ultrasound as a complement to other outcome assessment tools are also discussed. Finally, the clinical effects of subclinical bleeding on joint function are described, to motivate screening for synovial proliferation. POCUS can facilitate the early detection of joint damage and can monitor disease progression while providing insights into the efficacy of treatment regimens, and should be considered as an essential assessment tool for managing the care of patients with haemophilia.

Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit.

Purpose of ReviewThis review summarizes the diverse uses of point-of-care ultrasound (POCUS) in critically ill children with congenital and acquired heart disease. Diagnostic utility and practicality of POCUS is reviewed. Importantly, the role of POCUS in the medical management of children in the cardiac intensive care unit is highlighted.Recent FindingsThe use of POCUS in critically ill pediatric patients has emerged as an essential diagnostic tool that enhances the physical examination and influences delivery of care. Assessment of a wide range of body systems and pathologies has been impacted by the use of POCUS. Recent studies have demonstrated the use of POCUS for evaluation of cardiac tamponade, pneumonia, vocal cord function, and loss of muscle mass in critically ill children (Hamilton et al. Pediatr Crit Care Med 22(10):e532-e539, 2021; Hoffmann et al. Pediatr Crit Care Med 22(10):889-897, 2021; Najgrodzka et al. Ultrasound Q 35(2):157 163, 2019; Alerhand et al. Pediatr Ann 50(10):e424-e431, 2021).SummaryPOCUS is a non-invasive, low-risk, imaging modality that can be used to diagnose and help guide management of critically ill children in the cardiac intensive care unit. POCUS can be performed by an intensivist at the patient’s bedside with real-time interpretation, leading to rapid clinical decision-making and the hope of improving patient outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40746-022-00250-1.

Integrating Point of Care Ultrasound into Nephrology Fellowship Training: Insights from a Pilot Program.

In nephrology, point-of-care ultrasound (POCUS) has multiple applications including the rapid evaluation of acute kidney injury, enhancing the initial evaluation of chronic kidney disease, direct evaluation of vascular access, and improved fluid balance management in acute and chronic settings [1, 2]. Recently, the role of POCUS has been formally acknowledged by the American College of Physicians and curricula specific to nephrology have been proposed [3, 4]. However, the integration of a novel clinical skill into a field comes with its unique set of challenges. Above all, most nephrologists in leadership roles within fellowship training programs lack POCUS experience, which represent a significant barrier for adequate exposure and teaching. Although educational curriculum centered on nephrology have been proposed, the optimal model to ensure adequate POCUS exposure considering the scarcity of expertise among educators is not known.

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort...

Application of Point-of-Care Ultrasound(POCUS) in Children with End-Stage KidneyDisease

The use of point-of-care ultrasound is becoming increasingly common among non-radiologist clinicians. There has also been increased interest in the bedside assessment of fluid status in hemodialytic patients. Lung ultrasound and inferior vena cava collapsibility index measurement methods may assist the detection of fluid overload. Current information on the role of POCUS in regard of the assessment of predialytic fluid overload in hemodialytic children is scarce. In this article, we aim to review and emphasize the importance of a non-invasive bedside method of assessing the predialytic volume overload of children based on the published literature. Well-designed studies with larger samples are needed to prove the reliability of the use of lung ultrasound and inferior vena cava collapsibility index in the assessment of predialysis fluid overload in children.

Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review.

Right-to-left pulmonary and cardiac shunts (RLS) are important causes of refractory hypoxia in the critically-ill perioperative patient. Using a point-of-care ultrasound (POCUS) agitated saline bubble study for an early diagnosis allows patients with clinically significant RLSs to receive expedited therapy. This narrative review discusses the principles of agitated saline ultrasonography as well as the role of POCUS in detecting the most common RLS types seen in the intensive care unit, including patent foramen ovale, atrial septal defects, and pulmonary arterio-venous malformations. An illustrated discussion of the procedure, as well as shunt-enhancing maneuvers (Valsalva or lung recruitment maneuver with subsequent rapid release) is provided. With the wide dissemination of bedside ultrasound within the perioperative and critical care arena, POCUS practitioners should be knowledgeable of the potential pitfalls leading to both false-positive and false-negative studies. False-positive studies may be due to congenital abnormalities, mischaracterization of intrapulmonary shunts as intracardiac shunts (and vice versa), or evidence of the Valsalva effect. False negatives are typically due to respiratory-phasic variation, performing an inadequate shunt-enhancing maneuver, inadequate injection of agitated saline, or pathophysiologic states of elevated left atrial pressure. Finally, alternative POCUS methods for determining presence of an RLS in patients with poor echocardiographic windows are discussed, with a focus on pulsed-wave Doppler interrogation of arterial signals.

POCUS in Acute Medicine

POCUS in Acute Medicine

A Case of Thrombus in Transit: Role of POCUS in Early Diagnosis of Pulmonary Thromboembolism.

Pulmonary embolism is a cause of significant morbidity and mortality. Thrombus in transit is defined on ultrasound as mobile echogenic material, temporarily located in the right heart chambers making its way to the pulmonary vasculature, which is highly diagnostic of pulmonary embolism. Point-of-care ultrasound (POCUS) places significant role in early diagnosis of thrombus in transit. Point-of-care ultrasound also avoids the need for subsequent computed tomography angiogram for diagnosis of pulmonary embolism. We present the case of 53-year-old male who presented with shortness of breath and was noted to have sinus tachycardia; thrombus in transit was diagnosed by point-of-care ultrasound and was subsequently confirmed through computer tomography angiogram of the pulmonary artery.