Ultrasound Journal最新文献

{"title":"Clinical research on point-of-care lung ultrasound: misconceptions and limitations.","authors":"Giovanni Volpicelli, Serena Rovida","doi":"10.1186/s13089-024-00368-3","DOIUrl":"10.1186/s13089-024-00368-3","url":null,"abstract":"<p><p>Over the last 20 years, advances in point-of-care lung ultrasound (PoCLUS) have been consistent. The clinical application of PoCLUS has drastically changed the diagnosis of some respiratory conditions mainly in the acute setting. Despite these improvements, misconceptions regarding the current scientific evidence and errors in the direction given to the latest research are delaying the implementation of PoCLUS in the clinical field. The diagnostic power of PoCLUS is still under-evaluated in many settings and there is a generalized yet unjustified feeling that further evidence is needed before introducing PoCLUS as a standard of care. In the effort to build up further evidence by new studies, the role of randomized clinical trials is over-emphasized and gold standards used to investigate diagnostic accuracy of PoCLUS are sometimes not appropriate. Moreover, the sonographic patterns and techniques used to confirm the diagnoses not always are adapted to the patients' clinical condition, which limit the scientific value of those clinical studies. Finally, there is a recurrent confusion in the role of PoCLUS scoring techniques, which should be only applied to quantify and monitor injury severity and not to diagnose lung diseases. Awareness of these misconceptions and errors could help the researchers when approaching new study projects on PoCLUS.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"28"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11087399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veno-venous extracorporeal membrane oxygenation (VV ECMO) cannula malposition identified with point-of-care ultrasound.","authors":"Taylor Becker, Roger D Struble, Charles Rappaport","doi":"10.1186/s13089-024-00357-6","DOIUrl":"10.1186/s13089-024-00357-6","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) has become a mainstay in the evaluation of critically ill patients in the intensive care unit (ICU). ECMO patients are susceptible to complications during prolonged ICU stay, including cannula malposition, which has deleterious consequences. Although the literature surrounding utility of ultrasound on ECMO patients is expansive, direct comparison between radiographic imaging versus ultrasound for identification of cannula malposition is lacking.</p><p><strong>Case presentation: </strong>The authors identified four patients with cannula malposition discovered through POCUS that was missed on routine radiographic imaging. Identification and correction of malposition changed their ECMO course.</p><p><strong>Conclusion: </strong>This case series is the first in literature demonstrating that ultrasound may be superior to radiographic images for ECMO cannula malposition. Further investigation into this subject is warranted.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"27"},"PeriodicalIF":3.4,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11078911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic assessment of right ventricular performance in COVID-19 related acute respiratory distress syndrome: the importance of systo-diastolic interaction.","authors":"Valentino Dammassa, Costanza Natalia Julia Colombo, Massimo Erba, Fabio Ciarrocchi, Michele Pagani, Susanna Price, Francesco Mojoli, Guido Tavazzi","doi":"10.1186/s13089-024-00366-5","DOIUrl":"10.1186/s13089-024-00366-5","url":null,"abstract":"<p><strong>Background: </strong>The cardiac manifestations of COVID-19 have been described in patients with acute respiratory distress syndrome (ARDS) admitted to intensive care unit (ICU). The presence and impact of right ventricular (RV) diastolic function and performance has not been studied in this population yet. We describe the prevalence of RV diastolic dysfunction, assessed by the pulmonary valve pre-ejection A wave (PV A wave), and the RV systo-diastolic interaction, using the RV total isovolumic time (t-IVT), in COVID-19 ARDS.</p><p><strong>Results: </strong>Prospective observational study enrolling patients with moderate to severe COVID-19 ARDS admitted to ICU who underwent a transthoracic echocardiogram within 24 h of ICU admission and at least a second one during the ICU stay. Respiratory, hemodynamic and biochemistry parameters were collected. 163 patients (age 61.0 ± 9.3 years, 72% males) were enrolled. 36 patients (22.1%) had RV dysfunction, 45 (27.1%) LV systolic dysfunction. 73 patients (44.7%) had PV A wave. The RV t-IVT correlated with TAPSE at ICU admission (p < 0.002; r - 0.61), presence of PV A wave (p < 0.001; r 0.78), peak inspiratory pressure (PIP) (p < 0.001; r 0.42), PEEP (p < 0.001; r 0.68), dynamic driving pressure (DDP) (p < 0.001; r 0.58), and PaO₂/FiO₂ ratio (p < 0.01; r - 0.35). The presence of PV A wave was associated with higher PIP (p < 0.001; r 0.45), higher PEEP (p < 0.001; r 0.56), higher DDP (p < 0.01, r 0.51), and lower PaO₂/FiO₂ ratio (p < 0.001; r - 0.49).</p><p><strong>Conclusions: </strong>RV t-IVT and the presence of PV A wave are non-invasive means to describe a significant RV diastolic dysfunction and may be consider descriptive signs of RV performance in COVID-19 ARDS.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"26"},"PeriodicalIF":3.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11076422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of the Venous Excess Ultrasound (VEXUS) score to track dynamic change in volume status in patients undergoing fluid removal during haemodialysis - the ACUVEX study.","authors":"Adrian Wong, Olusegun Olusanya, Jim Watchorn, Kate Bramham, Sam Hutchings","doi":"10.1186/s13089-024-00370-9","DOIUrl":"10.1186/s13089-024-00370-9","url":null,"abstract":"<p><strong>Background: </strong>The use of ultrasound assessment, including the Venous Excess Ultrasound (VEXUS) score, is increasingly being utilised as part of fluid status assessment in clinical practice. We aimed to evaluate the ability of the VEXUS score to track fluid removal during the course of the dialysis session and explore the relationship between traditional measures of fluid status and venous congestion.</p><p><strong>Methods: </strong>Single-centre, observational study in patients undergoing intermittent haemodialysis, who presented above their target dry weight. Patients had serial assessment using VEXUS, lung ultrasound and selected echocardiographic measures, before, during and after fluid removal.</p><p><strong>Results: </strong>Amongst 33 patients analysed, 5 (15%) had an elevated VEXUS score (> 0). There was no difference in starting weight, dry weight or amount of fluid removed in patients with a normal VEXUS score and those with an elevated VEXUS score. In all patients with elevated VEXUS scores, the degree of venous congestion improved during the course of fluid removal. All patients with an elevated VEXUS score had evidence of both right and left ventricular systolic impairment.</p><p><strong>Conclusion: </strong>In patients with ESRF undergoing haemodialysis, the incidence of venous congestion as measured by the VEXUS is low. In patients with elevated VEXUS scores, removal of fluid through haemodialysis improves the venous congestion score. The pattern of LV and RV systolic dysfunction suggests that VEXUS may be a reflection of cardiac failure rather than venous volume status.</p><p><strong>Trial registration: </strong>Ethical approval was provided by South Central-Berkshire Research and Ethics Committee and registered on clinicaltrials.org (IRAS305720).</p><p><strong>Trial registration: </strong>ISRCTN14351189 - Retrospectively registered on 30/11/2023.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"23"},"PeriodicalIF":3.4,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roberto Copetti, MD (1954-2024).","authors":"Giovanni Volpicelli","doi":"10.1186/s13089-024-00372-7","DOIUrl":"10.1186/s13089-024-00372-7","url":null,"abstract":"","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"22"},"PeriodicalIF":3.4,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10965867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Internal Medicine Ultrasound (CIMUS) consensus statement: recommendations for mandatory ultrasound competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterization.","authors":"","doi":"10.1186/s13089-024-00363-8","DOIUrl":"10.1186/s13089-024-00363-8","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a Canadian Internal Medicine Ultrasound (CIMUS) consensus statement on recommended mandatory point-of-care ultrasound (POCUS) competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterizations (CVC) for internal medicine physicians.</p><p><strong>Methods: </strong>The 2022 CIMUS group consists of 27 voting members, with representations from all 17 Canadian academic institutions across 8 provinces. Members voted in 3 rounds on 46 procedural competencies as \"mandatory, must include\", \"optional, could include\" or \"superfluous, do not include\". These 46 competencies included 6 general competencies that apply to all POCUS-guided procedures, 11 competencies for thoracentesis, 10 competencies for paracentesis, and 19 competencies for CVC.</p><p><strong>Results: </strong>In the first round, members reached consensus on 27 competencies (5 general, 6 thoracentesis, 8 paracentesis, 8 CVC). In the second round, 10 competencies (1 general, 2 thoracentesis, 1 paracentesis, 6 CVC) reached consensus. In the third round, 2 additional competencies (1 paracentesis, 1 CVC) reached consensus for being mandatory and 3 as optional (1 thoracentesis and 2 CVC). Overall, a total of 28 competencies reached consensus as mandatory, 3 as optional, while 11 competencies reached consensus as superfluous. Four competencies did not reach consensus for either inclusion or exclusion.</p><p><strong>Conclusions: </strong>The CIMUS group recommends 28 competencies be considered mandatory and 3 as optional for internal medicine physicians performing POCUS guided thoracentesis, paracentesis, and CVC placement. National curriculum development and implementation efforts should include training these mandatory competencies.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"21"},"PeriodicalIF":3.4,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung ultrasound score predicts outcomes in patients with acute respiratory failure secondary to COVID-19 treated with non-invasive respiratory support: a prospective cohort study.","authors":"Mauro Castro-Sayat, Nicolás Colaianni-Alfonso, Luigi Vetrugno, Gustavo Olaizola, Cristian Benay, Federico Herrera, Yasmine Saá, Guillermo Montiel, Santiago Haedo, Ignacio Previgliano, Ada Toledo, Catalina Siroti","doi":"10.1186/s13089-024-00365-6","DOIUrl":"10.1186/s13089-024-00365-6","url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasound has demonstrated its usefulness in several respiratory diseases management. One derived score, the Lung Ultrasound (LUS) score, is considered a good outcome predictor in patients with Acute Respiratory Failure (ARF). Nevertheless, it has not been tested in patients undergoing non-invasive respiratory support (NIRS). Taking this into account, the aim of this study is to evaluate LUS score as a predictor of 90-day mortality, ETI (Endotracheal intubation) and HFNC (High Flow Nasal Cannula) failure in patients with ARF due to COVID-19 admitted to a Respiratory Intermediate Care Unit (RICU) for NIRS management.</p><p><strong>Results: </strong>One hundred one patients were admitted to the RICU during the study period. Among these 76% were males and the median age was 55 (45-64) years. Initial ARF management started with HFNC, the next step was the use of Continuous Positive Airway Pressure (CPAP) devices and the last intervention was ETI and Intensive Care Unit (ICU) admission. Of the total study population, CPAP was required in 40%, ETI in 26%, while 15% died. By means of a ROC analysis, a LUS ≥ 25 points was identified as the cut-off point for mortality(AUC 0.81, OR 1.40, 95% CI 1.14 to 1.71; p < 0.001), ETI (AUC 0.83, OR 1.43, 95% CI 1.20 to 1.70; p < 0.001) and HFNC failure (AUC 0.75, OR 1.25, 95% CI 1.12 to 1.41; p < 0.001). Kaplan-Meier survival curves also identified LUS ≥ 25 as a predictor of 90-days mortality (HR 4.16, 95% CI 1.27-13.6) and 30 days ETI as well.</p><p><strong>Conclusion: </strong>In our study, a ≥ 25 point cut-off of the Lung Ultrasound Score was identified as a good outcome prediction factor for 90-days mortality, ETI and HFNC failure in a COVID-19 ARF patients cohort treated in a RICU. Considering that LUS score is easy to calculate, a multicenter study to confirm our findings should be performed.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"20"},"PeriodicalIF":3.4,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10923765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating a self-directed ultrasound curriculum for the internal medicine clerkship.","authors":"Emily Signor, John Gerstenberger, Jennifer Cotton, Jorie Colbert-Getz, Katie Lappé","doi":"10.1186/s13089-024-00367-4","DOIUrl":"10.1186/s13089-024-00367-4","url":null,"abstract":"<p><strong>Background: </strong>Incorporating ultrasound into the clinical curriculum of undergraduate medical education has been limited by a need for faculty support. Without integration into the clinical learning environment, ultrasound skills become a stand-alone skill and may decline by the time of matriculation into residency. A less time intensive ultrasound curriculum is needed to preserve skills acquired in preclinical years. We aimed to create a self-directed ultrasound curriculum to support and assess students' ability to acquire ultrasound images and to utilize ultrasound to inform clinical decision-making.</p><p><strong>Methods: </strong>Third year students completed the self-directed ultrasound curriculum during their required internal medicine clerkship. Students used Butterfly iQ+ portable ultrasound probes. The curriculum included online modules that focused on clinical application of ultrasound as well as image acquisition technique. Students were graded on image acquisition quality and setting, a patient write-up focused on clinical decision-making, and a multiple-choice quiz. Student feedback was gathered with an end-of-course survey. Faculty time was tracked.</p><p><strong>Results: </strong>One hundred and ten students participated. Students averaged 1.79 (scale 0-2; SD = 0.21) on image acquisition, 78% (SD = 15%) on the quiz, and all students passed the patient write-up. Most reported the curriculum improved their clinical reasoning (72%), learning of pathophysiology (69%), and patient care (55%). Faculty time to create the curriculum was approximately 45 h. Faculty time to grade student assignments was 38.5 h per year.</p><p><strong>Conclusions: </strong>Students were able to demonstrate adequate image acquisition, use of ultrasound to aid in clinical decision-making, and interpretation of ultrasound pathology with no in-person faculty instruction. Additionally, students reported improved learning of pathophysiology, clinical reasoning, and rapport with patients. The self-directed curriculum required less faculty time than prior descriptions of ultrasound curricula in the clinical years and could be considered at institutions that have limited faculty support.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"19"},"PeriodicalIF":3.4,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10914648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound to inform antiviral treatment initiation in chronic hepatitis B virus infection in low-resource settings - the PUSH protocol.","authors":"Tom Heller, Veronica Phiri, Tapiwa Kumwenda, Wongani Mzumara, Michael Jeffrey Vinikoor, Ethel Rambiki, Claudia Wallrauch","doi":"10.1186/s13089-024-00369-2","DOIUrl":"10.1186/s13089-024-00369-2","url":null,"abstract":"<p><strong>Background: </strong>Chronic Hepatitis B (CHB) is prevalent worldwide and most related deaths occur in low-resource settings. Antiviral treatment of CHB is indicated in those with significant liver disease and markers of viral replication. However, recommended diagnostics such as elastography (a non-invasive imaging measure of fibrosis/cirrhosis) or HBV viral load are often lacking in these settings, which creates barriers to treatment. Point-of-care clinical B-mode ultrasound (US) has potential to overcome implementation barriers in HBV care programs in low-resource settings.</p><p><strong>Methods: </strong>We describe a Point-of-care US protocol for Hepatitis (\"PUSH\") to check for signs of cirrhosis and hepatocellular carcinoma in the liver of people with CHB. We performed a prospective observational study applying the protocol, first by trainee clinicians and then by trainers, in consecutive patients referred to our clinic for CHB treatment eligibility assessment. All patients additionally underwent physical examination, liver function tests (LFTs) and platelet counts. We describe the PUSH training approach and performance of the protocol.</p><p><strong>Results: </strong>Four clinicians and 111 adult patients with HBV infection were included in the development of PUSH. Using US, liver complications of HBV were documented in 31 (27.9%) patients; including cirrhosis in 15 patients, HCC with cirrhosis in 13, and HCC without cirrhosis in 3. Patients with sonographic findings had significantly more clinical symptoms also their LFTs were higher and more frequently indicative for HBV treatment. Of 28 patients with sonographic diagnosis of cirrhosis, 23 (82.1%) showed a nodular liver surface, 24 (85.7%) a coarse echotexture, 20 (71.4%) scarce vessels, and 9 (32.1%) an enlarged caudate lobe. Overall concordance of the findings between assessment of trainees and experienced sonographers was high, ranging from 90 to 95%; trainees were not blinded to clinical and laboratory findings.</p><p><strong>Conclusion: </strong>Ultrasound can facilitate same-day initiation of antiviral therapy for chronic HBV monoinfection in a resource-limited setting and a streamlined protocol-driven liver ultrasound can be feasibly used by front line clinicians managing HBV.</p>","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"18"},"PeriodicalIF":3.4,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10912069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right ventricular free wall longitudinal strain during weaning from mechanical ventilation using high-flow or conventional oxygen treatment: a pilot study.","authors":"Eleni Xourgia, Apostolos Koronaios, Anastasia Kotanidou, Ilias I Siempos, Christina Routsi","doi":"10.1186/s13089-024-00358-5","DOIUrl":"10.1186/s13089-024-00358-5","url":null,"abstract":"","PeriodicalId":36911,"journal":{"name":"Ultrasound Journal","volume":"16 1","pages":"17"},"PeriodicalIF":3.4,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10899142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}