Best Practice & Research-Clinical Anaesthesiology最新文献

{"title":"Point of care ultrasound (PoCUS) in low- and middle-income countries","authors":"Mohamed Eissa ,&nbsp;Gabrielle Lessard ,&nbsp;Juan Morales ,&nbsp;Wesley Rajaleelan ,&nbsp;Jose A. Calvache","doi":"10.1016/j.bpa.2025.11.005","DOIUrl":"10.1016/j.bpa.2025.11.005","url":null,"abstract":"<div><div>Point-of-Care Ultrasound (PoCUS) is a portable, affordable, and versatile diagnostic and procedural tool that enhances bedside decision-making. Its simplicity and safety make it especially valuable in low- and middle-income countries (LMICs), where access to advanced imaging is limited. PoCUS helps bridge diagnostic gaps by enabling real-time, noninvasive assessment and procedural guidance across anesthesiology, perioperative care, critical care, and emergency-medicine. However, implementation in LMICs faces barriers such as limited device availability, high costs, maintenance difficulties, and insufficient training. Equipment availability, accessibility and structured education remain key determinants of adoption. Training programs are often short-term and externally led, with limited long-term integration into local systems. Emerging strategies including “train-the-trainer” approaches, blended learning, and tele-mentoring—offer scalable solutions. Coordinated efforts across access, education, and sustainability—supported by mentorship and standardized credentialing—are essential. Ultimately, PoCUS represents more than a diagnostic tool; it is a driver of equity, safety, and empowerment in global health.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 382-389"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitative transesophageal echocardiography","authors":"Jacobo Moreno Garijo ,&nbsp;Pablo Pérez d’Empaire ,&nbsp;Benjamin Weingarten","doi":"10.1016/j.bpa.2025.10.004","DOIUrl":"10.1016/j.bpa.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Resuscitative transesophageal echocardiography (rTEE) has emerged as a transformative point-of-care imaging modality that integrates diagnostic and procedural guidance into real-time resuscitation. Unlike transthoracic echocardiography (TTE), rTEE provides continuous, high-resolution cardiac imaging without interrupting chest compressions, overcoming traditional limitations in patients with undifferentiated shock or cardiac arrest.</div></div><div><h3>Content</h3><div>This review summarizes the evolution, technical foundations, and clinical applications of rTEE across resuscitation, extracorporeal membrane oxygenation (ECMO), and peri-arrest care. We discuss the development of focused scanning protocols—such as the ACEP 3-view, Resuscitative TEE 4-view, and 3 + 2 frameworks—that enable rapid qualitative assessment of cardiac activity, ventricular function, volume status, and reversible causes of arrest. Diagnostic advantages include superior rhythm classification (distinguishing <strong>pulseless electrical activity (PEA)</strong>, pseudo-PEA, fine VF, and standstill), improved pulse-check accuracy, and identification of the area of maximal compression (AMC) to optimize CPR quality. Procedurally, rTEE supports real-time ECMO cannulation, monitoring, and decannulation, complementing ELSO recommendations for both V-A and V–V configurations. Evidence-based echocardiographic parameters—such as LVOT velocity time integral (VTI), MAPSE, TAPSE, and t-IVT—inform readiness for ECMO liberation and predict recovery or need for durable mechanical support.</div></div><div><h3>Outlook</h3><div>Focused rTEE training pathways and credentialing frameworks are now available for anesthesiologists, intensivists, and emergency physicians, expanding its accessibility in perioperative and critical care environments. As the technology becomes more widespread, future research should standardize rTEE competency assessment, validate outcome-based protocols, and further integrate rTEE into precision-guided resuscitation algorithms.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 338-350"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"POCUS for Pediatrics","authors":"Deepa Kattail ,&nbsp;Walid Alrayashi ,&nbsp;Andrea Gomez Morad ,&nbsp;Rodrigo Daly Guris ,&nbsp;John G. Hagen","doi":"10.1016/j.bpa.2025.11.009","DOIUrl":"10.1016/j.bpa.2025.11.009","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) has transformed pediatric acute care by enabling rapid, bedside assessment that enhances diagnostic precision and procedural safety across perioperative, emergency, and critical care settings. Core pediatric POCUS applications include lung, cardiac, gastric, abdominal, vascular, and airway imaging. Lung and cardiac ultrasound improve evaluation of ventilation, effusions, and hemodynamic function, while gastric ultrasound assists in aspiration risk assessment. Abdominal and vascular applications enhance trauma evaluation and procedural success, and airway ultrasound aids in tube placement and emergency access. As POCUS becomes a core clinical competency, contemporary trainees are gaining formal proficiency, and established clinicians are integrating it into practice. Broader adoption, standardized education, and ongoing research are essential to optimize its role in improving pediatric patient outcomes.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 360-372"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From probe to practice: Implementing point-of-care ultrasound in anesthesiology","authors":"Riet Dehouwer ,&nbsp;Lynn Vernieuwe ,&nbsp;Barbara Versyck","doi":"10.1016/j.bpa.2025.11.001","DOIUrl":"10.1016/j.bpa.2025.11.001","url":null,"abstract":"<div><div>Point-of-care ultrasound is a transformative tool in anesthesiology. It provides real-time bedside imaging that enhances diagnostics, accelerates decision-making, and improves perioperative safety. Despite clear benefits, routine integration remains limited due to financial, educational, and organizational barriers.</div><div>Strategies focus on affordable device procurement, structured training with standardized curricula, and faculty development. Change is driven by integration into residency programs, local ambassadors, and pilot projects, while institutional policies on credentialing, quality assurance, and medicolegal protection safeguard consistent practice. Future developments such as handheld devices, AI-assisted interpretation, tele-ultrasonography, and electronic health record integration promise broader accessibility and improved quality control. By systematically addressing barriers, point-of-care ultrasound can become embedded in perioperative workflows as a standard of care, ultimately improving patient outcomes and advancing modern perioperative medicine. This review outlines a structured framework for implementing point-of-care ultrasound in anesthesiology.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 279-285"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway POCUS. Perspectives on clinical usefulness in scanning the airway","authors":"L.A. Bruijstens ,&nbsp;P. Van de Putte ,&nbsp;J. Bruhn ,&nbsp;M.S. Kristensen","doi":"10.1016/j.bpa.2025.11.007","DOIUrl":"10.1016/j.bpa.2025.11.007","url":null,"abstract":"<div><div>Airway point-of-care ultrasound (POCUS) has the potential to make airway assessment and planning more accurate and complete. Studies have examined feasibility and usefulness of POCUS to predict and facilitate difficult airway management. This paper presents a brief overview of contemporary POCUS airway applications and current opinion on their place in clinical practice. Despite evidence, infraglottic airway assessment and its potential to improve patient safety remains relatively underused. A case series is presented to illustrate the translation of POCUS training to real life routine and acute practice. For each case, how ultrasound contributed to decision-making, preparedness, and successful management of challenging airways is highlighted. Understanding the airway's true orientation and midline through imaging helps prevent failed front-of-neck access (FONA) attempts and supports deliberate, safe airway strategies. Wider adoption, structured training, and further research are needed to standardize POCUS airway techniques and evaluate their impact on patient outcomes.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 309-320"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From shadows to clarity: The rise of point-of-care ultrasound in perioperative medicine","authors":"Peter Van de Putte ,&nbsp;Pablo Perez d'Empaire","doi":"10.1016/j.bpa.2025.11.004","DOIUrl":"10.1016/j.bpa.2025.11.004","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 277-278"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous excess ultrasound score (VExUS)","authors":"Hari Naga Garapati ,&nbsp;Srinivas Dandamudi ,&nbsp;Hari Kalagara","doi":"10.1016/j.bpa.2025.11.010","DOIUrl":"10.1016/j.bpa.2025.11.010","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 351-359"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PoCUS in the pregnant patient","authors":"Anna Impiumi ,&nbsp;Ryan Howle","doi":"10.1016/j.bpa.2025.10.003","DOIUrl":"10.1016/j.bpa.2025.10.003","url":null,"abstract":"<div><div>Point-of-care ultrasound (PoCUS) is an essential diagnostic tool increasingly adopted by obstetric anaesthesiologists to complement the physical examination and rapidly assess and manage pregnant patients in a variety of clinical scenarios. This review explores the use of PoCUS focusing on the anatomical and physiological changes in pregnancy that impact its technique and interpretation. It examines the evidence supporting the use of lung, cardiac, lower limbs, abdominal and optic nerve sheath PoCUS in multiple clinical conditions, as well as its use in guiding preoperative aspiration risk via gastric assessment and in facilitation airway management in the obstetric patient. The review highlights both the strengths and challenges inherent to obstetric PoCUS and aims to equip the reader with a framework to combine different PoCUS modalities in order to achieve a diagnosis based on the combination of the pregnant patient's symptomatology and ultrasonographic findings.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 373-381"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular point-of-care ultrasound: A comprehensive guide to bedside echocardiography","authors":"Stefaan Bouchez","doi":"10.1016/j.bpa.2025.11.008","DOIUrl":"10.1016/j.bpa.2025.11.008","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) has greatly transformed bedside patient care by enabling clinicians to conduct rapid, non-invasive evaluations of cardiac structure and function. This review presents a systematic approach to structural and functional cardiac assessment using POCUS, with an emphasis on left and right ventricular dimensions and function, preload and volume responsiveness, and valvular assessment. The echocardiographic measurements that can be readily performed at the bedside are discussed. This review also emphasizes the vital role of POCUS in identifying life-threatening conditions, such as pericardial effusion and tamponade, acute pulmonary embolism, cardiogenic shock due to left ventricular failure, hypovolemic shock, and aortic stenosis. Finally, the importance of clinician training in cardiac POCUS is highlighted, with a focus on standardized methods, structured training programs, and developing clinician competencies.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 321-337"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care gastric ultrasound: Redefining aspiration risk assessment in anesthesia","authors":"Valentina Franco-Uribe ,&nbsp;Laura Girón-Arango","doi":"10.1016/j.bpa.2025.11.006","DOIUrl":"10.1016/j.bpa.2025.11.006","url":null,"abstract":"<div><div>Point-of-care gastric ultrasound is a key tool to assess perioperative aspiration risk especially in patients with risk factors (uncertain fasting, diabetes, pregnancy, glucagon-like peptide-1 receptor agonist use) and those scheduled for urgent procedures. The assessment of antral content qualitatively (empty, clear fluid, thick fluid/solid) and, when appropriate, the quantification of volume in the presence of clear fluid, helps to identify those patients at high risk of aspiration influencing the anesthetic plan—avoiding unnecessary cancellations when the stomach is empty and prompting rapid-sequence induction or delay when is full, increasing patient safety. The benefit of a structured application guided by the I-AIM framework (indication-acquisition-interpretation and medical-decision making) and population-specific cutoffs, makes its application reliable and accurate. The aim of this review is to summarize the current evidence, describe practical aspects of the technique, interpretation, and discuss future applications.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"39 4","pages":"Pages 286-295"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}