POCUS journal最新文献

{"title":"VExUS in Mechanical Circulatory Support: Unveiling the Role of Doppler Ultrasound in Assessing Venous Congestion.","authors":"Abhilash Koratala, Mark Jacobs, Uday Gulati, Ayush Sutaria, Ali A Naqvi, Anthony Carlese","doi":"10.24908/pocusj.v11i01.19348","DOIUrl":"10.24908/pocusj.v11i01.19348","url":null,"abstract":"<p><p>Persistent congestion in decompensated heart failure predicts poor outcomes. The Venous Excess Ultrasound (VExUS) score, which integrates hepatic, portal, and intrarenal Doppler waveforms, provides a dynamic, noninvasive measure of venous congestion and outperforms right atrial pressure alone. Its utility during mechanical circulatory support remains largely unexplored. We report a case of right ventricular failure requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) and intra-aortic balloon pump (IABP). Despite changes in arterial waveform with IABP settings, venous Doppler signals remained stable, suggesting minimal impact on congestion. In contrast, clamping the ECMO circuit led to marked worsening of portal and intrarenal waveforms, highlighting the drainage cannula's role in right-sided offloading. Hepatic vein Doppler remained unchanged due to severe tricuspid regurgitation (TR). This case illustrates the value of VExUS in monitoring venous congestion during advanced cardiac support and its potential in guiding decongestion strategies, weaning decisions, and right heart support. Further research is needed to validate these observations.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"54-61"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936163","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":"Visualizing an Umbilical Venous Catheter in Malposition Using POCUS.","authors":"Jacob Kelner, Douglas Moote","doi":"10.24908/pocusj.v11i01.19974","DOIUrl":"10.24908/pocusj.v11i01.19974","url":null,"abstract":"<p><p>Umbilical venous catheters (UVCs) are commonly needed in critically ill infants in the neonatal intensive care unit (NICU). However, there is an increased risk for major adverse events with improper positioning. There is a strong argument for using point of care ultrasound (POCUS) to determine catheter tip positioning during and after UVC placement, but X-rays remain the gold standard in many NICUs. This case reports a UVC in malposition in the liver viewed on POCUS after appearing to be in the correct position on both anteroposterior (AP) and lateral X-rays.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"126-129"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936138","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":"Modified Venous Excess Ultrasound (mVExUS) in the Prediction of Ventilator Weaning Failure: a Cohort Study.","authors":"Tiago Hermes Maeso Montes, Wagner Luis Nedel, Márcio Manozzo Boniatti","doi":"10.24908/pocusj.v11i01.19496","DOIUrl":"10.24908/pocusj.v11i01.19496","url":null,"abstract":"<p><strong>Background: </strong>Ventilator weaning failure is a significant challenge in critically ill patients, and venous congestion has emerged as a potentially modifiable factor influencing weaning outcomes. This study aimed to investigate the association between venous congestion identified by the modified venous excess ultrasound (mVExUS) score and ventilator weaning failure in critically ill patients.</p><p><strong>Methods: </strong>We prospectively enrolled patients aged 18 years or older who had received mechanical ventilation (MV) for at least 48 hours. A mVExUS score, excluding the intrarenal component, and a lung point of care ultrasound (POCUS) assessment were performed before a spontaneous breathing trial (SBT). The primary outcome was weaning failure, defined as a failed SBT or the need for MV (invasive or non-invasive) within 72 hours.</p><p><strong>Results: </strong>Among 111 patients, 57 (51.4%) experienced ventilator weaning failure. Ventilator weaning failure occurred in 63.9% of patients with mVExUS scores of 2-3, compared to 45.3% with scores of 0-1 (p = 0.067). In adjusted analyses, mVExUS scores of 2-3 were independently associated with weaning failure (OR 2.756, p = 0.03). A post-hoc analysis combining mVExUS and lung POCUS scores showed a weaning failure incidence of 76.5% in patients with mVExUS scores of 2-3 and lung POCUS scores ≥7, compared to 34.1% in patients with mVExUS scores of 0-1 and lung POCUS scores <7 (p = 0.002).</p><p><strong>Conclusion: </strong>mVExUS scores of 2-3 are significantly associated with a higher risk of weaning failure and post-extubation respiratory failure. Combining VExUS and lung POCUS scores may enhance the assessment of weaning readiness in critically ill patients.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"37-44"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936026","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":"Pyogenic Pericarditis Leading to Cardiac Arrest: a Case Report Highlighting POCUS-Guided Pericardiocentesis.","authors":"Nadine Ajami, Brian Kohen, Donny Perez, Eric Boccio","doi":"10.24908/pocusj.v11i01.19751","DOIUrl":"10.24908/pocusj.v11i01.19751","url":null,"abstract":"<p><p>A 44-year-old man with a history of intravenous drug use presented to the emergency department in cardiac arrest. Point of care ultrasound (POCUS) revealed a pericardial effusion with tamponade physiology. Initial landmark-guided pericardiocentesis returned blood but failed to confirm guidewire placement via POCUS. A repeat, ultrasound-guided pericardiocentesis yielded purulent fluid. Subsequent drainage of 50 mL of fluid improved cardiac contractility and hemodynamics. The patient was admitted to the intensive care unit, and pericardial fluid cultures grew <i>Streptococcus pneumoniae</i>. This case highlights the diagnostic and procedural utility of POCUS in managing purulent pericardial tamponade as a cause of cardiac arrest.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"30-33"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936165","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":"Laying a Strong Foundation with a Novel \"Basal-Bolus\" Point of Care Ultrasound Curriculum for Internal Medicine Residents.","authors":"Erin M Finn, John R Stephens, Hillary Spangler, Margaret Fennell, Olivia Hardy, Ria Dancel","doi":"10.24908/pocusj.v11i01.20051","DOIUrl":"10.24908/pocusj.v11i01.20051","url":null,"abstract":"<p><strong>Background: </strong>While professional societies acknowledge the importance of point of care ultrasound (POCUS), a minority of internal medicine (IM) residencies have a formal curriculum. This study aims to 1) describe the implementation of a longitudinal POCUS curriculum for first-year IM trainees and 2) assess the effectiveness of the curriculum in improving knowledge and confidence.</p><p><strong>Methods: </strong>We implemented a longitudinal curriculum for IM interns, with didactic and hands-on sessions throughout the year. We assessed curriculum effectiveness through knowledge tests and confidence surveys at the beginning and end of the intern year. Trainees who took our POCUS elective were given the same tests to assess knowledge retention.</p><p><strong>Results: </strong>Between 2021 and 2024, 87 interns completed the curriculum; 37 (42.5%) completed pre- and post-test questionnaires. Mean scores for knowledge tests improved from 44.4% to 62.9% (mean difference 18.5%, 95% CI 14.9-22.1, p < 0.001). Confidence in using POCUS to identify pathologic findings and apply it in clinical scenarios improved for all 17 measures (p < 0.001). Of the 37 interns who completed the knowledge assessments, 15 (40.5%) took the upper-level elective and completed knowledge assessments. There were no differences between first-year post-curriculum and elective pre-curriculum scores.</p><p><strong>Conclusions: </strong>Knowledge scores and confidence in POCUS improved following a longitudinal curriculum for internal medicine interns. Residents participating in a subsequent POCUS elective maintained their knowledge scores.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935962","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":"Post-Myocardial Infarction Left Ventricular Free Wall Rupture Diagnosed by POCUS.","authors":"Jessica Adams, Shannon Overholt, Edward Descallar, Taryn Hoffman","doi":"10.24908/pocusj.v11i01.19500","DOIUrl":"10.24908/pocusj.v11i01.19500","url":null,"abstract":"<p><strong>Background: </strong>ST segment elevation myocardial infarction (STEMI) is a common cause of death and disability in the United States. A rare, though highly morbid complication of STEMI is a rupture of the left ventricular free wall. Prompt recognition and action by emergency physicians is essential. This report describes a case of left ventricular free wall rupture in the setting of a STEMI, diagnosed by point of care ultrasound (POCUS) in the emergency department (ED).</p><p><strong>Case presentation: </strong>A 72-year-old man presented with severe chest pain and STEMI on his electrocardiogram (ECG), days after an untreated episode of chest pain. Cardiac POCUS revealed a complex pericardial effusion with partially clotted blood, which raised concern for a rupture of the left ventricular free wall.</p><p><strong>Conclusion: </strong>Cardiac POCUS enabled providers to quickly recognize a complex pericardial effusion and cardiac tamponade in a patient presenting with a STEMI.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936088","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":"Erratum: Normal Anatomy Mimicking an Abdominal Aortic Dissection.","authors":"Olivia Klee, Julia Buechler, Molly Fears, Caroline Gosser, Jeffery Baker, Kahra Nix","doi":"10.24908/pocusj.v11i01.20821","DOIUrl":"10.24908/pocusj.v11i01.20821","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.24908/pocusj.v10i01.18498.].</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"50-53"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935977","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":"Cranial POCUS in Neonates and Infants: Structured Evidence Synthesis and Proposal of the KORE Brain POCUS Protocol.","authors":"Salvatore Michele Carnazzo, Desirèe Balconara, Salvatore Scirè Calabrisotto, Andrea Domenico Praticò","doi":"10.24908/pocusj.v11i01.20031","DOIUrl":"10.24908/pocusj.v11i01.20031","url":null,"abstract":"<p><strong>Background: </strong>Cranial point of care ultrasound (POCUS) is an emerging bedside tool for rapid evaluation of neurological emergencies in neonates and infants. Although widely used in neonatal intensive care, its application in emergency and critical care remains heterogeneous and lacks standardized protocols.</p><p><strong>Objective: </strong>To synthesize the current literature on cranial POCUS in neonates and infants and propose a structured clinical protocol (KORE Brain POCUS Protocol) to support early diagnosis and management in emergency and critical care settings.</p><p><strong>Methods: </strong>A structured search of PubMed, Scopus, Web of Science, and Cochrane Library (through August 2025) identified studies on cranial POCUS in neonatal and infant acute care. Eligible studies included original research, observational studies, case series, and narrative or systematic reviews. Two reviewers independently screened and extracted data on study characteristics, clinical context, and feasibility.</p><p><strong>Results: </strong>Nine studies met the inclusion criteria. Cranial POCUS was consistently reported as feasible for detecting intracranial hemorrhage (ICH), ventricular dilatation, sinovenous thrombosis, and posterior fossa lesions, and for assessing cerebral hemodynamics using transcranial Doppler. Based on converging findings, we developed the KORE Brain POCUS Protocol, a stepwise framework integrating standardized ultrasound windows and Doppler assessment for pediatric emergency and critical care.</p><p><strong>Conclusions: </strong>Cranial POCUS is a promising, rapid, noninvasive tool for the bedside evaluation of acute neurological conditions in neonates and infants. The proposed KORE Brain POCUS Protocol provides a structured approach to support early diagnosis and clinical decision-making. Prospective studies are needed to validate its diagnostic performance and clinical impact.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"110-120"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936198","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":"Diagnosis of a Right Congenital Diaphragmatic Hernia in a Neonate with POCUS.","authors":"Alyssa DaVolio, Brandon S Hays, Matthew O Thompson, Michael J Walsh, Parvesh M Garg, Ricardo J Rodriguez","doi":"10.24908/pocusj.v11i01.19486","DOIUrl":"10.24908/pocusj.v11i01.19486","url":null,"abstract":"<p><p>Point of care ultrasound (POCUS) can be used to diagnose neonatal lung diseases, especially in the setting of a newborn with significant respiratory distress. A neonate was born at 38.4 weeks gestational age to a 36-year-old Gravida 5 Para 3013 woman with prenatal concerns for fetal cardiothoracic anomalies. Fetal echocardiogram demonstrated left atrial compression of unclear etiology. After delivery, the neonate experienced significant respiratory distress. A transthoracic echocardiogram revealed pulmonary hypertension but no structural heart disease. A lung POCUS exam revealed a homogenous echogenic structure within the right pleural cavity consistent with liver parenchyma. The initial diagnosis of right Congenital Diaphragmatic Hernia (CDH) was made and confirmed by a radiology-performed lung ultrasound and a computed tomography (CT) scan of the chest. This case demonstrated the utility of lung POCUS as an initial diagnostic tool in the neonatal intensive care unit (NICU) for CDH.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"121-125"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935954","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":"Creation of an Open-Access Lung POCUS Image Database for Deep Learning and Neural Network Applications.","authors":"Andre Kumar, Pawan Nandakishore, Alexandra June Gordon, Evan Baum, Jai Madhok, Youyou Duanmu, John Kugler","doi":"10.24908/pocusj.v11i01.19439","DOIUrl":"10.24908/pocusj.v11i01.19439","url":null,"abstract":"<p><strong>Background: </strong>Lung point of care ultrasound (POCUS) offers advantages over traditional imaging for diagnosing pulmonary conditions, with superior accuracy compared to chest X-ray and lower cost compared to computed tomography. Despite these benefits, widespread adoption is limited by operator dependency, moderate interrater reliability, and training requirements. Deep learning (DL) could potentially address these challenges, but the development of effective algorithms is hindered by the scarcity of comprehensive image repositories with proper metadata.</p><p><strong>Methods: </strong>We created an open-source dataset of lung POCUS images derived from a multi-center study involving 226 adult patients presenting to emergency departments with respiratory symptoms between March 2020 and April 2022. Images were acquired using a standardized scanning protocol (12-zone or modified 8-zone) with various POCUS devices. Three blinded researchers independently analyzed each image following consensus guidelines, with disagreements adjudicated to provide definitive interpretations. Videos were preprocessed to remove identifiers, and frames were extracted and standardized to 512×512 pixels using letterboxing to maintain aspect ratios.</p><p><strong>Results: </strong>The dataset contained 1,871 video clips comprising 324,027 frames extracted and standardized to 512×512 pixels. Half of the participants (50%) had COVID-19 pneumonia. Among all clips, 66% contained no abnormalities, 18% contained B-lines, 4.5% contained consolidations, 6.4% contained both B-lines and consolidations, and 5.2% had indeterminate findings. Pathological findings varied significantly by lung zone, with anterior zones more frequently normal and less likely to show consolidations compared to lateral and posterior zones.</p><p><strong>Discussion: </strong>This dataset represents a large, annotated lung POCUS repository and includes patients with and without COVID-19. The repository metadata and expert interpretations enhance its utility for DL applications. Despite limitations including potential device-specific characteristics and COVID-19 predominance, this repository provides a valuable resource for developing artificial intelligence tools to improve lung POCUS acquisition and interpretation.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"11 1","pages":"62-67"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936184","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}