The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients.
Objectives
The purpose of this study was to determine the prevalence and scope of point‐of‐care ultrasound (US) education in internal medicine, pediatric, and medicine‐pediatric residency programs nationwide.
Methods
Program directors were surveyed between January and June 2016 with a 15‐item online questionnaire to assess the state of point‐of‐care US training in their programs. The survey aimed to identify whether programs had an established point‐of‐care US curriculum and, if not, what reasons may have existed for a lack of point‐of‐care US training in their programs.
Results
The survey was distributed to 685 program directors, and the response rate was 19.2%. Only 31.5% of respondents reported having a formal point‐of‐care US curriculum in their program, and in 12.4% of programs, there was no US training at all. The presence of point‐of‐care US training as reported by internal medicine (n = 64) and medicine‐pediatric (n = 24) respondents showed formal point‐of‐care US curriculum rates of 37.5% and 43.5%, respectively. Pediatric programs (n = 24) reported limited point‐of‐care US training, with formal curriculum in only 12.4% of programs and 27.3% having no point‐of‐care US training at all. The most common reasons for lack of a point‐of‐care US curriculum among program directors were lack of trained faculty/instructors (70.4%), lack of guidelines/standards by governing societies (44.4%), and lack of the necessary technology (33.3%).
Conclusions
Less than half of residents with internal medicine training will have trained at a program with a point‐of‐care US curriculum, and point‐of‐care US training in pediatrics is even more limited. The major reason for the lack of point‐of‐care US education is a lack of trained faculty or instructors.
The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients.
Objective
To summarize knowledge and identify gaps in evidence regarding treatment of right ventricular dysfunction (RVD) in acute respiratory distress syndrome (ARDS).
Data sources
We conducted a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials.
Study selection
Studies were included if they reported effects of treatments on right ventricular function, whether or not the intent was to modify right ventricular function.
Data extraction
Data extraction was performed independently and in duplicate by two authors. Data items included the study design, patient population, type of intervention, comparison group, and RV-specific outcomes.
Data synthesis
Of 1,430 studies screened, 51 studies reporting on 1,526 patients were included. By frequency, the included studies examined the following interventions: ventilator settings (29.4%), inhaled medications (33.3%), extracorporeal life support (13.7%), intravenous or oral medications (13.7%), and prone positioning (9.8%). The majority of the studies were non-randomized experimental studies (53%), with the next most common being case reports (16%). Only 5.9% of studies were RCTs. In total, 27% of studies were conducted with the goal of modifying RV function.
Conclusions
Given the prevalence of RVD in ARDS and its association with mortality, the dearth of research on this topic is concerning. This review highlights the need for prospective trials aimed at treating RV dysfunction in ARDS.
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