A Comparison by Medicine Residents of Physical Examination Versus Hand-Carried Ultrasound for Estimation of Right Atrial Pressure

Brennan, J. Matthew; Blair, John E.; Goonewardena, Sascha N.; Ronan, Adam; Shah, Dipak; Vasaiwala, Samip; Brooks, Erica L; Levy, A.D.; Kirkpatrick, James N.; Spencer, Kirk T.

doi:10.1016/j.amjcard.2007.01.037

Cited by 152 publications

(118 citation statements)

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“…Prior feasibility studies of teaching internal medical residents are characterized by heterogeneity in imaging protocols, nonrandomized enrollment of a small number of trainees, and training that is short-lived, 6,[9][10][11][12][13][14] making their results difficult to generalize. Few data exist on the effects of sustained incorporation of a comprehensive, structured program within a conventional 3-year internal medicine residency.…”

Section: Discussionmentioning

confidence: 99%

“…Given the multiple subspecialty applications for ultrasound, the potential exists of excessive diversity in bedside ultrasound practice, weakening the development of a single, simplified exam technique as a clinical tool for all physicians. 31 Prior feasibility studies [9][10][11][12][13][14] have evaluated the learning curve of internal medicine or primary care residents in performing various limited exams, but have not provided the rationale regarding the imaging protocols, the methods used for teaching, and the assessment of the program results over a sustained period of time. Furthermore, prior studies have not randomized subject trainees, likely resulting in the selected enrollment of highly motivated or skilled residents who want to perform a particular technique or have a bias to learn it.…”

Section: Discussionmentioning

confidence: 99%

“…IVC plethora IVC AP diameter equals or exceeds the same-level aortic diameter and fails to reduce size with respiration 14,26,30 Reduced SN when mistaking a hepatic vein for the IVC. FP when mistaking the descending aorta for a dilated IVC, particularly when IVC is collapsed.…”

Section: Lung Comet-tail Artifactmentioning

confidence: 99%

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Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Kimura

Amundson

Phan

et al. 2012

Journal of Hospital Medicine

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BACKGROUND: Despite the future potential of using ultrasound stethoscopes to augment the bedside cardiac physical, few data exist on a general cardiovascular imaging protocol that can be taught to physicians on a perpetual basis as a curriculum in graduate medical education. METHODS: During the past decade, we developed and integrated a cardiovascular limited ultrasound training program within the confines of an internal medicine residency. The evidence‐based rationale for the exam, the teaching methods, and curriculum are delineated, and subsequent observations regarding program requirements, proficiency, and academic outcomes are explored. Analysis of variance and linear regression assessed for relationships between academic scores, chief resident selection, and gender to proficiency in ultrasound. RESULTS: A brief, 5‐minute cardiovascular limited ultrasound exam (CLUE) was taught using both didactic and bedside methods, and practiced primarily within the cardiology consult, outpatient clinic, and intensive care rotations. Program costs were minimized by employing readily available institutional resources. After a 2‐year lead‐in training phase, the subsequent 4 years of senior resident performance (n = 41 residents) showed an 81% pass rate in CLUE competency. Resident ultrasound performance did not relate to academic scores (r = 0.05, P = 0.75), chief resident selection, nor gender. Observations regarding resident pitfalls in CLUE practice and increased participation in extracurricular research are described. CONCLUSIONS: We report our initial experience in developing and implementing a training program for bedside cardiovascular ultrasound examination that employed evidence‐based techniques, set proficiency goals, and assessed resident performance. It may be feasible to teach future internist–hospitalists the technique of bedside ultrasound during residency. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Kimura

Amundson

Phan

et al. 2012

Journal of Hospital Medicine

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“…Studies have included healthy volunteers, 2 continuous ambulatory peritoneal dialysis patients, 3 hemodialysis patients, 4,5 healthy volunteers at phlebotomy centers, 6 and critically ill patients in intensive care units. 7,8 In addition, the locations of IVC measurements differ across studies [9][10][11][12][13][14][15][16][17][18][19] (Table 1). This study aimed to determine if the degree of IVC collapsibility (also referred to as ''caval index'') varied within the same subject at commonly measured sites.…”

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confidence: 99%

Inferior Vena Cava Percentage Collapse During Respiration Is Affected by the Sampling Location: An Ultrasound Study in Healthy Volunteers

Wallace

Allison

Stone

2010

Academic Emergency Medicine

148

109

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Objectives: Physicians are unable to reliably determine intravascular volume status through the clinical examination. Respiratory variation in the diameter of the inferior vena cava (IVC) has been investigated as a noninvasive marker of intravascular volume status; however, there has been a lack of standardization across investigations. The authors evaluated three locations along the IVC to determine if there is clinical equivalence of the respiratory percent collapse at these sites. The objective of this study was to determine the importance of location when measuring the IVC diameter during quiet respiration.Methods: Measurements of the IVC were obtained during quiet passive respiration in supine healthy volunteers. All images were recorded in B-mode, with cine-loop adjustments in real time, to ensure that maximum and minimum IVC dimensions were obtained. One-way repeated-measures analysis of variance (ANOVA) was used for comparison of IVC measurement sites.Results: The mean (±SD) percentage collapse was 20% (±16%) at the level of the diaphragm, 30% (±21%) at the level of the hepatic vein inlet, and 35% (±22%) at the level of the left renal vein. ANOVA revealed a significant overall effect for location of measurement, with F(2,35) = 6.00 and p = 0.006. Contrasts showed that the diaphragm percentage collapse was significantly smaller than the hepatic (F(1,36) = 5.14; p = 0.03) or renal caval index (F(1,36) = 11.85; p = 0.002).Conclusions: Measurements of respiratory variation in IVC collapse in healthy volunteers are equivalent at the level of the left renal vein and at 2 cm caudal to the hepatic vein inlet. Measurements taken at the junction of the right atrium and IVC are not equivalent to the other sites; clinicians should avoid measuring percentage collapse of the IVC at this location.ACADEMIC EMERGENCY MEDICINE 2010; 17:96-99 ª

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“…30,31 Similar to elevated jugular venous distension, bedside ultrasound examination of the IVC diameter can serve as a rapid and noninvasive measurement of right atrial pressure. 32 Elevated right atrial pressure is most often due to elevated left ventricular filling pressure transmitted via the pulmonary vasculature, but it is important to note that right-and …”

Section: Discussionmentioning

confidence: 99%

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Cubo-Romano

Torres‐Macho

Soni

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN Prospective observational study. SETTING A 247‐bed urban teaching hospital in Spain PATIENTS Ninety‐seven patients hospitalized with ADHF. INTERVENTION None. MEASUREMENTS The IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90‐day all‐cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180‐day all‐cause mortality. Patients were followed for 180 days. RESULTS Data from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90‐day follow‐up period, 11 patients (13.7%) died. An admission IVCmax diameter ≥1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90‐day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21‐28.10; P = 0.025) and 90‐day readmission (HR: 3.20; 95% CI: 1.24‐8.21; P = 0.016). CONCLUSION In patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90‐day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778–784. © 2016 Society of Hospital Medicine

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A Comparison by Medicine Residents of Physical Examination Versus Hand-Carried Ultrasound for Estimation of Right Atrial Pressure

Cited by 152 publications

References 24 publications

Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination

Inferior Vena Cava Percentage Collapse During Respiration Is Affected by the Sampling Location: An Ultrasound Study in Healthy Volunteers

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

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