Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study

Cortellaro, Francesca; Ferrari, Laura; Molteni, Francesco; Aseni, Paolo; Velati, Marta; Guarnieri, Linda; Cazzola, Katia Barbara; Colombo, Silvia; Coen, Daniele

doi:10.1007/s11739-016-1470-2

Cited by 47 publications

(38 citation statements)

References 24 publications

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“…Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. 11,12 However, limited data exists on the evaluation of POCUS for septic cardiomyopathy. There are no specific or sensitive sonographic signs for identifying sepsis or septic cardiomyopathy (SCM) other than those associated with infection at a specific site.…”

Section: Introductionmentioning

confidence: 99%

Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

Lahham

Lee

Ali

et al. 2020

WestJEM

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Introduction: Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis. Methods: We prospectively enrolled patients who presented to the emergency department (ED) with concern for severe sepsis or septic shock in a pilot study. In patients that screened positive, the treating physician then performed POCUS to measure the TAPSE value. We compared the intensive care unit (ICU) admission rate, hospital length of stay, and morbidity with their respective TAPSE values. Results: We enrolled 24 patients in the study. Eight patients had TAPSE values less than 16 millimeters (mm), two patients had TAPSE values between 16mm-20mm, and fourteen patients had TAPSE values greater than 20mm. There was no statistically significant association between TAPSE levels and ICU admission (p=0.16), or death (p=0.14). The difference of length of stay (LOS) was not statistically significant in case of hospital LOS (p= 0.72) or ICU LOS. Conclusion: Our pilot data did not demonstrate a correlation between severe sepsis or septic shock and TAPSE values. This may be due to several factors including patient comorbidities, strict definitions of sepsis and septic shock, as well as the absence of septic cardiomyopathy (SCM) in patients with sepsis and septic shock. Future large-scale studies are needed to determine if TAPSE can be beneficial in the ED evaluation of patients with concern for SCM.

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Section: Introductionmentioning

confidence: 99%

Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

Lahham

Lee

Ali

et al. 2020

WestJEM

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“…Step five is “etiology explored.” Diagnose the etiology by integrating the above four steps; search for the source of infection according the clues extracted from the focused ultrasound exam; additional ultrasound exams or other tests should applied if needed. The clues are listed as examples: acute cor pulmonale indicates pulmonary embolism, unreasonable ventilation setting, or severe mismatch of the ventilation and flow representing ARDS [ 45 ]; acute increase in PAOP derives from decrease in systolic function, left side valve insufficiency, hypervolemia, or decreased myocardium compliance [ 66 ]; diffuse sonointerstitial syndrome (SIS) indicates hypervolemic pulmonary edema, cardiogenic pulmonary edema, leakage pulmonary edema, acute pneumonitis, pulmonary alveolar proteinosis, and chronic pulmonary fibrosis [ 6 , 37 , 67 ]; consolidation with shred sign in lung ultrasound indicates pneumonia [ 68 – 70 ]; hypoechoic yet heterogeneous at plural cavity indicates hemothorax or pyothorax [ 32 , 33 ]; echogenic dots in free fluid indicate abscessus [ 33 , 71 ]; echogenic dots in physiology cavity indicate infection [ 33 , 71 ] and so forth. With the clues above, we can clearly know what to do next and the diagnosis procedure can be efficient.…”

Section: The Piepear Workflow: a Critical Care Ultrasound Based 7-mentioning

confidence: 99%

The PIEPEAR Workflow: A Critical Care Ultrasound Based 7-Step Approach as a Standard Procedure to Manage Patients with Acute Cardiorespiratory Compromise, with Two Example Cases Presented

Yin

Wang

et al. 2018

BioMed Research International

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Critical care ultrasound (CCUS) has been widely used as a useful tool to assist clinical judgement. The utilization should be integrated into clinical scenario and interact with other tests. No publication has reported this. We present a CCUS based “7-step approach” workflow—the PIEPEAR Workflow—which we had summarized and integrated our experience in CCUS and clinical practice into, and then we present two cases which we have applied the workflow into as examples. Step one is “problems emerged?” classifying the signs of the deterioration into two aspects: acute circulatory compromise and acute respiratory compromise. Step two is “information clear?” quickly summarizing the patient's medical history by three aspects. Step three is “focused exam launched”: (1) focused exam of the heart by five views: the assessment includes (1) fast and global assessment of the heart (heart glance) to identify cases that need immediate life-saving intervention and (2) assessing the inferior vena cava, right heart, diastolic and systolic function of left heart, and systematic vascular resistance to clarify the hemodynamics. (2) Lung ultrasound exam is performed to clarify the predominant pattern of the lung. Step four is “pathophysiologic changes reported.” The results of the focused ultrasound exam were integrated to conclude the pathophysiologic changes. Step five is “etiology explored” diagnosing the etiology by integrating Step two and Step four and searching for the source of infection, according to the clues extracted from the focused ultrasound exam; additional ultrasound exams or other tests should be applied if needed. Step six is “action” supporting the circulation and respiration sticking to Step four. Treat the etiologies according step five. Step seven is “recheck to adjust.” Repeat focused ultrasound and other tests to assess the response to treatment, adjust the treatment if needed, and confirm or correct the final diagnosis. With two cases as examples presented, we insist that applying CCUS with 7-step approach workflow is easy to follow and has theoretical advantages. The coming research on its value is expected.

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“…There have been many consensus statements describing and supporting the accurate use of POCUS by EM physicians . From US‐guided procedures to diagnostic algorithms, POCUS has proven to benefit patients at the bedside within the acute setting . Despite this, there still remain areas of contention.…”

Section: Introductionmentioning

confidence: 99%

Emergency Medicine Advanced Ultrasound Service: A new paradigm

Bogseth

Gawthrope

Rippey

2020

Emerg Medicine Australasia

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Objective: Point-of-care ultrasound (POCUS) is now ubiquitous in emergency medicine. Increased accessibility does not, however, ensure expertise in its use. We present a unique model of an Emergency Medicine Advanced Ultrasound Service (EMAUS). In our model specialist emergency physicians with advanced ultrasound (US) qualifications (emergency sonologists), provide images and reports for the entire department. The service is considered an extension of the traditional radiology model. It is consultative, diagnostic and procedural, and includes full US examinations as well as POCUS examinations. Methods: A 4-month prospective descriptive observational study was conducted at a tertiary hospital during which data was recorded about emergency medicine US use and its outcomes. Results: A total of 1336 US scans were recorded. Emergency sonologists conducted the majority of examinations, 69.8%. Half the consultative USs demonstrated positive findings. Follow-up computed tomography (CT) was recommended in 8.8% of consultative US studies and 12.4% of POCUS studies. Concerning incidental findings requiring further investigation (usually CT/magnetic resonance imaging) were infrequent at 1.6%. Conclusion: Globally POCUS has proliferated with varying expertise and data to support its use. The EMAUS provides a trusted and accountable service with the advantages of simultaneously integrating consultative US into the clinical context by an emergency physician. A diverse range of indications, scan types and pathology was recorded over the period demonstrating the utility of combining the roles of senior clinician, sonographer and radiologist and the benefits of advanced training and credentialing.

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Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study

Cited by 47 publications

References 24 publications

Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

The PIEPEAR Workflow: A Critical Care Ultrasound Based 7-Step Approach as a Standard Procedure to Manage Patients with Acute Cardiorespiratory Compromise, with Two Example Cases Presented

Emergency Medicine Advanced Ultrasound Service: A new paradigm

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