Bedside echocardiography in the assessment of the critically ill

Beaulieu, Yanick

doi:10.1097/01.ccm.0000260673.66681.af

Cited by 215 publications

(126 citation statements)

References 152 publications

(93 reference statements)

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“…Transesophageal echocardiography (TEE) is the most reliable method for verifying the position of the CVC tip: it allows almost full-length visualization of the SVC up to its junction with the right atrium [62]. TEE, however, is not available for routine use during CVC insertion, and it is difficult to use when the patient is unstable (e.g., secondary to severe respiratory distress) [63]. In contrast, transthoracic echocardiography (TTE) is widely available, and thanks to the introduction of increasingly portable scanners, it can be performed easily as a bedside procedure for rapid verification of catheter position.…”

Section: Diagnosing Complications Of Central Venous Catheterizationmentioning

confidence: 99%

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

et al. 2013

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Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins. The mechanical, infectious, and thrombotic complications of central venous catheterization are markedly reduced when the procedure is performed with real-time ultrasound guidance or (to a slightly lesser extent) ultrasound assistance. Ultrasound guidance is also used to create peripheral venous accesses, for catheterization of peripheral veins and for peripheral insertion of central venous catheters. In this setting, it increases the catheterization success rate, especially during difficult procedures (e.g., obese patients, children) and reduces complications such as catheter-related infections and venous thrombosis. Arterial cannulation is used for invasive monitoring of arterial pressure and for access during diagnostic or therapeutic procedures. Ultrasound guidance reduces the risk of catheterization failure and complications. It is especially useful for arterial catheterization procedures performed in the absence of a palpable pulse (e.g., patient in shock, ECMO). Imaging support is being used increasingly to facilitate the creation of vascular accesses under difficult conditions, in part because of the growing use of ultrasonography as a bedside procedure. In clinical settings where patients are becoming increasingly vulnerable as a result of advanced age and/or complex disease, the possibility to reduce the risks associated with these invasive procedures should motivate clinicians to acquire the technical skills needed for routine use of sonographic support during vascular access procedures. Keywords Vascular access Á UltrasoundRiassunto Gli accessi vascolari utilizzati nella cura dei pazienti comprendono gli accessi venosi centrali e periferici e gli accessi arteriosi. L'incannulamento di accessi venosi centrali è manovra largamente diffusa nella pratica clinica e si rende necessaria per la cura dei pazienti in molteplici contesti. I vasi centrali che usualmente vengono incannulati sono la vena giugulare interna, la vena succlavia e la vena femorale. Nell'incannulamento venoso centrale sia l'eco-assistenza che l'eco-guida real time, pur con una leggera superiorità di quest'ultima, riducono drasticamente le complicanze meccaniche, infettive e trombotiche. La guida ecografica viene utilizzata anche per l'accesso venoso periferico, per l'incannulamento di vasi periferici e di vasi centrali a inserzione periferica (PICC). In questo contesto la guida ecografica aumenta il successo della manovra di incannulamento soprattutto in condizioni di difficoltà, come avviene nei pazienti obesi o nei bambini, e diminuisce le complicanze quali le infezioni catetere correlate e le trombosi venose. L'incannulamento arterioso viene utilizzato per il monitoraggio cruent...

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Section: Diagnosing Complications Of Central Venous Catheterizationmentioning

confidence: 99%

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

et al. 2013

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“…Negli ultimi anni, la valutazione ecocardiografica del paziente emodinamicamente instabile da parte dell'intensivista non cardiologo si è sviluppata con un approccio "focale", "limitato" o "goal-directed echocardiogram (GDE)" (8). Questa strategia, nota anche come "ecocardioscopia" si sta rapidamente evolvendo in altre realtà specialistiche non cardiologiche, rivelandosi molto utile non solo per la diagnosi, ma anche per il monitoraggio e per la gestione clinica delle complicanze cardiache dei pazienti.…”

Section: Ecocardiografia O Ecocardioscopia?unclassified

“…Queste realtà, però, sono più diffuse in ambienti intensivisti e un po' meno in quelli internistici (7)(8)(9)(10), mentre appaiono ancora poco comuni nei contesti nefrologici. Esiste, effettivamente, una serie di svantaggi o limitazioni da considerare prima di investire in un'attività diagnostica di questa portata.…”

Section: Vantaggi E Svantaggi Dell'ecocardioscopia In Nefrologiaunclassified

Echocardioscopy in Cardiovascular Stratification of Chronic Kidney Diseases: The Nephrologist is the Protagonist

Rivera

Pascalis

Floccari

et al. 2016

Giornale di Tecniche Nefrologiche e Dialitiche

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Giornale di Tecniche Nefrologiche e Dialitiche 2016; 28 (2): 122-127 fattori di rischio "tradizionali", come età, ipertensione arteriosa, diabete, dislipidemie, obesità, tabagismo e così via e quelli "specifici" dell'uremia, come anemia, iperomocisteinemia, disfunzione endoteliale e stato infiammatorio (3). Tuttavia, alcuni fattori tipici della MRC, come il controllo pressorio e la gestione della volemia, hanno un effetto diretto sul miocardio, generando alterazioni morfologiche e funzionali come l'ipertrofia ventricolare sinistra, il rimodellamento cardiaco, la dilatazione cavitaria, la fibrosi miocardica e lo scompenso sistolico-diastolico (4). Inoltre, i noti disturbi del metabolismo minerale e l'iperparatiroidismo secondario conducono alle calcificazione vascolari e valvolari (5), aumentando da 3 a 4 volte il rischio di mortalità CV degli uremici (6).L'incremento di queste complicanze nella MRC ha progressivamente incoraggiato i nefrologi ad acquisire nel proprio background le competenze tecnico-strumentali per la diagnosi della patologia cardiaca. Infatti, sia sul territorio nazionale che all'estero, sono sempre più presenti strutture operative nefrologiche che si occupano di diagnostica cardiovascolare e di stratificazione di rischio di pazienti nefropatici. Il ricorso all'ecocardiografia al di fuori degli ambienti cardiologici non è solo una prerogativa nefrologica, ma la tendenza è percepibile anche in altri settori come quelli internistici, generalistici e intensivisti. I IntroduzioneLa patologia cardiovascolare (CV) rappresenta la principale causa di morbidità e di mortalità nei pazienti affetti da malattie renali croniche (MRC) (1). L'Annual Data Report dell'USRDS (2) riporta che più del 38% dei decessi tra i pazienti in trattamento dialitico avviene come conseguenza di patologie CV. Dal punto di vista fisiopatologico, il fenomeno è la conseguenza dell'interazione tra Echocardioscopy in cardiovascular stratification of chronic kidney diseases: the nephrologist is the protagonist Cardiovascular disease (CV) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The increase in cardiac complications in patients with CKD has encouraged nephrologists to acquire the cardiac diagnostic competences in the use of ultrasound. A formal echocardiographic approach requires standard times and the immediate availability of the cardiac-sonographer. Therefore, a goal-directed cardiac ultrasound and a focused echocardiogram or echocardioscopy strategy were created specifically tailored to the non-cardiologists as well as internists, interventists and intensivists. The concept of echocardioscopy has been incompletely evaluated and it is necessary to find a curricular program to grant proficiency. The introduction of echocardioscopy in the nephrologist's tasks has the advantage of widening the spectrum of the diagnostic of cardiac complications in CKD patients, but also confers several technical limitations. The aim of this revision is to analyze the use of the cardiac ultrasound ...

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“…[6] In the practice of EM, this reduces the time taken to reach a critical diagnosis as the ultrasound can be done at the bedside by the emergency clinician. [7–11] In India's developing EM system, imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and even traditional technician-performed ultrasound examinations are often not immediately available. EUS helps the treating clinician to diagnose a vast array of emergent conditions immediately at the point-of-care, thus facilitating the rapid diagnosis and treatment of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluating emergency ultrasound training in India

Gupta

Peckler

Stone

et al. 2010

J Emerg Trauma Shock

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Background:In countries with fully developed emergency medicine systems, emergency ultrasound (EUS) plays an important role in the assessment and treatment of critically ill patients.Methods:The authors sought to introduce EUS to a group of doctors working in the emergency departments (EDs) in India through an intensive 4-day adult and pediatric ultrasound course held at the Apex Trauma Center and EM division of the All India Institute of Medical Sciences in New Delhi. The workshop was evaluated with a survey questionnaire and a hands-on practical test. The questionnaire was designed to assess the current state of EUS in India's EDs, and to identify potential barriers to the incorporation of EUS into current EM practice. The EUS course consisted of a general introductory didactic session followed by pediatric, abdominal and trauma, cardiothoracic, obstetrical and gynecologic, and vascular modules. Each module had a didactic session followed by handson applications with live models and/or simulators. A post-course survey questionnaire was given to the participants, and there was a practical test on the final day of the course. The ultrasound images taken by the participants were digitally recorded, and were subsequently graded for their accuracy by independent observers, residency, and/or fellowship trained in EUS.Results:There were a total of 42 participants who completed the workshop and took the practical examination; 32 participants filled in the course evaluation survey. Twenty-four (75%) participants had no prior experience with EUS, 5 (16%) had some experience, and 3 (9%) had significant experience. During the practical examination, 38 of 42 participants (90%) were able to identify Morison's pouch on the focused abdominal sonography for trauma (FAST) examination, and 32 (76%) were able to obtain a parasternal long axis cardiac view and identify the left ventricle. The inferior vena cava was identified as it crosses the diaphragm into the right atrium by 20 (48%) participants. All participants felt they would be able to incorporate what they had learned into their practice, and indicated that they were advocates for further training of non-radiologist clinicians in the use of ED ultrasound.Conclusion:After this introductory workshop in EUS, the participants were comfortable in their ability to use the ultrasound machine. Participants deemed it particularly useful for certain ED applications, particularly the FAST examination, the lung examination, and vascular access.

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Bedside echocardiography in the assessment of the critically ill

Cited by 215 publications

References 152 publications

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

Echocardioscopy in Cardiovascular Stratification of Chronic Kidney Diseases: The Nephrologist is the Protagonist

Evaluating emergency ultrasound training in India

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