Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada

Slemko, Jocelyn; Daniels, Vijay; Bagshaw, Sean M.; Brindley, Peter G.; Buchanan, Brian

doi:10.1186/s13089-021-00249-z

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…Although more medical schools and internal medicine residency programs are incorporating POCUS into training curricula, few geriatric fellowships currently provide POCUS training [ 12 , 17 ]. Training-related barriers, including lack of POCUS experts to oversee training and time for practice, are well described barriers to POCUS use in multiple specialties in the United States [ 19 – 21 , 29 , 30 ] and other countries [ 31 , 32 ]. Therefore, development of national POCUS training programs for academic geriatricians are needed to train geriatricians in-practice and ensure adequate supervision of trainees.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasound in geriatrics: a national survey of VA medical centers

Gogtay,

Choudhury,

Williams

et al. 2023

BMC Geriatr

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Background Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care (“geriatric”) clinics at Veterans Affairs Medical Centers (VAMCs). Methods We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. Results All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics (“chiefs”) at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. Conclusions POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.

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Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasound in geriatrics: a national survey of VA medical centers

Gogtay,

Choudhury,

Williams

et al. 2023

BMC Geriatr

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“…The same is true for consolidation, an essential skill to differentiate between pneumonia, atelectasis, contusion and pulmonary embolism. It requires advanced skills supporting the idea that competence cannot easily be divided into basic and advanced skills [ 71 , 72 ].…”

Section: Lung Ultrasound: Basic and Advanced Skillsmentioning

confidence: 99%

Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993–2023)

Vetrugno,

Biasucci,

Deana

et al. 2024

Ultrasound J

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In critically ill patients with acute respiratory failure, thoracic images are essential for evaluating the nature, extent and progression of the disease, and for clinical management decisions. For this purpose, computed tomography (CT) is the gold standard. However, transporting patients to the radiology suite and exposure to ionized radiation limit its use. Furthermore, a CT scan is a static diagnostic exam for the thorax, not allowing, for example, appreciation of "lung sliding". Its use is also unsuitable when it is necessary to adapt or decide to modify mechanical ventilation parameters at the bedside in real-time. Therefore, chest X-ray and lung ultrasound are today's contenders for shared second place on the podium to acquire a thoracic image, with their specific strengths and limitations. Finally, electrical impedance tomography (EIT) could soon have a role, however, its assessment is outside the scope of this review. Thus, we aim to carry out the following points: (1) analyze the advancement in knowledge of lung ultrasound use and the related main protocols adopted in intensive care units (ICUs) over the latest 30 years, reporting the principal publications along the way, (2) discuss how and when lung ultrasound should be used in a modern ICU and (3) illustrate the possible future development of LUS.

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“…It is a fact that preexisting cardiovascular status remains unknown till echocardiography is performed in the absence of exact medical history obtained. Ultrasound machines are not readily available in many neither emergency departments, nor ICUs, or staff is untrained in their use [ 20 , 21 ]. Therefore, stepwise fluid resuscitation with guarded clinical monitoring and starting vasopressors after the administration of an intravenous fluid bolus will be a useful and practical modality to address hypotension in patients presenting with septic shock in the ER and ICU as well [ 14 , 22 , 23 ].…”

Section: Important Aspects Of Fluid Management During Septic Shockmentioning

confidence: 99%

Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

Sánchez¹,

Pinsky

Sinha

et al. 2023

The Journal of Critical Care Medicine

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Septic shock is a common condition associated with hypotension and organ dysfunction. It is associated with high mortality rates of up to 60% despite the best recommended resuscitation strategies in international guidelines. Patients with septic shock generally have a Mean Arterial Pressure below 65 mmHg and hypotension is the most important determinant of mortality among this group of patients. The extent and duration of hypotension are important. The two initial options that we have are 1) administration of intravenous (IV) fluids and 2) vasopressors, The current recommendation of the Surviving Sepsis Campaign guidelines to administer 30 ml/kg fluid cannot be applied to all patients. Complications of fluid over-resuscitation further delay organ recovery, prolong ICU and hospital length of stay, and increase mortality. The only reason for administering intravenous fluids in a patient with circulatory shock is to increase the mean systemic filling pressure in a patient who is volume-responsive, such that cardiac output also increases. The use of vasopressors seems to be a more appropriate strategy, the very early administration of vasopressors, preferably during the first hour after diagnosis of septic shock, may have a multimodal action and potential advantages, leading to lower morbidity and mortality in the management of septic patients. Vasopressor therapy should be initiated as soon as possible in patients with septic shock.

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Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada

Cited by 7 publications

References 23 publications

Point-of-care ultrasound in geriatrics: a national survey of VA medical centers

Point-of-care ultrasound in geriatrics: a national survey of VA medical centers

Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993–2023)

Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet?

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