The state of point-of-care ultrasonography use and training in neonatal–perinatal medicine and pediatric critical care medicine fellowship programs

Nguyen, Jimmy; Amirnovin, Rambod; Ramanathan, Rangasamy; Noori, Shahab

doi:10.1038/jp.2016.126

Cited by 68 publications

(53 citation statements)

References 39 publications

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“…These time savings are probably most realized by POCUS, though a recent survey of neonatal-perinatal medicine fellowship directors suggests a lack of access to US machines in many units in the United States. 4 Saul et al described their experience using US for ETT, umbilical line, and peripherally inserted central line positions with a mean scan time of 7 minutes and less, and with > 90% successful identification rates for all examinations. 18 The benefits of US in regard to minimal patient manipulation and lack of radiation exposure warrants further investigation even if the time needed for the examination is ultimately similar to XR.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

2016

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Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults and older children but has been less studied in the neonates and infants. The literature regarding US utility for ETT positioning in this population is reviewed. A literature search was conducted using the EMBASE, Google Scholar, MEDLINE, Ovid, and Scopus databases with search terms regarding US relating to ETT intubation and positioning in neonates and infants. Nine relevant studies were included for review. All studies report > 80% visualization of the ETT tip by US. US interpretation of the ETT position correlated with the radiography position in 73 to 100% of cases when the ETT tip was visible. There were variations in technique, sonographer, and sonographer training between studies. US appears to be well tolerated by neonates and infants and may augment the determination of proper ETT position. Further studies are needed regarding optimal technique and sonographer training.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

2016

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“…Several impediments for the adoption of point‐of‐care sonography in the NICU have been identified. A recent survey of neonatal‐perinatal medicine and pediatric critical care medicine fellowship programs across the United States suggested that the lack of ultrasound equipment and funding sources were significant obstacles . Another major barrier identified in this study was the lack of trained ultrasound personnel to instruct fellows and faculty in ultrasound scanning techniques.…”

Section: Obstacles For Adoption Of Bedside Sonography In Neonatologymentioning

confidence: 90%

“…A recent survey of neonatalperinatal medicine and pediatric critical care medicine fellowship programs across the United States suggested that the lack of ultrasound equipment and funding sources were significant obstacles. 8 Another major barrier identified in this study was the lack of trained ultrasound personnel to instruct fellows and faculty in ultrasound scanning techniques. Somewhat surprisingly, legal concerns over point-of-care sonography in the NICU was not a chief concern, which is consistent with a recent analysis of a noteworthy legal database in the United States that suggested point-of-care sonography use and interpretation is not a substantial source of lawsuits against neonatologists and pediatric subspecialists.…”

Section: Obstacles For Adoption Of Bedside Sonography In Neonatologymentioning

confidence: 98%

“…From our review of literature, one of the stated barriers to implementation of sonography in NICU was cost. More probes would translate to a higher cost and reduced chance of implementation . In addition, the image quality was better with the abdominal probe compared to the sector probe.…”

Section: Rapid Assessment Of the Neonate With Sonography Scan—collabomentioning

confidence: 99%

“…More probes would translate to a higher cost and reduced chance of implementation. 8 In addition, the image quality was better with the abdominal probe compared to the sector probe. By using the curvilinear probe, we wanted to steer away from any potential of extending into functional echocardiography, which is much more complex and potentially could create conflict with pediatric cardiology.…”

Section: Rapid Assessment Of the Neonate With Sonography Scan-collabomentioning

confidence: 99%

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Rapid Assessment of the Neonate With Sonography (RANS) Scan

Safarulla

Kühn

Lyon

et al. 2018

J of Ultrasound Medicine

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The use of point‐of‐care sonography in clinical settings such as emergency medicine and intensive care units has increased, but adoption in neonatology has been slow. Unlike the focused assessment with sonography for trauma scan used in adults, a quick bedside scan to rapidly evaluate an acutely deteriorating neonate does not exist. The objective of our article is to introduce a focused bedside ultrasound scan that is easy to learn, rapidly performed, and relatively inexpensive.© 2018 by the American Institute of Ultrasound in Medicine

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The Inter‐Rater Reliability of Pediatric Point‐of‐Care Lung Ultrasound Interpretation in Children With Acute Respiratory Failure

DeSanti

Cowan

Kory

et al. 2021

J of Ultrasound Medicine

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Objectives-Use of point-of-care lung ultrasound (POC-LUS) has increased significantly in pediatrics yet it remains under-studied in the pediatric intensive care unit (PICU). No studies explicitly evaluate the reliability of POC-LUS artifact interpretation among critically ill children with acute respiratory failure (ARF) in the PICU. We thus designed this study to determine the inter-rater reliability of POC-LUS interpretation in pediatric ARF among pediatric intensivists trained in POC-LUS and an expert intensivist.Methods-We compared the interpretation of lung sliding, pleural line characteristics, ultrasound artifacts, and POC-LUS diagnoses among pediatric intensivists and an expert intensivist in a cohort of children admitted to the PICU for ARF. Kappa statistics (k) adjusted for maximum attainable agreement (k/k max ) were used to quantify chance-correct agreement between the pediatric intensivist and expert physician.Results-We enrolled 88 patients, evaluating 3 zones per hemithorax (anterior, lateral, and posterior) for lung sliding, pleural line characteristics, ultrasound artifacts, and diagnosis. There was moderate agreement between the PICU intensivist and expert-derived diagnoses with 56% observed agreement (k/k max = 0.46, 95% confidence interval [CI] 0.31-0.65). Agreement in identification of lung sliding (k = 0.19, 95% CI À0.17 to 0.56) and pleural line characteristics (k = 0.24, 95% CI 0.08-0.40) was slight and fair, respectively, while agreement in the interpretation of ultrasound artifacts ranged from moderate to substantial.Conclusions-Evidence supporting the evaluation of neonatal and adult patients with POC-LUS should not be extrapolated to critically ill pediatric patients. This study adds to the evidence supporting use of POC-LUS in the PICU by demonstrating moderate agreement between PICU intensivist and expert-derived POC-LUS diagnoses.

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The state of point-of-care ultrasonography use and training in neonatal–perinatal medicine and pediatric critical care medicine fellowship programs

Cited by 68 publications

References 39 publications

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Rapid Assessment of the Neonate With Sonography (RANS) Scan

The Inter‐Rater Reliability of Pediatric Point‐of‐Care Lung Ultrasound Interpretation in Children With Acute Respiratory Failure

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