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      Point-of-Care Ultrasound

      review-article
      Author(s): ,
      Publication date (Electronic):
      Journal: Current Cardiology Reports
      Publisher: Springer US
      Keywords: POCUS, Cardiac, Ultrasound, Echocardiography, Education, Training

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          Abstract

          Purpose of the Review

          Point-of-care ultrasound using small ultrasound devices has expanded beyond emergency and critical care medicine to many other subspecialties. Awareness of the strengths and limitations of the technology and knowledge of the appropriate settings and common indications for point-of-care ultrasound is important.

          Recent Findings

          Point-of-care ultrasound is widely embraced as an extension of the physical exam and is employed in acute care and medical education settings. Echocardiography laboratories involved in education must individualize training to the intended scope of practice of the user. Advances in artificial intelligence may assist in image acquisition and interpretation by novice users.

          Summary

          Point-of-care ultrasound is widely available in a variety of clinical settings. The field has advanced substantially in the past 2 decades and will likely continue to expand with advancement in technology, reduced cost, and improved opportunities to assist new users.

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          Most cited references58

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          The respiratory variation in inferior vena cava diameter as a guide to fluid therapy.

          Marc Feissel, Frederic Michard, Jean-Pierre Faller … (2004)
          To investigate whether the respiratory variation in inferior vena cava diameter (DeltaD(IVC)) could be related to fluid responsiveness in mechanically ventilated patients. Prospective clinical study. Medical ICU of a non-university hospital. Mechanically ventilated patients with septic shock (n=39). Volume loading with 8 mL/kg of 6% hydroxyethylstarch over 20 min. Cardiac output and DeltaD(IVC) were assessed by echography before and immediately after the standardized volume load. Volume loading induced an increase in cardiac output from 5.7+/-2.0 to 6.4+/-1.9 L/min (P or =15% (responders). Before volume loading, the DeltaD(IVC) was greater in responders than in non-responders (25+/-15 vs 6+/-4%, P<0.001), closely correlated with the increase in cardiac output (r=0.82, P<0.001), and a 12% DeltaD(IVC) cut-off value allowed identification of responders with positive and negative predictive values of 93% and 92%, respectively. Analysis of DeltaD(IVC) is a simple and non-invasive method to detect fluid responsiveness in mechanically ventilated patients with septic shock.
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            Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.

            Christophe Barbier, Yann Loubières, Christophe Schmit … (2004)
            To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness. Prospective clinical study. Hospital intensive care unit. Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury. Inferior vena cava diameter (D) at end-expiration (Dmin) and at end-inspiration (Dmax) was measured by echocardiography using a subcostal approach. The distensibility index of the IVC (dIVC) was calculated as the ratio of Dmax - Dmin / Dmin, and expressed as a percentage. The Doppler technique was applied in the pulmonary artery trunk to determine cardiac index (CI). Measurements were performed at baseline and after a 7 ml/kg volume expansion using a plasma expander. Patients were separated into responders (increase in CI > or =15%) and non-responders (increase in CI <15%). Using a threshold dIVC of 18%, responders and non-responders were discriminated with 90% sensitivity and 90% specificity. A strong relation (r = 0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion. Baseline central venous pressure did not accurately predict fluid responsiveness. Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.
            Article 0 comments Cited 190 times – based on 0 reviews     Review now
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              Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.

              Raoul Breitkreutz, Susanna Price, Holger Steiger … (2010)
              Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management. A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently. A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases. Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
              Article 0 comments Cited 112 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Linda Lee: Linda.Lee@uchospitals.edu
                Jeanne M. DeCara: jdecara@medicine.bsd.uchicago.edu
                Journal
                Journal ID (nlm-ta): Curr Cardiol Rep
                Journal ID (iso-abbrev): Curr Cardiol Rep
                Title: Current Cardiology Reports
                Publisher: Springer US (New York )
                ISSN (Print): 1523-3782
                ISSN (Electronic): 1534-3170
                Publication date (Electronic): 17 September 2020
                Publication date (Print): 2020
                Volume: 22
                Issue: 11
                Electronic Location Identifier: 149
                Affiliations
                GRID grid.170205.1, ISNI 0000 0004 1936 7822, Department of Medicine, Section of Cardiology, , University of Chicago Medicine, ; 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637 USA
                Article
                Publisher ID: 1394
                DOI: 10.1007/s11886-020-01394-y
                PMC ID: 7498117
                PubMed ID: 32944835
                SO-VID: 8fd0a7b1-7163-486a-acfc-7b11b479d777
                Copyright © © Springer Science+Business Media, LLC, part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Categories
                Subject: Echocardiography (JM Gardin and AH Waller, Section Editors)
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature 2020

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pocus,cardiac,ultrasound,echocardiography,education,training
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pocus, cardiac, ultrasound, echocardiography, education, training

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