Critical care ultrasonography in circulatory shock

Koster, Geert; Horst, Iwan C. C. van der

doi:10.1097/mcc.0000000000000428

Cited by 17 publications

(12 citation statements)

References 69 publications

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“…Patients' outcomes were not improved by the use of central venous pressure and oxygen saturation as part of the EGDT protocol [21] or by the use of cardiac output monitoring in general ICU patients [34] or those with early shock [35]. The use of alternative strategies, such as critical care ultrasonography, has not been tested in trials of sepsis resuscitation [36], and the validity of some of the measures obtained by echocardiography should be established [37][38][39][40].…”

Section: Triggers and Targetsmentioning

confidence: 99%

Expert statement for the management of hypovolemia in sepsis

et al. 2018

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Hypovolemia is frequent in patients with sepsis and may contribute to worse outcome. The management of these patients is impeded by the low quality of the evidence for many of the specific components of the care. In this paper, we discuss recent advances and controversies in this field and give expert statements for the management of hypovolemia in patients with sepsis including triggers and targets for fluid therapy and volumes and types of fluid to be given. Finally, we point to unanswered questions and suggest a roadmap for future research.

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Section: Triggers and Targetsmentioning

confidence: 99%

Expert statement for the management of hypovolemia in sepsis

et al. 2018

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“…Critical care ultrasonography (CCUS) is a deliberately focused examination, aimed at rapidly answering straightforward clinical questions [1]. In the field of emergency and critical care medicine, CCUS is increasingly used to guide interventions in critically ill patients in various settings by experts and novices [2][3][4][5][6][7][8][9][10][11][12][13][14]. The training process required for users to attain competency in CCUS has varied widely between studies, reflecting the diversity in CCUS training between centers.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of cardiac output measurements in critically ill patients by medical students

et al. 2020

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Background: Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective: The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods: In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results: There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min −1 with limits of agreement of − 2.6 L min −1 to 2.7 L min −1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions: Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements.

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“…As presented in the above article, interventional ultrasonography and emergency procedures can help diagnose and implement treatment in patients with many disease entities that we will not be able to recognize during an interview or physical examination [45,46]. The ultrasound machine gives us the possibility of a quick and non-invasive view of the problem directly, with the simultaneous possibility of indicating the cause of the ill condition of the patient without any doubts -especially in unconscious patients.…”

Section: Discussionmentioning

confidence: 99%

Application of interventional ultrasound in emergency medicine conditions

Dudek

Szarpak

Ruetzler

2018

Disaster Emerg Med J

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ULTrAsonogrAphy is a modern diagnostic tool both in intensive care and emergency medicine. Small, portable and simple ultrasound devices have been introduced due to technological advances. The image quality, size, and weight of portable ultrasound devices are improving. Prehospital point-of-care ultrasonography may have an impact on the decision making in prioritizing initial treatment. First aid at the scene of the accident and transporting the patient to the hospital is a key element, which in the case of appropriate diagnostics allows you to fight life-threatening injuries. The intention of using ultrasound protocols is to shorten and simplify the ultrasound examination allowing to eliminate or find complications of an injury as soon as possible. The protocols used include elements of ultrasonography and echocardiography of the lung tissue, abdominal cavity, pelvis, large vessels or the eyeball. The intention of the authors of the article was to present to the reader the basic ultrasound protocols applicable to patients in emergency situations.

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Critical care ultrasonography in circulatory shock

Cited by 17 publications

References 69 publications

Expert statement for the management of hypovolemia in sepsis

Expert statement for the management of hypovolemia in sepsis

Feasibility of cardiac output measurements in critically ill patients by medical students

Application of interventional ultrasound in emergency medicine conditions

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