Implementation of a Pediatric Critical Care Focused Bedside Ultrasound Training Program in a Large Academic PICU*

Conlon, Thomas; Himebauch, Adam S.; Fitzgerald, Julie C.; Chen, Aaron E.; Dean, Anthony J.; Panebianco, Nova L.; Darge, Kassa; Cohen, Meryl S.; Greeley, William J.; Berg, Robert A.; Nishisaki, Akira

doi:10.1097/pcc.0000000000000340

Cited by 70 publications

(57 citation statements)

References 21 publications

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“…Among the studies reporting on the effects of training attending clinicians to perform POCUS, the application of POCUS was considered to contribute to changes in management in 16–37% of cases in different clinical contexts . Studies reported similar findings after training residents or fellows, with POCUS contributing to management changes in 16–40% of clinical applications . Only one study evaluated any impact on patient‐relevant outcomes of training medical students to perform POCUS, demonstrating improved safety of simulated central venous catheter placement using ultrasound …”

Section: Resultsmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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IntroductionPoint-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications. MethodsThis research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA. ResultsWe identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent, and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate. DiscussionOur analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

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Section: Resultsmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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“…Though the length and components of sonographer training as well as assessments of proficiency generally were not reported in these studies, learning US for ETT verification seems consistent with current literature suggesting that short application-focused US training regimens can be effective. [24][25][26] Chowdhry et al published the successful training of 12 US technicians in this application with a one-time 1-hour session by a pediatric radiologist. 17 Sethi et al reported training of their sonographer for 2 weeks.…”

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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“…15 Institutional credentialing is desirable however, and methods for credentialing are being developed. 16 Risk assessment for patients undergoing fetal surgery can be difficult because of limited experience and the questionable applicability of typical risk indices to this patient population. In this case, the fetus had a Chiari II malformation with a slight hindbrain herniation and large myelomeningocele likely to result in incontinence and weakness of the lower extremities.…”

Section: Discussionmentioning

confidence: 99%

High-Dose Desflurane for Tocolysis During Intrapartum Myelomeningocele Repair in a Patient With Post-Adriamycin Cardiomyopathy

Feldman²

2016

A & A Case Reports

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High-dose desflurane is an uncommon need during general anesthesia. At our institution, open fetal surgery cases are managed with high desflurane concentrations to ensure uterine relaxation. We present a case of a 32-year-old parturient with a history of mild cardiomyopathy undergoing open fetal myelomeningocele repair. Phenylephrine and dopamine infusions helped maintain hemodynamic stability at 18% desflurane, while cardiac function was monitored with transthoracic echocardiography. This case is notable for the unknown risk of using high-dose desflurane with a preexisting cardiomyopathy and raises the question of the acceptable maternal risk in the setting of fetal surgery.

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Implementation of a Pediatric Critical Care Focused Bedside Ultrasound Training Program in a Large Academic PICU*

Abstract: Implementation of a critical care bedside ultrasound program for critical care providers in a large academic PICU is feasible. Bedside ultrasound evaluation and interpretation by intensivists affected the management of critically ill children.

Cited by 70 publications

References 21 publications

Ultrasound in undergraduate medical education: a systematic and critical review

Ultrasound in undergraduate medical education: a systematic and critical review

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

High-Dose Desflurane for Tocolysis During Intrapartum Myelomeningocele Repair in a Patient With Post-Adriamycin Cardiomyopathy

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