Role of echocardiography in the hemodynamic monitorization of critical patients

Azcárate, J.M. Ayuela; Terré, François; Ochagavía, A.; Pereira, R. Vicho

doi:10.1016/j.medine.2012.05.002

Cited by 10 publications

(9 citation statements)

References 58 publications

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“…Concerns have been raised about small handheld systems with regard to their narrow sector, smaller field of view, lower resolution, and simplified transducer technology. 25,104,105 Although studies have documented that small ultrasonography devices can be used to answer focused questions, 18,61,[106][107][108][109][110][111][112][113][114][115] operators must be aware of their limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Although a movement to integrate POCUS education into medical schools or internal medicine residency programs has been gaining momentum over the past decade, 43,121,[123][124][125][126][127][128][129] there is no consensus on the training required to reach adequate POCUS competency levels in general internal medicine. 25,104,110,111,[130][131][132][133] It is generally agreed that training must include basic knowledge of ultrasound physics and supervised image acquisition and interpretation practice. 25,104,110,111,[130][131][132][133] Other potential challenges include the availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing.…”

Section: Discussionmentioning

confidence: 99%

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Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Bhagra

Tierney

Sekiguchi

et al. 2016

Mayo Clinic Proceedings

188

151

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Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Bhagra

Tierney

Sekiguchi

et al. 2016

Mayo Clinic Proceedings

188

151

View full text Add to dashboard Cite

show abstract

“…Patients with previously unknown PAH are occasionally seen for the first time in the emergency department. If a patient with PAH is seen on an emergency basis, echocardiography is extremely important to assess the current status of RV function . A central venous catheter allows for monitoring of SvO 2 and central venous pressure in response to therapy.…”

Section: Clinical Managementmentioning

confidence: 99%

“…If a patient with PAH is seen on an emergency basis, echocardiography is extremely important to assess the current status of RV function. 63,64 A central venous catheter allows for monitoring of SvO 2 and central venous pressure in response to therapy. Continuous and complete haemodynamic assessment might require the placement of a pulmonary artery catheter, but the expected benefits for patient management should be weighed against the risk of complications, including complications with vein access, life-threatening arrhythmias as well as infections and thrombosis.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Harjola

Mebazaa

Čelutkienė

et al. 2016

European J of Heart Fail

530

427

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Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses 227to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.

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“…In addition to point of care diagnosis, the patient and clinician can also benefit from augmented hemodynamic monitoring giving additional information to conventional pressure and flow-based measurement. [1][2][3][4][5][6] The size, portability, ease of use, and the high quality of the imaging has made the case for widespread international adoption undeniable. Ultrasound is technical and operator dependent with a significant learning curve.…”

mentioning

confidence: 99%

Can Simulation Help to Answer the Demand for Echocardiography Education?

Clau-Terré

Sharma²,

Cholley³

et al. 2014

Anesthesiology

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There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve.

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Role of echocardiography in the hemodynamic monitorization of critical patients

Cited by 10 publications

References 58 publications

Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Can Simulation Help to Answer the Demand for Echocardiography Education?

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