FOCUS on #POCUS

*This webinar was kindly sponsored by GE*

We would love to hear from you and any feedback/questions would be welcomed. OR if you want to find out more about #POCUS fellowships……

The presentation….

Reference list

What is #POCUS

Lichtenstein D, van Hooland S, Elbers P et al. Ten good reasons to practice ultrasound in critical care. 

Lichtenstein D and Mezière G (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-protocol. 

Perera P, Mailhot T, Riley D et al. The RUSH exam: Rapid ultrasound in shock in the evaluation of the critically ill. 

Lichtenstein D.A. Lung Ultrasound as the First Step of Management of a Cardiac Arrest: The SESAME-Protocol. In: Lung Ultrasound in the Critically Ill. Springer, 2016 Cham

Training in #POCUS

Malbrain MLNG, De Tavernier B, Haverals S et al. Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU). 

Mayo P, Beaulieu Y, Doelken P et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. 

Expert Round Table on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. 

Wong A, Galarza L and Duska F. Critical Care Ultrasound: A systematic review of international training competencies and program. 

Galarza L, Wong A and Malbrain M. The state of critical care ultrasound training in Europe: A survey of trainers and a comparison of available accreditation programmes. 

Future of #POCUS

Robba C, Goffi A, Geeraerts T et al. Brain ultrasonography: methodology, basic and advanced principles and clinical application. A narrative review. 

Aitkinson P, Beckett N, French N et al. Does point-of-care ultrasound use impact resuscitation length, rates of intervention and clinical outcomes during cardiac arrest? A study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. 

Feng M, McSparron JI, Kien Dt et al. Transthoraccic echocardiography and mortality in sepsis: analysis of MIMIC-III database.

If you are REALLY interested in pushing the limits of ultrasonography in critical care … https://thinkingcriticalcare.com/

Recommended textbooks

Focused Intensive Care Ultrasound (Oxford Clinical Imaging Guides)

Bedside Ultrasound: A Primer for Clinical Integration, 2nd edition Paperback – 2019

Whole Body Ultrasonography in the Critically Ill 1st ed. 2010 Edition

Acute and Critical Care Echocardiography (Oxford Clinical Imaging Guides)

POCUS comes to PICU: Introducing #CACTUS

Had the privilege of being invited to talk to colleagues in PICU Great Ormond Street Hospital, London about #POCUS and the newly introduced….

Children’s ACuTe UltraSound (CACTUS)

Very hot off the press is the Training Document (competencies and pathways) which isn’t even on the Paediatric Intensive Care Society website yet (it will be). Have a look below…

CACTUS is being led by Mike Griksaitis (Southampton) and team.

My presentation is available here. I compare the adult programme in the UK (#FICE + #CUSIC = #FUSIC) to the new #CACTUS.

Ultrasound at #SMARTmi2019 #POCUS

Multiorgan ultrasound assessment in the ED (@giovolpicelli)

Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension.

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

A controversial view perhaps??

Echography is mandatory for the initial management of critically ill patients: no

Septic shock: from pathophysiology to treatment (Tavazzi)

Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database.

Sepsis and cardiac dysfunction is common

Diastolic dysfunction is under-recognised

Strain echocardiography is useful BUT not very feasible as it is challenging to get good quality views

Strain echocardiography in septic shock – a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome

Elastase measurement in sepsis gives an idea of ventriculoarterial coupling and is easy to perform (apparently)

It allows differentiation of volume responders vs norepinephrine responders

Lung ultrasound for septic patients with acute respiratory failure (Mongodi)

https://www.ncbi.nlm.nih.gov/pubmed/30372119

Lung ultrasound as a diagnostic tool for consolidations in patients under mechanical ventilation is sensitive (91.7-93%) but poor specificity (0-63.2%)

Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. AUC ROC 0.83 – link

Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome.

Spleen and kidney: a mirror to organ perfusion (Corradi)

Renal Resistive Index: not only kidney

Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography.

Ultrasound to open a window in the brain (@fabio_taccone)

Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review.

https://www.ncbi.nlm.nih.gov/pubmed/30280261
Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients

Using contrast-enhanced ultrasound to study kidney perfusion – Acute kidney injury is associated with a decrease in cortical renal perfusion during septic shock

Setting up the ventilator using ultrasound (Golligher)

Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity.

My personal opinion is that there are high inter- and intra- observer variation in measurements of diaphragm thickness.

Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure.
Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort

Is there an ideal amount of ‘effort’ diaphragm thickening that impacts outcomes? If so, could you design a treatment pathway?