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

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)

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

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.

Fascinating. Anyone calibrate #renal doppler analysis with splenic doppler analysis? #POCUS #SMARTmi2019

— Adrian Wong (@avkwong) May 8, 2019

1/ Yep. RRI is mostly info about macro hemodynamics, but there’s some local micro hemodynamic information in there. Improving RRI seems to improve renal outcomes. The question is if this is due to local or systemic flow patterns. If drop in RRI>SRI results inked AKI compared

— korbinhaycockmd (@khaycock2) May 9, 2019

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

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

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.

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