SonoKids CCM

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25-50 exams on respective systems or organs for a total not less than 125 studies on ICU...

Critical care ultrasonography (CCUS) has been defined as an ultrasound evaluation of the heart, abdomen, pleura and lungs at the bedside by the intensivist, 24/7. Within CCUS, critical care echocardiography (CCE) is used to assess cardiac function and more generally haemodynamics. Experts in haemodynamics have published a 'consensus of 16' regarding an update on haemodynamic monitoring. They reported the ten key properties of an 'ideal' haemodynamic monitoring system, which perfectly match the ten good reasons we describe here for performing CCE in critically ill patients...

The reversal of lung collapse is one of the challenges of lung injury prevention in pediatric acute respiratory distress syndrome. In this case, lung recruitment maneuver (RM) with positive end-expiratory pressure under computed tomography guidance is the procedure of choice, but cumulative ionizing radiation exposure is a major radiologic concern, especially in infants. Real-time guidance of lung recruitment under bedside lung ultrasound (US) assessment in adults has shown to be an effective procedure for performing RM that avoids ionizing radiation overexposure...

An increasingly amount of evidence suggests that lung ultrasonography constitutes a relevant complementary diagnostic tool for adults patient in acute respiratory failure. A comprehensive and standardized ultrasonographic semiology has been described, relying on accurate and reproducible data directly obtained at patient's bedside. Therefore, pleural effusion, pneumothorax, pulmonary consolidation and interstitial lung disease can be diagnosed in a critical care environment with a similar level of performance than when reference diagnosis methods such as thoracic CT-scan are employed...

Transcranial sonography (TCS) is an ultrasound-based imaging technique, which allows the identification of several structures within the brain parenchyma. In the past it has been applied for bedside assessment of different intracranial pathologies in children. Presently, TCS is also used on adult patients to diagnose intracranial space occupying lesions of various origins, intracranial hemorrhage, hydrocephalus, midline shift and neurodegenerative movement disorders, in both acute and chronic clinical settings...

OBJECTIVES: Our primary objective was to determine the prevalence and outcome of diastolic dysfunction in children with fluid refractory septic shock. The secondary objective was to determine possible early predictors of diastolic dysfunction. DESIGN: Prospective observational study. SETTING: PICU of a tertiary care teaching hospital. PATIENTS: Consecutive children 17 years old or younger with fluid refractory septic shock and not on mechanical ventilation admitted to our ICU from June 2011 to August 2012 were included...

AIM: The purpose of this study was to compare lung ultrasound findings in both the supine and upright positions in heart failure patients presenting with dyspnea or chest pain. METHODS AND RESULTS: We performed lung ultrasonography on 50 heart failure patients in the emergency department. Each subject underwent eight-zone lung sonography in the seated upright position, followed by a repeat ultrasound in the supine position. Each ultrasound video clip was later assigned a score (0-2 B-lines=0 points, 3-7 B-lines=1 point, >7 B-lines=2 points) by a physician who was blinded to patient position, chest zone, and clinical information...

Shock is a hemodynamic situation that aggravates the vital prognostic of every patient regardless of the underlying pathology. It has been well documented that the speed at which hemodynamics is restored to standard values significantly decreases the mortality and morbidity in these patients. Initially described in traumatology, then in every type of shock, the contribution of ultrasonography performed at the bedside by the physician in charge allows for a significant shortening of the diagnostic procedure and thus an earlier start for a goal-directed treatment...

PURPOSE: Assessment of volume status remains a challenge in critical care. Our purpose was to determine if Doppler waveform analysis of carotid artery blood flow correlates with changes in volume status. MATERIALS AND METHODS: Dehydrated patients receiving an intravenous fluid bolus were enrolled with exclusions including age less than 18 years, pregnancy, vasopressor administration, or atrial fibrillation. Ultrasound examination with Doppler analysis of the carotid artery was performed with measurements taken to calculate corrected flow time (FTc)...

OBJECTIVE: To discuss pediatric intensivist-driven ultrasound and the exigent need for research and practice definitions pertaining to its implementation within pediatric critical care, specifically addressing issues in ultrasound-guided vascular access and intensivist-driven echocardiography. CONCLUSIONS: Intensivist-driven ultrasound improves procedure safety and reduces time to diagnosis in clinical ultrasound applications, as demonstrated primarily in adult patients...

BACKGROUND: Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. METHODS: The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

INTRODUCTION: Performed for many years in clinical settings, pleural and lung ultrasound (PLUS) has emerged to be an invaluable tool to diagnose underlying conditions of respiratory failure, to monitor disease progression and to ensure appropriate therapeutic intervention. PLUS basically relies on the analysis of two prevalent ultrasound artefacts: A-lines and B-lines. A-lines are hyperechoic reverberation artefacts of the pleural line. A-lines combined with lung sliding show that lungs are well aerated...

Central venous catheterization (CVC) can be difficult, especially with pediatric patients in critical care. Accessing the subclavian vein (SCV) can cause serious complications, including pneumothorax, arterial puncture, and hemothorax. Recently, the ultrasonographic (USG) technique has gained popularity, but its efficiency is not yet confirmed. Subclavian venous catheterization (SCVC) through the supraclavicular approach (SCA) with USG or accessing the brachiocephalic vein through the infraclavicular approach (ICA) has been reported in the past...

Functional echocardiography (fECHO) is the bedside use of ultrasound to longitudinally assess myocardial function, systemic and pulmonary blood flow, and intra and extracardiac shunts. This review will focus on fECHO as a tool for the clinician to assess the hemodynamic condition of sick neonates and describe situations where fECHO can help determine a pathophysiological choice for cardiovascular support. The very low birth weight infant with hypotension during the first 24h of life, assessment and monitoring of the ductus arteriosus, assessment and response to treatment of infants with pulmonary hypertension, the infant with perinatal asphyxia and the infant with sepsis and cardiovascular compromise are reviewed...

BACKGROUND: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. METHODS: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians...

UNLABELLED: Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers a training certificate for fnECHO. In Europe, the use and indications of fnECHO and the extent of point-of-care fnECHO training and accreditation are unknown. We aimed to assess utilisation and training of fnECHO in Europe...

OBJECTIVES: Previous studies demonstrated that the collapsibility index (percent decrease in inferior vena cava [IVC] diameter with inspiration) of 50% or greater and an IVC/aorta ratio of 0.8 or less correlated with a low intravascular volume. Our study sought to determine if bedside ultrasound (BUS) measurements of the IVC diameter correlate with central venous pressure (CVP) measurements as an indicator of intravascular volume status in acutely ill children. METHODS: A convenience sample of children younger than 21 years who were admitted to the pediatric critical care unit and required CVP monitoring had BUS measurements of both IVC and aortic diameters with simultaneous CVP measurement...

Heart failure as a result of cardiomyopathy is an uncommon presentation in the pediatric emergency department (PED). The initial presenting symptoms in these cases are often nonspecific and may be confused with more common pediatric illnesses. We report a case of a 3-year-old girl initially discharged from a PED after routine evaluation of vomiting and diarrhea with a diagnosis of acute gastroenteritis only to return 1 week later in heart failure from a dilated cardiomyopathy. A bedside ultrasound performed by the emergency physician in the PED allowed for the initiation of appropriate, rapid, goal-directed therapy and expedited timely transport to a facility with pediatric cardiothoracic surgery...