Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting.
TL;DR: In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
Abstract: Introduction
In the emergency setting, focused cardiac ultrasound has become a fundamental tool for diagnostic, initial emergency treatment and triage decisions. A new ultra-miniaturized pocket ultrasound device (PUD) may be suited to this specific setting. Therefore, we aimed to compare the diagnostic ability of an ultra-miniaturized ultrasound device (Vscan™, GE Healthcare, Wauwatosa, WI) and of a conventional high-quality echocardiography system (Vivid S5™, GE Healthcare) for a cardiac focused ultrasonography in patients admitted to the emergency department.
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TL;DR: In this article, the authors use smartphones and connected sensors to monitor, analyze, display, store, and share multiple physiologic signals and data in perioperative care, and simplify clinicians' life.
9 citations
TL;DR: It is suggested that novice users learning to use the PUD readily learn to image ULC, which was prognostic in this ICU population and was the only sign that had statistically significant prognostic value in the residents’ and cardiologist’s interpretations.
Abstract: Biais and colleagues [1] have shown that echocardiographers can adequately perform a three-view cardiac examination in the emergency setting using a pocket ultrasound device (PUD). We have similarly noted that an evidence-based 'quick-look', cardiac limited ultrasound examination has diagnostic and prognostic value [2], can affect medical decision-making [3], and can be successfully taught to internal medicine residents [4]. As few data describe the learning curve of ultrasound imaging with PUDs, we observed the initial quality and prognostic value of six 'quick-look' signs obtained by residents learning to use the PUD.
Internal medicine residents in an ultrasound training program [4] recorded a brief, previously described [2] cardiac limited ultrasound examination designed to detect six 'quick-look' signs of left ventricular systolic dysfunction, left atrial enlargement, ultrasound lung comet (ULC) tail artifact representing interstitial lung edema, elevated central venous pressure, pleural effusion, and right ventricular enlargement on a convenience-sample of intensive care unit (ICU) patients with respiratory failure, shock, or severe cardiac disease, using a PUD (Vscan, GE Healthcare, Wauwatosa, WI, USA). An expert echocardiographer reviewed the resident-acquired images and assigned a quality score: 0 (no image), 1 (only motion detected; off-axis), 2 ('suboptimal', poor delineation of structures), 3 ('adequate' for diagnosis of particular sign), or 4 ('optimal', good delineation of all structures).
Only technically adequate quality views (score >2) were entered into a multivariate logistic regression combining the six signs, clinical presentation and inpatient mortality (SPSS version 12.0). A P-value <0.05 was considered statistically significant. The Scripps Institutional Review Board approved the study.
Twenty-one residents recorded 749 views on 107 critically ill patients (mean 5.1 patients/resident): mean patient age of 65.2 ± 16.8 years, inpatient mortality of 25.2%, and mean quality score of 2.1 ± 1.4. Presentation, mortality and overall percentage adequate quality views were: respiratory failure (n = 55, 32.7%, 48.0%), shock (n = 16, 25.0%, 51.6%) and cardiac disease (n = 36, 13.9%, 51.7%). ULC had the most adequate quality images and is the only sign that had statistically significant prognostic value in the residents’ and cardiologist’s interpretations (Table 1).
Table 1
Mortality odds ratios for 'quick-look' signs determined by residents’ and cardiologist’s interpretations of adequate quality images
Galen cautioned against extrapolating Biais and colleagues’ data for non-expert users [5]. As few studies address the learning curve of quick-look ultrasound imaging tasks, this study suggests that novice users learning to use the PUD readily learn to image ULC, which was prognostic in this ICU population. In light of a substantial number of initially difficult psternal long-axis and subcostal views, the PUD’s most simple and immediate use may be in the rapid detection of life-threatening pulmonary edema.
9 citations
Cites background from "Evaluation of a new pocket echoscop..."
...After several years of experience with PUDs, we have demonstrated its reliability for goal-directed examinations aiming to answer brief and important clinical questions encountered by front-line physicians in the emergency setting [1,6]....
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...Biais and colleagues [1] have shown that echocardiographers can adequately perform a three-view cardiac examination in the emergency setting using a pocket ultrasound device (PUD)....
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TL;DR: Huang et al. as mentioned in this paper used lipopolysaccharide (LPS)-induced mouse sepsis model and a 1H NMR-based metabolomics approach complemented with survival rate studies, histopathological inspection, biochemical assays, mRNA expression analysis and western blot analysis was used to study the effects of HLJDD treatment.
Abstract: Sepsis is a life-threatening disease in humans caused by a systemic inflammatory response, leading to high mortality. Huang-Lian-Jie-Du decoction (HLJDD) has been used to treat sepsis and improve its survival rate. In this investigation, a lipopolysaccharide (LPS)-induced mouse sepsis model was established and a 1H NMR-based metabolomics approach complemented with survival rate studies, histopathological inspection, biochemical assays, mRNA expression analysis and western blot analysis was used to study the effects of HLJDD treatment on sepsis. LPS produced severe metabolic disturbance, including inflammation, oxidative stress, energy and amino acid metabolism, and it activated the ERK and SRC/STAT3 signaling pathways. HLJDD could greatly attenuate the disturbed metabolites and may exert its treatment effect by inhibiting the ERK and SRC/STAT3 signaling pathways.
8 citations
TL;DR: The application of a pocket-sized echocardiography device for focused intraoperative TTE is feasible and can appropriate be used for the initial evaluation of relevant pathologies in the operating theatre.
Abstract: Background The intraoperative application of focused transthoracic echocardiography (TTE) is often considered to be restricted. Echocardiography with pocket-sized hand held ultrasound systems has been shown to be feasible in various settings. Objective The aim of this study was to investigate the feasibility of the intraoperative application of pocket-sized echocardiography and the comparison of its imaging quality and diagnostic reliability and variability with a standard ultrasound system. Methods After written informed consent, TTE was performed on 40 anaesthetised general, vascular, visceral, thoracic surgical and orthopaedic patients according to the FATE protocol: first, with a pocket-sized and second, with a high-end ultrasound system randomly by two anaesthetists. Imaging quality of four basic and three additional FATE views was rated on an established scale from 1 (impossible) to 5 (perfect). Successful TTE was defined, if one basic FATE views would be rated as grade 4 or 5 or alternatively two views as grade 3. Pathologic findings by both ultrasound devices were documented and imaging quality and pathologic findings were compared. Results All 40 patients presented acceptable imaging quality, resulting in a success rate of 1.0 (97.5%-CI 0.91-1, p= 0.015). The individual imaging ratings of each view were significantly lower with the pocket-sized system, but still showed acceptable imaging quality. With the high-end device more pathologic findings were detected (107 vs. 87), but none of the relevant or severe pathologies were overseen with the hand-held device. Conclusion The application of a pocket-sized echocardiography device for focused intraoperative TTE is feasible and can appropriate be used for the initial evaluation of relevant pathologies in the operating theatre.
7 citations
Cites methods from "Evaluation of a new pocket echoscop..."
...The use of pocket-sized ultrasound systems for echocardiography has been described for various settings: in cardiologic routine [16–19], intensive care units [4], emergency settings [20], and patients before one-day surgeries [21]....
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TL;DR: In trauma, ultrasonography can be used in the pre-hospital setting, in disaster situations, during patient retrieval, and in the hospital setting from the emergency department to the operating room, intensive care units, and the wards.
Abstract: Ultrasonography has gained a unique role in assisting emergency medicine physicians in the trauma setting. Its major advantages include safety, bedside availability, repeatability, and portability. In addition, it does not have to interrupt resuscitation, it does not require sedation, it takes image
7 citations
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"Evaluation of a new pocket echoscop..." refers methods in this paper
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"Evaluation of a new pocket echoscop..." refers methods in this paper
...The ability of the PUD to discriminate the severity of the global LV systolic dysfunction (normal was greater than 50%, moderately depressed was 30% to 50%, and severely depressed was less than 30%) was tested by using Cohen’s coefficient, and 95% confidence intervals (CIs) were calculated [26]....
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TL;DR: This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.
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4,014 citations
"Evaluation of a new pocket echoscop..." refers methods in this paper
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...Recently, a consensus statement by the American Society of Echocardiography/American College of Emergency Physicians emphasized the complementary role of focused cardiac US to that of a more comprehensive echocardiography [9]....
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TL;DR: This review includes videos demonstrating the use of ultrasonography to guide central venous access, detect pneumothorax, detect evidence of hemorrhage after trauma, and screen for abdominal aortic aneurysm.
Abstract: Compact ultrasound technology has facilitated growth in point-of-care uses in many specialties. This review includes videos demonstrating the use of ultrasonography to guide central venous access, detect pneumothorax, detect evidence of hemorrhage after trauma, and screen for abdominal aortic aneurysm.
1,267 citations
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