Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: Practice Guidelines and Recommendations for Training Writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC)
01 Oct 2011-Journal of The American Society of Echocardiography (Elsevier)-Vol. 24, Iss: 10, pp 1057-1078
TL;DR: The aim of this research was to establish a theory that can be applied to the management of infectious disease in a post-operative setting and to improve the quality of medical treatment for these patients.
Abstract: Luc Mertens, MD, PhD, FASE, FESC, Istvan Seri, MD, PhD, HonD, Jan Marek, MD, PhD, FESC, Romaine Arlettaz, MD, Piers Barker, MD, FASE, Patrick McNamara, MD, MB, FRCPC, Anita J. Moon-Grady, MD, Patrick D. Coon, RDCS, FASE, Shahab Noori, MD, RDCS, John Simpson, MD, FRCP, FESC, Wyman W. Lai, MD, MPH, FASE, Toronto, Ontario, Canada; Los Angeles and San Francisco, California; London, United Kingdom; Zurich, Switzerland; Durham, North Carolina; Philadelphia, Pennsylvania; New York, New York
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King Abdulaziz Medical City1, University of the Witwatersrand2, University of Minnesota3, King Saud University4, Harvard University5, Icahn School of Medicine at Mount Sinai6, University of Belgrade7, Beth Israel Deaconess Medical Center8, Aarhus University Hospital9, University of South Florida10, Scripps Mercy Hospital11, University Hospital of Wales12, Sydney Adventist Hospital13, Peking Union Medical College Hospital14, Apollo Hospitals15, University of South Carolina16, Cornell University17
TL;DR: For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
Abstract: 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. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
397 citations
TL;DR: Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available and will be useful to optimise the use, training programs and further research, which are urgently needed given the weak quality of evidence available.
Abstract: Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.
258 citations
TL;DR: This research presents a poster presented at the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists meeting in Charleston, South Carolina, on Wednesday, 2 March 2016, to discuss the future direction of research in perioperative and laparoscopic anesthesiology.
Abstract: Scott T Reeves, MD, FASE, Alan C Finley, MD, Nikolaos J Skubas, MD, FASE, Madhav Swaminathan, MD, FASE, William S Whitley, MD, Kathryn E Glas, MD, FASE, Rebecca T Hahn, MD, FASE, Jack S Shanewise, MD, FASE, Mark S Adams, BS, RDCS, FASE, and Stanton K Shernan, MD, FASE, for the Council on Perioperative Echocardiography of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists, Charleston, South Carolina; New York, New York; Durham, North Carolina; Atlanta, Georgia; Boston, Massachusetts
165 citations
Cites methods from "Targeted Neonatal Echocardiography ..."
...The use of a noncomprehensive basic PTE examination to delineate the cause of hemodynamic instability was originally proposed for the emergency room and neonatal intensive care unit settings and is meant to be complementary to comprehensive echocardiography.(1,2) However, the principal goal of a basic PTE examination is intraoperative monitoring....
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TL;DR: An overview of the pathological contributors to PPHN, the physiologic constituents of its phenotypic expression, standard approach to therapeutic intervention, and the role of bedside echocardiography in enhancing the decision-making process is provided.
Abstract: Persistent pulmonary hypertension of the newborn (PPHN) is a frequent cause for admission to the neonatal intensive care unit and is associated with mortality and variable morbidities. It is primarily a state of oxygenation failure representing a failure of the normal postnatal decline in pulmonary vascular resistance that may be associated with right ventricular dysfunction. Enhanced knowledge of the pathophysiologic contributors to this syndrome helps clinicians understand its phenotypic expression and facilitates more focused intensive care decision-making. The approach to treatment should be based on alleviation of the elevation in pulmonary vascular resistance and should include optimization of lung recruitment and judicious use of pulmonary vasodilators. When response to inhaled nitric oxide is suboptimal, the physiologic contributors to impaired oxygenation need further investigation. Targeted neonatal echocardiography provides novel physiologic insights; in particular, it may help assess the adequacy of right ventricular performance, the relative contribution of the fetal shunts and the magnitude of the overall impairment to cardiac output. This information may facilitate therapeutic next steps and whether adjunctive vasodilators or drugs to augment ventricular function are preferable. This article provides a comprehensive overview of the pathological contributors to PPHN, the physiologic constituents of its phenotypic expression, standard approach to therapeutic intervention, and the role of bedside echocardiography in enhancing the decision-making process.
155 citations
Cites background from "Targeted Neonatal Echocardiography ..."
...Increasingly, neonatologists around the world are beginning to use bedside targeted neonatal echocardiography (TnECHO) or functional echocardiography to facilitate clinical decision-making for critically ill neonates in neonatal intensive care units [56,57]....
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Boston Children's Hospital1, Children's National Medical Center2, Maimonides Medical Center3, New York Methodist Hospital4, Hospital for Sick Children5, The Queen's Medical Center6, University of California, Davis7, Morgan Stanley Children's Hospital8, University of California, San Diego9, Boston Medical Center10, Harvard University11, Columbia University Medical Center12, Mount Sinai St. Luke's and Mount Sinai Roosevelt13, Montefiore Medical Center14, Newark Beth Israel Medical Center15, Mount Sinai Hospital16, Cornell University17, University of Colorado Boulder18
TL;DR: This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations for pediatric emergency medicine providers.
Abstract: The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
146 citations
References
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TL;DR: Recommendations for the evaluation of left ventricular diastolic function by echocardiography are made and further research is needed to determine the best method for this evaluation.
Abstract: Recommendations for the evaluation of left ventricular diastolic function by echocardiography
4,162 citations
TL;DR: The assessment of left ventricular (LV) diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment.
Abstract: The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination, particularly in patients presenting with dyspnea or heart failure. About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions (EFs). These patients are diagnosed with “diastolic heart failure” or “heart failure with preserved EF.”1 The assessment of LV diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment.
LV filling pressures as measured invasively include mean pulmonary wedge pressure or mean left atrial (LA) pressure (both in the absence of mitral stenosis), LV end-diastolic pressure (LVEDP; the pressure at the onset of the QRS complex or after A-wave pressure), and pre-A LV diastolic pressure (Figure 1).Although these pressures are different in absolute terms, they are closely related, and they change in a predictable progression with myocardial disease, such that LVEDP increases prior to the rise in mean LA pressure.
Figure 1
The 4 phases of diastole are marked in relation to high-fidelity pressure recordings from the left atrium (LA) and left ventricle (LV) in anesthetized dogs. The first pressure crossover corresponds to the end of isovolumic relaxation and mitral valve opening. In the first phase, left atrial pressure exceeds left ventricular pressure, accelerating mitral flow. Peak mitral E roughly corresponds to the second crossover. Thereafter, left ventricular pressure exceeds left atrial pressure, decelerating mitral flow. These two phases correspond to rapid filling. This is followed by slow filling, with almost no pressure differences. During atrial contraction, left atrial pressure again exceeds left ventricular pressure. The solid arrow points to left ventricular minimal pressure, the dotted arrow to left ventricular …
3,659 citations
"Targeted Neonatal Echocardiography ..." refers background in this paper
...In children and adults, evaluation of diastolic function relies on a combination of different measurements, including mitral inflow, pulmonary venous flow, and tissue velocity measurements of the mitral annulus.(42,43) In infants, the available data on diastolic function assessment are limited and based mainly on analysis of mitral inflow patterns....
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Wayne State University1, Yale University2, University of Texas at Austin3, RTI International4, University of Cincinnati5, Case Western Reserve University6, National Institutes of Health7, University of California, San Diego8, University of Alabama9, University of Miami10, Duke University11, Stanford University12, Emory University13, Indiana University – Purdue University Indianapolis14, University of Rochester15
TL;DR: Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic–ischemic encephalopathy and there was no increase in major disability among survivors.
Abstract: background Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain. methods We conducted a randomized trial of hypothermia in infants with a gestational age of at least 36 weeks who were admitted to the hospital at or before six hours of age with either severe acidosis or perinatal complications and resuscitation at birth and who had moderate or severe encephalopathy. Infants were randomly assigned to usual care (control group) or whole-body cooling to an esophageal temperature of 33.5°C for 72 hours, followed by slow rewarming (hypothermia group). Neurodevelopmental outcome was assessed at 18 to 22 months of age. The primary outcome was a combined end point of death or moderate or severe disability. results Of 239 eligible infants, 102 were assigned to the hypothermia group and 106 to the control group. Adverse events were similar in the two groups during the 72 hours of cooling. Primary outcome data were available for 205 infants. Death or moderate or severe disability occurred in 45 of 102 infants (44 percent) in the hypothermia group and 64 of 103 infants (62 percent) in the control group (risk ratio, 0.72; 95 percent confidence interval, 0.54 to 0.95; P=0.01). Twenty-four infants (24 percent) in the hypothermia group and 38 (37 percent) in the control group died (risk ratio, 0.68; 95 percent confidence interval, 0.44 to 1.05; P=0.08). There was no increase in major disability among survivors; the rate of cerebral palsy was 15 of 77 (19 percent) in the hypothermia group as compared with 19 of 64 (30 percent) in the control group (risk ratio, 0.68; 95 percent confidence interval, 0.38 to 1.22; P=0.20). conclusions Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic–ischemic encephalopathy.
2,311 citations
TL;DR: Induced head cooling is not protective in a mixed population of infants with neonatal encephalopathy, but it could safely improve survival without severe neurodevelopmental disability in infants with less severe aEEG changes.
1,863 citations
TL;DR: There are extensive revisions, especially of the sections on ischemic heart disease; congestive heart failure, cardiomyopathy, and assessment of left ventricular (LV) function; and screening and echocardiography in the critically ill.
1,523 citations