A Week of POCUS
Concluding our Special Topic: POCUS
This has been a busy week!
We’ve covered five key papers from a range of researchers with a focus on Point-of-Care Ultrasound. This has been complemented by the excellent ‘Introduction to…’ blog posts from Adrian and Segun.
We hope you have enjoyed the week as much as we have. In preparing these papers, the TBL team have also learned new concepts and been inspired to try new techniques. Personally, I’m fascinated by the idea of ocular ultrasound, and the #FOAMed resources given in Segun’s blog post have been really useful.
Here’s a short summary of the week:
Editorial Blog Posts
Lichtenstein – Lung Ultrasound
TBL: “In patients with acute respiratory failure bedside, ultrasound appears to help determine the diagnosis. Validation studies are required to confirm the utility of the BLUE protocol. Due to biases in the study design the performance of the BLUE protocol is likely to be less accurate than the results reported in this trial.”
Moretti – IVC Distensibility and Fluid Responsiveness
TBL: “In patients with a grade 3/4 SAH and a low cardiac index, who are mechanically ventilated with tidal volumes of 8ml/kg, and are sedated and paralysed, dIVC was a useful predictor of fluid responsiveness. Further trials will need to determine if these results can apply to other populations.”
Feissel – Aortic Blood Velocity and Fluid Responsiveness
TBL: “In this small study, patients with septic shock who were mechanically ventilated with tidal volumes of 8-10ml/kg, the respiratory changes in peak aortic blood velocity predicted which patients would have a significant increase in cardiac index with a fluid challenge. The increase in LV end-diastolic area index with a fluid challenge significantly correlated with the increase in cardiac index; where as the baseline LV end-diastolic area index did not predict if a patient would be fluid responsive.”
Battlori – Transducer Orientation and Vascular Access
TBL: “This study confirms the view that ultrasound-guided IJV cannulation is quicker and technically less demanding in SAX compared to LAX but is associated with greater risk of complication. OAX is a relatively less well-known approach which has the potential to combine the advantages of SAX and LAX but requires further evaluation and training.”
Kristensen – Identifying the Airway in Morbidly Obese Patients
TBL: “This study highlights the usefulness of ultrasound in identification of the cricothyroid membrane in airway management. Like the use of ultrasound in vascular access, optimal and preferred probe orientation will be dependant on various individual factors.”
TBL would like to promote two POCUS courses coming up in the UK:
ICSSOA CUSIC Workshop
Adrian and his colleagues are hosting a two day workshop before the internationally-renowned ICS State of the Art meeting at London in December 2016.
Portsmouth FICE Course
David and his colleagues are hosting an approved FICE course at Portsmouth in March 2017.
Further details of this and other approved FICE courses can be found here, or contact David directly: [email protected].
Duncan, on behalf of the TBL team: David, Steve, Adrian, Segun, Celia and Charlotte.