SonoRoundtable Journal Club
Thanks to Srikar Adhikari and Steve Leech for coordinating our first ever SonoRoundtable Journal Club. We discussed 3 recent research articles in critical care applications of ultrasound that were published in 2013.
Steve reviewed Usefulness Of Cardiothoracic Chest Ultrasound In The Management Of Acute Respiratory Failure In Critical Care Practice by Silva et.al in Chest. 2013 Sep;144(3):859-65. This was a prospective trial of an ultrasound protocol versus standard evaluation in ICU patients with acute respiratory failure. The authors showed increased diagnostic accuracy of using ultrasound versus clinical judgment in differentiating causes of acute respiratory failure. We discussed the study in detail and how we can apply this protocol in the ED.
Srikar reviewed Accuracy Of Point-Of-Care Multiorgan Ultrasonography For The Diagnosis Of Pulmonary Embolism by Nazerian et al in Chest. 2013 Oct 3. doi: 10.1378/chest.13-1087. This was a multi-center study of multi-organ ultrasound for PE in patients with a Wells Score >4 or a positive d-dimer. Using an ultrasound protocol, they found a sensitivity of 90% and a specificity of 86.2% compared to chest CT scan. We reviewed their protocol and ultrasound findings, and discussed limitations and how to use this in our practice.
Steve reviewed The Use Of Bioreactance And Carotid Doppler To Determine Volume Responsiveness And Blood Flow Redistribution Following Passive Leg Raising In Hemodynamically Unstable Patients by Marik et al, Chest. 2013 Feb 1;143(2):364-70. This was a retrospective study looking at passive leg raising and increases in carotid flow to predict volume responsiveness in critically ill ICU patients. They showed a marked increase in carotid flow in volume responders vs. non responders, 79% vs 0.1%. Using a cutoff of a 20% increase in carotid flow would yield a sensitivity of 94% and specificity of 86%. We discussed the implications and technique in detail, as well as people's experience using this technique and other resuscitative maneuvers in the ED. For an excellent review of this technique, check out this episode of The Ultrasound Podcast.
Thanks again to all our participants for another great meeting. We will be scheduling dates and topics for January - June 2014, so keep your eye out for the email newsletter.
00:00 - Welcome & Introduction
00:36 - Steve Leech presentation & discussion on article: Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice.
23:40 - Srikar Adhikari presentation & discussion on article: Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism.
44:30 - Steve Leech presentation & discussion on article: The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients..
1:02:00 - Thank you & wrap up
- Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice.
- Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism.
- The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients.