作者希望认识到他对这篇手稿的贡献, 他是肾病学和危重护理专家 Paul 菲克斯·萨穆迪奥博士。

1. 在利尿前评估外间隔: 胸部超声
<ol><li>使用低频, 相控阵探头。</li>
	<li>选择适当的机器设置 (腹部或肺) 与屏幕标记操作员左。</li>
	<li>将深度调整到8-12 厘米。</li>
	<li>将病人置于仰卧或半卧位, 露出前胸。将换能器置于90°角, 用探针标记面对头侧。<ol>
<li>在胸部两侧两个位置的锁骨中线线上执行此协议, 共四个位置: 在2和-3路或 3路-4 次肋间空间, 并在4日-5日或 5日6次肋间空间。</li>
		<li>可视化 B 线, 如果存在。 注意: B 线是回声的伪影, 在胸膜线上有一个狭窄的原点, 它们与呼吸运动同步移动 (图 1)。</li>
	</ol>
</li>
	<li>计算每张扫描平面的 B 线数目, 以量化肺水肿的程度。 注: 最多一条 B 线正常;两至三 b 线代表轻度肺水肿, 而4或更多 b 线代表中度至严重水肿;没有一条线的白化模式代表非常严重的肺水肿 (图 2)。</li>
</ol>2. 在利尿前评估血管内间隔: 静脉超声
<ol><li>使用低频, 相控阵探头。</li>
	<li>选择心脏机器设置与屏幕标记操作员-权利和调整深度到 12-21 cm 为最佳的图像分辨率。</li>
	<li>将病人置于仰卧位, 露出前胸。将传感器放置在90°角度, 将探头标记在头侧的剑突区域。<ol>
<li>执行此协议与传感器位于右中线, 倾斜轻微右侧和头侧。</li>
		<li>通过扫描从右向左, 可视化的静脉和主动脉。</li>
		<li>注意, 其目的是在纵向平面上可视化 cavo-心房交界、膈肌、肝、肝静脉和静脉。通过 angulating 扫描平面内侧来可视化主动脉 (图 3)。</li>
	</ol>
</li>
	<li>一旦发现了 cavo 和心房交界处, 就将超声波设置为 M 型, 以测量静脉的前后直径。<ol>
<li>使用触摸屏, 选择对应于近正交截面的 M 型光束, 2-4 厘米远端至 cavo-心房交界处, 刚好超出可见的肝静脉。</li>
		<li>第二次选择 m 模式按钮, 在 m 模式读数完成至少1个呼吸周期后, 将屏幕冻结。</li>
		<li>使用机器卡尺进行所有测量, 测量从内部边缘到内部边缘的容器。</li>
	</ol>
</li>
	<li>在正常的呼吸周期中测量 d-最大和 d 分钟。</li>
</ol>3. 根据肺水肿和静脉内径分级确定流体管理目标
<ol><li>评估肺超声以确定是否需要利尿 (图 2)。</li>
	<li>评估静脉超声检查以确定患者的耐利尿能力 (图 3)。</li>
</ol>4. 在利尿治疗过程中重新评估外和血管内隔间。
<ol><li>每6小时重复上述协议, 评估利尿治疗的进展, 指导流体管理目标。</li>
</ol>

<ol>
	<li>Zoccali, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+congestion+predicts+cardiac+events+and+mortality+in+ESRD.">Pulmonary congestion predicts cardiac events and mortality in ESRD.</a> Journal of the Amerian Society of Nephrology. 24, 639-646 (2013).</li><li>Vitturi, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasound+during+hemodialysis,+the+role+in+the+assessment+of+volume+status.">Lung ultrasound during hemodialysis, the role in the assessment of volume status.</a> International Urology and Nephrology. 46, 169-174 (2014).</li><li>Noble, V. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+assessment+for+extravascular+lung+water+in+patients+undergoing+hemodialysis.+Time+course+for+resolution.">Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution.</a> Chest. 135, 1433-1439 (2009).</li><li>Lang, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recommendations+for+Cardiac+Chamber+Quantification+by+Echocardiography+in+Adults:+An+Update+from+the+American+Society+of+Echocardiography+and+the+European+Association+of+Cardiovascular+Imaging.">Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.</a> Journal of the American Society of Echocardiography. 28, 1-39 (2015).</li><li>Barbier, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Respiratory+changes+in+inferior+vena+cava+diameter+are+helpful+in+predicting+fluid+responsiveness+in+ventilated+septic+patients.">Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.</a> Intensive Care Medicine. 30, 1740-1746 (2004).</li><li>Feissel, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+respiratory+variation+in+inferior+vena+cava+diameter+as+a+guide+to+fluid+therapy.">The respiratory variation in inferior vena cava diameter as a guide to fluid therapy.</a> Intensive Care Medicine. 30, 1834-1837 (2004).</li><li>Lichtenstein, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasound+in+the+critically+ill.">Lung ultrasound in the critically ill.</a> Annals of Intensive Care. 4, 1 (2014).</li><li>Lichtenstein, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=BLUE-Protocol+and+FALLS-Protocol:+Two+Applications+of+Lung+Ultrasound+in+the+Critically+Ill.">BLUE-Protocol and FALLS-Protocol: Two Applications of Lung Ultrasound in the Critically Ill.</a> Chest. 147, 1659-1670 (2015).</li><li>Moore, C. L., Copel, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasonography.">Point-of-care ultrasonography.</a> New England Journal of Medicine. 364, 749-757 (2011).</li><li>Lichtenstein, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A-lines+and+B-lines:+lung+ultrasound+as+a+bedside+tool+for+predicting+pulmonary+artery+occlusion+pressure+in+the+critically+ill.">A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill.</a> Chest. 136, (2009).</li><li>Trezzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasonography+for+the+assessment+of+rapid+extravascular+water+variation,+evidence+from+hemodialysis+patients.">Lung ultrasonography for the assessment of rapid extravascular water variation, evidence from hemodialysis patients.</a> Internal and Emergency Medicine. 8, 409-415 (2013).</li><li>Lyon, M., Blaivas, M., Brannam, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+measurement+of+the+inferior+vena+cava+as+a+marker+of+blood+loss.">Sonographic measurement of the inferior vena cava as a marker of blood loss.</a> American Journal of Emergency Medicine. 23, 45-50 (2005).</li><li>Katzarski, K. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+critical+evaluation+of+ultrasound+measurement+of+inferior+vena+cava+diameter+in+assessing+dry+weight+in+normotensive+and+hypertensive+hemodialysis+patients.">A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients.</a> American Journal of Kidney Disease. 30, 459-465 (1997).</li><li>Goyfman, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+aquaretic+and+diuretic+therapy+in+acute+heart+failure.">Combined aquaretic and diuretic therapy in acute heart failure.</a> International Journal of Nephrology and Renovascular Disease. 10, 129-134 (2017).</li></ol>

作者没有什么可透露的。

许多研究表明, 床边美国是一个可靠的诊断工具, 可用于指导管理的各种疾病状态, 如休克和呼吸困难5。B 线与外肺水的相关性在评价肺水肿方面具有良好的灵敏度和特异性, 研究表明, 肺美可可靠地检测到外肺水2的微小变化, 10. 同样, 研究表明, 经美国技术测量的静脉内径是血管内容积损失12、13</...

液体滞留是最常见的可修改的危险因素的死亡率和心血管事件的体积超载患者1。液体滞留导致高血压、心脏功能不全和肺水肿, 并与此人群的过量死亡率有关。临床评估患者的体积状态, 结合患者的症状, 血压和体重的变化代表了临床评价, 容易不精确2。本文提出了一种利用床边超声 (美国) 技术指导肺水肿有效治疗的协议。胸部和下腔静脉 (静脉) 我们构成了这一建议的临床方案的基石, 以去除液体。无论是胸部还是静脉, 我们在文献中都有很长的记录, 包括急性呼吸衰竭的管理、终末期肾病 (ESRD) 和循环休克。
胸美已被证明为评估 ESRD 患者的肺水肿提供客观的数据, 并准确地反映了3的透析中肺水肿的减少程度。同样, 我们的下腔静脉 (静脉) 已长期用于各种临床应用。我们建议作为经胸超声心动图检查的例行组成部分, 并提供几个目的, 包括估计右心房压力 (说唱), 这是一个标记的体积状态和预负荷的心脏4。几项研究已经阐明了在休克状态5,6的响应的静脉口径与液体的关系。在休克状态的管理中也值得注意的是, 胸部超声已被用来检测在循环休克的液体复苏过程中新的肺水肿的发生, 通常是通过床边美国应用称为流体管理有限的肺超声 (瀑布) 协议7,8。这里提出的《反瀑布协议》的协议, 将胸部和静脉超声的良好记录功能结合起来, 以安全有效地管理肺水肿。
便携式, 或床边, 美国是一种成像方式, 提供即时和可靠的数据, 减少暴露于辐射, 消除了病人运输的需要, 并减少资源利用。由于它的可用性和基本没有相关的不良影响, 床边我们可以重复监测和调整利尿治疗。最后, 床边的我们是很容易的临床医生执行和解释的实时9。
胸部美国是一种广泛接受的技术, 检测特定的工件模式, 代表各种胸膜和实质病理。例如, "一条线" 是胸膜表面的水平回声 (明亮) 混响伪影, 它们表明没有液体的正常的实质。或者, "B 线" 是回声垂直的工件, 开始于胸膜线的下半部分, 延伸到屏幕的末尾, 与呼吸同步移动。存在的 B 线在设置怀疑体积超载表明外肺水。这些 B 线典型地消散在利尿期间以对应于容量撤除导致再出现干 a 线工件样式3。研究表明, 这些美国发现与高肺充填压力密切相关, 如侵入方法10所评估。
美国也可以用来测量静脉血管直径和湿陷指数, 这是在自发呼吸过程中直径减少的百分比。有几项研究表明, 在利尿过程中, 静脉血流量的测量与容积的变化有相关性, 这表明该工具对11例肺水肿患者的可行性和适用性。
在这里, 我们提出了一个样本美国协议, 反瀑布协议, 它结合了肺和静脉我们指导液体去除治疗的肺水肿患者。

<table><tbody><tr><td>Portable Ultrasound machine&amp;nbsp;</td><td>Shown in video: FUGIFILM/Sonosite</td><td>Shown in video:&amp;nbsp; M- Turbo</td><td>Any portable ultrasound machine with the following capabilities&lt;br/&gt; &amp;bull;&amp;nbsp; B- Mode&lt;br/&gt; &amp;bull;&amp;nbsp; M- Mode&lt;br/&gt; &amp;bull;&amp;nbsp; Caliper measurement tool</td></tr><tr><td>Transducer</td><td>Shown in video: FUGIFILM/Sonosite</td><td>Shown in video:&amp;nbsp; P21</td><td>Any ultrasound transducer probe with the following capabilities:&lt;br/&gt; &amp;bull;&amp;nbsp; Phased Array&lt;br/&gt; &amp;bull;&amp;nbsp; Low frequency (1-5MHz)</td></tr></tbody></table>

bedside ultrasound for guiding fluid removal in patients with pulmonary edema: the reverse-falls protocol

液体滞留是最常见的危险因素的死亡率和心血管并发症的患者的容积过重的疾病状态。利尿或液体清除的程度经常由身体检查决定, 这是不准确的。
床边超声 (美国) 是一种便携式工具, 它能给病人的床边带来实时的诊断影像。这种多才多艺的方式使临床医生有可能调查患者的外和血管内容积状态。外体积, 特别是在肺水肿的情况下, 可以定量地评估我们的前胸部。血管内容积的估计通过可视化下腔静脉 (静脉) 口径。两者结合起来, 外肺水的程度和静脉的口径提供客观的数据, 可以指导临床医生确定需要的利尿水平, 有效地安全治疗肺水肿。
本文的目的是三重: 1) 总结以往研究的结果, 关于便携式美国指导流体管理的功效, 2) 描述一个建议的超声协议, 以帮助指导流体管理, 和 3), 以阐明技术,使用便携式美国来处理血管内和外体积的测量。

肺超声通过可视化一条线或 B 线工件来估计外车厢内的流体量, 如图 1所示。肺超声 B 线的数量有助于确定所需的液体去除量, 如图 2所示。混合的 a 线和 B 线模式, 或一条线的主导模式表明, 肺实质是相对没有额外的液体。轻度利尿可能是必要的完全解决外肺水。B 线的主要模式表明存在过量外肺水。适度到积极的液体去除疗法?...

Watch this Scientific Journal Video about Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol at JoVE.com

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

床边超声在肺水肿患者导液中的效果: 反瀑布协议

我们描述了一种成像协议, 使临床医生能够实时可视化病人的血管内和外空间体积, 并设置利尿和流体清除参数, 以安全和有效地治疗肺水肿。

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

bedside-ultrasound-for-guiding-fluid-removal-patients-with-pulmonary

Research

JoVE Journal

Medicine

11.1K 次观看.  Stony Brook University School of Medicine. 我们描述了一种成像协议, 使临床医生能够实时可视化病人的血管内和外空间体积, 并设置利尿和流体清除参数, 以安全和有效地治疗肺水肿。

视频: Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

Lung ultrasound is a noninvasive and valuable tool for bedside evaluation of neonatal lung diseases. However, a relative lack of reference standards, protocols and guidelines may limit its application. Here, we aim to develop a standardized neonatal lung ultrasound diagnostic protocol to be used in clinical decision-making.

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

科研

医学

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent need to find effective therapies. Preclinical studies have shown that inhaled halogenated agents may have beneficial effects in animal models of ARDS. The development of new devices to administer halogenated agents using modern intensive care unit (ICU) ventilators has significantly simplified the dispensing of halogenated agents to ICU patients. Because previous experimental and clinical research suggested potential benefits of halogenated volatiles, such as sevoflurane or isoflurane, for lung alveolar epithelial injury and inflammation, two pathophysiologic landmarks of diffuse alveolar damage during ARDS, we designed an animal model to understand the mechanisms of the effects of halogenated agents on lung injury and repair. After general anesthesia, tracheal intubation, and the initiation of mechanical ventilation, ARDS was induced in piglets via the intratracheal instillation of hydrochloric acid. Then, the piglets were sedated with inhaled sevoflurane or isoflurane using an ICU-type device, and the animals were ventilated with lung-protective mechanical ventilation during a 4 h period. During the study period, blood and alveolar samples were collected to evaluate arterial oxygenation, the permeability of the alveolar-capillary membrane, alveolar fluid clearance, and lung inflammation. Mechanical ventilation parameters were also collected throughout the experiment. Although this model induced a marked decrease in arterial oxygenation with altered alveolar-capillary permeability, it is reproducible and is characterized by a rapid onset, good stability over time, and no fatal complications.
We have developed a piglet model of acid aspiration that reproduces most of the physiological, biological, and pathological features of clinical ARDS, and it will be helpful to further our understanding of the potential lung-protective effects of halogenated agents delivered through devices used for inhaled ICU sedation.

We describe a model of hydrochloric acid-induced acute respiratory distress syndrome (ARDS) in piglets receiving sedation with halogenated agents, isoflurane and sevoflurane, through a device used for inhaled intensive care sedation. This model can be used to investigate the biological mechanisms of halogenated agents on lung injury and repair.

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent ...

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge

A preload challenge (PC) is a clinical maneuver that, first, increases the cardiac filling (i.e., preload) and, second, calculates the change in cardiac output. Fundamentally, a PC is a bedside approach for testing the Frank-Starling-Sarnoff (i.e., "cardiac function") curve. Normally, this curve has a steep slope such that a small change in the cardiac preload generates a large change in the stroke volume (SV) or cardiac output. However, in various disease states, the slope of this relationship flattens such that increasing the volume into the heart leads to little rise in the SV. In this pathological scenario, additional cardiac preload (e.g., intravenous fluid) is unlikely to be physiologically effective and could lead to harm if organ congestion evolves. Therefore, inferring both the cardiac preload and output is clinically useful as it may guide intravenous (IV) fluid resuscitation. Accordingly, the goal of this protocol is to describe a method for contemporaneously tracking the surrogates of cardiac preload and output using a novel, wireless, wearable ultrasound during a well-validated preload challenge.

The Frank-Starling-Sarnoff curve is clinically important and describes the relationship between cardiac preload and output. This report illustrates a novel method of simultaneous jugular venous and carotid arterial Doppler velocimetry as transient surrogates of cardiac preload and output, respectively; this approach is enabled by wireless, wearable Doppler ultrasound.

负荷前激发期间的连续静脉动脉多普勒超声检查

A preload challenge (PC) is a clinical maneuver that, first, increases the cardiac filling (i.e., preload) and, second, calculates the change in cardiac ...

Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava

Over the past several decades, clinicians have incorporated several applications of diagnostic point-of-care ultrasound (POCUS) into medical decision-making. Among the applications of POCUS, imaging the inferior vena cava (IVC) is practiced by a wide variety of specialties, such as nephrology, emergency medicine, internal medicine, critical care, anesthesiology, pulmonology, and cardiology. Although each specialty uses IVC data in slightly different ways, most medical specialties, at minimum, attempt to use IVC data to make predictions about intravascular volume status. While the relationship between IVC sonographic data and intravascular volume status is complex and highly context-dependent, all clinicians should collect the sonographic data in standardized ways to ensure repeatability. This paper describes standardized IVC image acquisition including patient positioning, transducer selection, probe placement, image optimization, and the pitfalls and limitations of IVC sonographic imaging.&#160;This paper also describes the commonly performed anterior IVC long-axis view and three other views of the IVC that can each provide helpful diagnostic information when the anterior long-axis view is difficult to obtain or interpret.

Point-of-care ultrasound evaluation of the inferior vena cava (IVC) is commonly utilized to identify, among other things, the volume status. Imaging should be performed systematically to ensure repeatability. This manuscript reviews the methods and pitfalls of sonographic IVC examination.

一种下腔静脉超声评估的图像采集方法

Over the past several decades, clinicians have incorporated several applications of diagnostic point-of-care ultrasound (POCUS) into medical ...

Point-of-Care Lung Ultrasound in Adults: Image Acquisition

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally prevents direct visualization of the lung parenchyma. When showing the lung parenchyma, ultrasound typically generates a number of non-anatomic artifacts. However, over the past several decades, these artifacts have been studied by diagnostic point-of-care ultrasound (POCUS) practitioners, who have identified findings that have value in narrowing the differential diagnoses of cardiopulmonary dysfunction. For instance, in patients presenting with dyspnea, lung POCUS is superior to chest radiography (CXR) for the diagnosis of pneumothorax, pulmonary edema, lung consolidations, and pleural effusions. Despite its known diagnostic value, the utilization of lung POCUS in clinical medicine remains variable, in part because training in this modality across hospitals remains inconsistent. To address this educational gap, this narrative review describes lung POCUS image acquisition in adults, including patient positioning, transducer selection, probe placement, acquisition sequence, and image optimization.

Point-of-care ultrasound (POCUS) of the lungs provides quick answers in rapidly changing clinical scenarios. We present an efficient and informative protocol for image acquisition for use in acute care settings.

成人床旁肺部超声:图像采集

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally ...

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h equipment availability. In 2018, the sonographic algorithm for life-threatening emergencies (SAFE) protocol was published, which allows the assessment of neonates with sudden decompensation to identify abnormal contractility, tamponade, pneumothorax, and pleural effusion. In the study unit (with a consulting neonatal hemodynamics and POCUS service), the algorithm was adapted by including consolidated core steps to support at-risk newborns, aiding clinicians in managing cardiac arrest, and adding views to verify correct intubation. This paper presents a protocol that can be applied in the NICU and the delivery room (DR) in relation to three scenarios: cardiac arrest, hemodynamic deterioration, or respiratory decompensation. 
This protocol can be performed with a state-of-the-art ultrasound machine or an affordable handheld device; the image acquisition protocol is carefully detailed. This method was designed to be learned as a general competence to obtain the timely diagnosis of life-threatening scenarios; the method aims to save time but does not represent a substitute for comprehensive and standardized hemodynamic and radiological analyses by a multidisciplinary team, which might not universally be on call but needs to be involved in the process. From January 2019 to July 2022, in our center, 1,045 hemodynamic consultation/POCUS consults were performed with 25 patients requiring the modified SAFE protocol (2.3%), and a total of 19 procedures were performed. In five cases, trained fellows on call resolved life-threatening situations. Clinical examples are provided that show the importance of including this technique in the care of critical newborns.

Here, we present a protocol that can be applied in the neonatal intensive care unit and the delivery room in relation to three scenarios: cardiac arrest, hemodynamic deterioration, or respiratory decompensation. This protocol can be performed with a state-of-the-art ultrasound machine or an affordable handheld device; an image acquisition protocol is carefully detailed.

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h ...

Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition

Over the past twenty years, the Focused Assessment with Sonography for Trauma (FAST) exam has transformed the care of patients presenting with a combination of trauma (blunt or penetrating) and hypotension. In these hemodynamically unstable trauma patients, the FAST exam permits rapid and noninvasive screening for free pericardial or peritoneal fluid, the latter of which implicates intra-abdominal injury as a likely contributor to the hypotension and justifies emergent abdominal surgical exploration. Further, the abdominal portion of the FAST exam can also be used outside of the trauma setting to screen for free peritoneal fluid in patients who become hemodynamically unstable in any context, including after procedures that may inadvertently injure abdominal organs. These "non-trauma" situations of hemodynamic instability are often triaged by providers from specialties other than emergency medicine or trauma surgery who are not familiar with the FAST exam. Therefore, there is a need to promulgate knowledge about the FAST exam to all clinicians caring for critically ill patients. Toward this end, this article describes FAST exam image acquisition: patient positioning, transducer selection, image optimization, and exam limitations. Since the free fluid is likely to be found in specific anatomic locations that are unique for each canonical FAST exam view, this work centers on the unique image acquisition considerations for each window: subcostal, right upper quadrant, left upper quadrant, and pelvis.

Focused Assessment with Sonography for Trauma FAST Exam: Image Acquisition

The Focused Assessment with Sonography for Trauma (FAST) exam is a diagnostic point-of-care ultrasound examination used to screen for the presence of free fluid in the pericardium and peritoneum. Indications, techniques, and pitfalls of the procedure are discussed in this article.

创伤超声重点评估 （FAST） 检查:图像采集

Over the past twenty years, the Focused Assessment with Sonography for Trauma (FAST) exam has transformed the care of patients presenting with a ...

<meta charset="utf8"></head><body>用于 IVC 评估治疗心力衰竭的 POCUS 方案

Workflow and Framework for Collecting and Implementing Point-of-Care Ultrasound Data in the Management of Heart Failure Patients

Management and prevention of acute decompensated heart failure remain highly prevalent and challenging medical conditions. Incorporation of Point-of-Care Ultrasound (POCUS) as an adjunctive tool for assessing volume status and treatment response has shown significant promise. POCUS can be used for imaging internal anatomic structures serially and capturing these images for comparison and measurement over time. This protocol describes a scalable and standardized methodology for the serial assessment of the inferior vena cava (IVC). The methodology includes serial image collection, measurement, and presentation in the electronic medical record. A workflow for POCUS-acquired images of the IVC was created to capture the images and measure the diameter in a discrete data field for direct comparison over time and in response to clinical management. The protocol also includes the assessment of the presence or absence of pleural effusion as discrete data in the standardized workflow. By integrating POCUS into heart failure management, clinicians can improve patient outcomes through more precise and timely adjustments in treatment.

<meta charset="utf8"></head><body>作者聚焦:将 POCUS 数据集成到 EHR 中以管理心力衰竭患者的工作流程

This protocol presents a scalable workflow for the use of point-of-care ultrasound in the management of hospitalized and outpatient heart failure patients.

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架 

Management and prevention of acute decompensated heart failure remain highly prevalent and challenging medical conditions. Incorporation of Point-of-Care ...

床边超声在肺水肿患者导液中的效果: 反瀑布协议

摘要

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基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

负荷前激发期间的连续静脉动脉多普勒超声检查

一种下腔静脉超声评估的图像采集方法

成人床旁肺部超声:图像采集

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

创伤超声重点评估（FAST）检查:图像采集

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架

床边超声在肺水肿患者导液中的效果: 反瀑布协议

摘要

探索更多视频

此视频中的章节

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

负荷前激发期间的连续静脉动脉多普勒超声检查

一种下腔静脉超声评估的图像采集方法

成人床旁肺部超声:图像采集

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

创伤超声重点评估 （FAST） 检查:图像采集

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架

在心力衰竭患者管理中收集和实施床旁超声数据的工作流程和框架

创伤超声重点评估（FAST）检查:图像采集