This work was supported in part by the Center for Experiential Learning and Assessment (CELA) at Vanderbilt University Medical Center (VUMC), Nashville, TN, USA.&#160; The authors would also like to thank the staff, faculty, and personal at CELA for their guidance, assistance, and support throughout this project.&#160; Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of CELA or VUMC.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Vanderbilt University Medical Center institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The protocol was derived after a review of the published literature by an expert panel of intensivists16,21,22,23,25,28,32,33 representing five health systems across the United States. Imaging was performed on the authors themselves for the normal images and as part of routine educational ultrasound scans done for teaching purposes for the positive images. The inclusion criterion was any patient on V-A ECMO, and the exclusion criterion was a refusal to undergo an ultrasound exam. The equipment used in the study is listed in the Table of Materials.
1. Safety procedures
<ol>
	<li>Utilize nitrile or latex-free gloves. Follow infection control processes for the individual institution as applicable. 
	NOTE: If the patient has surgical wounds in stages of active healing, use sterile, individually processed ultrasound jelly packets.</li>
</ol>
2. Probe selection 
<ol>
	<li>Utilize a sector arc or sector array probe (colloquially called a &#8220;phased-array probe-)34,35,36,37.</li>
</ol>
3. Machine preset
<ol>
	<li>Set the machine to the cardiology (CARDIAC) preset function, which will then have the indicator on the right-hand side of the ultrasound screen.</li>
</ol>
4. Patient positioning
<ol>
	<li>Place the patient in a supine position. 
	NOTE: If supine is not possible, maintain the patient in the most favorable position so that ECMO cannulas are not displaced.</li>
	<li>Place blankets or ramps to slightly position the patient in a left-side down trajectory while maintaining safety with ECMO cannula placement if image quality is substandard.</li>
</ol>
5. Patient monitoring
<ol>
	<li>Parasternal long-axis view
	<ol>
		<li>Obtain the parasternal long-axis view38 of the heart (Figure 1) and click on Acquire.</li>
		<li>Assess the aortic valve3,13,14,18,38.
		<ol>
			<li>Assess for the valve opening: well vs. not at all (Figure 2; Video 1). Assess for aortic root thrombus: present vs. absent vs. indeterminate (Figure 2).</li>
		</ol>
		</li>
		<li>Left ventricular internal dimension (LVIDD)38
		<ol>
			<li>Activate the caliper tool. Measure LVIDD during the R wave of the QRS tracing on EKG (Figure 2) and click on Acquire.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Apical 4-chamber view
	<ol>
		<li>Obtain apical 4-chamber view38 (Figure 3) and click on Acquire. Assess LV cavity for presence of thrombus: present vs. absent vs. indeterminate10,11 (Figure 2; Video 2).</li>
	</ol>
	</li>
</ol>
6. Assessing tolerance of V-A ECMO weaning
NOTE: For details on the procedure, refer to previously published reports32,33.
<ol>
	<li>Evaluate cardiac recovery and feasibility of V-A ECMO weaning by asking the following questions to the patients:
	<ol>
		<li>Assess whether there has been recovery from the underlying disease process that prompted the initiation of V-A ECMO.</li>
		<li>Determine if the patient has regained hemodynamic stability, defined by institution-specific standards16,32,33.</li>
		<li>Confirm whether oxygenation and ventilation problems are no longer severe (e.g., check if paO2/FiO2 &#62; 100 and paCO2 &#60; 60)32. 
		NOTE: There is no agreed-upon protocol to determine when a patient has recovered from their underlying etiology, which caused them to be cannulated for V-A ECMO. It is recommended that a multidisciplinary team and approach be used to make this clinical decision.</li>
	</ol>
	</li>
	<li>Perform V-A ECMO weaning trial if patient answers to checklist questions are yes32. 
	NOTE: Weaning protocols differ between centers, and there is no agreed-upon standardized protocol.
	<ol>
		<li>Decrease ECMO flow rates in increments of 0.5 L/min under constant echocardiographic surveillance. 
		NOTE: At each incremental drop in ECMO flow, if the MAP falls more than 10-15 mmHg or below 65 mmHg, consider resuming full flow, as this suggests the patient is not yet ready to wean.</li>
		<li>Perform echocardiographic evaluation of each ECMO wean.
		<ol>
			<li>Parasternal long-axis view
			<ol>
				<li>Obtain the parasternal long-axis view38 and click on Acquire. Repeat Step 5.1.3. Qualitatively assess LV systolic function (akinetic vs. some degree of function)39 (Video 3).</li>
			</ol>
			</li>
			<li>Apical 4-chamber view
			<ol>
				<li>Obtain the apical 4-chamber view38 and click on Acquire. Qualitatively assess the RV/LV size ratio40 (Figure 4). Activate M-mode to measure Tricuspid Valve Annular Plane Systolic Excursion (TAPSE)40 (Figure 5).</li>
				<li>Perform Active tissue Doppler imaging. Measure RV S&#39;40 (Figure 6). Measure the lateral mitral annular S&#39;38&#160;(Figure 7).</li>
			</ol>
			</li>
		</ol>
		</li>
		<li>Apical 5-chamber view
		<ol>
			<li>Obtain the apical 5-chamber view38,41 and click on Acquire (Figure 8).</li>
			<li>To perform left ventricular outflow tract (LVOT) velocity time integral (VTI), activate pulse-wave Doppler (PWD). Place the PWD box in LVOT. Measure LVOT VTI41 (Figure 9).</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Decrease the flows to 1-1.5 L/min ECMO flow if previous ECMO weans are tolerated.</li>
	<li>Perform echocardiographic evaluation under minimal ECMO settings following steps 6.2.2.2.</li>
</ol>
7. Follow-up procedures
<ol>
	<li>After the patient passes a bedside tolerance for V-A ECMO weaning based on successful echocardiographic screening, stable hemodynamics, and end-organ function, perform an assessment for decannulation based on institutional protocols with multidisciplinary input.</li>
	<li>Continuously monitor for signs of ECMO-related complications such as bleeding, infection, thromboembolism, or organ dysfunction. Adjust treatment as necessary.</li>
</ol>

The Authors declare no relevant disclosures.

Significance with respect to existing methods 
The utilization of V-A ECMO as a rescue therapy for acute decompensated cardiac failure has been on the rise1. Peripheral V-A ECMO is utilized as a temporary intervention to allow time for the acutely failing heart to recover while optimizing end-organ function2,3. Although there is a lack of established guidelines regarding the application of echocardiography in the cont...

Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving temporizing strategy for patients, which has seen an ever-increasing utilization rate1,2. ECMO has two different configurations: veno-venous (V-V) and veno-arterial (V-A). Over the past several decades, V-A ECMO has emerged as a fundamental tool in the care of patients with severe cardiogenic shock and cardiopulmonary failure3,4,5,6. The two cannulation strategies for V-A ECMO are central and peripheral7. Central V-A ECMO usually requires sternotomy for direct cannulation of the right atrium for venous drainage and proximal aorta for antegrade arterial return. On the other hand, peripheral V-A ECMO has arterial return via the femoral artery via a retrograde mechanism. This retrograde flow can cause the following issues: differential oxygenation of the upper and lower body, worsening biventricular function, and LV distension, particularly if there is no strategy in place to unload the LV8. These complications of peripheral V-A ECMO, in addition to the inherent risks with ECMO, necessitate frequent, vigilant monitoring9,10,11. Due to the inherent instability of these patients, it is not practical to frequently transfer them out of the intensive care unit (ICU) for diagnostic testing and evaluation of their mechanical circulatory support and evolving cardiopulmonary status3,6. Therefore, bedside diagnostic tools are essential in their daily care. One such tool is point-of-care ultrasound (POCUS)12,13,14,15 of the heart, which can be used to assess all of the following non-invasively: left ventricular (LV) performance (size, systolic function, stroke volume, aortic valve opening)3,13,14,16,17,18,19, right ventricular (RV) performance (size, systolic function)20,21, and presence versus absence of intra-cardiac thrombus10,11. Furthermore, POCUS can be used to assess readiness for V-A ECMO weaning and eventual decannulation22,23,24,25,26,27,28.
Diagnostic ultrasound generally falls into two categories: point-of-care and consultative29,30 Consultative ultrasound is an exam requested by a patient&#39;s primary treating provider but performed by a separate specialist team29,30, whereas point-of-care ultrasound is performed and interpreted by a patient&#39;s primary treating provider29,30,31. Although ultrasound assessment of the heart on V-A ECMO has traditionally been performed through consultative services, such services are not always immediately available around the clock to meet an ECMO unit&#39;s high-volume and unpredictable sonographic needs. Thus, it behooves ECMO intensivists to be able to perform serial cardiac point-of-care ultrasound (POCUS) exams on their own patients for more efficient and timely patient care.
The utilization of POCUS in the V-A ECMO setting, however, remains heterogeneous due to the variability in training among providers. This study aims to address this gap in training by describing the POCUS image acquisition in peripheral V-A ECMO, particularly in the absence of LV venting, including details on patient positioning, transducer selection, probe placement, acquisition sequence, and image optimization. Other ECMO scenarios, such as LV venting in place, will be covered separately in other manuscripts in this special collection on diagnostic POCUS image acquisition.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Affiniti&#160;</td>
			<td>Philips</td>
			<td>Affiniti&#160;70</td>
			<td></td>
		</tr>
		<tr>
			<td>Edge 1 ultrasound machine</td>
			<td>SonoSite</td>
			<td>Edge II</td>
			<td></td>
		</tr>
		<tr>
			<td>Vivid iq</td>
			<td>GE</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

point-of-care ultrasound for peripheral veno-arterial extracorporeal membrane oxygenation without left ventricular venting

Over the past several decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has become a critical tool in the management of patients with severe cardiogenic shock and cardiopulmonary failure. Due to the inherent instability of these patients, their transport away from intensive care units is fraught with risk. As a result, bedside diagnostic tools are essential for their daily care. One such tool is point-of-care ultrasound (POCUS) of the heart, which can non-invasively assess several parameters: left ventricular (LV) performance (size, systolic function, stroke volume, aortic valve opening), right ventricular (RV) performance (size, systolic function), and the presence of intracardiac thrombus. Additionally, POCUS can assist in evaluating readiness for V-A ECMO weaning and eventual decannulation. Despite its potential, the use of POCUS in the context of V-A ECMO remains inconsistent due to variability in provider training. This study aims to address this gap by detailing POCUS image acquisition in V-A ECMO, particularly in the absence of LV venting. It covers key aspects such as patient positioning, transducer selection, probe placement, acquisition sequence, and image optimization.

This article describes the interpretation of point-of-care cardiac ultrasound in patients supported on peripheral V-A ECMO in two clinical scenarios: (1) As a monitoring tool during ECMO support to assess for the presence of left ventricular (LV) distension and the presence of intracardiac or aortic root thrombus, and (2) as a screening tool to evaluate readiness from liberation of mechanical support.
There is no single accepted...

This protocol outlines the use of point-of-care ultrasound (POCUS) to monitor patients on peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) without left ventricular venting. It evaluates left ventricular distension, intracardiac or aortic root thrombus, and identifies useful cardiac POCUS parameters for weaning from V-A ECMO.

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting

Over the past several decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has become a critical tool in the management of patients with ...

point-care-ultrasound-for-peripheral-veno-arterial-extracorporeal

Research

JoVE Journal

Medicine

195 Views.  Vanderbilt University Medical Center. This protocol outlines the use of point-of-care ultrasound (POCUS) to monitor patients on peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) without left ventricular venting. It evaluates left ventricular distension, intracardiac or aortic root thrombus, and identifies useful cardiac POCUS parameters for weaning from V-A ECMO.

Video: Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting

Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse

The use of extracorporeal membrane oxygenation (ECMO) has increased substantially in recent years. ECMO has become a reliable and effective therapy for acute as well as end-stage lung diseases. With the increase in clinical demand and prolonged use of ECMO, procedural optimization and prevention of multi-organ damage are of critical importance. The aim of this protocol is to present a detailed technique of veno-venous ECMO in a non-intubated, spontaneously breathing mouse. This protocol demonstrates the technical design of the ECMO and surgical steps. This murine ECMO model will facilitate the study of pathophysiology related to ECMO (e.g., inflammation,bleeding and thromboembolic events). Due to the abundance of genetically modified mice, the molecular mechanisms involved in ECMO-related complications can also be dissected.

Here we present a protocol describing the technique of veno-venous extracorporeal membrane oxygenation (ECMO) in a non-intubated, spontaneously breathing mouse. This murine model of ECMO can be effectively implemented in experimental studies of acute and end-stage lung diseases.

The use of extracorporeal membrane oxygenation (ECMO) has increased substantially in recent years. ECMO has become a reliable and effective therapy for ...

Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At present, most primary medical institutions in China have a poor percentage of adoption of blood-testing technology, and a hematology detection system with a high price to performance ratio and easy operation is urgently needed in primary healthcare centers. This paper introduces the principle and operation procedures of a point-of-care testing (POCT) card-based leukocyte analyzer (evaluated system), which was used to detect WBC indexes such as neutrophils, lymphocytes, and intermediate group cells (including eosinophils, basophils, and monocytes) in whole blood. The results from the evaluated system were compared to those from two commercial automatic hematology analyzers (reference system). The correlation and consistency between the evaluated system and the commercial reference systems were analyzed. The results showed that WBC count and number of granulocytes detected by the evaluated and reference systems showed a strong positive correlation (rs = 0.972 and 0.973, respectively), while the number of lymphocytes showed a relatively low correlation (rs = 0.851). A Bland-Altman plot showed that the major difference between the values detected by the evaluated system and the reference systems is within 95% limits of agreement (LoA), indicating that the two systems are in good agreement. In conclusion, the evaluated system has an excellent correlation, robust consistency, and a reliable comparison with the results of the widely used automatic hematology analyzers. It is ideal for WBC detection in primary medical institutions where a full-automatic five-category hematology analyzer is unavailable, especially during the COVID-19 normalized prevention and control period.

A protocol to measure peripheral blood leukocytes using a POCT card-based leukocyte analyzer is presented here. Same blood samples were tested by two automated hematology analyzers to evaluate the consistency and accuracy of the results. The results showed that the evaluated analyzer had a good correlation with the reference system.

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening sequelae. While whole leg compression ultrasound with color and spectral Doppler is commonly performed in radiology and vascular labs, point-of-care ultrasound (POCUS) is becoming more common in the acute care setting. Providers appropriately trained in focused POCUS can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. This paper describes a simplified yet validated approach to POCUS by describing a three-zone protocol for lower extremity DVT POCUS image acquisition. The protocol explains the steps in obtaining vascular images at six compression points in the lower extremity. Beginning at the level of the proximal thigh and moving distally to the popliteal space, the protocol guides the user through each of the compression points in a stepwise manner: from the common femoral vein to the femoral and deep femoral vein bifurcation, and, finally, to the popliteal vein. Further, a visual aid is provided that may assist providers during real-time image acquisition. The goal in presenting this protocol is to help make proximal lower extremity DVT exams more accessible and efficient for POCUS users at the patient&#39;s bedside.

Traditionally, lower extremity deep venous thrombosis (DVT) is diagnosed by radiology-performed venous duplex ultrasound. Providers appropriately trained in focused point-of-care ultrasound (POCUS) can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. We describe the scanning technique for focused POCUS DVT lower extremity examination.

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

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.

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

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON method, which looks for and evaluates the Mallampati classification, signs of obstruction, and neck mobility. Clinical findings help predict a higher likelihood of difficult tracheal intubation, but no clinical result reliably excludes difficult intubation. Ultrasound as an adjunct to clinical examination can provide the clinician with a dynamic anatomical airway assessment, which is impossible with clinical examination alone. In the hands of anesthesiologists, ultrasound is becoming more popular in the perioperative period. This method is particularly applicable for identifying proper endotracheal tube positioning in specific patient populations, such as those who are morbidly obese and patients with head and neck cancer or trauma. The focus is on identifying the normal anatomy, correctly positioning the endotracheal tube, and refining the parameters that predict difficult intubation. Several ultrasound measurements are clinical indicators of difficult direct laryngoscopy in the literature. A meta-analysis revealed that the distance from the skin to the epiglottis (DSE) is most associated with a difficult laryngoscopy. An ultrasound of the airway could be applied in routine practice as an adjunct to the clinical examination. A full stomach, rapid sequence intubation, gross visual anatomical abnormalities, and restricted neck flexibility prevent using ultrasound to assess the airway. The airway evaluation is performed with a linear array transducer of 12-4 MHz, with the patient in the supine position, with no pillow, and with the head and neck in a neutral position. The central axis of the neck is where the ultrasound parameters are measured. These image acquisitions guide the standard ultrasound examination of the airway.

A point-of-care ultrasound (POCUS) is a simple, non-invasive, and portable tool that enables dynamic airway assessment. Several studies have attempted to determine the role of ultrasound parameters as an adjunct to clinical examination in predicting difficult laryngoscopies.

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition

The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter (ONSD). Diagnostic ultrasound of the ONSD to detect intracranial hypertension has traditionally faced many problems because of methodologic discrepancies. Due to inconsistencies in the measuring techniques, the potential for ONSD to become a non-invasive bedside monitoring tool for ICP has been hampered. However, establishing a transparent, consistent methodology for measuring the ONSD would support its use as a valid and reliable method of identifying intracranial hypertension. This is important as it has both high sensitivity and specificity in acute care settings. This narrative review describes ONSD POCUS image acquisition, including patient positioning, transducer selection, probe placement, the acquisition sequence, and image optimization. Further, visual aids are provided to assist in real-time during image acquisition. This method should be considered for patients for whom there are concerns regarding intracranial hypertension but who do not have an intracranial monitor in place.

Point-of-care ultrasound (POCUS) of the optic nerve sheath diameter (ONSD) has been shown to be useful in identifying patients with increased intracranial pressure (ICP). However, the non-standardized technique for this POCUS has hampered its use. We present a standardized image acquisition protocol for use in the acute care setting.

The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter ...

Imaging the Abdominal Aorta with Point-of-Care Ultrasound

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography (CT) is the current gold standard to image the abdominal aorta, the process of obtaining a CT may be time-consuming, requires the use of intravenous contrast dye, and involves exposure to ionizing radiation. Point-of-care Ultrasound (POCUS) can be performed at the bedside and has excellent sensitivity and specificity for the diagnosis of abdominal aortic aneurysm and excellent specificity for the diagnosis of abdominal aortic dissection. Additionally, POCUS is non-invasive, cost-effective, lacks ionizing radiation, requires no intravenous contrast dye, and can be performed without taking the patient from a critical care area. Screening for abdominal aortic aneurysm (AAA) can be done in primary care settings as well. 
This article will review the approach to POCUS of the abdominal aorta to evaluate such critical pathology. In this paper, we will review the sonographic anatomy of the abdominal aorta as well as the choice of the ultrasound probe, description of POCUS image acquisition, and some pearls and pitfalls of using POCUS to aid in the diagnosis of potentially life-threatening abdominal aortic pathology.

Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta

This protocol reviews the steps to image the abdominal aorta with point-of-care ultrasound. We discuss image acquisition, troubleshooting imaging pitfalls and artifacts, and the recognition of life-threatening abdominal aortic pathology.

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...

Gastric Ultrasound Technique for Mitigating Peri-Procedural Aspiration Risk

Gastric Point of Care Ultrasound in Adults: Image Acquisition and Interpretation

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical inquiries related to gastric content. One emerging concern pertains to patients about to undergo sedation and/or endotracheal intubation: the elevated risk of aspiration from the patient&#39;s stomach contents. Aspiration of gastric contents into the lungs poses a serious and potentially life-threatening complication. This occurs more frequently when the stomach is considered &#34;full&#34; and can be affected by the techniques employed for airway management, making it potentially preventable. To mitigate the risk of peri-procedural aspiration, two distinct medical specialties (anesthesiology and critical care medicine) have independently developed techniques to utilize ultrasonography for identifying patients requiring &#34;full stomach&#34; precautions. Due to these separate specialties, the work of each group remains relatively unfamiliar outside its respective field. This article presents descriptions of both techniques for gastric ultrasound. Furthermore, it explains how these approaches can complement each other when one of them falls short. Regarding image acquisition, the article covers the following topics: indications and contraindications, selection of the appropriate probe, patient positioning, and troubleshooting. The article also delves into image interpretation, complete with example images. Additionally, it demonstrates how one of the two techniques can be employed to estimate gastric fluid volume. Lastly, the article briefly discusses medical decision-making based on the findings of this examination.

Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care 

This protocol introduces two methods for image acquisition in gastric ultrasonography. Additionally, tips are provided for interpreting this information to assist in medical decision-making.

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical ...

Ultrasound in Evaluating Diaphragm Dysfunction and Monitoring Treatment

Measuring Diaphragm Thickness and Function Using Point-of-Care Ultrasound

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes affected individuals to respiratory failure. In mechanically ventilated patients, the diaphragm is susceptible to atrophy and dysfunction through disuse and other mechanisms. This contributes to failure to wean and poor long-term clinical outcomes. Point-of-care ultrasound provides a valid and reproducible method for evaluating diaphragm thickness and contractile activity (thickening fraction during inspiration) that can be readily employed by clinicians and researchers alike. This article presents best practices for measuring diaphragm thickness and quantifying diaphragm thickening during tidal breathing or maximal inspiration. Once mastered, this technique can be used to diagnose and prognosticate diaphragm dysfunction, and guide and monitor response to treatment over time in both healthy individuals and acute or chronically ill patients.

Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes 

Diaphragm thickness and function can be assessed in healthy individuals and critically ill patients using point-of-care ultrasound. This technique offers an accurate, reproducible, feasible, and well-tolerated method for evaluating diaphragm structure and function.

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes ...

Advancing Bedside Care: A Multidisciplinary Guide to Kidney-Genitourinary POCUS

Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition

A range of conditions involving the kidneys and urinary bladder can cause organ-threatening complications that are preventable if diagnosed promptly with diagnostic imaging. Common imaging modalities include either computed tomography or diagnostic ultrasound. Traditionally, ultrasound of the kidney-genitourinary system has required consultative teams consisting of a sonographer performing image acquisition and a radiologist performing image interpretation. However, diagnostic point-of-care ultrasound (POCUS) has recently emerged as a useful tool to troubleshoot acute kidney injury at the bedside. Studies have shown that non-radiologists can be trained to perform diagnostic POCUS of the kidneys and bladder with high accuracy for a set number of important conditions. Currently, diagnostic POCUS of the kidney-genitourinary system remains underused in actual clinical practice. This is likely because image acquisition for this organ system is unfamiliar to most clinicians in specialties that encounter acute kidney injury, including primary care, emergency medicine, intensive care, anesthesiology, nephrology, and urology. To address this multi-specialty educational gap, this narrative review was developed by a multi-disciplinary group to provide a specialty-agnostic framework for kidney-genitourinary POCUS image acquisition: indications/contraindications, patient positioning, transducer selection, acquisition sequence, and exam limitations. Finally, we describe foundational concepts in kidney-genitourinary ultrasound image interpretation, including key abnormal findings that every bedside clinician performing this modality should know.

Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography

Point-of-care ultrasound (POCUS) of the renal and genitourinary (renal-GU) system can help to screen for certain causes of kidney dysfunction. However, despite its clinical utility, renal-GU POCUS remains underutilized due to a lack of training among clinicians. To address this gap, this article describes renal-GU image acquisition and interpretation.

A range of conditions involving the kidneys and urinary bladder can cause organ-threatening complications that are preventable if diagnosed promptly with ...

Methods Article

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting