Risultati per: La POCUS e le patologie dei tessuti molli: la lesione di Morel Lavallee

Circulation, Volume 150, Issue Suppl_1, Page A4143488-A4143488, November 12, 2024. Background:Patients with acute decompensated heart failure (ADHF) often require admission to the Cardiac Care Unit (CCU). Clinical examination alone may be inadequate for management, leading to suboptimal diuretic regimens and prolonged hospital stays. The use of Point-of-care ultrasound (POCUS) to evaluate the lungs for pulmonary edema and inferior vena cava (IVC) for size and collapsibility can enhance volume status evaluation.Aim:Reduce the average duration of IV diuresis by 20% among patients admitted to the CCU for ADHF in 1 yearMethods:An algorithm for POCUS guided diuretic regimen escalation was implemented across three Plan-Do-Study-Act (PDSA) cycles. Patients who were intubated, on dialysis, or with isolated RV failure were excluded. PDSA-1 introduced the algorithm and provided training to a team of 5 residents. PDSA-2 included weekly reminders and recruitment of 14 residents to increase buy-in. PDSA-3 focused on incorporating POCUS assessments into nighttime care to facilitate early morning decision-making.Results:Process Measure: Quarterly compliance rates using the number of POCUS orders that were completed- Baseline (0%, n=23), PDSA-1 (0%, n=35), PDSA-2 (19%, n=15), PDSA-3 (31%, n=46).Outcome Measure: The average duration of IV diuresis progressively decreased through the year: Baseline (5 days), PDSA-1 (5.3 days), PDSA-2 (4.4 days), PDSA-3 (3.5 days). There was an increase of 6% in PDSA-1 compared to baseline, but PDSA-2 and 3 showed a progressive reduction of 12% and 30% respectively.Balancing Measure: The mean potassium supplementation showed variation throughout the year: Baseline (63.3 mg), PDSA-1 (141 mg), PDSA-2 (151.7 mg), PDSA-3 (75.7 mg), reflecting no significant negative impact from the intervention.Equity Lens: The duration of IV diuresis, which at baseline ranged from 3 to 8 days across different races, standardized to approximately 5 days for all races by PDSA-3.Conclusion:We progressively reduced the duration of IV diuresis using POCUS-guided lung and IVC assessments with a structured diuretic regimen. This demonstrated improved patient care from early decongestion and symptomatic relief. Additionally, we demonstrate that POCUS plays a crucial role in promoting health equity by providing an objective assessment of volume status across diverse racial groups. This integration promises optimized heart failure management and potential cost reductions from reduced length of stay, highlighting the value of POCUS in clinical practice.

La ricerca degli atenei Tor Vergata e Ucla apre la strada ad ampie applicazioni in medicina e biotecnologia

Objectives
This study aims to explore and describe critical care nurses’ (CCNs’) experiences and perceptions of using point-of-care ultrasound (POCUS) to establish peripheral intravenous access in patients with difficult intravenous access (DIVA).

Design
A qualitative design with a hermeneutic approach was chosen for this study. From May to August 2022, data were collected using individual, face-to-face, and digital semistructured interviews and analysed using Braun and Clarke’s reflexive thematic analysis.

Setting
The study were conducted in six intensive care units in both Norway and Sweden.

Participants
Nine CCNs experienced in using point-of-care ultrasound (POCUS) to establish peripheral intravenous access in patients with DIVA were recruited.

Results
Data analysis led to the construction of the overarching theme: ‘POCUS simplifies a complicated procedure’ based on the following five subthemes: ‘Sharing the experience’, ‘Seeing inside the body’, ‘Independent in establishing difficult intravenous access’, ‘Using POCUS to increase action readiness’, and ‘Appreciating an expanded role as critical care nurses’.

Conclusion
Ultrasound-guided peripheral intravenous access can become a valuable skill for CCN’s caring for patients with DIVA in the intensive care unit. This practice can potentially reduce patient suffering, improve patient outcomes, enable the CCN to provide high-quality care, improve action readiness, time management and job satisfaction for the nurses.

Campagna Sostieni la sua felicità Dynamo per terapia ricreativa

Circulation, Volume 148, Issue Suppl_1, Page A16836-A16836, November 6, 2023. Background:Recently, our team developed an end-to-end artificial intelligence (AI) framework that can successfully estimate left ventricular ejection fraction (LVEF) from echocardiogram videos. However, this framework requires specific views (A2C and PLAX), and cannot estimate LVEF for studies from which these views are missing.Goal:To develop a deep learning model to estimate LVEF from any type and number of echocardiogram video(s).Methods:We built a deep learning model for B-mode echocardiogram videos of the left ventricle (A2C, A3C, A4C, or PLAX views), using retrospective transthoracic echocardiography (TTE) data. The model was evaluated with two test datasets: one with random valid (i.e., showing the left ventricle) views, and one with preselected views (both having 433 patients). Later, the model was tested with a prospective patient cohort that had both TTE and point-of-care ultrasound (POCUS) data collected simultaneously (393 patients).Results:On the retrospective TTE test set, we observed excellent performance (five random valid views per study: RMSE of 6.87% and Pearson correlation (PC) of 0.82 on LVEF estimation, and an AUC of 0.96 (95% CI: of 0.94-0.98) on low LVEF classification (

Pizzo: “Riconoscerne alcune non ancora tabellate”

Dalla Banca della Cute di Cesena,funziona a temperatura ambiente

Venerdì 1 settembre e sabato 2 in occasione del Gran Premio di Formula 1 visite gratuite in piazza a cura dell’Istituto Stomatologico Italiano

Possono accumularsi e resistere ma gli effetti sono sconosciuti

Introduction
Endotracheal intubation (ETI) is a crucial but risky procedure, especially among patients suspected of difficult endotracheal intubation (DTI). Bronchoscope, as an improved technique commonly used in DTI, might encounter visualisation difficulties. The magnetic point-of-care ultrasound (MGPOCUS) provides a novel visualisation from the outside and enables estimation of the relative position and trajectory of the bronchoscope. The purpose of the study was to evaluate the efficiency of MGPOCUS-guided bronchoscopy, including the time required for successful ETI, the first attempt and overall success rate, the number of attempts, complications, and satisfaction with the visualization of the procedures.

Methods and analysis
The study is a randomised, parallel-group, single-blinded, single-centre study. Participants (n=108) will be recruited by the primary anaesthesiologist and randomised to groups of ETI with bronchoscope or MGPOCUS-guided bronchoscope. The primary outcome is the time taken to the first-attempt success ETI. Secondary outcomes include procedure time, the first-attempt and overall success, complications, and satisfaction of visualisation. Cox regression with Bonferroni correction and linear mixed regression will be used to analyse the outcomes.

Ethics and dissemination
The trial protocol was approved by the ethics committees at the Peking Union Medical College Hospital (Institutional Review Board #ZS-3428). Findings will be disseminated through conference presentations and peer-reviewed journals.

Trial registration number
NCT05647174

Rientra nel progetto Donnemd, promosso dal Policlinico Gemelli

Rientra nel progetto Donnemd, promosso da Policlinico Gemelli

Dedicato a migliaia di pazienti, col sostegno di Fondazione Heal