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BMC Medical Education (1)
Cardiology Research and Practice (1)
Critical Care Research and Practice (1)
Frederiksen, Christian Alcaraz (3)
Juhl-Olsen, Peter (3)
Sloth, Erik (2)
Eika, Berit (1)
Hermansen, Johan Fridolf (1)
Jakobsen, Carl-Johan (1)
Kirkegaard, Hans (1)
Nielsen, Dorte Guldbrand (1)
Vistisen, Simon Tilma (1)
Year of Publication
Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
Hermansen, Johan Fridolf
Critical Care Research and Practice
Background. The use of echocardiography in intensive care settings impacts decision making. A prerequisite for the use of echocardiography is relative resistance to changes in volume status and levels of positive pressure ventilation (PPV). Studies on indices of diastolic function report conflicting results with regard to dependence on volume status. Evidence is scarce on PPV. Methods. Ten healthy subjects were exposed to 6 levels of positive end-expiratory pressure (PEEP) and pressure support (PS) following a baseline reading. All ventilator settings were performed at three positions: horizontal, reverse-Trendelenburg, and Trendelenburg. Echocardiography was performed throughout. Results. During spontaneous breathing, early diastolic transmitral velocity (E) changed with positioning (P < 0.001), whereas early diastolic velocity of the mitral annulus (e′) was independent (P = 0.263). With PPV, E and e′ proved preload dependent (P values < 0.001). Increases in PEEP, PS, or a combination influenced E and e′ in reverse-Trendelenburg- and horizontal positions, but not in the Trendelenburg position. Discussion. The change towards preload dependency of e′ with PPV suggests that PPV increases myocardial preload sensitivity. The susceptibility of E and e′ to preload changes during PPV discourages their use in settings of volume shifts or during changes in ventilator settings. Conclusion. Positioning and PPV affect E and e′.
Limited intervention improves technical skill in focus assessed transthoracic echocardiography among novice examiners
Nielsen, Dorte Guldbrand
BMC Medical Education
Previous studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE) and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation.
Twenty-one physicians with no previous training in FATE or echocardiography (Novices) participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts) was included. Novices received an initial theoretical and practical introduction (2 hours), after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation) of the same two healthy volunteers from the baseline examination was performed.
At baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005). 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4) and mean global image rating after intervention was 75.0 (CI 72.9-77.0), p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9).
Improvement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.
Point-of-care; Bedside; Ultrasound; Echocardiography; Learning
Procedural Aspects and Physiologic Mechanisms of the Deep Inspiratory Maneuver
Vistisen, Simon Tilma
Cardiology Research and Practice
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