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Does Every Anesthesiologist Need to Learn Point-of-Care Ultrasound? PRO

Published:December 22, 2022DOI:https://doi.org/10.1053/j.jvca.2022.12.018
      THE APPLICATIONS OF ULTRASOUND for the anesthesiologist are diverse and expanding rapidly. Although national society guidelines governing the appropriate use of ultrasound in anesthesiology have been available only for transesophageal echocardiography (TEE) and vascular access imaging, clinical guidance has more recently been published describing the use of focused cardiac ultrasound in multiple clinical contexts.
      • Troianos CA
      • Hartman GS
      • Glas KE
      • et al.
      Guidelines for performing ultrasound guided vascular cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.
      American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography
      Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.
      • Spencer KT
      • Kimura BJ
      • Korcarz CE
      • et al.
      Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography.
      • Via G
      • Hussain A
      • Wells M
      • et al.
      International evidence-based recommendations for focused cardiac ultrasound.
      Additionally, numerous point-of-care ultrasound (POCUS) protocols now exist to guide the examination of nearly every organ system and area, including cardiac, pulmonary and/or pleural, abdominal, genitourinary, ocular, and airway.
      • Via G
      • Hussain A
      • Wells M
      • et al.
      International evidence-based recommendations for focused cardiac ultrasound.
      • Haskins SC
      • Bronshteyn Y
      • Perlas A
      • et al.
      American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: Clinical indications.
      • Haskins SC
      • Bronshteyn Y
      • Perlas A
      • et al.
      American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: Recommendations.
      • Holm JH
      • Frederiksen CA
      • Johl-Olsen P
      • et al.
      Perioperative use of focus assessed transthoracic echocardiography (FATE).
      • Lichtenstein DA
      • Mezière GA.
      Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol.
      • Volpicelli G
      • Elbarbary M
      • Blaivas M
      • et al.
      International evidence-based recommendations for point-of-care lung ultrasound.
      • Scalea TM
      • Rodriguez A
      • Chiu WC
      • et al.
      Focused Assessment with Sonography for Trauma (FAST): Results from an international consensus conference.
      • Perlas A
      • Van de Putte P
      • Van Houwe P
      • et al.
      I-AIM framework for point-of-care gastric ultrasound.
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      References

        • Troianos CA
        • Hartman GS
        • Glas KE
        • et al.
        Guidelines for performing ultrasound guided vascular cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.
        J Am Soc Echocardiogr. 2011; 24: 1291-1318
        • American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography
        Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.
        Anesthesiology. 2010; 112: 1084-1096
        • Spencer KT
        • Kimura BJ
        • Korcarz CE
        • et al.
        Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2013; 26: 567-581
        • Via G
        • Hussain A
        • Wells M
        • et al.
        International evidence-based recommendations for focused cardiac ultrasound.
        J Am Soc Echocardiogr. 2014; 27 (683.e1-683.e33)
        • Haskins SC
        • Bronshteyn Y
        • Perlas A
        • et al.
        American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: Clinical indications.
        Reg Anesth Pain Med. 2021; 46: 1031-1047
        • Haskins SC
        • Bronshteyn Y
        • Perlas A
        • et al.
        American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: Recommendations.
        Reg Anesth Pain Med. 2021; 46: 1048-1060
        • Holm JH
        • Frederiksen CA
        • Johl-Olsen P
        • et al.
        Perioperative use of focus assessed transthoracic echocardiography (FATE).
        Anesth Analg. 2012; 115: 1029-1032
        • Lichtenstein DA
        • Mezière GA.
        Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol.
        Chest. 2008; 134: 117-125
        • Volpicelli G
        • Elbarbary M
        • Blaivas M
        • et al.
        International evidence-based recommendations for point-of-care lung ultrasound.
        Intensive Care Med. 2012; 38: 577-591
        • Scalea TM
        • Rodriguez A
        • Chiu WC
        • et al.
        Focused Assessment with Sonography for Trauma (FAST): Results from an international consensus conference.
        J Trauma. 1999; 46: 466-472
        • Perlas A
        • Van de Putte P
        • Van Houwe P
        • et al.
        I-AIM framework for point-of-care gastric ultrasound.
        Br J Anaesth. 2016; 116: 7-11
        • Johnson DW
        • Oren Grinberg A
        Perioperative point-of-care ultrasonography: The past and the future are in anesthesiologists’ hands.
        Anesthesiology. 2011; 115: 460-462
        • Shillcutt SK
        • Walsh DP
        • Thomas WR
        • et al.
        The implementation of a preoperative transthoracic echocardiography consult service by anesthesiologists.
        Anesth Analg. 2017; 125: 1479-1481
      1. Accreditation Council for Graduate Medical Education. Accreditation Council for Graduate Medical Education Program Requirements for Graduate Medical Education in Anesthesiology, effective July 1, 2019. Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/040_anesthesiology_2021.pdf. Accessed June 15, 2022.

      2. American Board of Anesthesiology. Exams. Available at: https://theaba.org/staged%20exams.html. Accessed June 15, 2022.

      3. American Medical Association. Privileging for ultrasound imaging H-230.960. Available at: https://policysearch.ama-assn.org/policyfinder/detail/Ultrasoundimaging?uri=%2FAMADoc%2FHOD.xml-0-1591.xml. Accessed June 15, 2022.

        • Bronshteyn YS
        • Anderson TA
        • Badakhsh O
        • et al.
        American Society of Anesthesiologists Ad Hoc Committee on PoCUS. Diagnostic point-of-care ultrasound: Recommendations from an expert panel.
        J Cardiothorac Vasc Anesth. 2022; 36: 22-29
        • Cowie B.
        Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: Feasible and alters patient management.
        J Cardiothorac Vasc Anesth. 2009; 23: 450-456
        • Andruszkiewicz P
        • Sobczyk D
        • Gorkiewicz-Kot I
        • et al.
        Reliability of focused cardiac ultrasound by novice sonographer in perioperative anaesthetic assessment: An observational study.
        Cardiovasc Ultrasound. 2015; 13: 45
        • Bøtker MT
        • Vang ML
        • Grøfte T
        • et al.
        Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures: Pre-operative focused ultrasonography.
        Acta Anaesthesiol Scand. 2014; 58: 807-814
        • Cowie B.
        Three years’ experience of focused cardiovascular ultrasound in the perioperative period: Focused peri-operative cardiovascular ultrasound.
        Anaesthesia. 2011; 66: 268-273
        • Canty DJ
        • Royse CF
        • Kilpatrick D
        • et al.
        The impact on cardiac diagnosis and mortality of focused transthoracic echocardiography in hip fracture surgery patients with increased risk of cardiac disease: A retrospective cohort study: Pre-operative echocardiography in hip fracture surgery.
        Anaesthesia. 2012; 67: 1202-1209
        • Pescarissi C
        • Brogi E
        • Sidoti A
        • et al.
        Role of lung ultrasound in the preoperative evaluation of surgical patients.
        Minerva Anestesiol. 2020; 86: 791-793
        • Xirouchaki N
        • Magkanas E
        • Vaporidi K.
        Lung ultrasound in critically ill patients: Comparison with bedside chest radiography.
        Intensive Care Med. 2011; 37: 1488-1493
        • Blaivas M
        • Lyon M
        • Duggal S.
        A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.
        Acad Emerg Med. 2005; 12: 844-849
        • Gillmann HJ
        • Dieding J
        • Schrimpf C
        • et al.
        Prospective evaluation of preoperative lung ultrasound for prediction of perioperative outcome and myocardial injury in adult patients undergoing vascular surgery (LUPPO study).
        Minerva Anestesiol. 2020; 86: 1151-1160
        • Perlas A
        • Arzola C
        • Van de Putte P.
        Point-of-care gastric ultrasound and aspiration risk assessment: A narrative review.
        Can J Anaesth. 2018; 65: 437-448
        • Reddy PB
        • Punetha P
        • Chalam KS.
        Ultrasonography – A viable tool for airway assessment.
        Indian J Anaesth. 2016; 60: 807-813
        • Fulkerson JS
        • Moore HM
        • Anderson TS
        • et al.
        Ultrasonography in the preoperative difficult airway assessment.
        J Clin Monit Comput. 2017; 31: 513-530
        • Hahn RT
        • Abraham T
        • Adams MS
        • et al.
        Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.
        J Am Soc Echocardiogr. 2013; 26: 921-964
        • Patel KM
        • Desai RG
        • Trivedi K
        • et al.
        Complications of transesophageal echocardiography: A review of injuries, risk factors, and management.
        J Cardiothorac Vasc Anesth. 2022; 36: 3292-3302
        • Kratz T
        • Campo Dell-Orto M
        • Exner M
        • et al.
        Focused intraoperative transthoracic echocardiography by anesthesiologists: A feasibility study.
        Minerva Anestesiol. 2015; 81: 490-496
        • Ramsingh D
        • Runyon A
        • Gatling J
        • et al.
        Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: Quality improvement initiative.
        Reg Anesth Pain Med. 2020; 45: 95-101
        • Navas-Blanco JR
        • Louro J
        • Reynolds J
        • et al.
        Intraoperative focused cardiac ultrasound for assessment of hypotension: A systematic review.
        Anesth Analg. 2021; 133: 852-859
        • Kratz T
        • Steinfeldt T
        • Exner M
        • et al.
        Impact of focused intraoperative transthoracic echocardiography by anesthesiologists on management in hemodynamically unstable high-risk noncardiac surgery patients.
        J Cardiothorac Vasc Anesth. 2017; 31: 602-609
        • Staudt G
        • Shelton K.
        Development of a rescue echocardiography protocol for noncardiac surgery patients.
        Anesth Analg. 2019; 129: 37-40
        • Ramsingh D
        • Frank E
        • Haughton R
        • et al.
        Auscultation versus point-of-care ultrasound to determine endotracheal versus bronchial intubation: A diagnostic accuracy study.
        Anesthesiology. 2016; 124: 1012-1020
        • Nicholls SE
        • Sweeney TW
        • Ferre RM
        • et al.
        Bedside sonography by emergency physicians for the rapid identification of landmarks relevant to cricothyrotomy.
        Am J Emerg Med. 2008; 26: 852-856
        • Osman A
        • Sum KM.
        Role of upper airway ultrasound in airway management.
        J Intesive Care. 2016; 4: 52
        • Rooney KD
        • Schilling UM.
        Point-of-care testing in the overcrowded emergency department—can it make a difference?.
        Crit Care. 2014; 18: 692
        • Breitkreutz R
        • Price S
        • Steiger HV
        • et al.
        Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: A prospective trial.
        Resuscitation. 2010; 81: 1527-1533
        • Ramsingh D
        • Singh S
        • Canales C
        • et al.
        The evaluation point-of-care ultrasound in the post-anesthesia unit—a multicenter prospective observational study.
        J Clin Med. 2021; 10: 2389
        • Haskins SC
        • Desai NA
        • Fields KG
        • et al.
        Diagnosis of intraabdominal fluid extravasation after hip arthroscopy with point-of-care ultrasonography can identify patients at an increased risk for postoperative pain.
        Anesth Analg. 2017; 124: 791-799
        • Daurat A
        • Choquet O
        • Bringuier S
        • et al.
        Diagnosis of postoperative urinary retention using a simplified ultrasound bladder measurement.
        Anesth Analg. 2015; 120: 1033-1038
        • Melniker LA
        • Leibner E
        • McKenney MG.
        Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: The first sonography outcomes assessment program trial.
        Ann Emerg Med. 2006; 48: 227-235
        • Morgan BB
        • Kao A
        • Trent SA
        • et al.
        Effect of emergency physician-performed point-of-care ultrasound and radiology department-performed ultrasound examinations on the emergency department length of stay among pregnant women at <20 weeks’ gestation.
        J Ultrasound Med. 2018; 37: 2497-2505
        • Wilson S.P.
        • Connolly K.
        • Lahham S.
        • et al.
        Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay.
        World J Emerg Med. 2016; 7: 178-182
        • Mozzini C
        • Di Dio Perna M
        • Pesce G
        • et al.
        Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time.
        Intern Emerg Med. 2018; 13: 27-33
        • Chen Z
        • Hong Y
        • Dai J
        • et al.
        Incorporation of point-of-care ultrasound into morning round is associated with improvement in clinical outcomes in critically ill patients with sepsis.
        J Clin Anesth. 2018; 48: 62-66
        • Ramsingh D
        • Rinhart J
        • Kain Z
        • et al.
        Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents.
        Anesthesiology. 2015; 123: 670-682
        • Coker BJ
        • Zimmerman JM.
        Why anesthesiologists must incorporate focused cardiac ultrasound into daily practice.
        Anesth Analg. 2017; 124: 761-765
        • Mahmood F
        • Matyal R
        • Skubas N
        • et al.
        Perioperative ultrasound training in anesthesiology: A call to action.
        Anesth Analg. 2016; 122: 1794-1804