Date: 3rd January 2025
Happy New Year all - we come bearing gifts!
...A new monthly blog dedicated to POCUS papers
Since launching our g&h Newsletter last year, we've been keeping our (free) mailing list subscribers current with critical care ultrasound literature through our curated PoCUS Papers section. Based on your fantastic feedback, we're converting this into its own monthly blog article, which will still be linked directly in your newsletter so you won't miss out. Each month, we'll handpick the newest publications that may impact your bedside ultrasound practice, providing concise summaries and highlighting practical implications for your clinical work. From landmark studies to emerging research, we focus on papers that enhance your understanding and application of point-of-care ultrasound
Overcoming Left Diaphragm Ultrasound Challenges
🌐 Context and Background
Diaphragm ultrasound is a crucial tool in critical care, yet imaging the left hemidiaphragm poses challenges due to anatomical and technical constraints. This correspondence reviews alternative techniques proposed for overcoming these difficulties, emphasising their experimental status and the need for further validation.
🔍 Key Developments and Insights
Probe Positioning: Positioning along the mid-axillary line with "anatomic M-mode" improves visualisation but risks orientation errors if not precisely aligned.
Pleural Sliding Displacement (PSD): Proposed as an alternative measure, PSD correlates poorly with diaphragmatic excursion due to confounding factors like lung hyperinflation.
Abdominal Organ Displacement: Spleen displacement is highlighted as a qualitative marker for diaphragmatic motion but remains unvalidated for routine use.
💡 Impact and Significance
Whilst innovative, these methods currently serve as investigational tools. Emphasis remains on validated bedside techniques until further evidence substantiates the broader clinical utility of alternatives.
Right Ventricular Outflow Tract Doppler and Pulmonary Embolism
🌐 Context and Background
Pulmonary embolism (PE) remains a diagnostic challenge in emergency medicine. This case series highlights the potential of early systolic notching (ESN) on right ventricular outflow tract (RVOT) Doppler ultrasound as a specific sign of intermediate-risk PE, even when traditional echocardiographic markers are absent.
🔍 Key Developments and Insights
Three patients with intermediate-risk PE exhibited ESN, correlating with proximal emboli on CT angiograms despite normal RV size and function.
ESN's pathophysiological basis stems from early pressure wave reflection due to pulmonary vascular obstruction, independent of pulmonary artery pressure.
💡 Impact and Significance
ESN has the potential to improve risk stratification in PE, avoiding radiation exposure in select cases. However, broader application requires validation through prospective studies to define its diagnostic accuracy and limitations.
Correlation Between Right Atrial Pressure and Non-Invasive Techniques
🌐 Context and Background
Venous congestion is a critical determinant of adverse cardiovascular outcomes. This study investigates correlations between right atrial pressure (RAP) measured via right heart catheterisation (RHC) and non-invasive modalities like Venous Excess Ultrasound Score (VExUS), inferior vena cava (IVC) indices, and jugular venous pressure (uJVP).
🔍 Key Developments and Insights
VExUS, particularly in grade 3 cases, and uJVP showed strong correlations with RAP, while IVC collapsibility index (CI) improved the discriminatory power of VExUS.
A modified VExUS grading system integrating IVC CI enhanced RAP stratification, addressing limitations in conventional VExUS.
💡 Impact and Significance
These findings underscore the clinical utility of non-invasive ultrasound in assessing venous congestion, offering potential alternatives to RHC in certain contexts. The study advocates further validation, particularly in mechanically ventilated and critically ill populations.
Conclusion
We hope this dedicated monthly blog format will make it even easier for you to stay on top of the latest ultrasound evidence base. Not subscribed to our free newsletter yet? Sign up today to get these paper summaries and more ultrasound education content delivered straight to your inbox each month. As always, we welcome your thoughts on which papers you'd like to see reviewed - drop us an email at info@ghcritcareecho.co.uk
About the writer
Hannah Conway, a clinical-academic and National FUSIC Heart Lead for the UK.
Interests lie in PoCUS education, Echocardiography, RV injury and telemedicine
Follow me on Twitter/X for more PoCUS related educational content https://x.com/cardiacaccp
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