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Point of care ultrasound (PoCUS) in low- and middle-income countries 低收入和中等收入国家的护理点超声(PoCUS)
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.005
Mohamed Eissa , Gabrielle Lessard , Juan Morales , Wesley Rajaleelan , Jose A. Calvache
Point-of-Care Ultrasound (PoCUS) is a portable, affordable, and versatile diagnostic and procedural tool that enhances bedside decision-making. Its simplicity and safety make it especially valuable in low- and middle-income countries (LMICs), where access to advanced imaging is limited. PoCUS helps bridge diagnostic gaps by enabling real-time, noninvasive assessment and procedural guidance across anesthesiology, perioperative care, critical care, and emergency-medicine. However, implementation in LMICs faces barriers such as limited device availability, high costs, maintenance difficulties, and insufficient training. Equipment availability, accessibility and structured education remain key determinants of adoption. Training programs are often short-term and externally led, with limited long-term integration into local systems. Emerging strategies including “train-the-trainer” approaches, blended learning, and tele-mentoring—offer scalable solutions. Coordinated efforts across access, education, and sustainability—supported by mentorship and standardized credentialing—are essential. Ultimately, PoCUS represents more than a diagnostic tool; it is a driver of equity, safety, and empowerment in global health.
即时超声(PoCUS)是一种便携、经济、多功能的诊断和程序工具,可提高床边决策。它的简单性和安全性使其在获得先进成像的机会有限的低收入和中等收入国家(LMICs)特别有价值。PoCUS通过实现麻醉学、围手术期护理、重症监护和急诊医学的实时、无创评估和程序指导,帮助弥合诊断差距。然而,在中低收入国家的实施面临着诸如设备可用性有限、成本高、维护困难和培训不足等障碍。设备可用性、可及性和结构化教育仍然是采用的关键决定因素。培训项目通常是短期的,由外部主导,与当地系统的长期整合有限。新兴战略包括“培训培训师”方法、混合学习和远程指导,提供了可扩展的解决方案。在指导和标准化证书的支持下,在获取、教育和可持续性方面的协调努力至关重要。最终,PoCUS不仅仅是一种诊断工具;它推动全球卫生领域的公平、安全和赋权。
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引用次数: 0
Resuscitative transesophageal echocardiography 复苏经食管超声心动图
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.10.004
Jacobo Moreno Garijo , Pablo Pérez d’Empaire , Benjamin Weingarten

Background

Resuscitative transesophageal echocardiography (rTEE) has emerged as a transformative point-of-care imaging modality that integrates diagnostic and procedural guidance into real-time resuscitation. Unlike transthoracic echocardiography (TTE), rTEE provides continuous, high-resolution cardiac imaging without interrupting chest compressions, overcoming traditional limitations in patients with undifferentiated shock or cardiac arrest.

Content

This review summarizes the evolution, technical foundations, and clinical applications of rTEE across resuscitation, extracorporeal membrane oxygenation (ECMO), and peri-arrest care. We discuss the development of focused scanning protocols—such as the ACEP 3-view, Resuscitative TEE 4-view, and 3 + 2 frameworks—that enable rapid qualitative assessment of cardiac activity, ventricular function, volume status, and reversible causes of arrest. Diagnostic advantages include superior rhythm classification (distinguishing pulseless electrical activity (PEA), pseudo-PEA, fine VF, and standstill), improved pulse-check accuracy, and identification of the area of maximal compression (AMC) to optimize CPR quality. Procedurally, rTEE supports real-time ECMO cannulation, monitoring, and decannulation, complementing ELSO recommendations for both V-A and V–V configurations. Evidence-based echocardiographic parameters—such as LVOT velocity time integral (VTI), MAPSE, TAPSE, and t-IVT—inform readiness for ECMO liberation and predict recovery or need for durable mechanical support.

Outlook

Focused rTEE training pathways and credentialing frameworks are now available for anesthesiologists, intensivists, and emergency physicians, expanding its accessibility in perioperative and critical care environments. As the technology becomes more widespread, future research should standardize rTEE competency assessment, validate outcome-based protocols, and further integrate rTEE into precision-guided resuscitation algorithms.
背景复苏经食管超声心动图(rTEE)已成为一种变革性的护理点成像方式,将诊断和程序指导整合到实时复苏中。与经胸超声心动图(TTE)不同,rTEE在不中断胸部按压的情况下提供连续、高分辨率的心脏成像,克服了对未分化性休克或心脏骤停患者的传统限制。本文综述了rTEE在复苏、体外膜氧合(ECMO)和骤停围期护理中的发展、技术基础和临床应用。我们讨论了聚焦扫描方案的发展-如ACEP 3-视图,复苏TEE 4-视图和3 + 2框架-能够快速定性评估心脏活动,心室功能,容量状态和可逆的骤停原因。诊断优势包括更好的节律分类(区分无脉电活动(PEA)、伪PEA、细VF和静止),提高脉搏检查准确性,识别最大受压区域(AMC)以优化CPR质量。在程序上,rTEE支持实时ECMO插管、监测和脱管,补充了ELSO对V-A和V-V配置的建议。基于证据的超声心动图参数-如LVOT速度时间积分(VTI), MAPSE, TAPSE和t- ivt -通知ECMO解放的准备情况,并预测恢复或需要持久的机械支持。面向未来的rTEE培训途径和资格认证框架现已适用于麻醉师、重症医师和急诊医师,扩大了其在围手术期和重症监护环境中的可及性。随着技术的普及,未来的研究应规范rTEE能力评估,验证基于结果的方案,并进一步将rTEE整合到精确引导的复苏算法中。
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引用次数: 0
POCUS for Pediatrics 儿科POCUS
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.009
Deepa Kattail , Walid Alrayashi , Andrea Gomez Morad , Rodrigo Daly Guris , John G. Hagen
Point-of-care ultrasound (POCUS) has transformed pediatric acute care by enabling rapid, bedside assessment that enhances diagnostic precision and procedural safety across perioperative, emergency, and critical care settings. Core pediatric POCUS applications include lung, cardiac, gastric, abdominal, vascular, and airway imaging. Lung and cardiac ultrasound improve evaluation of ventilation, effusions, and hemodynamic function, while gastric ultrasound assists in aspiration risk assessment. Abdominal and vascular applications enhance trauma evaluation and procedural success, and airway ultrasound aids in tube placement and emergency access. As POCUS becomes a core clinical competency, contemporary trainees are gaining formal proficiency, and established clinicians are integrating it into practice. Broader adoption, standardized education, and ongoing research are essential to optimize its role in improving pediatric patient outcomes.
护理点超声(POCUS)通过实现快速床边评估,提高围手术期、急诊和重症监护环境的诊断精度和程序安全性,改变了儿科急性护理。核心儿科POCUS应用包括肺、心脏、胃、腹部、血管和气道成像。肺和心脏超声改善通气、积液和血流动力学功能的评估,而胃超声有助于误吸风险评估。腹部和血管的应用提高了创伤评估和手术成功率,气道超声有助于插管和急诊。随着POCUS成为一种核心临床能力,当代受训者正在获得正式的熟练程度,成熟的临床医生正在将其融入实践。更广泛的采用、标准化的教育和正在进行的研究对于优化其在改善儿科患者预后方面的作用至关重要。
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引用次数: 0
From probe to practice: Implementing point-of-care ultrasound in anesthesiology 从探测到实践:在麻醉学中实施即时超声
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.001
Riet Dehouwer , Lynn Vernieuwe , Barbara Versyck
Point-of-care ultrasound is a transformative tool in anesthesiology. It provides real-time bedside imaging that enhances diagnostics, accelerates decision-making, and improves perioperative safety. Despite clear benefits, routine integration remains limited due to financial, educational, and organizational barriers.
Strategies focus on affordable device procurement, structured training with standardized curricula, and faculty development. Change is driven by integration into residency programs, local ambassadors, and pilot projects, while institutional policies on credentialing, quality assurance, and medicolegal protection safeguard consistent practice. Future developments such as handheld devices, AI-assisted interpretation, tele-ultrasonography, and electronic health record integration promise broader accessibility and improved quality control. By systematically addressing barriers, point-of-care ultrasound can become embedded in perioperative workflows as a standard of care, ultimately improving patient outcomes and advancing modern perioperative medicine. This review outlines a structured framework for implementing point-of-care ultrasound in anesthesiology.
即时超声是麻醉学中一种变革性的工具。它提供实时床边成像,增强诊断,加速决策,提高围手术期安全性。尽管有明显的好处,但由于财政、教育和组织方面的障碍,常规整合仍然有限。战略侧重于负担得起的设备采购,标准化课程的结构化培训和教师发展。变革是由住院医师项目、地方大使和试点项目的整合推动的,而有关资格认证、质量保证和医疗法律保护的制度政策则保障了实践的一致性。未来的发展,如手持设备、人工智能辅助口译、远程超声检查和电子健康记录集成,承诺更广泛的可访问性和更好的质量控制。通过系统地解决障碍,护理点超声可以作为标准护理嵌入围手术期工作流程,最终改善患者预后并推进现代围手术期医学。这篇综述概述了在麻醉学中实施点护理超声的结构化框架。
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引用次数: 0
Airway POCUS. Perspectives on clinical usefulness in scanning the airway 气道巫师。气道扫描的临床应用前景
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.007
L.A. Bruijstens , P. Van de Putte , J. Bruhn , M.S. Kristensen
Airway point-of-care ultrasound (POCUS) has the potential to make airway assessment and planning more accurate and complete. Studies have examined feasibility and usefulness of POCUS to predict and facilitate difficult airway management. This paper presents a brief overview of contemporary POCUS airway applications and current opinion on their place in clinical practice. Despite evidence, infraglottic airway assessment and its potential to improve patient safety remains relatively underused. A case series is presented to illustrate the translation of POCUS training to real life routine and acute practice. For each case, how ultrasound contributed to decision-making, preparedness, and successful management of challenging airways is highlighted. Understanding the airway's true orientation and midline through imaging helps prevent failed front-of-neck access (FONA) attempts and supports deliberate, safe airway strategies. Wider adoption, structured training, and further research are needed to standardize POCUS airway techniques and evaluate their impact on patient outcomes.
气道即时超声(POCUS)有可能使气道评估和规划更准确和完整。研究已经检验了POCUS在预测和促进气道困难管理方面的可行性和有效性。本文介绍了当代POCUS气道应用的简要概述和目前对其在临床实践中的地位的看法。尽管有证据表明,气道不全评估及其改善患者安全的潜力仍然相对未得到充分利用。通过一系列的案例来说明POCUS培训如何转化为现实生活中的日常和急性实践。对于每个病例,如何超声有助于决策,准备和成功的管理挑战气道被强调。通过成像了解气道的真实方向和中线有助于防止失败的颈前通道(FONA)尝试,并支持审慎、安全的气道策略。需要更广泛的采用、结构化的培训和进一步的研究来标准化POCUS气道技术,并评估其对患者预后的影响。
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引用次数: 0
From shadows to clarity: The rise of point-of-care ultrasound in perioperative medicine 从阴影到清晰:围手术期医学中即时超声的兴起
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.004
Peter Van de Putte , Pablo Perez d'Empaire
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引用次数: 0
Venous excess ultrasound score (VExUS) 静脉过量超声评分(VExUS)
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.010
Hari Naga Garapati , Srinivas Dandamudi , Hari Kalagara
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引用次数: 0
PoCUS in the pregnant patient 妊娠患者的PoCUS
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.10.003
Anna Impiumi , Ryan Howle
Point-of-care ultrasound (PoCUS) is an essential diagnostic tool increasingly adopted by obstetric anaesthesiologists to complement the physical examination and rapidly assess and manage pregnant patients in a variety of clinical scenarios. This review explores the use of PoCUS focusing on the anatomical and physiological changes in pregnancy that impact its technique and interpretation. It examines the evidence supporting the use of lung, cardiac, lower limbs, abdominal and optic nerve sheath PoCUS in multiple clinical conditions, as well as its use in guiding preoperative aspiration risk via gastric assessment and in facilitation airway management in the obstetric patient. The review highlights both the strengths and challenges inherent to obstetric PoCUS and aims to equip the reader with a framework to combine different PoCUS modalities in order to achieve a diagnosis based on the combination of the pregnant patient's symptomatology and ultrasonographic findings.
即时超声(PoCUS)是一种重要的诊断工具,越来越多地被产科麻醉师采用,以补充身体检查,并在各种临床情况下快速评估和管理妊娠患者。本文综述了PoCUS的应用,重点探讨了妊娠期解剖学和生理变化对其技术和解释的影响。它研究了支持在多种临床条件下使用肺、心脏、下肢、腹部和视神经鞘PoCUS的证据,以及它在通过胃评估指导术前误吸风险和促进产科患者气道管理中的应用。这篇综述强调了产科PoCUS固有的优势和挑战,旨在为读者提供一个框架,结合不同的PoCUS模式,以便根据孕妇的症状和超声检查结果进行诊断。
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引用次数: 0
Cardiovascular point-of-care ultrasound: A comprehensive guide to bedside echocardiography 心血管护理点超声:床边超声心动图的综合指南
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.008
Stefaan Bouchez
Point-of-care ultrasound (POCUS) has greatly transformed bedside patient care by enabling clinicians to conduct rapid, non-invasive evaluations of cardiac structure and function. This review presents a systematic approach to structural and functional cardiac assessment using POCUS, with an emphasis on left and right ventricular dimensions and function, preload and volume responsiveness, and valvular assessment. The echocardiographic measurements that can be readily performed at the bedside are discussed. This review also emphasizes the vital role of POCUS in identifying life-threatening conditions, such as pericardial effusion and tamponade, acute pulmonary embolism, cardiogenic shock due to left ventricular failure, hypovolemic shock, and aortic stenosis. Finally, the importance of clinician training in cardiac POCUS is highlighted, with a focus on standardized methods, structured training programs, and developing clinician competencies.
即时超声(POCUS)通过使临床医生能够对心脏结构和功能进行快速、无创的评估,极大地改变了床边病人的护理。本文综述了一种使用POCUS进行心脏结构和功能评估的系统方法,重点是左心室和右心室的尺寸和功能、预负荷和容量反应性以及瓣膜评估。超声心动图测量,可以很容易地在床边进行讨论。这篇综述还强调了POCUS在识别危及生命的疾病中的重要作用,如心包积液和心包填塞、急性肺栓塞、左心室衰竭引起的心源性休克、低血容量性休克和主动脉狭窄。最后,强调了临床医生培训在心脏POCUS中的重要性,重点是标准化的方法,结构化的培训计划和发展临床医生的能力。
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引用次数: 0
Point-of-care gastric ultrasound: Redefining aspiration risk assessment in anesthesia 即时胃超声:重新定义麻醉中误吸风险评估
IF 2.8 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.006
Valentina Franco-Uribe , Laura Girón-Arango
Point-of-care gastric ultrasound is a key tool to assess perioperative aspiration risk especially in patients with risk factors (uncertain fasting, diabetes, pregnancy, glucagon-like peptide-1 receptor agonist use) and those scheduled for urgent procedures. The assessment of antral content qualitatively (empty, clear fluid, thick fluid/solid) and, when appropriate, the quantification of volume in the presence of clear fluid, helps to identify those patients at high risk of aspiration influencing the anesthetic plan—avoiding unnecessary cancellations when the stomach is empty and prompting rapid-sequence induction or delay when is full, increasing patient safety. The benefit of a structured application guided by the I-AIM framework (indication-acquisition-interpretation and medical-decision making) and population-specific cutoffs, makes its application reliable and accurate. The aim of this review is to summarize the current evidence, describe practical aspects of the technique, interpretation, and discuss future applications.
即时胃超声是评估围手术期误吸风险的关键工具,特别是对于有危险因素(不确定禁食、糖尿病、妊娠、使用胰高血糖素样肽-1受体激动剂)和计划进行紧急手术的患者。对胃窦内容物进行定性评估(空、清液、浓液/固体),并在适当时对清液存在时的体积进行定量评估,有助于识别那些有吸入影响麻醉计划高风险的患者——避免在胃空时不必要地取消麻醉,避免在胃满时提示快速序贯诱导或延迟,从而提高患者的安全性。由I-AIM框架(适应症获取-解释和医疗决策)和特定人群截止指导的结构化应用程序的好处,使其应用可靠和准确。这篇综述的目的是总结目前的证据,描述该技术的实际方面,解释,并讨论未来的应用。
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引用次数: 0
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Best Practice & Research-Clinical Anaesthesiology
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