Search

Purpose The purpose of the study is to evaluate the frequency and barriers to use of ultrasound guidance for central venous catheter (CVC) insertion by physicians specializing in critical care and hospital medicine. Materials and methods A national cross-sectional electronic survey of intensivists and hospitalists was administered from November 2014 to January 2015. Results The survey response rate was 5.9% (1013/17 233). Moderate to very frequent use of ultrasound guidance varied by site: internal jugular vein (80%), subclavian vein (31%), and femoral vein (45%). Nearly all physicians (99%) who insert internal jugular CVCs daily use ultrasound guidance, whereas only 46% of physicians who insert subclavian CVCs daily use ultrasound guidance. Use of real-time ultrasound guidance varied by insertion site: internal jugular vein (73%), subclavian vein (28%), and femoral vein (42%). Most physicians (59%) reported not being comfortable with real-time needle tracking at the subclavian site. The most frequently reported barriers to use of ultrasound guidance were (1) limited availability of ultrasound equipment (28%), (2) perception of increased total procedure time (22%), and (3) concern for loss of landmark skills (13%). Conclusions Most intensivists routinely use ultrasound guidance to insert internal jugular CVCs but not subclavian CVCs. The most commonly reported barrier to ultrasound use was limited access to an ultrasound machine.

Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.

Effects of lipopolysaccharide on RBC alteration in mice endotoxemic model Seolju Park, Jeihak Myung, Yeonhee Kim, Sungmook Yoo, Jaekwan Lim, Choonhak Lim Korea University Anam Hospital, Republic of Korea Korea University Ansan Hospital, Republic of Korea Korea University Medicine Graduate School, Republic of Korea Korean Artificial Organ Research Center, Republic of Korea Background/Purpose: Sepsis is a complex pathophysiological process that involves both alterations in the microcirculation (vessels with a diameter b100 m) and changes in the biochemical and physiological characteristics of the blood constituents. Alterations in RBC rheology participate in the alterations of the microcirculation. Early alterations of RBC rheology are reported to be seen commonly in the septic patients. However, time course of RBC alterations is not revealed. Therefore, we evaluated the change of RBC deformability and RBC aggregation in the mice endotoxemic model using lipopolysaccharide (LPS). Methods: Six-week-old male BALB/c mice were used in this study. The LPS-induced sepsis mice received LPS (20 mg/kg) intraperitoneally. Elongation indices (EIs) and aggregation indices (AIs) were tested at shear stresses of 1, 3, 7, 10, and 20 Pa for 0.5, 1, 2, 4, 6, 9, 12, and 24 hours after LPS. Results: There were no difference in AIs on 0.5, 1, 2, 4, 6, 9, 12, and 24 hours after LPS; however, EIs significantly decreased in only 10 and 20 Pa at 24 hours after LPS (P b .05). Conclusions: Our results suggested that change of RBC deformability was revealed on 24 hours after LPS injection, and choice of an appropriate shear stress may detect alterations of RBC deformability in LPS-induced sepsis mice.