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In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy. Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-esophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making. [ABSTRACT FROM AUTHOR]

Objectives: Focused cardiac ultrasound (FoCUS) is increasingly applied in many specialities, and adequate education and training of physicians is therefore mandatory. This study aimed to assess the impact of artificial intelligence (AI)-assisted interactive focused cardiac ultrasound (FoCUS) teaching session on undergraduate medical students' confidence level and knowledge in cardiac ultrasound., Methods: The AI-assisted interactive FoCUS teaching session was held during the 9th National Undergraduate Cardiovascular Conference in London in March 2023 and all undergraduate medical students were invited to attend, and 79 students enrolled and attended the training. Two workshops were conducted each over 3-hour period. Each workshop consisted of a theoretical lecture followed by a supervised hands-on session by experts, first workshop trained 39 students and the second workshop trained 40 students. The students' pre- and post-session knowledge and confidence levels were assessed by Likert-type-scale questionnaires filled in by the students before and immediately after the workshop., Results: A total of 61 pre-session and 52 post-session questionnaires were completed. Confidence level in ultrasound skills increased significantly for all six domains after the workshop, with the greatest improvement seen in obtaining basic cardiac views (p < 0.001 for all six domains). Students strongly agreed about the effectiveness of the teaching session and supported the integration of ultrasound training into their medical curriculum., Conclusions: AI-assisted interactive FoCUS training can be an effective and powerful tool to increase ultrasound skills and confidence levels of undergraduate medical students. Integration of such ultrasound courses into the medical curriculum should therefore be considered., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2024.)

Introduction: Use of the prone position in patients with acute lung injury improves their oxygenation. Most of these patients die from multisystem organ failure and not from hypoxia, however. Moreover, there is some evidence that the organ failure is caused by increased cell apoptosis. In the present study we therefore examined whether the position of the patients affects histological changes and apoptosis in the lung and 'end organs', including the brain, heart, diaphragm, liver, kidneys and small intestine., Methods: Ten mechanically ventilated sheep with a tidal volume of 15 ml/kg body weight were studied for 90 minutes. Five sheep were placed in the supine position and five sheep were placed in the prone position during the experiment. Lung changes were analyzed histologically using a semiquantitative scoring system and the extent of apoptosis was investigated with the TUNEL method., Results: In the supine position intra-alveolar hemorrhage appeared predominantly in the dorsal areas, while the other histopathologic lesions were homogeneously distributed throughout the lungs. In the prone position, all histological changes were homogeneously distributed. A significantly higher score of lung injury was found in the supine position than in the prone position (4.63 +/- 0.58 and 2.17 +/- 0.19, respectively) (P < 0.0001). The histopathologic changes were accompanied by increased apoptosis (TUNEL method). In the supine position, the apoptotic index in the lung and in most of the 'end organs' was significantly higher compared with the prone position (all P < 0.005). Interestingly, the apoptotic index was higher in dorsal areas compared with ventral areas in both the prone and supine positions (P < 0.003 and P < 0.02, respectively)., Conclusion: Our results suggest that the prone position appears to reduce the severity and the extent of lung injury, and is associated with decreased apoptosis in the lung and 'end organs'.