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  1. Article ; Online: Exploring Brain and Heart Interactions during Electroconvulsive Therapy with Point-of-Care Ultrasound.

    Chang, Marvin G / Barbour, Tracy A / Bittner, Edward A

    Medical sciences (Basel, Switzerland)

    2024  Volume 12, Issue 2

    Abstract: Background: Electroconvulsive therapy (ECT) is a procedure commonly used to treat a number of severe psychiatric disorders, including pharmacologic refractory depression, mania, and catatonia by purposefully inducing a generalized seizure that results ... ...

    Abstract Background: Electroconvulsive therapy (ECT) is a procedure commonly used to treat a number of severe psychiatric disorders, including pharmacologic refractory depression, mania, and catatonia by purposefully inducing a generalized seizure that results in significant hemodynamic changes as a result of an initial transient parasympathetic response that is followed by a marked sympathetic response from a surge in catecholamine release. While the physiologic response of ECT on classic hemodynamic parameters such as heart rate and blood pressure has been described in the literature, real-time visualization of cardiac function using point-of-care ultrasound (POCUS) during ECT has never been reported. This study utilizes POCUS to examine cardiac function in two patients with different ages and cardiovascular risk profiles undergoing ECT.
    Methods: Two patients, a 74-year-old male with significant cardiovascular risks and a 23-year-old female with no significant cardiovascular risks presenting for ECT treatment, were included in this study. A portable ultrasound device was used to obtain apical four-chamber images of the heart before ECT stimulation, after seizure induction, and 2 min after seizure resolution to assess qualitative cardiac function. Two physicians with expertise in echocardiography reviewed the studies. Hemodynamic parameters, ECT settings, and seizure duration were recorded.
    Results: Cardiac standstill was observed in both patients during ECT stimulation. The 74-year-old patient with a significant cardiovascular risk profile exhibited a transient decline in cardiac function during ECT, while the 23-year-old patient showed no substantial worsening of cardiac function. These findings suggest that age and pre-existing cardiovascular conditions may influence the cardiac response to ECT. Other potential contributing factors to the cardiac effects of ECT include the parasympathetic and sympathetic responses, medication regimen, and seizure duration with ECT. This study also demonstrates the feasibility of using portable POCUS for real-time cardiac monitoring during ECT.
    Conclusion: This study reports for the first time cardiac standstill during ECT stimulation visualized using POCUS imaging. In addition, it reports on the potential differential impact of ECT on cardiac function based on patient-specific factors such as age and cardiovascular risks that may have implications for ECT and perioperative anesthetic management and optimization.
    MeSH term(s) Male ; Female ; Humans ; Young Adult ; Adult ; Aged ; Electroconvulsive Therapy/adverse effects ; Electroconvulsive Therapy/methods ; Point-of-Care Systems ; Brain ; Hemodynamics/physiology ; Seizures ; Heart Arrest
    Language English
    Publishing date 2024-03-22
    Publishing country Switzerland
    Document type Case Reports ; Journal Article
    ZDB-ID 2754473-4
    ISSN 2076-3271 ; 2076-3271
    ISSN (online) 2076-3271
    ISSN 2076-3271
    DOI 10.3390/medsci12020017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Bedside Ultrasound: The Silent Guardian for Upper Airway Assessment and Management.

    Chang, Marvin G / Berra, Lorenzo / Bittner, Edward A

    Seminars in ultrasound, CT, and MR

    2023  Volume 45, Issue 1, Page(s) 46–57

    Abstract: Ultrasound evaluation of the upper airway has emerged as an essential instrument for clinicians, offering real-time assessment that can help to guide interventions and improve patient outcomes. This review aims to provide health care providers with a ... ...

    Abstract Ultrasound evaluation of the upper airway has emerged as an essential instrument for clinicians, offering real-time assessment that can help to guide interventions and improve patient outcomes. This review aims to provide health care providers with a practical approach to performing ultrasound evaluation of the upper airway, covering basic physics relevant to upper airway ultrasound, the identification of key anatomical structures, and elucidating its various clinical applications, such as prediction of difficult airway, confirmation of endotracheal intubation, and guidance for surgical airway procedures and airway blocks. We also discuss evidence-based training programs, limitations, and future directions of ultrasound imaging of the upper airway.
    MeSH term(s) Humans ; Intubation, Intratracheal/methods ; Ultrasonography/methods
    Language English
    Publishing date 2023-12-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1353113-x
    ISSN 1558-5034 ; 0887-2171
    ISSN (online) 1558-5034
    ISSN 0887-2171
    DOI 10.1053/j.sult.2023.12.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1594: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  3. Article: An Assessment of Carotid Flow Time Using a Portable Handheld Ultrasound Device: The Ideal Tool for Guiding Intraoperative Fluid Management?

    Gibson, Lauren E / Mitchell, James E / Bittner, Edward A / Chang, Marvin G

    Micromachines

    2023  Volume 14, Issue 3

    Abstract: Volume resuscitation is a cornerstone of modern anesthesia care. Finding the right balance to avoid inadequate or excess volume administration is often difficult to clinically discern and can lead to negative consequences. Pulse pressure variation is ... ...

    Abstract Volume resuscitation is a cornerstone of modern anesthesia care. Finding the right balance to avoid inadequate or excess volume administration is often difficult to clinically discern and can lead to negative consequences. Pulse pressure variation is often intraoperatively used to guide volume resuscitation; however, this requires an invasive arterial line and is generally only applicable to patients who are mechanically ventilated. Unfortunately, without a pulmonary artery catheter or another costly noninvasive device, performing serial measurements of cardiac output is challenging, time-consuming, and often impractical. Furthermore, noninvasive measures such as LVOT VTI require significant technical expertise as well as access to the chest, which may not be practical during and after surgery. Other noninvasive techniques such as bioreactance and esophageal Doppler require the use of costly single-use sensors. Here, we present a case report on the use of corrected carotid flow time (ccFT) from a portable, handheld ultrasound device as a practical, noninvasive, and technically straightforward method to assess fluid responsiveness in the perioperative period, as well as the inpatient and outpatient settings.
    Language English
    Publishing date 2023-02-22
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2620864-7
    ISSN 2072-666X
    ISSN 2072-666X
    DOI 10.3390/mi14030510
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Severe COVID pneumonia and undetectable B cells after vaccination in patients previously treated with rituximab: a case series.

    Sakano, Takashi / Bittner, Edward A / Chang, Marvin G

    Postgraduate medicine

    2022  Volume 134, Issue 2, Page(s) 239–243

    Abstract: Introduction: The risk of developing severe COVID-19 illness despite completing vaccination for patients who have previously received immunosuppressive therapy is unclear.: Case presentation: We present three patients who received rituximab for ... ...

    Abstract Introduction: The risk of developing severe COVID-19 illness despite completing vaccination for patients who have previously received immunosuppressive therapy is unclear.
    Case presentation: We present three patients who received rituximab for treatment of autoimmune disorders who subsequently developed severe COVID-19 pneumonia post-vaccination requiring intensive care unit admission and found to have undetectable B cells.
    Discussion: While there have been concerns about the effectiveness of COVID-19 vaccines in this patient cohort, this is the first case series to report development of severe COVID-19 illness after completing vaccination in those who previously received rituximab. Guidelines for the optimal timing of COVID-19 vaccination in relation to immunosuppressive therapy have been recently published, albeit after many patients in this subpopulation have already been vaccinated.
    Conclusion: This case series brings attention to the limited humoral response to vaccines in patients treated with rituximab, highlights existing guidelines and their limitations, and raises future considerations about the potential benefits to testing vaccine responsiveness.
    MeSH term(s) COVID-19 ; COVID-19 Vaccines/adverse effects ; Humans ; Rituximab/adverse effects ; SARS-CoV-2 ; Vaccination
    Chemical Substances COVID-19 Vaccines ; Rituximab (4F4X42SYQ6)
    Language English
    Publishing date 2022-02-09
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 410138-8
    ISSN 1941-9260 ; 0032-5481
    ISSN (online) 1941-9260
    ISSN 0032-5481
    DOI 10.1080/00325481.2022.2037359
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ua VI Zs.407: Show issues Location:
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    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  5. Article: Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management.

    Tankard, Kelly A / Sharifpour, Milad / Chang, Marvin G / Bittner, Edward A

    Journal of clinical medicine

    2022  Volume 11, Issue 21

    Abstract: Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms ... ...

    Abstract Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM is associated with significant morbidity and mortality. Evidence suggests that a dedicated airway response team (ART) can help mitigate the risks associated with EAM and provide a framework for airway management in acute settings. We review the risks and challenges related to EAM and describe strategies to improve patient care and outcomes via implementation of an ART.
    Language English
    Publishing date 2022-10-27
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11216336
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Characteristics of Simulation-Based Point-of-Care Ultrasound Education: A Systematic Review of MedEdPORTAL Curricula.

    Singh, Jaskaran / Matern, Lukas H / Bittner, Edward A / Chang, Marvin G

    Cureus

    2022  Volume 14, Issue 2, Page(s) e22249

    Abstract: Point-of-care ultrasonography (POCUS) is increasingly recognized as a safe, efficacious, and cost-effective diagnostic and procedural tool used by many medical disciplines. Although standardized POCUS curricula are lacking, simulation represents an ... ...

    Abstract Point-of-care ultrasonography (POCUS) is increasingly recognized as a safe, efficacious, and cost-effective diagnostic and procedural tool used by many medical disciplines. Although standardized POCUS curricula are lacking, simulation represents an effective modality to teach the fundamentals of POCUS in medical education. We sought to characterize POCUS simulation cases available within MedEdPORTAL, the primary repository of learning resources for health professions, to highlight areas for future curricular development and study. This systematic review was performed based on a comprehensive search of MedEdPORTAL. Identified simulations were categorized and contrasted with respect to their target audiences, settings, pathologies, required materials and equipment, and POCUS techniques tested. A total of eight curricula were identified. The majority (6/8) were targeted at trainees in acute care specialties. Pathologies included in most simulations involved cardiac or pericardial disease, although obstetric and medical diseases were also tested in isolated cases. While half (4/8) of the identified simulation curricula incorporated diagnostic POCUS interpretation, only a few (2/8) allowed for high-fidelity ultrasound simulation. While self-reported learner satisfaction appeared to be generally high, most (7/8) identified curricula did not include objective assessments of learning outcomes. A small number of simulation-based POCUS curricula have been published within MedEdPORTAL. The widespread use of simulation for POCUS may be limited by the financial costs of high-fidelity training equipment. While simulation provides a highly promising solution to the need for greater instruction in POCUS, there is a need for comprehensive, standardized, and cost-effective curricula that can be adapted to varied educational environments.
    Language English
    Publishing date 2022-02-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.22249
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Teleguidance Technology for Endotracheal Intubation: A Scoping Review.

    Levin, Benjamin S / Chang, Marvin G / Bittner, Edward A

    Critical care explorations

    2021  Volume 3, Issue 12, Page(s) e0582

    Abstract: Objectives: Teleguidance facilitated intubation has recently reemerged during the coronavirus disease 2019 pandemic as a strategy to provide expert airway management guidance and consultation to practitioners in settings where such expertise is not ... ...

    Abstract Objectives: Teleguidance facilitated intubation has recently reemerged during the coronavirus disease 2019 pandemic as a strategy to provide expert airway management guidance and consultation to practitioners in settings where such expertise is not readily available onsite or in-person. We conducted a scoping review to provide a synthesis of the available literature on teleguidance facilitated intubation. Specifically, we aimed to evaluate the feasibility, safety, and efficacy of teleguidance facilitated intubation given existing technology.
    Data sources: A librarian-assisted search was performed using three primary electronic medical databases from January 2000 to November 2020.
    Study selection: Articles that reported outcomes focused on implementing or evaluating the performance of teleguidance facilitated intubation were included.
    Data extraction: Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system.
    Data synthesis: Of 255 citations identified, 17 met eligibility criteria. Studies included prospective investigations and proof of technology reports. These studies were performed in clinical and simulation environments. Five of the prospective investigations that examined time to intubation and intubation success rates. Multiple different commercially available and noncommercial teleconference software systems were used in these studies.
    Conclusions: There is a limited body of literature evaluating the feasibility, safety, and efficacy of teleguidance facilitated intubation. Based on the studies available that examined a variety of technologies within simulation and clinical environments, teleguidance facilitated intubation appears to be feasible, safe, and efficacious. Given the exponential growth in the use of telemedicine technology during the coronavirus disease 2019 pandemic and the evidence supporting teleguidance facilitated intubation, there is a need to critically evaluate the most effective mechanisms to integrate and optimize these technologies across diverse practice settings.
    Language English
    Publishing date 2021-12-09
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000582
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Biplane Imaging Using Portable Ultrasound Devices for Vascular Access.

    Convissar, David / Bittner, Edward A / Chang, Marvin G

    Cureus

    2021  Volume 13, Issue 1, Page(s) e12561

    Abstract: The use of ultrasound guidance for the placement of difficult IVs, arterial lines, and central venous access has become the standard of care. While imaging quality has improved over the last two decades, the lack of affordability, availability, and ... ...

    Abstract The use of ultrasound guidance for the placement of difficult IVs, arterial lines, and central venous access has become the standard of care. While imaging quality has improved over the last two decades, the lack of affordability, availability, and training have been major limitations in its routine clinical use. We detail the first reported use of biplane imaging using a portable ultrasound probe for difficult vascular access to increase first past success, efficiency, safety, and sterility during the coronavirus disease 2019 (COVID-19) pandemic.
    Language English
    Publishing date 2021-01-07
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.12561
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Biplane Imaging Versus Standard Transverse Single-Plane Imaging for Ultrasound-Guided Peripheral Intravenous Access: A Prospective Controlled Crossover Trial.

    Convissar, David / Bittner, Edward A / Chang, Marvin G

    Critical care explorations

    2021  Volume 3, Issue 10, Page(s) e545

    Abstract: Obtaining peripheral IV access in critically ill patients is often challenging especially for novice providers. The availability of biplane imaging for ultrasound guided peripheral access has the potential to improve successful venous cannulation ... ...

    Abstract Obtaining peripheral IV access in critically ill patients is often challenging especially for novice providers. The availability of biplane imaging for ultrasound guided peripheral access has the potential to improve successful venous cannulation compared with standard plane imaging.
    Design: Single-center quasi-randomized (alternate allocation) crossover trial.
    Setting: Surgical ICU at the Massachusetts General Hospital.
    Subjects: Twenty surgical ICU nurses with no prior experience using ultrasound for peripheral IV were enrolled.
    Interventions: All participants viewed instructional videos on single-plane and biplane imaging for peripheral IV insertion. The participants were then quasi-randomly assigned to use either single-plane or biplane imaging for peripheral IV insertion using a phantom model. The time to catheter completion, successful lumen cannulation, and attempts in which the needle was observed to go through the back wall of the vessel were recorded for each of the three attempts. The following day the participants repeated the peripheral IV insertion with the alternate imaging modality.
    Measurements and main results: Biplane imaging compared with single-plane imaging was associated with a significantly greater overall success rate (78.3% ± 22.4% vs 41.7% ± 26%;
    Conclusions: This proof-of-principle study demonstrates that the biplane ultrasound imaging approach for vessel cannulation resulted in an overall faster, more successful, and safer peripheral IV access than the standard single-plane transverse approach when performed by novice ultrasound users.
    Language English
    Publishing date 2021-10-08
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000545
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock.

    Gibson, Lauren E / Chang, Marvin G / Berra, Lorenzo

    The New England journal of medicine

    2021  Volume 385, Issue 22, Page(s) 2108

    MeSH term(s) Cardiotonic Agents/therapeutic use ; Dobutamine/therapeutic use ; Epinephrine ; Humans ; Milrinone/therapeutic use ; Shock, Cardiogenic/drug therapy
    Chemical Substances Cardiotonic Agents ; Dobutamine (3S12J47372) ; Milrinone (JU9YAX04C7) ; Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2021-11-26
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc2114890
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ua VI Zs.34: Show issues Location:
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