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      Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine 

      review-article
      1 , 2 , , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ,   11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , The European Society of Intensive Care Medicine task force for critical care ultrasonography* 24
      Intensive Care Medicine
      Springer Berlin Heidelberg
      Ultrasonography, Intensive care unit, Consensus, Brain ultrasound, Echocardiography, Lung ultrasound, Abdominal ultrasound, Vascular ultrasound

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          Abstract

          Purpose

          To provide consensus, and a list of experts’ recommendations regarding the basic skills for head-to-toe ultrasonography in the intensive care setting.

          Methods

          The Executive Committee of the European Society of Intensive Care (ESICM) commissioned the project and supervised the methodology and structure of the consensus. We selected an international panel of 19 expert clinicians–researchers in intensive care unit (ICU) with expertise in critical care ultrasonography (US), plus a non-voting methodologist. The panel was divided into five subgroups (brain, lung, heart, abdomen and vascular ultrasound) which identified the domains and generated a list of questions to be addressed by the panel. A Delphi process based on an iterative approach was used to obtain the final consensus statements. Statements were classified as a strong recommendation (84% of agreement), weak recommendation (74% of agreement), and no recommendation (less than 74%), in favor or against.

          Results

          This consensus produced a total of 74 statements (7 for brain, 20 for lung, 20 for heart, 20 for abdomen, 7 for vascular Ultrasound). We obtained strong agreement in favor for 49 statements (66.2%), 8 weak in favor (10.8%), 3 weak against (4.1%), and no consensus in 14 cases (19.9%). In most cases when consensus was not obtained, it was felt that the skills were considered as too advanced. A research agenda and discussion on training programs were implemented from the results of the consensus.

          Conclusions

          This consensus provides guidance for the basic use of critical care US and paves the way for the development of training and research projects.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00134-021-06486-z.

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          Most cited references50

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          • Article: not found

          International evidence-based recommendations for point-of-care lung ultrasound.

          The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Seventy-three proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. This document reflects the overall results of the first consensus conference on "point-of-care" lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.
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            • Abstract: found
            • Article: not found

            Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact.

            Increased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP).
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              Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010.

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                Author and article information

                Contributors
                kiarobba@gmail.com
                chiara.robba@unige.it
                Journal
                Intensive Care Med
                Intensive Care Med
                Intensive Care Medicine
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0342-4642
                1432-1238
                5 October 2021
                5 October 2021
                : 1-21
                Affiliations
                [1 ]GRID grid.410345.7, ISNI 0000 0004 1756 7871, Anesthesia and Intensive Care, , Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, ; Genoa, Italy
                [2 ]Italy and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy
                [3 ]GRID grid.46699.34, ISNI 0000 0004 0391 9020, Department of Critical Care, , King’s College Hospital, ; London, UK
                [4 ]GRID grid.410345.7, ISNI 0000 0004 1756 7871, Anesthesia and Intensive Care Operative Unit, , S. Martino Hospital, ; Belluno, Italy
                [5 ]GRID grid.415462.0, ISNI 0000 0004 0607 3614, Consultant Intensivist, Head of ICU/RT Department Security Forces Hospital , ; Dammam, Saudi Arabia
                [6 ]GRID grid.39381.30, ISNI 0000 0004 1936 8884, Division of Critical Care Medicine, , Western University, ; London, ON Canada
                [7 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, , Linköping University, ; S-58185 Linköping, Sweden
                [8 ]GRID grid.5395.a, ISNI 0000 0004 1757 3729, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, , University of Pisa, ; Pisa, Italy
                [9 ]GRID grid.450697.9, ISNI 0000 0004 1757 8650, E.O. Ospedali Galliera, ; Genoa, Italy
                [10 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Interdepartmental Division of Critical Care Medicine, Department of Anesthesia and Pain Management, , University Health Network, University of Toronto, ; Toronto, ON M5G 2N2 Canada
                [11 ]GRID grid.415502.7, Department of Medicine, Division of Critical Care Medicine, , St. Michael’s Hospital, ; Toronto, ON Canada
                [12 ]Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
                [13 ]Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
                [14 ]GRID grid.417728.f, ISNI 0000 0004 1756 8807, Humanitas Clinical and Research Center-IRCCS, ; Rozzano, Milan, Italy
                [15 ]Anaesthesia and Intensive Care, San Matteo Hospital, Pavia, Italy
                [16 ]GRID grid.512756.2, ISNI 0000 0004 0370 4759, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, ; Hempstead, NY USA
                [17 ]GRID grid.11630.35, ISNI 0000000121657640, Intensive Care Unit, Clinicas Hospital School of Medicine, , University of the Republic, ; Montevideo, Uruguay
                [18 ]GRID grid.412860.9, ISNI 0000 0004 0459 1231, Department of Neurology, , Wake Forest Baptist Medical Center, ; Winston Salem, NC USA
                [19 ]GRID grid.134996.0, ISNI 0000 0004 0593 702X, Medical Intensive Care Unit and INSERM U1088, , Amiens University Hospital, ; Amiens, France
                [20 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Department of Intensive Care Medicine, Erasme Hospital, , Université Libre de Bruxelles, ; Brussels, Belgium
                [21 ]GRID grid.411178.a, ISNI 0000 0001 1486 4131, Medical-Surgical Intensive Care Unit, Inserm CIC 1435, , Limoges University Hospital, ; Limoges, France
                [22 ]GRID grid.50550.35, ISNI 0000 0001 2175 4109, Intensive Care Medicine Unit, , Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, ; Billancourt, 92100 Boulogne, France
                [23 ]GRID grid.12832.3a, ISNI 0000 0001 2323 0229, INSERM UMR-1018, CESP, Team Kidney and Heart, , University of Versailles Saint-Quentin en Yvelines, ; Villejuif, France
                [24 ]GRID grid.489664.1, ISNI 0000 0001 1034 0437, European Society of Intensive Care Medicine (ESICM), ; 19 Rue Belliard, Brussels, 1040 Belgium
                Author information
                http://orcid.org/0000-0003-1628-3845
                Article
                6486
                10.1007/s00134-021-06486-z
                8596353
                34787687
                6dcbfb5d-fc2d-4a7e-9cb2-883bd05da172
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 11 June 2021
                : 16 July 2021
                Categories
                Consensus And Expert Recommendation

                Emergency medicine & Trauma
                ultrasonography,intensive care unit,consensus,brain ultrasound,echocardiography,lung ultrasound,abdominal ultrasound,vascular ultrasound

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