Point-of-care lung ultrasound in paediatric critical and emergency care.

Ultrasound techniques have been developed since the past century and are becoming more useful in different areas of medical knowledge. More recently, lung ultrasound gained importance throughout artefacts analysis to help clinical evaluation at bedside and became subject of interest in the paediatric intensive care and emergency department settings for both procedural and diagnostic purposes. The normal pattern of lung ultrasound is defined by the presence of lung sliding associated with A-lines whereas B-lines may be representative of pathologic findings. This review focuses on some of the most common pulmonary conditions, their respective sonographic features and clinical implications in the emergency department and paediatric intensive care unit.

Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians.

BACKGROUND: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. METHODS: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations. RESULTS: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training. CONCLUSIONS: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.

Videoendoscopic surgery by extraperitoneal access

Laparoscopic surgery in urology is definitely incorporated to the techniques of minimally invasive treatment for urogenital diseases. Though the classic access to organs in the urinary tract is extraperitoneal, this access has not been prioritized when the videoendoscopic technique is used. In Brazil, few groups use this approach and little has been discussed about its true practical applicability. The authors intended to discuss the main technical aspects and criteria for indication, reported though the improvement achieved in a 5-year period with 150 operated cases. A review of the literature shows that the worldly acceptance of the extraperitoneal endoscopic approach is increasing. Nevertheless, there are no evidences that the extraperitoneal access is superior to the transperitoneal route. Thus, the choice depends basically on the surgeon's preference. Major advantages are the immediate access to the renal hilum and isolation of peritoneal structures. Employing this access is useful when one suspects that significant peritoneal adherences could prevent the surgical act or when one wishes to preserve the integrity of the peritoneal cavity.

Videoendoscopic surgery by extraperitoneal access: technical aspects and indication.

Laparoscopic surgery in urology is definitely incorporated to the techniques of minimally invasive treatment for urogenital diseases. Though the classic access to organs in the urinary tract is extraperitoneal, this access has not been prioritized when the videoendoscopic technique is used. In Brazil, few groups use this approach and little has been discussed about its true practical applicability. The authors intended to discuss the main technical aspects and criteria for indication, reported though the improvement achieved in a 5-year period with 150 operated cases. A review of the literature shows that the worldly acceptance of the extraperitoneal endoscopic approach is increasing. Nevertheless, there are no evidences that the extraperitoneal access is superior to the transperitoneal route. Thus, the choice depends basically on the surgeon's preference. Major advantages are the immediate access to the renal hilum and isolation of peritoneal structures. Employing this access is useful when one suspects that significant peritoneal adherences could prevent the surgical act or when one wishes to preserve the integrity of the peritoneal cavity.