University Hospital Wishaw (formerly known as Wishaw General Hospital) is a district general hospital in Wishaw, North Lanarkshire, situated between the areas of Craigneuk to the north and Netherton to the south. The hospital, managed by NHS Lanarkshire, is 11 miles (18 kilometres) southeast of Glasgow.
PURPOSE:To provide an expert consensus framework for standardizing lung ultrasound training for neonatologists. METHODS:We selected an international panel of 15 neonatologist experts in lung ultrasound, based on clinical and research expertise criteria. Ten questions were proposed by the chairs to the expert panel, who assessed their priority (using a 1-9 Likert-type scale). Five subgroups of 2 to 3 experts were identified to develop the statements for each clinical question; each expert contributed to developing 2 statements with their scientific rationale. All expert panelists, including the chairs, voted on all statements using a 1 to 9 Likert-type scale. A maximum of 2 rounds of voting was agreed as part of the modified Delphi process, although consensus on all the statements was reached after the first round. The statements were classified as agreement (range 7-9), uncertainty (4-6), or disagreement (1-3) when the median score and ≥ 75% of votes laid within the specific range. RESULTS:All 10 statements reached an agreement with a median score of 9 for 9 statements and of 8.5 for 1 statement. The percentage of level of agreement ranged between 80% and 100%. CONCLUSION:This consensus provides a framework for the development of neonatal lung ultrasound training program dedicated to neonatologists.
BACKGROUND:Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic. METHODS:We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. RESULTS:A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography. CONCLUSION:In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access. EDITORIAL COMMENT:This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.
Umbilical venous catheters (UVCs) are essential in neonatal intensive care, yet malposition and early migration are common and can cause serious hepatic or cardiac injury. We set out a structured, image-based approach to UVC placement and surveillance using point-of-care ultrasound (POCUS). We undertook a targeted narrative review of literature from 2005 to 2025, drawing on comparative studies, systematic reviews, meta-analyses, and society guidance on neonatal POCUS and vascular access. Findings were synthesised into a continuous bedside workflow covering placement, real-time correction of malposition, surveillance, and governance. POCUS directly visualises the UVC tip at the inferior vena cava–right atrial junction and detects portal, hepatic, and intracardiac malposition more reliably than radiography (reported sensitivity and specificity for cavoatrial localisation > 90
