Introduction:Point-of-care ultrasound has become an essential tool in critical care medicine. The provision of adequate ultrasound training is one of the most significant barriers to point-of-care ultrasound adoption. Sonographers are a valuable resource for ultrasound training but often lack support and formal recognition of their role as educators. This paper describes a short course to equip sonographers for interprofessional ultrasound teaching. Methods:A continuing education course was collaboratively developed by a faculty of sonographers and physicians from Australia and New Zealand. Hybrid delivery included online learning modules and an interactive skills day. The content focused on increasing sonographer knowledge of ultrasound integration and skills teaching in critical care settings. Pre- and post-course evaluation of participant knowledge and confidence was conducted. Faculty feedback was also sought. Results:Twenty-three general and cardiac sonographers participated in the course. Self-rated confidence showed significant post-course increase for 93% (14/15) ultrasound teaching competency items (p < 0.05). Qualitative analysis of participant and faculty feedback comments was predominantly positive. Participants reported the course was well-organised, engaging and valuable for their professional development. Discussion:The course involved multiple stakeholders with the aim to benefit the wider ultrasound community. It recognised the valuable contribution sonographers can make as ultrasound educators and provided educational support for sonographers transitioning to interprofessional teaching roles. Conclusion:A collaboratively designed course for sonographers has successfully been piloted, demonstrating positive results. This continuing education course is the first of its kind to equip sonographers for interprofessional ultrasound teaching in critical care settings.

Abstract Aims Heart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short‐term hospital readmission and showed that higher‐risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse‐led HF DMP in selected patients at high risk of short‐term hospital readmission, using ultrasound‐guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting. Methods and results Risk‐HF is a prospective multisite randomized controlled trial that will allocate 404 patients hospitalized with acute decompensated HF, and ≥33% risk of readmission and/or death at 30 days, into risk‐guided nurse intervention (DMP‐Plus group) compared with usual care. Intervention elements include (i) fluid management with a handheld ultrasound (HHU) device at point of care; (ii) post‐discharge follow‐up; (iii) optimal programmed drug titration; (iv) better transition of care; (v) intensive self‐care education via an avatar‐based ‘digital health coach’; and (vi) exercise guidance through the digital coach. Usual care involves standard post‐discharge hospital care. The primary outcome is reduced death and/or hospital readmissions at 30 days post‐discharge, and secondary outcomes include quality of life, fluid management efficacy, and feasibility and patient engagement. Assuming that our intervention will reduce readmissions and/or deaths by 50%, with a 1:1 ratio of intervention vs. usual care, we plan to randomize 404 patients to show a difference at a statistical power of 80%, using a two‐sided alpha of 0.05. We anticipate this recruitment will be achieved by screening 2020 hospitalized HF patients for eligibility. An 8 week pilot programme of our digital health coach in 21 HF patients, age > 75 years, showed overall improvements in quality of life (13 of 21), self‐care (12 of 21), and HF knowledge (13 of 21). A pilot of the use of HHU by nurses showed that it was feasible and accurate. Conclusions The Risk‐HF trial will evaluate the effectiveness of a risk‐guided intervention to improve HF outcomes and will evaluate the efficacy of trained HF nurses delivering a fluid management protocol that is guided by lung ultrasound with an HHU at point of care.

BACKGROUND: Catecholamine inotropes are frequently used after cardiopulmonary bypass (CPB) but may have undesirable effects. The aim was to identify whether the routine use of inhaled pulmonary vasodilators might reduce the requirement for inotrope drugs after cardiac surgery. METHODS: Retrospective cohort study of sequential patients undergoing cardiac surgery at the Royal Melbourne Hospital performed by a single surgeon and anesthesia care team, within 14 months before and after routine implementation of inhaled pulmonary vasodilators, August 2017. Milrinone 4 mg and iloprost 20 µg were inhaled using a vibrating mesh nebulizer (Aerogen) before initiation of CPB and at chest closure. Other aspects of clinical management were unaltered over the time period. Two investigators blinded to each other extracted data from electronic and written medical records. The primary outcome was any use of inotropes in the perioperative period; a Fisher exact test was used to analyze any differences between the 2 groups. Demographic data, hemodynamic data, and use of inotropes and vasopressors were collected from induction of anesthesia to 36 hours postoperative in the intensive care unit (ICU). Hospital and ICU length of stay, cost, and complications were collected. RESULTS: Any use of inotropes was significantly lower with inhaled pulmonary dilators (62.5% vs 86.8%, odds ratio [95% confidence interval {CI}], 0.253 (0.083–0.764); P = .011), including intraoperative inotrope use (37.5% vs 86.8%, odds ratio [95% CI], 0.091 (0.03–0.275); P < .001). ICU length of stay was significantly lower with inhaled pulmonary dilators (45 hours, interquartile range [IQR], 27–65 vs 50 hours, IQR, 45–74; P = .026). There were no significant differences among major postoperative complications or costs between groups. CONCLUSIONS: Routine use of inhaled milrinone 4 mg and iloprost 20 µg before and after CPB is associated with reduced postoperative inotrope use.