Point of care Ultrasound: fad, future or current standard of care?

A session blog from Day 1 of State of the Art, London December 2015. See the full list

Blog by Adrian Wong

A Pro/Con Debate on the topic of Echocardiography and Lung Ultrasound on the Intensive Care Unit. If you have any thoughts on this area, we would love to hear from you.

ECHOCARDIOGRAPHY

Pro-Con 1) Intensivist-delivered echo: dangerous in the wrong hands

Susanna Price

Pro-Con 1) Echo-directed therapy saves lives on ICU

Antoine Vieillard-Baron

Summary

Both were proponents on the use of echocardiography and hence the presentation and the discussion that followed addressed several issues surrounding the use of Echocardiography on the ICU. A straw-poll of delegates in the room showed that the vast majority worked in ICUs which had Intensivist-performed echocardiography.

  • Echocardiography on ICU is a challenge because the patients are challenging. Cardiologist are not necessarily comfortable with scanning ICU patients (this will change) and Focused-examination by Intensivists may not be sufficient.
  • Training in echocardiography is crucial as it is an essential skill on the ICU. Misdiagnosis can expose the patient to significant harm.
  • TransOesophageal Echocardiography for haemodynamic monitoring (and diagnosis) may be coming to a general ICU near you. Once again, training is the key issue.

 

Lung Ultrasound

Pro-Con 2) Lung ultrasound: why not just get a CXR?

Ashley Miller

Pro-Con 2) Lung ultrasound: the key to rapid diagnosis

Daniel Lichtenstein

Summary

A David vs Goliath battle with Ashley gamely facing off with the man who is THE giant in the field (he wrote the books, papers, lectures etc…..). Although the delegates in the packed room where convinced that Lung US had a place on the ICU, only 4 would consider themselves ‘experts’. The rest were ‘dabblers’.

There is little doubt that lung US is a useful tool. BUT like echocardiography, the key issue discussed surrounded training. There was simply not enough trainers at the moment to meet demand. It took Daniel 26 years to master lung ultrasound! The ICS’ CUSIC accreditation believes that it can be achieved within 6 months in the right training environment. Given this situation, it may be awhile yet before Lung Ultrasound replaces the humble chest radiograph.

 

THE take home message from all 4 members of the panel – ALWAYS START WITH THE PATIENT. Ultrasound does not replace the need to take a good history and examining the patient.

 

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For a list of useful resources as well as information on the ICS’s CUSIC (Point-of-Care Ultrasound) Accreditation programme, please click here