expert commentary

By Adam C. Adler, MD, MS

Point of care ultrasound is an invaluable tool for real-time physical exam assisted diagnosis. Application of bedside ultrasound can prove beneficial throughout the entire perioperative period from fluid and functional assessment prior to induction to assessment of IV functionality in the neonate or lung ultrasound with suspected pneumothorax(1). As Dr. Joffe has excellently highlighted, the use of point of care ultrasound can rapidly help to establish a differential diagnosis in an emergency situation and determine the appropriate management path(2).

Recently, we published a guided approach for the use of bedside ultrasound in the perioperative period as performed by the anesthesiologist(3). With a small degree of training, non-cardiology/radiology providers can acquire the necessary skills and knowledge to recognize significant findings(4).  Dr. Joffe appropriately stresses the importance of developing a curriculum in conjunction with local experts to assure proper application of point of care ultrasound. A program similar to the one described by Dr. Joffe was created at The Children’s Hospital of Philadelphia within the division of Critical Care Medicine to allow for a formal approach to imaging and interpretation with oversight and assistance from internal experts(5, 6).

Numerous studies have revealed the lacking sensitivity and specificity of the physical examination by stethoscope. Perhaps we have lost the skills of the past or maybe we have evolved into a technological way of practicing. Either way ultrasound is here to stay.

References:

  1. Adler AC, Jablonka DH. Bedside Ultrasound: A Tool for Assessment of IV Functionality. Anesthesiology. 2016;124(4):959.
  2. Adler AC. Cardiac ultrasound: it's not just for cardiologists! Journal of Cardiothoracic and Vascular Anesthesia. 2016. [Ahead of Print]
  3. Adler AC, Greeley WJ, Conlin F, Feldman JM. Perioperative Anesthesiology UltraSonographic Evaluation (PAUSE): A Guided Approach to Perioperative Bedside Ultrasound. J Cardiothorac Vasc Anesth. 2016;30(2):521-9.
  4. See KC, Ong V, Ng J, Tan RA, Phua J. Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model*. Crit Care Med. 2014;42(10):2169-77.
  5. Conlon TW, Himebauch AS, Fitzgerald JC, Chen AE, Dean AJ, Panebianco N, et al. Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU. Pediatr Crit Care Med. 2015;16(3):219-26.
  6. Conlon TW, Ishizuka M, Himebauch AS, Cohen MS, Berg RA, Nishisaki A. Hemodynamic Bedside Ultrasound Image Quality and Interpretation After Implementation of a Training Curriculum for Pediatric Critical Care Medicine Providers. Pediatr Crit Care Med. 2016.

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