Investigating the Importance of Point-of-care Ultrasound for Rapid Diagnosis and Management of Critical Illness, Including Its Role in Guiding Procedures and Assessing Fluid Status at the Bedside

Ashraf AbdelAziz Elkamhawy *

Sheikh Khalifa Medical City, Abu Dhabi, UAE.

*Author to whom correspondence should be addressed.


Abstract

Point of care ultrasound commonly known as POCUS is now an essential tool in managing critical illness since it is involved in diagnosing several illnesses. POCUS enables clinicians to image patients at the bedside, making diagnosis more accurate and helping to guide procedures and assessment of fluid status, all of which are fundamental in treating critically ill patients. Yet, one of the most significant advantages of POCUS is that it helps to shorten the time needed to make a diagnosis. This is because, in emergency and critical care situations, time is one of the most valuable resources that can be called into play. For instance, in the traumatized patient the POCUS can easily diagnose serious conditions like hemorrhage or pneumothorax, and then the patient can be treated. Moreover, in the realm of cardiac diseases, POCUS is also helpful in diagnosing trauma patients. Bedside echocardiography can detect pericardial effusions, ventricular dysfunction, and fundamental valve disorders to inform appropriate treatments expeditiously. POCUS offers the advantages of rapid diagnosis, which is critical for making appropriate therapeutic decisions and warranting better outcomes of patient treatment. This paper will show that the use of POCUS in patient management has been linked with positive enhancements specifically in the critically ill populace. POCUS does influence patient care because it allows for quicker and more accurate diagnosis, safer execution of specific procedures, and an accurate evaluation of a patient’s fluid status. The analysis of the existing literature revealed that the application of POCUS in the ICU is effective in shortening the length of stay, decreasing the frequency of ordering of other imaging studies, and reducing the incidence of adverse outcomes from invasive procedures.

Keywords: Point-of-care ultrasound, POCUS, critical illness, emergencies, ICU, better patient outcomes


How to Cite

Elkamhawy, Ashraf AbdelAziz. 2024. “Investigating the Importance of Point-of-Care Ultrasound for Rapid Diagnosis and Management of Critical Illness, Including Its Role in Guiding Procedures and Assessing Fluid Status at the Bedside”. Asian Journal of Medical Principles and Clinical Practice 7 (2):327-33. https://journalajmpcp.com/index.php/AJMPCP/article/view/240.


References

Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med. 2022 Mar 9;11(2): 70–84.

Pourmand A, Pyle M, Yamane D, Sumon K, Frasure SE. The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients. World J Emerg Med. 2019;10(4):232–8.

Fraleigh CDM, Duff E. Point-of-care ultrasound. Nurse Pract. 2022 Aug;47(8): 14–20.

a. Mirian AO, Nneamaka OA, Angela AU. Comparing the accuracy of sonoelastographic ultrasound with biopsy in the assessment of breast masses among Nigerian Women in the lagos university teaching hospital, Lagos, Nigeria. Curr. J. Appl. Sci. Technol. 2022 Sep. 23 [cited 2024 Jun. 2];41(34):12-24.

Available:https://journalcjast.com/index.php/CJAST/article/view/3952

b. Mohamed FR, el-bahnasawy MG, Hasan El-shafey M, Samy Sharaf M. Role of point of care ultrasound in confirmation of endotracheal tube placement in children. J. Adv. Med. Med. Res. 2022 Mar. 25 [cited 2024 Jun. 2];34(5):45-51.

Available:https://www.journaljammr.com/index.php/JAMMR/article/view/4411

c. Breakey N, Osterwalder J, Mathis G, Lehmann B, Sauter TC. Point of care ultrasound for rapid assessment and treatment of palliative care patients in acute medical settings. European Journal of Internal Medicine. 2020 Nov 1;81:7-14.

Smallwood N, Dachsel M. Point-of-care ultrasound (POCUS): Unnecessary gadgetry or evidence-based medicine? Clin Med. 2018 Jun;18(3):219–24.

Chelikam N, Vyas A, Desai R, Khan N, Raol K, Kavarthapu A, et al. Past and present of point-of-care ultrasound (PoCUS): A narrative review. Cureus. 15(12):e50155.

Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-care ultrasound—history, current and evolving clinical concepts in emergency medicine. Medicina (Mex). 2023 Dec 15;59(12):2179.

Argaiz ER, Koratala A, Reisinger N. Comprehensive assessment of fluid status by point-of-care ultrasonography. Kidney360. 2021 May 27;2(8):1326–38.

Balmuth EA, Luan D, Jannat-Khah D, Evans A, Wong T, Scales DA. Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting. PloS One. 2024;19(2):e0298665.

Tierney DM, Rosborough TK, Sipsey LM, Hanson K, Smith CS, Boland LL, et al. Association of internal medicine point of care ultrasound (POCUS) with length of stay, hospitalization costs, and formal imaging: A prospective cohort study. POCUS J. 8(2):184–92.

Rice JA, Brewer J, Speaks T, Choi C, Lahsaei P, Romito BT. The POCUS consult: How point of care ultrasound helps guide medical decision making. Int J Gen Med. 2021 Dec 15;14:9789–806.

Mengel-Jørgensen T, Jensen MB. Variation in the use of point-of-care ultrasound in general practice in various European countries. Results of a survey among experts. Eur J Gen Pract. 2016 Dec;22(4):274–7.

Ahn C, Kim C, Kang BS, Choi HJ, Cho JH. Variation of availability and frequency of emergency physician-performed ultrasonography between adult and pediatric patients in the academic emergency department in Korea. Clin Exp Emerg Med. 2015 Mar 31;2(1):16–23.

Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, et al. New international guidelines and consensus on the use of lung ultrasound. J Ultrasound Med. 2023 Feb;42(2):309–44.

Prosen G, Klemen P, Strnad M, Grmec Š. Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting. Crit Care. 2011;15 (2):R114.

Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J EMJ. 2014 May;31(5):369–73.

Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Sabatini S, Tulino R, Cei M, et al. General practitioner-performed compression ultrasonography for diagnosis of deep vein thrombosis of the leg: A multicenter, prospective cohort study. Ann Fam Med. 2017 Nov;15(6):535–9.

Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J EMJ. 2014 May;31(5):369–73.

Bravo-Merino L, González-Lozano N, Maroto-Salmón R, Meijide-Santos G, Suárez-Gil P, Fañanás-Mastral A. [Validity of the abdominal ecography in primary care for detection of aorta abdominal aneurism in male between 65 and 75 years]. Aten Primaria. 2019 Jan;51(1): 11–7.

Lindgaard K, Riisgaard L. Validation of ultrasound examinations performed by general practitioners. Scand J Prim Health Care. 2017 Sep;35(3):256–61.

Stein JC, Wang R, Adler N, Boscardin J, Jacoby VL, Won G, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: A meta-analysis. Ann Emerg Med. 2010 Dec;56(6):674–83.

Andersen CA, Jensen MBB, Toftegaard BS, Vedsted P, Harris M, Group ÖR. Primary care physicians’ access to in-house ultrasound examinations across Europe: A questionnaire study. BMJ Open. 2019 Sep 1;9(9):e030958.

Chen L, Malek T. Point-of-care ultrasonography in emergency and critical care medicine. Crit Care Nurs Q. 2018;41 (2):94–101.

Tanael M. Point-of-care ultrasonography, primary care, and prudence. Ann Intern Med. 2020 Oct 20;173(8):650–1.

Løkkegaard T, Todsen T, Nayahangan LJ, Andersen CA, Jensen MB, Konge L. Point-of-care ultrasound for general practitioners: A systematic needs assessment. Scand J Prim Health Care. 2020 Mar;38(1):3–11.

Gassner M, Killu K, Bauman Z, Coba V, Rosso K, Blyden D. Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods. J Ultrasound. 2014 Nov 12;18(2):127–33.

Montorfano L, Sarkissyan M, Wolfers M, Rodríguez F, Pla F, Montorfano M. POCUS and POCDUS: Essential tools for the evaluation and management of carotid artery pseudoaneurysms after a gunshot wound. Ultrasound J. 2020 Jul 22;12:35.

Cheong I, Bermeo M, Granberg G, Tamagnone FM. Tips for carotid ultrasound in the intensive care unit. J Ultrasound. 2022 Aug 2;26(1):277–83.

Chang WL, Chen PY, Hsu PJ, Lin SK. Validity and reliability of point-of-care ultrasound for detecting moderate- or high-grade carotid atherosclerosis in an outpatient department. Diagnostics. 2023 Jun 2;13(11):1952.

Patel S, Green A, Ashokumar S, Hoke A, Rachoin JS. Objective methods of assessing fluid status to optimize volume management in kidney disease and hypertension: The importance of ultrasound. J Clin Med. 2023 Oct 5;12(19):6368.

Pugliese CM, Adegbite BR, Edoa JR, Mombo-Ngoma G, Obone-Atome FA, Heuvelings CC, et al. Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients. Infection. 2022;50(1):65–82.

Calderon Martinez E, Diarte E, Othon Martinez D, Rodriguez Reyes L, Aguirre Cano DA, Cantu Navarro C, et al. Point-of-care ultrasound for the diagnosis of frequent cardiovascular diseases: A review. Cureus. 15(12):e51032.

Shaikh F, Kenny JE, Awan O, Markovic D, Friedman O, He T, et al. Measuring the accuracy of cardiac output using POCUS: The introduction of artificial intelligence into routine care. Ultrasound J. 2022 Dec 14;14:47.

Abraham JR, Torline E, Fentanes E. Focus on POCUS: Carcinoid heart disease found with point-of-care ultrasound during basic physical exam. CASE Cardiovasc Imaging Case Rep. 2021 Oct 7;5(6): 380–3.

Swanson JR, Shook DC, Vacanti JC, Molloy LM, Fields KG, Palmer LJ. Implementation of a self-guided focused cardiac ultrasound curriculum for anesthesiology residents. J Educ Perioper Med JEPM. 2020 Apr 1;22(2):E642.