Point-of-Care Ultrasonographic Techniques Save Lives in the ICU

University Hospitals Cleveland Medical Center is leading the way in advanced technology

Innovations in Pulmonology and Sleep Medicine | Summer 2019

Assessing patients in the intensive care unit (ICU) historically has included ordering tests and scans from other departments and waiting for results before beginning treatment. But thanks to advanced point-of-care ultrasonography (POCUS), physicians can now gather vital ICU patient information at the bedside, explains Shine Raju, MD, an expert in advanced ultrasonographic techniques and a new physician in the Division of Pulmonary, Critical Care and Sleep Medicine at University Hospitals Cleveland Medical Center.

Shine Raju, MD

ADVANCING PATIENT CARE

The field of critical care already relies heavily on ultrasonographic techniques for placement of invasive venous catheters and other thoracic and abdominal procedures. Now physicians are using these techniques in new and innovative ways in the ICU, such as POC echocardiography and POC lung, abdominal and extremity ultrasounds. In fact, some of the top hospitals in the country are routinely employing ultrasonography in the ICU to help intensivists like Dr. Raju diagnose and treat patients with complex cardiopulmonary diseases.

“Physicians can now use ultrasonography to look in a patient’s body in real time to understand if there is an anomaly with their heart or lungs, answering the question: Why are they critically ill?” Dr. Raju says.

“I can order an ultrasound from the radiology department at the hospital, but in the ICU, I need to make split-second decisions at the patient’s bedside,” he says. “I cannot afford to wait hours for the test and final report. With POCUS, I can scan the necessary organ systems myself. While not as comprehensive as a dedicated full-length ultrasound study, it still gives me crucial information by allowing me to directly visualize the organs and understand the complex hemodynamic interactions driving the critical illness. I can follow up with a more comprehensive test once the patient is stabilized.” 

This ability to assess cardiopulmonary function in real time has been a “tipping point in critical care medicine and has revolutionized the care of patients in the ICU.”¹

In addition to enabling real-time diagnosis, POCUS in the ICU offers other benefits. Intensivists do not have to move critically ill patients for testing, avoiding increased risk of worsening their hemodynamic function. POCUS also can reduce unnecessary testing by streamlining the diagnostic workup, decreasing patients’ exposure to radiation and lowering healthcare costs.²

The accuracy, sensitivity and specificity of thoracic ultrasound is similar to that for chest CT in patients who present with respiratory failure and, in fact, is becoming the standard of care in the ICU.¹

EXPANDING THE ROLE OF POCUS

Dr. Raju is excited about the changes POCUS has brought to critical care medicine. Right now, he and his fellow intensivists are actively using this modality to improve patient care at UH. With continued training and innovation, he is looking forward to using POC ultrasound in more sophisticated domains, such as transesophageal echocardiography. POC transesophageal echocardiography traditionally has been done by experts in the cardiac and surgical fields, and recent data suggest it offers utility in answering complex hemodynamic questions in critically ill patients.^3,4

Transesophageal ultrasound captures better images than a transthoracic echocardiograph and is a simple, safe and minimally invasive procedure that intensivists can perform at bedside. Dr. Raju says intensivists at some of the country’s top ICUs are performing this procedure, and he hopes to start offering it at UH soon.

TRAINING A NEW GENERATION OF INTENSIVISTS

Dr. Raju is channeling his expertise and enthusiasm for POCUS to develop a curriculum to train UH fellows in these ultrasonographic techniques. Stay tuned for more information about this training.

If you have questions about POCUS, or are interested in training, call Dr. Raju at 216-593-5864.

REFERENCES

1. Point-of care ultrasonography in critical care, ICU Management & Practice
2. A Whole-Body Approach to Point of Care Ultrasound, Chest Journal
3. Better with Ultrasound, Chest Journal 
4. Diagnostic Accuracy of Critical Care Transesophageal Echocardiography vs Cardiology-Led Echocardiography in ICU Patients, Chest Journal