COMMENTARY

The Utility of Ultrasonography-Guided Resuscitation in Surgery

Albert B. Lowenfels, MD

Disclosures

March 15, 2018

What is the utility of point-of-care ultrasonography (POCUS) in the management of critically ill patients? The authors of a paper published in JAMA Surgery[1] discuss this innovative tool for managing patients in the emergency department and in the critical care unit.

Image from Alamy

They point out its potential advantages for diagnosing not only abdominal disease, but also thoracic, cardiac, and vascular diseases. They cite as main advantages the bedside nature of the examination, which avoids transporting the critically ill patient to another unit, and the rapidity of POCUS. In their view, POCUS will eventually become the standard of care for the resuscitation of surgical patients with nearly any type of underlying problem.

Viewpoint

Within the past decade, ultrasound scans, which used to require a large, unwieldy, expensive apparatus, became able to be performed with a small handheld device that is available for a fraction of the cost. Although the report focuses on use of this modality in the emergency department and intensive care unit, this technology would be equally effective in any setting and any location, including the patient's room, where a surgeon is responsible for patient care and where a prompt diagnosis is essential.

The major barriers have been the training necessary to become proficient in performing and interpreting scans, and credentialing issues necessary to assure the ongoing success of the modality.

Unfortunately, criteria to delineate optimal training vary widely. A Danish national survey looking at emergency ultrasound use in trauma facilities documented nonuniform use and insufficient storage of scans for review.[2]Although the newer generation of ultrasound machines may eventually replace the stethoscope,[3] issues regarding critical training , which may have to begin as early as medical school, will need to be resolved.

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