Perioperative Point-of-Care Ultrasound: From Concept to Application

Davinder Ramsingh, M.D.; Yuriy S. Bronshteyn, M.D., F.A.S.E.; Stephen Haskins, M.D.; Joshua Zimmerman M.D., F.A.S.E.

Disclosures

Anesthesiology. 2020;132(4):908-916. 

In This Article

Abstract and Introduction

Introduction

Perhaps the most essential aspect of a physician's role is our diagnostic capabilities. If we cannot accurately diagnose pathology, we cannot effectively treat and may cause patient harm. Point-of-care ultrasound has emerged as a modality to improve bedside assessment. Point-of-care ultrasound refers to the use of ultrasonography at the patient's bedside for diagnostic and therapeutic purposes.[1] The physician acquires and interprets all images in real time and then uses that information to diagnose and direct therapies. While comprehensive imaging can be performed and interpreted at the point-of-care, the term point-of-care ultrasound typically refers to an ultrasound exam that is simple, rapid, and goal-oriented. It is a tool used most often to provide answers to acute "yes or no" clinical questions but can be more sophisticated based on the provider's qualifications. In the acute care setting, this modality has demonstrated utility for nearly every component of bedside assessment, including cardiovascular, pulmonary, airway, and abdominal evaluation.[2–5]

Point-of-care ultrasound has been identified as the most rapidly growing sector in medical ultrasound imaging.[6] Recent advances in this technology include improved image quality as well a significant reduction in price, with handheld devices costing approximately one twentieth the price of 10 yr ago (from $40,000+ to $2,000). These devices are now extremely portable, have intuitive interfaces, and are rapidly integrating methods of automation or semiautomation. Additionally, the integration of artificial intelligence is facilitating pathology identification.[7] With these innovations, the number of specialties utilizing point-of-care ultrasound and the frequency with which point-of-care ultrasound exams are being performed are dramatically increasing.

Thus far, point-of-care ultrasound has gained widespread acceptance in certain acute care specialties, such as emergency medicine and critical care. However, the adoption of many aspects of point-of-care ultrasound has been slower within anesthesiology, even though patients have similar comorbidities and acute care events in the perioperative setting as they do in the emergency and critical care settings.[3] Indeed, events such as pneumothorax, hypovolemia, cardiac dysfunction, pericardial and pleural effusions, gastric fullness, abdominal bleeding, and pulmonary edema are just a few of the scenarios that are omnipresent. Truly, from a patient care standpoint, why should the skill set for bedside evaluation change simply because the patient entered the perioperative environment? To this point, there has been a significant increase in interest in perioperative point-of-care ultrasound.

This clinical focus review seeks to highlight the recent evidence on perioperative point-of-care ultrasound, with a focus on its application for the general anesthesiologist. In addition, we will discuss the topics of training and certification. Finally, we will review the topic of reporting and billing. This article will focus on anesthesiologists in the United States as a review to support the consideration of national society guidelines on the topic.

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