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The term point-of-care ultrasound (POCUS) refers to portable ultrasound systems that allow the assessment of patients without requiring them to be physically present in a radiology department. In other words, a good point-of-care technology definition would be to say that POCUS covers the handheld portable ultrasound device used in the diagnostic process to address specific pathological hypotheses, at the bedside; in an emergency care unit, or in an ambulance.
Stork POCUS cardiac ultrasound is light (less than 300g) and has a battery inside, which is convenient to take outside. Though the existence of varied training pathways points to a lack of a standardized and centralized curriculum around the POCUS machine, this emerging field continues to expand rapidly. Evidence shows that the clinical ultrasound machine can undeniably improve "traditional examination techniques in the diagnosis and management" of critically ill patients. Technology has evolved so that practitioners can make informed decisions about patient care management and diagnoses quickly, no matter where the patient is.
POCUS is the abbreviation of point of care ultrasound. At present, clinical emergency ultrasound and severe ultrasound belong to the category of POCUS. Its core is that clinicians implement rapid diagnosis, evaluation and guide operation beside the patient's bed. A large number of clinical studies have shown that POCUS can ensure medical safety and improve the prognosis of patients.
With the advent of portable ultrasound, rapid bedside assessment of critical diseases has become possible. In the 1970s, first-line doctors, especially surgeons and emergency doctors, began to use ultrasound to evaluate trauma patients. In the 1990s, the key ultrasound assessment of trauma, namely fast examination, was proposed, and then fast examination was incorporated into ATLS guidelines. It can be said that fast examination is the pioneer of POCUS and promotes the routine application of POCUS in clinics. In the 21st century, some experts predict that in the coming decades, all clinical medical personnel (doctors, nurses, medical students, etc.) will use POCUS technology as a powerful tool for their clinical practice.
POCUS is essentially different from conventional ultrasound. The home ultrasound machine answers specific questions through focused and goal-oriented rapid screening. It can be used in most systems of the whole body, guide bedside operation, assist in diagnosis and evaluation, critical illness monitoring, etc. POCUS is not an independent diagnostic tool. The POCUS medical should always be used in the context of combining medical history, physical examination, laboratory and other imaging techniques.
In the past decades, the application of POCUS in intensive care units has developed rapidly. The core competence of POCUS is now widely regarded as a necessary skill required by clinicians in modern intensive care medicine. There are various applications of POCUS in ICU, including ICU specific echocardiography, LUS, abdominal ultrasound and vascular ultrasound. Echocardiography, TTE or TEE, has been used in ICU for a long time. The causes of ICU related hemodynamic instability are diverse, including but not limited to ventricular dysfunction, myocardial ischemia, arrhythmia, sepsis, acute blood loss, pericardial tamponade and respiratory failure.
The application of POCUS in ICU also bring benefits to patients who need mechanical circulatory support equipment. Trained intensive care personnel can conduct adequate bedside TTE, TEE and rapid examination for patients with mechanical circulation support to guide medical and surgical treatment. One study showed that 189 examinations were performed in the Cardiology / surgical ICU, in which 4% of the intubation of extracorporeal membrane oxygenation or ventricular assist device was reset, 2% of the setting of extracorporeal membrane oxygenation or ventricular assist device was changed, and 1% of the right ventricular assist device was guided.
In addition, point of care ultrasound machines also have certain practical value in volume evaluation and help guide fluid resuscitation. The researchers found that the combination of LUS and echocardiography (especially IVC imaging) can help the management of fluid resuscitation in critically ill patients. By combining the current literature on pulmonary and inferior vena cava ultrasound and the opinions of experts on the ability of transthoracic ultrasound to predict fluid response, researchers can develop a qualitative fluid resuscitation guide to divide critically ill patients into three categories: fluid resuscitation, fluid test, fluid resuscitation and fluid resuscitation, and fluid limitation. The effectiveness of this resuscitation guideline to help clinicians prescribe fluid therapy is still pending.
Abdominal POCUS has long been used in emergency medicine. The sensitivity, specificity and accuracy of bedside ultrasound in identifying intraoperative bleeding are 81.8%, 93.9% and 90.9% respectively, and it is completed in less than 1 minute in most ICU patients. Abdominal ultrasound is used to measure the diameter of abdominal aortic dissection and to diagnose dissection rupture. In addition, bedside abdominal ultrasound can be used to evaluate, quantify and guide abdominal puncture. POCUS is also used for the diagnosis of obstructive nephropathy, hydronephrosis, kidney stones and bladder dilatation, as well as for difficult Foley catheter indwelling. All these make abdominal ultrasound very suitable for routine use in ICU.
The application of vascular ultrasound in ICU ranges from vascular puncture (venipuncture, arterial puncture, peripheral venous puncture) to the diagnosis of DVT. For a long time, central venous access has been a recognized application of POCUS. The advantages of vascular ultrasound in central venous puncture include identifying appropriate vessels during puncture, identifying abnormal vascular anatomy, detecting vascular patency, and confirming the correct equipment placement in real-time. At the same time, it has a higher first puncture success rate and lower incidence of mechanical complications. The benefit was greatest in internal jugular vein puncture but relatively small in subclavian and femoral vein puncture. POCUS has also been proved to be superior to the traditional peripheral vein and artery catheterization in terms of success rate, catheterization time and skin puncture times. Related studies showed that compared with the standard ultrasound study, the sensitivity and specificity of POCUS in the diagnosis of proximal lower limb DVT were 86% and 96%. POCUS is used for early detection and timely intervention of thromboembolic diseases found in ICU.
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