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The Accuracy of Bedside Goal-Directed Echo by the Noncardiologist to Assist in Diagnosis of the Dyspneic Patient FREE TO VIEW

Mangala Narasimhan, DO; Subani Chandra, MD; Adey Tsegaye, MD; Christopher Dibello, MD; Paul Mayo, MD; Seth Koenig, MD
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NSLIJ, New Hyde Park, NY

Chest. 2011;140(4_MeetingAbstracts):896A. doi:10.1378/chest.1119651
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PURPOSE: Goal directed echocardiography (GDE) is useful in assessing the cause for cardiopulmonary failure. Performed by the pulmonary/critical specialist (PCCMS), GDE typically includes 5 standard views that are used to qualitatively assess for right and left ventricular (RV/LV) size/function, pericardial effusion, and severe valvular dysfunction. A key question remains as to whether PCCMS performed GDE yields results that are similar to cardiology performed echocardiography. We examined the accuracy of GDE performed to evaluate patients with respiratory dysfunction during initial bedside pulmonary consultation.

METHODS: GDE, consisting of parasternal long and short axis, apical four, and subcostal long and short axis views, was performed by one of four PCCMS as part of initial bedside pulmonary consultation in the emergency room or inpatient service. The PCCMS were all trained in GDE. The examination was interpreted at the bedside, and stored in digital format for offline review. Initial and final results were entered into a spreadsheet. A full echocardiogram, performed by cardiology technicians and read by an attending cardiologist, was performed within 24 hours of the GDE.

RESULTS: 36 GDE were performed. In 35 of these, the results were perfectly correlated with those of the full echocardiogram regarding assessment of RV/LV size/function, pericardial effusion, and severe valvular dysfunction. In one case, the cardiology study described suboptimal image quality with probable severe reduction of LV function, while the GDE reported moderate reduction in LV function. The most common abnormality identified was severe reduction of LV function. In all cases, offline review of the PCCMS examination by a separate PCCMS reader was identical to the initial bedside interpretation.

CONCLUSIONS: PCCMS perform accurate GDE during initial pulmonary consultation in patents with respiratory dysfunction with results that are similar to cardiology performed echocardiography.

CLINICAL IMPLICATIONS: This suggests that GDE is technically feasible in this operating environment. It remains to be determined whether the results of GDE, when combined with other aspects of ultrasonography result in clinical benefit to patient care.

DISCLOSURE: The following authors have nothing to disclose: Mangala Narasimhan, Subani Chandra, Adey Tsegaye, Christopher Dibello, Paul Mayo, Seth Koenig

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