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Correspondence |

Merging Two Worlds: Point-of-Care Ultrasonography and Tele-Medicine FREE TO VIEW

Gulrukh Zaidi, MD; Seth Koenig, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Gulrukh Zaidi, MD, North Shore Long Island Jewish Health System-Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd, Ste 107, New Hyde Park, NY 11042


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):605-606. doi:10.1016/j.chest.2015.11.023
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A critical care physician performs and interprets the examination, providing real-time diagnosis and therapeutic interventions; this is the world of point-of-care ultrasound (PCUS). It is a paradigm shift from traditional consultative imaging in which technologists and physicians not intimately involved in patient care are responsible for image acquisition and interpretation. The use of PCUS eliminates clinical and time dissociation in patient care, allows timely diagnosis without having to unnecessarily transport the patient, and can reduce radiation exposure. The critical care literature is replete with studies supporting the use of PCUS, and it is becoming the standard of care in many ICUs across the country., The expanding role of tele-medicine, as well as the shortage of critical care physicians, has led to a rapid growth of tele-ICUs across the country. As of 2013, tele-ICU monitoring and care delivery supported nearly 13% of all ICU beds in the United States.

With the expanding role of tele-ICUs, it is imperative to integrate critical care ultrasonography into the patient care model. Using our tele-ICU system, we conducted a pilot study to determine the feasibility of real-time interpretation of PCUS images acquired at the bedside via the tele-ICU. A total of 52 PCUS examinations (18 lung, 18 cardiac, and 16 lower extremity compression [le-CUS] studies) were performed by a bedside intensivist. Independent image interpretation was performed by the bedside intensivist and the tele-intensivist who interpreted the images via the video monitors zoomed in to the ultrasound screen. Six thoracic, 10 cardiac, and 10 le-CUS studies were read as normal. Twelve thoracic, eight cardiac, and six le-CUS studies revealed a pathologic finding (eg, B-lines, lung consolidation, pleural effusions, pericardial effusions, reduced left ventricular function with segmental wall motion abnormalities, DVT). There was 100% concordance in the image interpretation by the bedside intensivist and the tele-ICU physician. When the recorded video clips were reviewed by the third blinded intensivist, concordance regarding study results was also 100%.

A recent pilot study also showed that tele-intensivists were able to guide nonphysicians with minimal ultrasound training to acquire clinically useful images; in addition, the investigators demonstrated that there was no difference in the quality between images saved directly from the ultrasound and those viewed with the tele-ICU camera. In this study, 96% of the time the tele-intensivist felt comfortable making clinical decisions based on the images acquired. This finding should be particularly interesting to critical care physicians in areas in which tele-medicine services are used to monitor ICUs without 24-h in-house intensivist staffing. If providers (including advanced clinical practitioners, residents, and nonintensivist physicians staffing these units) can be trained to acquire PCUS images, a tele-intensivist with critical care ultrasound expertise can accurately interpret these examinations and use the results to guide patient management. Furthermore, a qualified critical care ultrasound-trained physician can enhance PCUS training via tele-ICU and monitor the progress of the practitioners responsible for image acquisition at the bedside. As technology continues to improve, coupled with the widespread acceptance of PCUS for intensive care patient management, the integration of tele-medicine and ultrasound seems inevitable.

References

Moore C.L. .Copel J.A. . Point-of-care ultrasonography. N Engl J Med. 2011;364:749-757 [PubMed]journal. [CrossRef] [PubMed]
 
Killu K. .Coba V. .Mendez M. .et al Model point-of-care ultrasound curriculum in an intensive care unit fellowship program and its impact on patient management. Crit Care Res Pract. 2014;2014:934796- [PubMed]journal. [PubMed]
 
Lilly C.M. .McLaughlin M.M. .Zhao H. .Baker S.P. .Cody S. .Irwin S. . the UMass Memorial Critical Care Operations Group A multicenter study of ICU telemedicine reengineering of adult critical care. Chest. 2014;145:500-507 [PubMed]journal. [CrossRef] [PubMed]
 
Zaidi G. .Dhar S. .Chen L. .Chandra S. .Koenig S. . Accuracy of interpretation of point of care ultrasound images in critically ill patients via telemedicine. Chest. 2015;148:331A- [PubMed]journal. [CrossRef]
 
Levine AR, McCurdy MT, Zubrow MT, Papali A, Mallemat HA, Verceles AC. Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images [published online ahead of print June 9, 2015].J Crit Care.http://dx/doi.org/10.1016/j.jcrc.2015.05.030.
 

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References

Moore C.L. .Copel J.A. . Point-of-care ultrasonography. N Engl J Med. 2011;364:749-757 [PubMed]journal. [CrossRef] [PubMed]
 
Killu K. .Coba V. .Mendez M. .et al Model point-of-care ultrasound curriculum in an intensive care unit fellowship program and its impact on patient management. Crit Care Res Pract. 2014;2014:934796- [PubMed]journal. [PubMed]
 
Lilly C.M. .McLaughlin M.M. .Zhao H. .Baker S.P. .Cody S. .Irwin S. . the UMass Memorial Critical Care Operations Group A multicenter study of ICU telemedicine reengineering of adult critical care. Chest. 2014;145:500-507 [PubMed]journal. [CrossRef] [PubMed]
 
Zaidi G. .Dhar S. .Chen L. .Chandra S. .Koenig S. . Accuracy of interpretation of point of care ultrasound images in critically ill patients via telemedicine. Chest. 2015;148:331A- [PubMed]journal. [CrossRef]
 
Levine AR, McCurdy MT, Zubrow MT, Papali A, Mallemat HA, Verceles AC. Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images [published online ahead of print June 9, 2015].J Crit Care.http://dx/doi.org/10.1016/j.jcrc.2015.05.030.
 
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