Diagnostic Accuracy of Point-of-Care Ultrasound Performed by Pulmonary Critical Care Physicians for Right Ventricle Assessment in Patients With Acute Pulmonary Embolism*. Issue 12 (December 2017)

• Record Type: Journal Article
• Authors: Filopei, Jason; Acquah, Samuel O.; Bondarsky, Eric E.; Steiger, David J.; Ramesh, Navitha; Ehrlich, Madeline; Patrawalla, Paru
• Is Part Of: Critical care medicine. Volume 45:Issue 12(2017)
• Publication Date: 2017-12
• Subjects: critical care -- diagnostic imaging -- echocardiography -- education -- pulmonary embolism; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002723
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: Risk stratification for acute pulmonary embolism using imaging presence of right ventricular dysfunction is essential for triage; however, comprehensive transthoracic echocardiography has limited availability. We assessed the accuracy and timeliness of Pulmonary Critical Care Medicine Fellow's performance of goal-directed echocardiograms and intensivists' interpretations for evaluating right ventricular dysfunction in acute pulmonary embolism. Design: Prospective observational study and retrospective chart review. Setting: Four hundred fifty bed urban teaching hospital. Patients: Adult in/outpatients diagnosed with acute pulmonary embolism. Interventions: Pulmonary critical care fellows performed and documented their goal-directed echocardiogram as normal or abnormal for right ventricular size and function in patients with acute pulmonary embolism. Gold standard transthoracic echocardiography was performed on schedule unless the goal-directed echocardiogram showed critical findings. Attending intensivists blinded to the clinical scenario reviewed these exams at a later date. Measurements and Main Results: Two hundred eighty-seven consecutive patients were evaluated for acute PE. Pulmonary Critical Care Medicine Fellows performed 154 goal-directed echocardiograms, 110 with complete cardiology-reviewed transthoracic echocardiography within 48 hours for comparison. Pulmonary Critical Care Medicine Fellow's area under the curve for size and function was 0.83 (95% CI, 0.75–0.90) and 0.83 (95% CI, 0.75–0.90), respectively. Intensivists' 1/2 area under the curve for size and function was (1) 0.87 (95% CI, 0.82–0.94), (1) 0.87 (95% CI, 0.80–0.93) and (2) 0.88 (95% CI, 0.82–0.95), (2) 0.88 (95% CI, 0.82–0.95). Median time difference between goal-directed echocardiogram and transthoracic echocardiography was 21 hours 18 minutes. Conclusions: This is the first study to evaluate pulmonary critical care fellows' and intensivists' use of goal-directed echocardiography in diagnosing right ventricular dysfunction in acute pulmonary embolism. Pulmonary Critical Care Medicine Fellows and intensivists made a timely and accurate assessment. Screening for right ventricular dysfunction using goal-directed echocardiography can and should be performed by pulmonary critical care physicians in patients with acute pulmonary embolism.