%0 Journal Article
%T Does the Integration of Personalized Ultrasound Change Patient Management in Critical Care Medicine? Observational Trials
%A Raoul Breitkreutz
%A Marco Campo del£¿ Orto
%A Christian Hamm
%A Colleen Cuca
%A Peter M. Zechner
%A Tanja Stenger
%A Felix Walcher
%A Florian H. Seeger
%J Emergency Medicine International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/946059
%X Objective. To test the influence of personalized ultrasound (PersUS) on patient management in critical care. Design of the Study. Prospective, observational, and critical care setting. Four substudies compared PersUS and mobile ultrasound, work distribution, and diagnostic and procedural quality. Patients and Interventions. 640 patient ultrasound exams including 548 focused diagnostic exams and 92 interventional procedures. Main Outcome Measures. Number of studies, physician¡¯s judgement of feasibility, time of usage per patient, and referrals to echo lab. Results. Randomized availability of PersUS increased its application in ICU work shifts more than twofold from 33 to 68 exams mainly for detection and therapy of effusions. Diagnostic and procedural quality was rated as excellent/very good in PersUS-guided puncture in 95% of cases. Integrating PersUS within an initial physical examination of 48 randomized cases in an emergency department, PersUS extended the examination time by 100 seconds. Interestingly, PersUS integration into 53 randomized regular ward rounds of 1007 patients significantly reduced average contact time per patient by 103 seconds from 8.9 to 7.2 minutes. Moreover, it lowered the patient referral rate to an echo lab from 20% to 2% within the study population. Conclusions. We propose the development of novel ultrasound-based clinical pathways by integration of PersUS. 1. Introduction Point-of-care ultrasound has become more popular in the environment of acute and critical care medicine [1, 2]. Various recommendations on its use mainly address clinical indications related to acute or severe dyspnoea, hypotension and shock, trauma, and abdominal pain [1¨C4]. The technical concept of a ¡°personal ultrasound imager¡± and an ¡°ultrasonic stethoscope¡± is more than 30 years old [5]. There is a strong interest in the integration of ultrasound into clinical pathways and many context-based protocols are available. A novel technology was born when the initial idea of a personalized ultrasound device (PersUS) used like a physician¡¯s generic stethoscope was realized [5, 6], a paradigm shift that now supports real point-of-care clinical pathway concepts. In 1978 it was suggested that bringing the echo lab to the patient would be a major step forward [5]. Previously, ultrasound labs contained stationary ultrasound systems, while mobile and hand-carried ultrasound was kept at facilities like emergency departments or intensive care units, making the technology available for multiple users. In fact, ¡°personalized¡± refers to the size and quick application of
%U http://www.hindawi.com/journals/emi/2013/946059/