Democratizing Cardiac Hand Held Ultrasound

More and more sub specialties use echocardiography at the POC and bedside. I have attended some of these echo courses during Critical Care Meetings. I have also seen Intensivists go beyond the interpretation that are taught in these classes and I have seen some truly scary conclusions that they draw , thinking they understand fully what they are looking at or measuring.

The wider adoption of hand-held ultrasound is inhibited not by the lack of special training, but more by the attenuation of imaging skills of the non-imaging cardiologist.  Democratizing ultrasound by providing ubiquitous axis devoid of formal studies interpreted by echocardiographers is truly scary.  A hand-held ultrasound performed by somewhat with insufficiency skills is probably worse than no information at all.  Perhaps this attenuation skills will be less marked as the generations of the fellow's in training would have had access to hand-held ultrasounds but your through their careers although, this development would be welcome, we have not seen evidence of it yet.

I have seen truly scary interpretations  in the assessment of diastolic dysfunction for example.  Diastolic dysfunction is grossly and oversimplify divided into 4 grades, but truly classifying the function is extremely difficult, dependent on multiple parameters, and in some cases actually impossible to place the results in a particular class.  Assessment of left atrial pressure which is closely bound to this assessment is even more difficult and should be left to cardiologist with many years of experience in reading echocardiograms.  In particular bedside hand-held ultrasounds will often give fraudulent data.

For example assessment of IVC size and respirophasic changes is useless in patients on mechanical ventilation, yet an assessment is regularly made this way to define filling pressures.

The American College of cardiology has developed multiple algorithms to classify diastolic dysfunction and determine left atrial pressure.  They are not easy to remember and each has variable accuracy [sensitivity and specificity].

See attached article 1 and 2 and my slide presentation.