Diagnostic Accuracy of Point-of-Care Ultrasound Performed by Pulmonary Critical Care Physicians for Right Ventricle Assessment in Patients With Acute Pulmonary Embolism

Crit Care Med. 2017 Dec;45(12):2040-2045. doi: 10.1097/CCM.0000000000002723.

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.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Echocardiography / methods*
  • Female
  • Hospitals, Teaching
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Systems*
  • Prospective Studies
  • Pulmonary Embolism / diagnostic imaging*
  • Reproducibility of Results
  • Retrospective Studies
  • Single-Blind Method
  • Time Factors
  • Ventricular Dysfunction, Right / diagnosis*
  • Ventricular Dysfunction, Right / diagnostic imaging