title: Hand-held echocardiography with Doppler capability for the assessment of critically-ill patients: is it reliable?
abstract: OBJECTIVE
  To evaluate the diagnostic capability of a hand-carried ultrasound device (HCU) in critically ill patients when using conventional transthoracic echocardiography (TTE) as a reference.
  
  
  METHODS
  Prospective, descriptive study.
  
  
  METHODS
  Medical-surgical intensive care unit of a teaching hospital.
  
  
  METHODS
  All patients requiring a TTE study were eligible.
  
  
  METHODS
  Each patient underwent an echocardiographic examination using a full-feature echocardiographic platform (Sonos 5500, Philips Medical Systems, Andover, MA) and a small battery-operated device (SonoHeart Elite, SonoSite, Bothell, WA). The operators (level III training in echocardiography) were randomized (HCU vs. TTE) and they independently interpreted the echocardiograms at the patient bedside.
  
  
  RESULTS
  During a 2-month period, 55 consecutive patients (age: 61+/-16 years, simplified acute physiology score 46+/-15, body mass index 26+/-7) were studied, 40 of them being mechanically ventilated (73%). The number of acoustic windows was comparable using HCU and TTE (2.3+/-0.8 vs. 2.4+/-0.8: P=0.24). The overall diagnostic accuracy of HCU was lower compared with conventional TTE (137/171 vs. 158/171 clinical questions solved: P=0.002), reaching 80% and 92%, respectively. Despite its spectral Doppler capability, HCU missed diagnoses that were adequately identified by TTE: elevated left ventricular pressure ( n=2), relevant valvulopathy ( n=2) and moderate ( n=4) or severe ( n=2) pulmonary hypertension. Acute management was altered by HCU and TTE findings in 27 patients (49%) and 28 patients (51%), respectively.
  
  
  CONCLUSIONS
  In this study, HCU had a lower diagnostic accuracy compared with conventional TTE, despite its spectral Doppler capability. Further studies are needed to validate these evolving diagnostic tools in critical care settings.
authors.affiliation: Service de Réanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87042 Limoges Cedex, France. vignon@unilim.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.forename: Mickaël B J
authors.initials: MB
authors.lastname: Frank
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lesage
authors.forename: Frédérique
authors.initials: F
authors.lastname: Mücke
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.forename: Sandrine
authors.initials: S
authors.lastname: Normand
authors.forename: Michel
authors.initials: M
authors.lastname: Bonnivard
authors.forename: Marc
authors.initials: M
authors.lastname: Clavel
authors.forename: Hervé
authors.initials: H
authors.lastname: Gastinne
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000175:diagnosis; D012131:Respiratory Insufficiency / Q000175:diagnosis