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

Filopei, Jason MD; Acquah, Samuel O. MD, FCCP; Bondarsky, Eric E. MD; Steiger, David J. MD, FCCP; Ramesh, Navitha MD; Ehrlich, Madeline BS; Patrawalla, Paru MD, FCCP

doi: 10.1097/CCM.0000000000002723
Clinical Investigations
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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.

All authors: Division of Pulmonary Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY.

*See also p. 2111.

Drs. Acquah and Patrawalla are both senior authors on this article and contributed equally.

This research was performed at Mount Sinai Beth Israel, New York, NY.

Supported, in part, by, Division of Pulmonary Critical Care and Sleep Medicine at Mount Sinai Beth Israel, Five Hundred USD.

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Jason Filopei, MD, Division of Pulmonary Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, 1st Avenue at 16th Street, 7th Floor Dazian Building, New York, NY, 10003. E-mail: Filopei@gmail.com

Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.