Focus on the POCUS | Spoon-Feed Version

November 3, 2021

Written by Jonathan Brewer

Spoon Feed
Point-of-Care Ultrasonography (POCUS) is an emerging but practice-changing concept that is rapidly becoming a mainstay in clinical practice. Whether POCUS is used for diagnosis, monitoring, or procedural guidance, this bedside clinical adjunct can provide rapid, real-time information to improve patient care.

Why does this matter?
POCUS is a relatively recent concept that allows for acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging by a clinician at the patient’s bedside. So, what are the benefits and key features of POCUS that differentiate it from other imaging modalities?

POCUS sounds like a good idea

This NEJM review article predominantly focuses on key trends in POCUS technology, advances in clinical applications, and the overlap of POCUS with “consultative ultrasonography.” Some of the key points of the article are listed below.

• POCUS has been shown to safely decrease the number of consultative ultrasounds and can reduce length of stay. However, in some cases POCUS can also lead to additional consultative ultrasounds, and there is significant overlap and complementarity of POCUS and consultative diagnostic modalities.

• POCUS can improve the safety, effectiveness, and efficiency of several diagnostic and therapeutic procedures including thoracentesis, paracentesis, lumbar puncture, central venous access, peripheral venous and arterial access, pericardiocentesis, abscess drainage, and joint injection/aspiration.

• POCUS can be used for clinical monitoring for patients with respiratory failure, heart failure, traumatic hemorrhage, or shock.  POCUS has also been shown to be a useful tool for monitoring CPR and providing guidance on whether to continue or cease resuscitation.

• The diagnostic accuracy of POCUS in the hands of trained clinicians is quite high and can be as good or better than standard radiographs for several conditions, including pulmonary edema, pneumonia, pneumothorax, heart failure, and thoracoabdominal trauma.

• Multiple studies show that POCUS is more cost-effective and time-efficient than traditional ultrasonography for several conditions including nephrolithiasis, uncomplicated biliary disease, early intrauterine pregnancy, and soft-tissue infection.

• Technological advances have led to low-cost, portable, handheld ultrasound devices as well as remote evaluation and feedback for image capture and interpretation. These advances allow POCUS to be used by more frontline providers, including in the pre-hospital environment and more austere settings.

• More research is needed to evaluate the amount of training required for clinicians to become proficient in POCUS and the effect that POCUS has on patient-centered outcomes such as morbidity and mortality.

Overall, POCUS appears to be an effective means to obtain real-time information for patient care. POCUS has a broad range of uses that transcends specialties and organ systems and is rapidly becoming a standard tool for the frontline physician.

Source
Point-of-Care Ultrasonography. N Engl J Med. 2021 Oct 21;385(17):1593-1602. doi: 10.1056/NEJMra1916062.

Edited and peer-reviewed by Sam Parnell