7938Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, CAN.
12255Tulane University School of Medicine, New Orleans, LA, USA.
J Intensive Care Med. 2022 Sep;37(9):1146-1151. doi: 10.1177/08850666221076041. Epub 2022 Feb 4.
Compared to traditional ultrasound machines, emerging handheld point-of-care-ultrasound (HPOCUS) systems exhibit superior portability and affordability. Thus, they have been increasingly embraced in the intensive care setting. However, there is scarce data on patient safety and current regulatory body guidelines are lacking. Here, we critically appraise the literature with a focus on the merits, concerns, and framework of existing POCUS guidelines. Subsequently, we provide recommendations for future regulatory guidelines.
A comprehensive literature review was conducted using the PubMed database employing the key words "point-of-care/handheld/portable ultrasound" and "guidelines" alone, in combination, and using thesaurus terms. Eligible articles were scrutinized for description of potential benefits and concerns of HPOCUS, especially from a patient safety perspective, as well as currently existing POCUS practice guidelines. Data was extracted, reported thematically using a narrative synthesis approach, then subsequently used to guide our proposed guidelines.
The most widely reported benefits of HPOCUS include superior portability, affordability, imaging, facilitation of expedited diagnosis and management, and integration with medical workplace flow. However, major barriers to adoption include device security/patient confidentiality and patient safety. Furthermore, except for a policy published by the American College of Emergency Physicians (ACEP) in 2018, there are few other national regulatory guidelines pertaining to handheld POCUS. In light of this, we propose a framework for HPOCUS guideline development to address these and other concerns. Such guidelines include training and credentialing, bioengineering approval, and strategic integration with electronic medical record systems.
HPOCUS can be a powerful tool for expedited diagnosis and management guidance. However, there is limited data regarding patient safety and current regulatory body guidelines are lacking. Our assessment illuminates that there remain many unsolved problems about HPOCUS, and in turn, we propose guidelines to address safe regulation and implementation.
与传统超声设备相比，新兴的即时护理超声（HPOCUS）系统具有更高的便携性和可负担性。因此，它们在重症监护环境中越来越受欢迎。然而，关于患者安全的数据很少，目前的监管机构指南也缺乏。在这里，我们重点评估文献，关注 HPOCUS 的优点、关注点和现有 POUS 指南的框架。随后，我们为未来的监管指南提供建议。
使用 PubMed 数据库进行全面的文献综述，使用关键词“即时护理/手持/便携式超声”单独使用、组合使用和使用词库术语。仔细审查合格文章，描述 HPOCUS 的潜在益处和关注点，特别是从患者安全的角度，以及当前现有的 POUS 实践指南。提取数据，使用叙述性综合方法进行主题报告，然后用于指导我们提出的指南。
HPOCUS 最广泛报道的益处包括卓越的便携性、可负担性、成像、促进快速诊断和管理，以及与医疗工作场所流程的整合。然而，采用的主要障碍包括设备安全性/患者保密性和患者安全。此外，除了美国急诊医师学院（ACEP）在 2018 年发布的一项政策外，几乎没有其他国家监管指南涉及手持 POUS。有鉴于此，我们提出了一个 HPOCUS 指南制定框架，以解决这些和其他问题。这些指南包括培训和认证、生物工程批准以及与电子病历系统的战略整合。
HPOCUS 可以成为加快诊断和管理指导的有力工具。然而，关于患者安全的数据有限，目前的监管机构指南也缺乏。我们的评估表明，HPOCUS 仍然存在许多未解决的问题，因此我们提出了指导方针，以确保安全监管和实施。
