How useful is hand-carried bedside echocardiography in critically ill patients?

OBJECTIVES: The study compared a hand-carried echocardiography (HC) device with standard echocardiography (SE) in critically ill patients. BACKGROUND: Recently, small HC devices have been introduced, and early reports showed a good correlation with SE. METHODS: We used HC (SonoSite, Bothell, Washington) echocardiography to evaluate critically ill patients, and we compared the results with SE obtained with state-of-the-art equipment (Sonos 5500, Hewlett-Packard, Andover, Massachusetts). Each of 80 critically ill patients was studied twice (HC and SE). The studies were done and interpreted separately in blinded fashion. RESULTS: The HC device missed a clinical finding related to the reason for referral in 31% of patients. In 19% of patients a clinically important finding separate from the indication for echocardiography was also missed. The total number of patients with one or more missed findings was 36 (45%). Findings were missed by HC for several reasons. First, HC does not contain spectral Doppler, electrocardiographic, or M-mode capabilities. Two-dimensional imaging is superior on SE, with improved image processing. In addition, although HC does contain color power Doppler, it does not have true color flow Doppler imaging. Therefore, HC often failed to detect or accurately quantify valvular regurgitation. CONCLUSIONS: Although the HC device was able to provide important anatomic information, the device falls far short of SE in the evaluation of critically ill patients.