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PRO: physician-performed ultrasound: the time has come for routine use in acute care medicine.

Copyright © 2012 International Anesthesia Research Society DOI: 10.1213/ANE.0b013e31826bfa7d Ultrasound-based assessment of critically ill patients has gained popularity in recent years. It has unparalleled advantages compared with other imaging modalities because of its safety, ease of use, portability, and rapidity of performance. It provides real-time dynamic images that can be interpreted online by the operator with immediate impact on patient management. This accounts for the exponential increase, especially in Europe, of ultrasonography for the diagnosis and management of the critically ill patient.1 This is far different from its historical field of use, which was restricted to the cardiology and radiology environments. Initially, imaging systems were bulky, expensive, and provided poor imaging quality. Despite this, pioneers in the field foresaw the power of the new technology, especially for unstable, critically ill patients.2 Outside the cardiology laboratories, transesophageal echocardiography (TEE) was first used in the operating room during cardiac surgery.3 Paradoxically, this confined the technique to a narrow field of use by a few experts and postponed the diffusion of TEE in the intensive care unit (ICU) until the early 1990s.4,5 During the past 2 decades, ultrasound systems have become smaller, less expensive, and of higher quality. In addition, evidence has accumulated to support the superiority of goal-directed ultrasound assessment over the standard physical examination both for diagnostic purposes and for procedural guidance.6 This led progressively to the concept of point-of-care ultrasonography, which refers to an ultrasound examination performed and interpreted in real-time by the provider at the patient’s bedside. Point-of-care ultrasonography may be focused on limited clinical questions and may be repeated if the patient’s condition changes over time.6 This paradigm shift has brought this powerful imaging technique to the community of anesthesiologists and ICU physicians in their daily clinical practice.7 Accordingly, scientific societies of critical care medicine have recently published international recommendations on the competence8 and the training9 required to perform critical care ultrasonography. In this issue of the Journal, Royse et al.10 have written a comprehensive and timely review on the use of point-ofcare ultrasound in anesthesiology and acute care medicine environments. The authors describe the progressive emergence of the concept of physician-performed critical care ultrasonography, which has been facilitated by continuous technological improvements and considerable educational efforts in providing tailored training programs to anesthesiologists and ICU physicians. They thoroughly review the diagnostic and therapeutic impact of critical care ultrasonography, and discuss the potential benefits and risks of its routine use in anesthesiology and acute care medicine. In their review, Royse et al.10 raise several points that deserve to be emphasized, while they support the widespread use of critical care ultrasound in daily critical care practice.