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Hand-held echocardiography with doppler capability for the assessment of critically-ill patients: is it reliable?

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To evaluate the diagnostic capability of a hand-carried ultrasound device (HCU) in critically ill patients when using conventional transthoracic echocardiography (TTE) as a reference.


Prospective, descriptive study.


Medical-surgical intensive care unit of a teaching hospital.


All patients requiring a TTE study were eligible.


Each patient underwent an echocardiographic examination using a full-feature echocardiographic platform (Sonos 5500, Philips Medical Systems, Andover, MA) and a small battery-operated device (SonoHeart Elite, SonoSite, Bothell, WA). The operators (level III training in echocardiography) were randomized (HCU vs. TTE) and they independently interpreted the echocardiograms at the patient bedside.


During a 2-month period, 55 consecutive patients (age: 61±16 years, simplified acute physiology score 46±15, body mass index 26±7) were studied, 40 of them being mechanically ventilated (73%). The number of acoustic windows was comparable using HCU and TTE (2.3±0.8 vs. 2.4±0.8: P=0.24). The overall diagnostic accuracy of HCU was lower compared with conventional TTE (137/171 vs. 158/171 clinical questions solved: P=0.002), reaching 80% and 92%, respectively. Despite its spectral Doppler capability, HCU missed diagnoses that were adequately identified by TTE: elevated left ventricular pressure (n=2), relevant valvulopathy (n=2) and moderate (n=4) or severe (n=2) pulmonary hypertension. Acute management was altered by HCU and TTE findings in 27 patients (49%) and 28 patients (51%), respectively.


In this study, HCU had a lower diagnostic accuracy compared with conventional TTE, despite its spectral Doppler capability. Further studies are needed to validate these evolving diagnostic tools in critical care settings.

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We thank SonoSite, France for their technical help in this study. The authors are grateful to all attending physicians and nurses of our department for their continuous help during this study.

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Correspondence to Philippe Vignon.

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Vignon, P., Frank, M.B.J., Lesage, J. et al. Hand-held echocardiography with doppler capability for the assessment of critically-ill patients: is it reliable?. Intensive Care Med 30, 718–723 (2004).

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