Échographie portable chez les patients en état critique

Echographic systems which are the size of a laptop computer are currently available. These hand-held ultrasound units have different technological characteristics: the first category includes low-cost simple portable systems and the second category includes miniaturized well-equipped units with most modern application tools. The first category of portable systems has only been tested in critically-ill patients. Validation studies conducted in intensive care units have pointed out the limitations of hand-held echocardiography and allowed to better define its field of application. The concept of “ultrasound stethoscope” uses hand-held echography as an extension of physical examination to rapidly answer simple questions (e.g. pump function, regional wall motion abnormalities, cavitary dilatation, pericardial, pleural or abdominal effusions). The efficacy of a limited training program to physicians without experience in ultrasound for goal-directed examination using portable systems is currently evaluated. Since this practice does not correspond to the state-of-the-art, portable echography is not an alternative to standard transthoracic echocardiography or conventional ultrasound when they are available. In addition, transesophageal echocardiography is still required to perform a comprehensive hemodynamic examination in ventilated critically-ill patients.