Diagnostic Modalities in Critical Care: Point-of-Care Approach

Abstract

The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

“…ECMO could be used as a salvage option for severe sepsis-induced cardiogenic shock, even if characterised with very high mortality [ 32 , 38 ]. However, early clinical suspicion, provision of blood cultures and timely initiation of empirical antimicrobial therapy can substantially decrease the mortality of sepsis [ 38 , 39 ].…”

Lung Sonography in Critical Care Medicine

“…Furthermore, the point-of-care sonography approach may reduce the likelihood of spreading hospital-acquired infections by avoiding intra-hospital transports of critically ill patients, minimizing the risk of additional healthcare staff exposure, while optimizing the availability of hospital resources and maintaining possibly necessary isolation measures for patients with infectious diseases [ 21 , 22 ]. This subject became especially important in the time of the coronavirus disease 2019 (COVID-19) pandemic, with intensive care units reaching their capacity limits, necessitating additional diagnostic methods for chest scans or radiography [ 23 ]. Thus, the constrained resources of stationary and constantly required imaging devices, such as CT scanners, can be retained for non-infectious patients, while the unused and mobile sonographic devices from departments that are operated less during the pandemic (e.g., outpatient clinics, specialized wards, etc.)…”

Optical Chemical Sensor Based on Fast-Protein Liquid Chromatography for Regular Peritoneal Protein Loss Assessment in End-Stage Renal Disease Patients on Continuous Ambulatory Peritoneal Dialysis

“…Point-of-care testing (POCT), otherwise referred to as "near-patient" or "bedside", is medical diagnostic testing that is performed at the place and time of patient care [1]. Various POCT diagnostic instruments, e.g., mobile X-ray [2][3][4] and ultrasound [5] imaging systems, cardiac monitors [6], and pulse oximeters [7], are well-established and have been used for decades. In the context of clinical biochemical diagnostics, POCT means any laboratory test performed in patient care areas, either in a hospital or at home [8].…”

“…In the context of clinical biochemical diagnostics, POCT means any laboratory test performed in patient care areas, either in a hospital or at home [8]. POCT biochemical diagnostic devices are extremely diverse and include hand-held analyzers, wearable [9,10] or smartphone-based sensors [11], single-use testing systems, paper-based microfluidics [12], or even bench-top analyzers [7], and they can be primarily intended for hospital or home use. The main distinctive feature of POCT devices is that they can be operated by personnel without special laboratory training, e.g., hospital or ambulatory nursing staff, paramedics, and patients, or their caregivers.…”