How I Teach the Estimation of Right Ventricular Systolic Pressure Using Point-of-Care Ultrasound

Abstract

Point-of-care ultrasound (POCUS) is a powerful diagnostic tool that combines image acquisition with bedside interpretation, enabling physicians to make rapid diagnoses at the bedside (1). Over the last decade, the popularity of POCUS has surged because of its versatility and the immediate insights it provides in clinical decision making (1). However, basic POCUS does not provide important hemodynamic information, such as intracardiac pressures, stroke volume, or valvular regurgitation assessment. Critical care echocardiography (CCE) becomes indispensable as a specialized application of POCUS focused on using Doppler techniques to provide detailed hemodynamic assessments in critically ill patients (2). Teaching hemodynamic evaluation in CCE, such as estimating right ventricular systolic pressure (RVSP), is a challenging yet essential aspect of modern critical care education. RVSP is used to assess the presence of pathologic elevation in right ventricular afterload, which has significant clinical implications for critically ill patients. Deriving RVSP requires understanding ultrasound physics, fluid mechanics, and Doppler techniques and mastery of cardiac image acquisition (3-4). These complex skills are not just important but crucial for effectively managing critically ill patients in the intensive care unit (ICU). In this edition of "How I Teach," we introduce our methodology for instructing learners in our ICU on RVSP estimation using CCE. We use hands-on ultrasound training and e-learning strategies to optimize knowledge retention, ensure accurate interpretation, and promote practical application.

Keywords: POCUS; RVSP; critical care echo; e-learning.

Figure 1.

E-learning module transducer movement (fanning) from the parasternal long axis to right ventricular inflow view.

Figure 2.

E-learning module 2 parasternal short axis base tricuspid valve view and color Doppler scale. RA = right atrium; RVOT = right ventricular outflow tract.

Figure 3.

E-learning showing tricuspid regurgitation in the parasternal short axis view and right ventricular inflow view. PLAX = parasternal long axis; PSAX = parasternal short axis; RV = right ventricular.

Figure 4.

E-learning module 5 continuous-wave Doppler estimation of TR jet velocity. PG = pressure gradient; TR = tricuspid regurgitation.

Figure 5.

Subcostal short axis view. The image on the left is a simulated view, and the image on the right is an actual patient view. AV = aortic valve; LA = left atrium; PV = pulmonic valve; RA = right atrium; RV = right ventricle; TV = tricuspid valve.