Assessing the Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery.

measurement, it is not a patient-specific diagnostic technique and cannot assist evaluation for ETT location that is at risk of endobronchial intubation. Placement of the ETT to a referenced distance, no matter how reliable, does not allow for the healthcare provider to be aware of how to determine inappropriate ETT location in a specific patient. (3) As the technology of point-of-care ultrasound becomes more available, it is on each specialty to identify how this advancing modality can provide patient benefit. This study was created to evaluate if airway ultrasound to assess the ETT location could be one modality that should be evaluated in this manner. Clearly, the stethoscope remains a rapid assessment modality, but other specialties such as emergency medicine and critical care have spent the last decade “evaluating” point-of-care ultrasound as another rapid assessment tool. For example, critical care has demonstrated utility with ultrasound for evaluation of pulmonary edema,10 while anesthesiologists more often rely on auscultation. In fact, emergency medicine has adopted point-of-care ultrasound training as a “core competency” for residency training and provides a year of fellowship training in clinical ultrasonography.11 In summary, both auscultation and point-of-care ultrasound can currently coexist as important diagnostic tools. Innovation in medicine does not mean replacement, and until the availability and cost are equal, one cannot replace the stethoscope with ultrasound. However, this day may come, and we should create room on our diagnostic tool belt for point-of-care ultrasound and evaluate how it can positively impact perioperative care. Importantly, however, we need to understand that just as all medical students and training physicians receive years of training on the stethoscope, so should we develop appropriate training for ultrasound. Dr. Filly12 wrote an Editorial in Radiology in 1988 entitled “Ultrasound: The Stethoscope of the Future, Alas” in which he stated: “As we look to the proliferation of US [ultrasound] instruments into the hands of untrained physicians, we can only come to the unfortunate realization that diagnostic sonography truly is the next stethoscope: used by many, understood by few.” With thoughtful research, perhaps we can define the role of perioperative point-of-care ultrasound before this occurs.