POCUS is Standard of Care in Critical Care, With Rhea Votipka, NP

Point-of-care ultrasound (POCUS) has moved steadily from a niche procedural skill to a guideline-supported standard of care in critical care medicine, appearing in sepsis management guidance for dynamic volume responsiveness assessment and in the American Heart Association's post-cardiac arrest care recommendations, among others.¹ For advanced practice providers (APPs) working in pulmonary and critical care settings, developing POCUS competency is no longer a differentiating credential — it is an expectation the field is moving toward, according to Rhea Votipka, AGACNP-BC, Adult Gerontology Acute Care Nurse Practitioner at Lahey Hospital and Medical Center and Assistant Professor of Medicine at UMass Chan Medical School, who participated in a POCUS bootcamp session at the Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Las Vegas, Nevada.²

Votipka's message to APPs just beginning to integrate POCUS into their practice was direct: start with formal training, then commit to volume. "POCUS education is more of a marathon than a sprint," she said, emphasizing that an initial course providing didactic instruction and hands-on simulation with models is a necessary foundation — but only a foundation. The real skill development happens through repeated scanning of patients, building comfort with probe handling and equipment, and developing pattern recognition for normal and abnormal findings. Seeking out mentors who can review images and provide feedback accelerates that process significantly.

The 2024 Society of Critical Care Medicine critical care ultrasonography guidelines recommend POCUS for guiding management across 5 key clinical scenarios — cardiac arrest, sepsis, acute dyspnea and respiratory failure, volume management, and cardiogenic shock — and suggest it over usual care without POCUS for targeted volume management given evidence of improved outcomes.¹ Ongoing clinical trials are further defining the role of POCUS-guided fluid management, and its integration into routine ICU care is expanding.

In many clinical scenarios — pneumothorax evaluation being a prime example — POCUS delivers the answer faster, without the delays of ordering and waiting for a portable radiograph, and with information that a plain film simply cannot provide. "When people can see the utility of POCUS in practice, that helps with the adoption process," she said. "If I'm concerned about a pneumothorax, I can take the probe and get my answer right away — and intervene right away. That's the beauty of ultrasound."

The primary limitation of POCUS, once training has been completed, is operator skill level — and Votipka described self-awareness on this point as a professional obligation. Knowing the boundaries of one's own competency, being willing to ask for a second opinion, and resisting overconfidence in image interpretation are as essential to safe POCUS practice as technical proficiency itself.

"I think the biggest message [about] POCUS is that you got to do it, that it's really going to be what's best for our patients, it's going to elevate your practice, it's going to elevate the care of your patients, and you might as well start now, because it is the standard,” she said.

Votipka has no relevant disclosures to report.

References

1. Bhagra A, Tierney DM, Sekiguchi H, Soni NJ; Guidelines Committee. Guidelines on adult critical care ultrasonography 2024: focused update. Crit Care Med. 2025;53(3):e434–e453. doi:10.1097/CCM.0000000000006531

2. DeRienzo V, Jozefowski M, Votipka R. POCUS Bootcamp. Presented at: Association of Pulmonary Advanced Practice Providers Annual Meeting (APAP 2026); Las Vegas, NV