Point of care testing in Critical Care Medicine: the clinician's view.

During the later years, Critical Care Medicine (CCM) has seen a rise in the possibilities of performing biochemical analyses at the point of care, or even continuous monitoring of biochemical variables. In general, point of care testing (POCT) is advantageous, by decreasing Therapeutic Turnaround Time, number of errors, and by reduction of blood-volume lost for analyses. Though not much evidence exist to prove beneficial effects with respect to early diagnostic accuracy, decrease in length of stay in Intensive Care Unit (ICU), decrease of costs, or decreased morbidity/mortality, clinicians in general agree that POCT is a prerequisite for early recognition of life-threatening conditions, and for titration of commonly applied therapies. Limitations in POCT include staff-dissatisfaction, diminished analytical accuracy, just as POCT-data must be integrated in the patients' medical record and the institutional information systems. Finally, POCT may induce economical stress, depending on many variables. All together, a strong, multidisciplinary, interdepartmental team-approach seems necessary to ensure cost-effectiveness. At present, POCT is not a replacement for conventional laboratory services in CCM, but a supplement. Before POCT can be introduced on a larger scale in CCM we must prove it reliable, consistent and cost-beneficial in order to avoid spreading of technology that provides more data and costs than true information and benefit.