Kavi Haji1, Darsim Haji2, David J Canty3, Alistair G Royse4, Dhaksha Tharmaraj5, Meor Azraee5, Lynda Hopkins6, Collin F Royse4. 1. Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. Electronic address: kevee@bigpond.com. 2. Frankston Hospital, Frankston, Victoria, Australia; Ultrasound Simulation, Department of Surgery, University of Melbourne, Melbourne, Australia. 3. Department of Surgery, University of Melbourne, Melbourne, Australia. 4. Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia. 5. Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia. 6. Frankston Hospital, Frankston, Victoria, Australia; Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia.
Abstract
OBJECTIVES: Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN: Prospective observational study. SETTINGS: Tertiary ICU. PARTICIPANTS: Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS: A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound. Ultrasound was performed by an independent intensivist and checked for accuracy offline by a second reviewer. RESULTS: Ultrasound images were interpretable in 99%, with good interobserver agreement. The hemodynamic diagnosis was altered in 66% of participants, including new (14%) or altered (25%) abnormal states or exclusion of clinically diagnosed abnormal state (27%). Valve pathology of at least moderate severity was diagnosed for mitral regurgitation (7%), aortic stenosis (1%), aortic stenosis and mitral regurgitation (1%), tricuspid regurgitation (3%), and 1 case of mitral regurgitation was excluded. Lung pathology diagnosis was changed in 58% of participants including consolidation (13%), interstitial syndrome (4%), and pleural effusion (23%), and exclusion of clinically diagnosed consolidation (6%), interstitial syndrome (3%), and pleural effusion (9%). Management changed in 65% of participants including increased (12%) or decreased (23%) fluid therapy, initiation (10%), changing (6%) or cessation (9%) of inotropic, vasoactive or diuretic drugs, non-invasive ventilation (3%), and pleural drainage (2%). CONCLUSION: Routine screening of patients with combined limited TTE and lung ultrasound on admission to ICU is feasible and frequently alters diagnosis and management.
OBJECTIVES: Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN: Prospective observational study. SETTINGS: Tertiary ICU. PARTICIPANTS: Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS: A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound. Ultrasound was performed by an independent intensivist and checked for accuracy offline by a second reviewer. RESULTS: Ultrasound images were interpretable in 99%, with good interobserver agreement. The hemodynamic diagnosis was altered in 66% of participants, including new (14%) or altered (25%) abnormal states or exclusion of clinically diagnosed abnormal state (27%). Valve pathology of at least moderate severity was diagnosed for mitral regurgitation (7%), aortic stenosis (1%), aortic stenosis and mitral regurgitation (1%), tricuspid regurgitation (3%), and 1 case of mitral regurgitation was excluded. Lung pathology diagnosis was changed in 58% of participants including consolidation (13%), interstitial syndrome (4%), and pleural effusion (23%), and exclusion of clinically diagnosed consolidation (6%), interstitial syndrome (3%), and pleural effusion (9%). Management changed in 65% of participants including increased (12%) or decreased (23%) fluid therapy, initiation (10%), changing (6%) or cessation (9%) of inotropic, vasoactive or diuretic drugs, non-invasive ventilation (3%), and pleural drainage (2%). CONCLUSION: Routine screening of patients with combined limited TTE and lung ultrasound on admission to ICU is feasible and frequently alters diagnosis and management.
Authors: Micah L A Heldeweg; Lian Vermue; Max Kant; Michelle Brouwer; Armand R J Girbes; Mark E Haaksma; Leo M A Heunks; Amne Mousa; Jasper M Smit; Thomas W Smits; Frederique Paulus; Johannes C F Ket; Marcus J Schultz; Pieter Roel Tuinman Journal: Ultrasound J Date: 2022-01-10