UMEM Educational Pearls

Category: Critical Care

Title: How point-of-care Ultrasound would change management of critically ill patients?

Keywords: thoracic ultrasound, critically ill, ICU, clinical management (PubMed Search)

Posted: 1/10/2023 by Quincy Tran, MD (Updated: 12/4/2023)
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Title:

The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study

 

Settings: 4 hospitals (3 in Netherlands and 1 in Italy)

Participants: All adults patients who were admitted to the ICU but patients who died within 8 hours of thoracic ultrasound were excluded.

Thoracic ultrasound procedure: cardiac, lung, diaphragm, inferior vena cava. The main indicators were Respiratory, Cardiac and Volume status.

Study Results:

725 thoracic ultrasound examinations and 534 patients.  Clinical management occurred in 247 (88.5%) patients within 8 hours of ultrasound.

Thoracic ultrasound was performed by 111 operators, ranging from inexperienced to very experienced.

Common findings from thoracic ultrasound among these ICU patients.

  • Atelectasis 233 (32.1%)
  • Pleural effusion 221 (30.5%)
  • Pulmonary edema 120 (16.6%)
  • Pneumonia 107 (14.8%)

 

Discussion:

  • There was a major impact in fluid management.
    • Patients who needed more fluid (N=63) would have a balance of +907 ml within 8 hours.
    • Patients who need euvolemia (N = 28) would have a balance of +80ml within 8 hours.
    • Patients who need less fluid (N=45) would have a balance of -411ml within 8 hours.
  • There was no information regarding management change according the experience of the operators.
  • The authors did not assess patient-centered outcomes from these management changes.

 

Conclusion: Thoracic ultrasound provided a significant change in management of critically ill patients.

References

Heldeweg MLA, Lopez Matta JE, Pisani L, Slot S, Haaksma ME, Smit JM, Mousa A, Magnesa G, Massaro F, Touw HRW, Schouten V, Elzo Kraemer CV, van Westerloo DJ, Heunks LMA, Tuinman PR. The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study. Crit Care Med. 2022 Dec 23. doi: 10.1097/CCM.0000000000005760. Epub ahead of print. PMID: 36562620.