Impact of an ultrasound-driven diagnostic protocol at early intensive-care stay: a randomized-controlled trial

Abstract

Background Point-of-care ultrasound (POCUS) is a tool in increasing use, but there is still a lack of basics for its routine use and evidence of its impact in intensive care. Objective To measure the impact of POCUS on resource utilization, diagnostic accuracy, and clinical management in medical-surgical intensive care units (ICUs). Methods Prospective, controlled study, in two polyvalent ICUs. The patients were randomly assigned to POCUS or control group. Interventions POCUS patients received systematic ultrasound examination of optic nerve, lung/pleura, heart, abdomen, and venous system, performed at the bedside by trained intensivists. Control patients were treated by critical care specialists who do not perform ultrasound in their clinical practice. Results We included 80 patients, 40 per group. There were no significant differences in age, sex, APACHE II score, or admission diagnosis. POCUS group used fewer resources per patient in the first 5 days of hospitalization: chest radiography (2.6 ± 2.0 vs 4.1 ± 3.5, P = 0.01), additional ultrasound evaluations performed by a radiology specialist (0.6 ± 0.7 vs 1.1 ± 0.7, P = 0.002), and computed tomography studies (0.5 ± 0.6 vs 0.9 ± 0.7, P = 0.007). Time to perform any requested ultrasound evaluation after ICU admission was 2.1 ± 1.6 h versus 7.7 ± 6.7 h (P = 0.001). Systematic ultrasound evaluation led to better characterization of ICU admission diagnosis in 14 (35%) patients and change in clinical management in 24 (60%). POCUS group had lower fluid balance at 48 and 96 h after admission (P = 0.01) and spent less time mechanically ventilated (5.1 ± 5.7 days vs 8.8 ± 9.4, P = 0.03). Conclusions Systematic application of POCUS may decrease utilization of conventional diagnostic imaging resources and time of mechanical ventilation, and facilitate meticulous intravenous fluid administration in critically ill patients during the first week of stay in the ICU. Trial registration ClinicalTrials.gov Identifier: NCT03608202.

Use of CT and artificial intelligence in suspected or COVID-19 positive patients: statement of the Italian Society of Medical and Interventional Radiology

“…• CT as additional tool that shows typical features of COVID pneumonia, as the most common bilateral ground-glass opacities involving mainly the lower lobes [9]. • Ultrasound of the lungs as monitoring tool also to evaluate the effectiveness of prone-supination maneuvers [10,11]. • SIRM recommends, as high priority, to ensure appropriate sanitation procedures on the scan equipment after detecting any suspected or positive COVID-19 patients, since the risk of spreading the infection into the CT suite.…”

Study Protocol for Draup: De-implementation Ofroutine Chest Radiographs After Adoption of Ultrasound Guided Insertion and Confirmation of Central Venous Catheter Protocol, A Hybrid Implementation/effectiveness Study

“…Clinicians already using POCUS for CVC insertion can quickly use DRAUP immediately after the procedure with no further con rmatory steps or resources needed. DRAUP would be best suited for academic medical environments where ultrasound equipment and ultrasound knowledge is standardized demonstrating adequate social validity and acceptance of POCUS amongst early adopters [49]. This study has the potential to impact public health by increasing our understanding of simultaneous implementation and deimplementation of physician behavior based on their risk pro les.…”

The Clinical and Translational Research Activities at the INT – IRCCS “Fondazione Pascale” Center (Naples, Italy) during the COVID-19 Pandemic

“…In this context, recent results have revealed the e ciency of some imaging methods in the management of COVID-19 disease. The chest ultrasound (POCUS -Point-Of-Care UltraSound) can be performed by the intensivists at the patient's bed and represent a valid monitoring tool to evaluate the effectiveness of the prono-supination maneuvers [42][43][44]. POCUS can reduce the use of diagnostic imaging resources, risk of contagion for personnel, and sani cation time.…”

“…Moreover, it helps in POC decision for critically ill patients. On the other hand, the ultrasound scan itself requires prolonged contact between the operator and the patient, and has other contraindications, including dependence on operators [42][43][44]. Computed tomography (CT) examination has been used extensively in China and now worldwide to evaluate the grade and the extension of the viral pneumonia by COVID-19 especially in the follow-up [45][46][47], also supported by Arti cial Intelligence algorithms [48,49].…”