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The Egyptian Journal of Bronchology
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Impact of integrated use of diagnostic ultrasound examinations in respiratory intensive care units

Egyptian Journal of Bronchology volume 12, pages 448–460 (2018)Cite this article

Abstract

Background

Implementing point-of-care multiorgan ultrasound (POCUS) to the initial assessment of ICU patients allows intensivists to immediately integrate ultrasound findings with the patient history, physical, and laboratory results, yielding a powerful clinical synergy, improving diagnostic accuracy, and ameliorating further management plans. The aim of this work was to assess the diagnostic performance and therapeutic effect of POCUS in patients admitted to respiratory ICU (RICU).

Patients and methods

A prospective study was carried out on patients admitted to the RICU. POCUS examination was performed to the patients within 12 h of admission that included echocardiography, lung ultrasound, abdominal ultrasound including inferior vena cava assessment and lower limb venous duplex.

Results

A total of 102 patients were included. The total number of sonographic findings was 320, of which 94 (29.3%) were new findings. This resulted in confirmation of the admitting diagnosis, modification of the admitting diagnosis, prompted further testing, change in medical therapy prescribed, and prompted invasive procedures in 35, 51, 11, 41, and 14% of patients, respectively. However, it was ineffective in confirming or modifying diagnosis, provided wrong diagnosis, and missed a diagnosis in 29.4, 2, and 11.7% of patients, respectively.

Conclusion

Integrating POCUS in the initial assessment of critically ill RICU patients together with standard diagnostic tests lead to diagnostic and therapeutic changes in most of patients which affected the management of these patients. Thus, it seems reasonable to consider the routine use of POCUS as a new respiratory examination option in the armamentarium of the intensivists.

References

  1. Leuppi JD, Dieterle T, Koch G, Martina B, Tamm M, Perruchoud AP, et al. Diagnostic value of lung auscultation in an emergency room setting. Swiss Med Wkly 2005;135:520–524.

    PubMed  Google Scholar 

  2. Manno E, Navarra M, Faccio L, Motevallian M, Bertolaccini L, Mfochivè A, et al. Deep impact of ultrasound in the intensive care unit:the ‘iCU-sound’ protocol. Anesthesiology 2012;117:801–809.

    Article  Google Scholar 

  3. Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2013;144:1868–1875.

    Article  Google Scholar 

  4. Lighthall GK, Vazquez-Guillamet C. Understanding decision making in critical care. Clin Med Res 2015;13:156–168.

    Article  Google Scholar 

  5. Laursen CB, Sloth E, Lassen AT, Christensen R, Lambrechtsen J, Madsen PH, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms:a single-blind, randomised controlled trial. Lancet Respir Med 2014;2:638–646.

    Article  Google Scholar 

  6. Bhagra A, Tierney DM, Sekiguchi H, Soni NJ. Point-of-care ultrasonography for primary care physicians and general internists. Mayo Clin Proc 2016;91:1811–1827.

    Article  Google Scholar 

  7. Narasimhan M, Koenig SJ, Mayo PH. A whole-body approach to point of care ultrasound. Chest 2016;150:772–776.

    Article  Google Scholar 

  8. Mantuani D, Frazee B, Fahimi J, Nagdev A. Point-of-care multi-organ ultrasound improves diagnostic accuracy in adults presenting to the emergency department with acute dyspnea. West J Emerg Med 2016;17:46–53.

    Article  Google Scholar 

  9. Khalil MM, ELMaraghy AA, Yousef YR. Could chest ultrasonography replace routine chest X-rays in mechanically ventilated patients? Egypt J Chest Dis Tuberc 2015;64:857–863.

    Article  Google Scholar 

  10. Salah H. Diagnostic impact of integrating ultrasonography into routine practice in respiratory intensive care units. Egypt J Bronchol 2014; 8:66.

    Article  Google Scholar 

  11. Bobbia X, Hansel N, Muller L, Claret PG, Moreau A, Genre Grandpierre R, et al. Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting:a French survey. Ann Fr Anesth Reanim 2014;33:e29–e33.

    Article  CAS  Google Scholar 

  12. Bernier-Jean A, Albert M, Shiloh AL, Eisen LA, Williamson D, Beaulieu Y. The diagnostic and therapeutic impact of point-of-care ultrasonography in the intensive care unit. J Intensive Care Med 2017;32:197–203.

    Article  Google Scholar 

  13. Zieleskiewicz L, Muller L, Lakhal K, Meresse Z, Arbelot C, Bertrand P-M , et al. .. Point-of-care ultrasound in intensive care units:assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 2015;41:1638–1647.

    Article  Google Scholar 

  14. Gall JR, Lemeshow S, Saulnier F. A New Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J Am Med Assoc 1993;270:2957–2963.

    Article  Google Scholar 

  15. Lichtenstein DA. BLUE-protocol and FALLS-protocol:two applications of lung ultrasound in the critically ill. Chest 2015;147:1659–1670.

    Article  Google Scholar 

  16. Bahner D, Blaivas M, Cohen HL, Fox JC, Hoffenberg S, Kendall J, et al. AIUM practice guideline for the performance of the focused assessment with sonography for trauma (FAST) examination. J Ultrasound Med 2014;33:2047–2056.

    Article  Google Scholar 

  17. Ilyas A, Ishtiaq W, Assad S, Ghazanfar H, Mansoor S, Haris M, et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically ill patients. Cureus 2017; 9:e1025.

    PubMed  PubMed Central  Google Scholar 

  18. Volpicelli G, Lamorte A, Tullio M, Cardinale L, Giraudo M, Stefanone V, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 2013;39:1290–1298.

    Article  CAS  Google Scholar 

  19. Ghoneim AHA, Hussein RM, El-Ghamry R, Mahmoud LY. Patterns of admitted cases to Respiratory Intensive Care Unit at Zagazig University Hospitals, Egypt. Egypt J Chest Dis Tuberc 2013;62:661–668.

    Article  Google Scholar 

  20. Joseph MX, Disney PJS, Da Costa R, Hutchison SJ. Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest 2004;126:1592–1597.

    Article  Google Scholar 

  21. Bataille B, Riu B, Ferre F, Moussot PE, Mari A, Brunel E, et al. Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure:a prospective observational study in ICU. Chest 2014;146:1586–1593.

    Article  Google Scholar 

  22. Forfia P, Roberts J. Diagnosis and assessment of pulmonary vascular disease by Doppler echocardiography. Pulm Circ 2011; 1:160.

    Article  Google Scholar 

  23. Chan KL, Currie PJ, Seward JB, Hagler DJ, Mair DD, Jamil Tajik A. Comparison of three Doppler ultrasound methods in the prediction of pulmonary artery pressure. J Am Coll Cardiol 1987;9:549–554.

    Article  CAS  Google Scholar 

  24. Zangiabadi A, De Pasquale CG, Sajkov D. Pulmonary hypertension and right heart dysfunction in chronic lung disease. Biomed Res Int 2014; 2014:739674.

    Article  Google Scholar 

  25. Oren-Grinberg A, Talmor D, Brown SM. Focused critical care echocardiography. Crit Care Med 2013;41:2618–2626.

    Article  Google Scholar 

  26. Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest 2009;135:1416–1420.

    Article  Google Scholar 

  27. Labbé V, Ederhy S, Pasquet B, Miguel-Montanes R, Rafat C, Hajage D, et al. Can we improve transthoracic echocardiography training in non-cardiologist residents? Experience of two training programs in the intensive care unit. Ann Intensive Care 2016; 6:44.

    Article  Google Scholar 

  28. Moss R. Injection drug use and right sided endocarditis. Heart 2003;89:577–581.

    Article  Google Scholar 

  29. Casaroto E, Mohovic T, Pinto LM, de Lara TR. Bedside echocardiography in critically ill patients. Einstein (São Paulo) 2015;13:644–646.

    Article  Google Scholar 

  30. Kitazono MT, Lau CT, Parada AN, Renjen P, Miller WT. Differentiation of pleural effusions from parenchymal opacities:accuracy of bedside chest radiography. Am J Roentgenol 2010;194:407–412.

    Article  Google Scholar 

  31. Mathis G, Blank W, Reißig A, Lechleitner P, Reuß J, Schuler A, et al. Thoracic ultrasound for diagnosing pulmonary embolism:a prospective multicenter study of 352 patients. Chest 2005;128:1531–1538.

    Article  Google Scholar 

  32. Blanco P, Volpicelli G. Common pitfalls in point-of-care ultrasound:a practical guide for emergency and critical care physicians. Crit Ultrasound J 2016; 8:15.

    Article  Google Scholar 

  33. Herth FJF, Becker HD. Transthoracic ultrasound. Respiration 2003;70:87–94.

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Chest Diseases, Faculty of Medicine, Ain Shams University, 12 Soliman al Tamawy st, Sheraton Buildings, Cairo, Egypt

    Taher A. Al Najjar, Ashraf M. Madkour, Nehad M. Osman, Ashraf A. Gomaa & Mohammed F. El Bagalaty MSc Chest Diseases (Assistant Lecturer)

  2. Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Ahmed M. Osman

  3. Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Khaled A. Abd EL Kader

Authors
  1. Taher A. Al Najjar
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  2. Ashraf M. Madkour
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  3. Nehad M. Osman
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  4. Ashraf A. Gomaa
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  5. Ahmed M. Osman
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  6. Mohammed F. El Bagalaty MSc Chest Diseases
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  7. Khaled A. Abd EL Kader
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Corresponding author

Correspondence to Mohammed F. El Bagalaty MSc Chest Diseases.

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Al Najjar, T.A., Madkour, A.M., Osman, N.M. et al. Impact of integrated use of diagnostic ultrasound examinations in respiratory intensive care units. Egypt J Bronchol 12, 448–460 (2018). https://doi.org/10.4103/ejb.ejb_56_18

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  • DOI: https://doi.org/10.4103/ejb.ejb_56_18

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