TY - JOUR
T1 - The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan)
T2 - An International Prospective Observational Study∗
AU - Heldeweg, Micah L. A.
AU - Lopez Matta, Jorge E.
AU - Pisani, Luigi
AU - Slot, Stefanie
AU - Haaksma, Mark E.
AU - Smit, Jasper M.
AU - Mousa, Amne
AU - Magnesa, Giovanna
AU - Massaro, Fabrizia
AU - Touw, Hugo R. W.
AU - Schouten, Viviane
AU - Elzo Kraemer, Carlos V.
AU - van Westerloo, David J.
AU - Heunks, Leo M. A.
AU - Tuinman, Pieter R.
N1 - Funding Information:
Dr. Heunks’ institution received funding from Liberate Medical; he received funding from Getinge and the American Thoracic Society. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Objectives: To investigate the impact of thoracic ultrasound (TUS) examinations on clinical management in adult ICU patients. Design: A prospective international observational study. Setting: Four centers in The Netherlands and Italy. Patients: Adult ICU patients (> 18 yr) that received a clinically indicated lung ultrasound examination. Interventions: None. Measurements and Main Results: Clinicians performing TUS completed a pre-and post-examination case report form. Patient characteristics, TUS, and resulting clinical effects were recorded. First, change of management, defined as a TUS-induced change in clinical impression leading to a change in treatment plan, was reported. Second, execution of intended management changes within 8 hours was verified. Third, change in fluid balance after 8 hours was calculated. A total of 725 TUS performed by 111 operators across 534 patients (mean age 63 ± 15.0, 70% male) were included. Almost half of TUS caused a change in clinical impression, which resulted in change of management in 39% of cases. The remainder of TUS confirmed the clinical impression, while a minority (4%) did not contribute. Eighty-nine percent of management changes indicated by TUS were executed within 8 hours. TUS examinations that led to a change in fluid management also led to distinct and appropriate changes in patient's fluid balance. Conclusions: In this international observational study in adult ICU patients, use of TUS had a major impact on clinical management. These results provide grounds for future randomized controlled trials to determine if TUS-induced changes in decision-making also lead to improved health outcomes.
AB - Objectives: To investigate the impact of thoracic ultrasound (TUS) examinations on clinical management in adult ICU patients. Design: A prospective international observational study. Setting: Four centers in The Netherlands and Italy. Patients: Adult ICU patients (> 18 yr) that received a clinically indicated lung ultrasound examination. Interventions: None. Measurements and Main Results: Clinicians performing TUS completed a pre-and post-examination case report form. Patient characteristics, TUS, and resulting clinical effects were recorded. First, change of management, defined as a TUS-induced change in clinical impression leading to a change in treatment plan, was reported. Second, execution of intended management changes within 8 hours was verified. Third, change in fluid balance after 8 hours was calculated. A total of 725 TUS performed by 111 operators across 534 patients (mean age 63 ± 15.0, 70% male) were included. Almost half of TUS caused a change in clinical impression, which resulted in change of management in 39% of cases. The remainder of TUS confirmed the clinical impression, while a minority (4%) did not contribute. Eighty-nine percent of management changes indicated by TUS were executed within 8 hours. TUS examinations that led to a change in fluid management also led to distinct and appropriate changes in patient's fluid balance. Conclusions: In this international observational study in adult ICU patients, use of TUS had a major impact on clinical management. These results provide grounds for future randomized controlled trials to determine if TUS-induced changes in decision-making also lead to improved health outcomes.
KW - clinical decision-making
KW - fluid management
KW - lung
KW - patient management
KW - thorax
KW - ultrasound
UR - https://www.scopus.com/pages/publications/85148677733
U2 - 10.1097/CCM.0000000000005760
DO - 10.1097/CCM.0000000000005760
M3 - Article
C2 - 36562620
SN - 0090-3493
VL - 51
SP - 357
EP - 364
JO - Critical care medicine
JF - Critical care medicine
IS - 3
ER -