The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study*. Issue 3 (23rd December 2022)

• Record Type: Journal Article
• Authors: Heldeweg, Micah L. A.; Lopez Matta, Jorge E.; Pisani, Luigi; Slot, Stefanie; Haaksma, Mark E.; Smit, Jasper M.; Mousa, Amne; Magnesa, Giovanna; Massaro, Fabrizia; Touw, Hugo R. W.; Schouten, Viviane; Elzo Kraemer, Carlos V.; van Westerloo, David J.; Heunks, Leo M. A.; Tuinman, Pieter R.
• Is Part Of: Critical care medicine. Volume 51:Issue 3(2023)
• Page Start: 357
• Page End: 364
• Publication Date: 2022-12-23
• Subjects: clinical decision-making -- fluid management -- lung -- patient management -- thorax -- ultrasound; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005760
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : 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.