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Impact of lung ultrasound on clinical decision making in critically ill patients

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Abstract

Purpose

To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients.

Methods

One hundred and eighty-nine patients took part in this prospective study. The patients were enrolled in the study when LU was requested by the primary physician for (1) unexplained deterioration of arterial blood gases and (2) a suspected pathologic entity [pneumothorax, significant pleural effusion (including parapneumonic effusion, empyema, or hemothorax), unilateral atelectasis (lobar or total), pneumonia and diffuse interstitial syndrome (pulmonary edema)].

Results

Two hundred and fifty-three LU examinations were performed; 108 studies (42.7 %) were performed for unexplained deterioration of arterial blood gases, and 145 (57.3 %) for a suspected pathologic entity (60 for pneumothorax, 34 for significant pleural effusion, 22 for diffuse interstitial syndrome, 15 for unilateral lobar or total lung atelectasis, and 14 for pneumonia). The net reclassification index was 85.6 %, indicating that LU significantly influenced the decision-making process. The management was changed directly as a result of information provided by the LU in 119 out of 253 cases (47 %). In 81 cases, the change in patient management involved invasive interventions (chest tube, bronchoscopy, diagnostic thoracentesis/fluid drainage, continuous venous–venous hemofiltration, abdominal decompression, tracheotomy), and in 38 cases, non-invasive (PEEP change/titration, recruitment maneuver, diuretics, physiotherapy, change in bed position, antibiotics initiation/change). In 53 out of 253 cases (21 %), LU revealed findings which supported diagnoses not suspected by the primary physician (7 cases of pneumothorax, 9 of significant pleural effusion, 9 of pneumonia, 16 of unilateral atelectasis, and 12 of diffuse interstitial syndrome).

Conclusion

Our study shows that LU has a significant impact on decision making and therapeutic management.

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Acknowledgments

The authors would like to acknowledge G. Chlouverakis, Associate Professor of Biostatistics, for his contribution to the statistical analysis.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Corresponding author

Correspondence to Dimitrios Georgopoulos.

Additional information

Take-home message: In mechanically ventilated critically ill patients lung ultrasound has a significant impact on clinical decision making and therapeutic management.

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Xirouchaki, N., Kondili, E., Prinianakis, G. et al. Impact of lung ultrasound on clinical decision making in critically ill patients. Intensive Care Med 40, 57–65 (2014). https://doi.org/10.1007/s00134-013-3133-3

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  • DOI: https://doi.org/10.1007/s00134-013-3133-3

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