Abstract
Objective
To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU).
Background
POCUS is of growing importance in the ICU. Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown.
Methods
Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified.
Results
Among 1954 patients hospitalized during the study period, 1073 (55 %) POCUS/day were performed in 709 (36 %) patients. POCUS served for diagnostic assessment in 932 (87 %) cases and procedural guidance in 141 (13 %) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16 % of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69 %, respectively. Ultrasound guidance was used in 54 and 15 % of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts.
Conclusions
With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.
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Acknowledgments
Author contributions: Drs Zieleskiewicz and Leone had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Arbelot, Chaumoitre, Cholley, Constantin, Jaber, Lakhal, Leone, Martin, Perbet, Zieleskiewicz.
Acquisition, analysis or interpretation of data: Arbelot, Bouhemad, Demory, M. Muller, L. Muller, Cholley, Duperret, Hammad, Langeron, Mahjoub, Maury, Meaudre, Michel, Nafati, Quintard, Bertrand, Guervilly, Jaber, Riu, Perbet.
Drafting of the manuscript: Lakhal, Meresse, De Backer, Leone, Allaouchiche, Zieleskiewicz, L Muller, Ichai, Lefrant.
Statistical analysis: Antonini, Leone, Meresse, Vigne, Zieleskiewicz.
Study supervision: Martin, Leone, De Backer, Chaumoitre.
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Take-home message: In the intensive care unit, the prevalence of point-of-care ultrasound was 55 %. Ultrasound was utilized for diagnostic assessment in 87 % of cases and procedural guidance in 13 % of cases; its use impacted diagnostic and therapeutic strategies in 84 and 69 % of cases. Transthoracic echocardiography and lung ultrasound were routinely performed by intensivists. In contrast, ultrasound guidance for central venous line and arterial catheter placement remains unsatisfactory.
For the CAR’Echo and AzuRea Collaborative Networks
c/o M. Leone, Département d’anesthésie et de réanimation, Hôpital Nord, Marseille, France.
Members of the CAR’Echo and AzuRea Collaborative Networks are listed in the Acknowledgments.
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Members of the CAR’Echo and AzuRea Collaborative Networks
Members of the CAR’Echo and AzuRea Collaborative Networks
Table 4 presents a list of members of the CAR’Echo and AzuRea Collaborative Networks.
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Zieleskiewicz, L., Muller, L., Lakhal, K. et al. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 41, 1638–1647 (2015). https://doi.org/10.1007/s00134-015-3952-5
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DOI: https://doi.org/10.1007/s00134-015-3952-5