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Intensive Care Medicine

, Volume 41, Issue 9, pp 1638–1647 | Cite as

Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study

  • Laurent Zieleskiewicz
  • Laurent Muller
  • Karim Lakhal
  • Zoe Meresse
  • Charlotte Arbelot
  • Pierre-Marie Bertrand
  • Belaid Bouhemad
  • Bernard Cholley
  • Didier Demory
  • Serge Duperret
  • Jacques Duranteau
  • Christophe Guervilly
  • Emmanuelle Hammad
  • Carole Ichai
  • Samir Jaber
  • Olivier Langeron
  • Jean-Yves Lefrant
  • Yazine Mahjoub
  • Eric Maury
  • Eric Meaudre
  • Fabrice Michel
  • Michel Muller
  • Cyril Nafati
  • Sébastien Perbet
  • Hervé Quintard
  • Béatrice Riu
  • Coralie Vigne
  • Kathia Chaumoitre
  • François Antonini
  • Bernard Allaouchiche
  • Claude Martin
  • Jean-Michel Constantin
  • Daniel De Backer
  • Marc LeoneEmail author
Original

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.

Keywords

Ultrasound Point-of-care Diagnosis Treatment Echocardiography 

Notes

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.

Supplementary material

134_2015_3952_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)

References

  1. 1.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228CrossRefPubMedGoogle Scholar
  2. 2.
    Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T (2012) International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). Intensive Care Med 38:577–591CrossRefPubMedGoogle Scholar
  3. 3.
    Bouzat P, Francony G, Declety P, Genty C, Kaddour A, Bessou P, Brun J, Jacquot C, Chabardes S, Bosson JL, Payen JF (2011) Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury. Neurosurgery 68:1603–1610CrossRefPubMedGoogle Scholar
  4. 4.
    Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, Reeves ST; Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography (2011) Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 24:1291–1318CrossRefPubMedGoogle Scholar
  5. 5.
    Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, Davidsen JR, Rasmussen F (2013) Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 144:1868–1875CrossRefPubMedGoogle Scholar
  6. 6.
    Joseph MX, Disney PJS, Da Costa R, Hutchison SJ (2004) Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest 126:1592–1597CrossRefPubMedGoogle Scholar
  7. 7.
    Orme RML, Oram MP, McKinstry CE (2009) Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice. Br J Anaesth 102:340–344CrossRefPubMedGoogle Scholar
  8. 8.
    Bossone E, DiGiovine B, Watts S, Marcovitz PA, Carey L, Watts C, Armstrong WF (2002) Range and prevalence of cardiac abnormalities in patients hospitalized in a medical ICU. Chest 122:1370–1376CrossRefPubMedGoogle Scholar
  9. 9.
    Manno E, Navarra M, Faccio L, Motevallian M, Bertolaccini L, Mfochivè A, Pesce M, Evangelista A (2012) Deep impact of ultrasound in the intensive care unit: the “ICU-sound” protocol. Anesthesiology 117:801–809CrossRefPubMedGoogle Scholar
  10. 10.
    Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:9–15CrossRefPubMedGoogle Scholar
  11. 11.
    Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D (2011) Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 37:1488–1493CrossRefPubMedGoogle Scholar
  12. 12.
    Peris A, Tutino L, Zagli G, Batacchi S, Cianchi G, Spina R, Bonizzoli M, Migliaccio L, Perretta L, Bartolini M, Ban K, Balik M (2010) The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg 111:687–692CrossRefPubMedGoogle Scholar
  13. 13.
    Moore CL, Copel JA (2011) Point-of-care ultrasonography. N Engl J Med 364:749–757CrossRefPubMedGoogle Scholar
  14. 14.
    Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, Marin B, François B, Gastinne H (2007) Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive Care Med 33:1795–1799CrossRefPubMedGoogle Scholar
  15. 15.
    Chalumeau-Lemoine L, Baudel JL, Das V, Arrivé L, Noblinski B, Guidet B, Offenstadt G, Maury E (2009) Results of short-term training of naïve physicians in focused general ultrasonography in an intensive-care unit. Intensive Care Med 35:1767–1771CrossRefPubMedGoogle Scholar
  16. 16.
    Carrié C, Biais M, Lafitte S, Grenier N, Revel P, Janvier G (2014) Goal-directed ultrasound in emergency medicine: evaluation of a specific training program using an ultrasonic stethoscope. Eur J Emerg Med. doi: 10.1097/MEJ.0000000000000172
  17. 17.
    Oks M, Cleven KL, Cardenas-Garcia J, Schaub JA, Koenig S, Cohen RI, Mayo PH, Narasimhan M (2014) The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest 146:1574–1577CrossRefPubMedGoogle Scholar
  18. 18.
    Lakhal K, Serveaux-Delous M, Lefrant JY, Capdevila X, Jaber S, AzuRéa network for the RadioDay study group (2012) Chest radiographs in 104 French ICUs: current prescription strategies and clinical value (the RadioDay study). Intensive Care Med 38:1787–1799CrossRefPubMedGoogle Scholar
  19. 19.
    Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P (2009) American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest 135:1050–1060CrossRefPubMedGoogle Scholar
  20. 20.
    Volpicelli G, Lamorte A, Tullio M, Cardinale L, Giraudo M, Stefanone V, Boero E, Nazerian P, Pozzi R, Frascisco MF (2013) Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 39:1290–1298CrossRefPubMedGoogle Scholar
  21. 21.
    Quintard H, Philip I, Ichai C (2011) French survey on current use of ultrasound in the critical care unit: ECHOREA. Ann Fr Anesth Reanim 30:e69–73CrossRefPubMedGoogle Scholar
  22. 22.
    Feissel M, Michard F, Faller JP, Teboul JL (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 30:1834–1837CrossRefPubMedGoogle Scholar
  23. 23.
    Muller L, Toumi M, Bousquet PJ, Riu-Poulenc B, Louart G, Candela D, Zoric L, Suehs C, de La Coussaye JE, Molinari N, Lefrant JY; AzuRéa Group (2011) An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology 115:541–547CrossRefPubMedGoogle Scholar
  24. 24.
    Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL (2007) Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 33:1125–1132CrossRefPubMedGoogle Scholar
  25. 25.
    Brun C, Zieleskiewicz L, Textoris J, Muller L, Bellefleur JP, Antonini F, Tourret M, Ortega D, Vellin A, Lefrant JY, Boubli L, Bretelle F, Martin C, Leone M (2013) Prediction of fluid responsiveness in severe preeclamptic patients with oliguria. Intensive Care Med 39:593–600CrossRefPubMedGoogle Scholar
  26. 26.
    Aliaga M, Forel JM, De Bourmont S, Jung B, Thomas G, Mahul M, Bisbal M, Nougaret S, Hraiech S, Roch A, Chaumoitre K, Jaber S, Gainnier M, Papazian L (2015) Diagnostic yield and safety of CT scans in ICU. Intensive Care Med 41:436–443CrossRefPubMedGoogle Scholar
  27. 27.
    Bataille B, Riu B, Ferre F, Moussot PE, Mari A, Brunel E, Ruiz J, Mora M, Fourcade O, Genestal M, Silva S (2014) Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest 146:1586–1593CrossRefPubMedGoogle Scholar
  28. 28.
    Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795–1815PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ (2011) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 183:341–347CrossRefPubMedGoogle Scholar
  30. 30.
    Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 38:84–92CrossRefPubMedGoogle Scholar
  31. 31.
    Volpicelli G, Melniker LA, Cardinale L, Lamorte A, Frascisco MF (2013) Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid. Radiol Med 118:196–205CrossRefPubMedGoogle Scholar
  32. 32.
    Zieleskiewicz L, Cornesse A, Hammad E, Haddam M, Brun C, Vigne C, Meyssignac B, Remacle A, Chaumoitre K, Antonini F, Martin C, Leone M (2015) Implementation of lung ultrasound in polyvalent intensive care unit: impact on irradiation and medical cost. Anaesth Crit Care Pain Med 34:41–44CrossRefPubMedGoogle Scholar
  33. 33.
    Laursen CB, Sloth E, Lassen AT, Christensen Rd, Lambrechtsen J, Madsen PH, Henriksen DP, Davidsen JR, Rasmussen F (2014) Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med 2:638–646CrossRefPubMedGoogle Scholar
  34. 34.
    Georgopoulos D, Xirouchaki N, Volpicelli G (2014) Lung ultrasound in the intensive care unit: let’s move forward. Intensive Care Med 40:1592–1594CrossRefPubMedGoogle Scholar
  35. 35.
    Hansen MA, Juhl-Olsen P, Thorn S, Frederiksen CA, Sloth E (2014) Ultrasonography-guided radial artery catheterization is superior compared with the traditional palpation technique: a prospective, randomized, blinded, crossover study. Acta Anaesthesiol Scand 58:446–452CrossRefPubMedGoogle Scholar
  36. 36.
    ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506CrossRefGoogle Scholar
  37. 37.
    Investigators ProCESS, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693CrossRefGoogle Scholar
  38. 38.
    Expert Round Table on Echocardiography in ICU (2014) International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med 40:654–666CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Laurent Zieleskiewicz
    • 1
  • Laurent Muller
    • 2
  • Karim Lakhal
    • 3
  • Zoe Meresse
    • 1
  • Charlotte Arbelot
    • 4
  • Pierre-Marie Bertrand
    • 5
  • Belaid Bouhemad
    • 6
  • Bernard Cholley
    • 7
  • Didier Demory
    • 8
  • Serge Duperret
    • 9
  • Jacques Duranteau
    • 10
  • Christophe Guervilly
    • 11
  • Emmanuelle Hammad
    • 1
  • Carole Ichai
    • 12
  • Samir Jaber
    • 13
  • Olivier Langeron
    • 4
  • Jean-Yves Lefrant
    • 2
  • Yazine Mahjoub
    • 14
  • Eric Maury
    • 15
  • Eric Meaudre
    • 16
  • Fabrice Michel
    • 1
  • Michel Muller
    • 17
  • Cyril Nafati
    • 18
  • Sébastien Perbet
    • 19
  • Hervé Quintard
    • 12
  • Béatrice Riu
    • 20
  • Coralie Vigne
    • 1
  • Kathia Chaumoitre
    • 21
  • François Antonini
    • 1
  • Bernard Allaouchiche
    • 22
  • Claude Martin
    • 1
  • Jean-Michel Constantin
    • 19
  • Daniel De Backer
    • 23
  • Marc Leone
    • 1
    • 24
    Email author
  1. 1.Service d’anesthésie et de réanimationHôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille UniversitéMarseilleFrance
  2. 2.Service des réanimations, pôle anesthésie réanimation douleur urgenceCHU NîmesNîmesFrance
  3. 3.Réanimation chirurgicale polyvalente, service d’anesthésie réanimationHôpital LaennecNantesFrance
  4. 4.Réanimation chirurgicale polyvalente, département d’anesthésie et de réanimationHôpital Pitié SalpétrièreParisFrance
  5. 5.Service de réanimationCentre hospitalier de CannesCannesFrance
  6. 6.Département d’anesthésie et de réanimationCHU DijonDijonFrance
  7. 7.Service d’anesthésie réanimationHôpital Européen Georges PompidouParisFrance
  8. 8.Service Réanimation Polyvalente-USCHôpital Sainte MusseToulonFrance
  9. 9.Réanimation chirurgicale, Hôpital Croix-RousseUniversité Claude BernardLyonFrance
  10. 10.Assistance Publique Hôpitaux de Paris, Service d’Anesthésie-Réanimation, Hôpitaux Universitaires Paris-SudUniversité Paris-Sud, Hôpital de BicêtreLe Kremlin-BicêtreFrance
  11. 11.Service de réanimation DRIS, Hôpital NordAix Marseille UniversitéMarseilleFrance
  12. 12.Réanimation médico-chirurgicale, Hôpital Saint RochCHU de NiceNiceFrance
  13. 13.Département d’anesthésie et de réanimation B, Hôpital Saint-Eloi Inserm U1046Université Montpellier 1MontpellierFrance
  14. 14.Département d’anesthésie et de réanimationCHU d’AmiensAmiensFrance
  15. 15.Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Service de Réanimation MédicaleUniversité Paris 06ParisFrance
  16. 16.Département d’anesthésieHôpital d’instruction des armées Saint AnneToulonFrance
  17. 17.Réanimation et surveillance continueCentre Hospitalier Annecy-GenevoisAnnecyFrance
  18. 18.Service d’anesthésie et de réanimation, Hôpital la ConceptionAix Marseille UniversitéMarseilleFrance
  19. 19.Département de Médecine PériopératoireCHU Clermont-FerrandClermont-FerrandFrance
  20. 20.Département d’anesthésie et de réanimation, CHU PurpanUniversité Toulouse 3 Paul SabatierToulouseFrance
  21. 21.Service d’imagerie médicale, Hôpital NordAix Marseille UniversitéMarseilleFrance
  22. 22.Département d’anesthésie et de réanimation, Hôpitaux Lyon-SudHospices Civils de Lyon et Université Lyon 1LyonFrance
  23. 23.Department of intensive care, Erasme hospitalUniversité libre de BruxellesBrusselsBelgium
  24. 24.Centre d’Investigation Clinique 9502Aix Marseille Université, Assistance Publique Hôpitaux de MarseilleMarseilleFrance

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