Original ArticleThe Feasibility and Impact of Routine Combined Limited Transthoracic Echocardiography and Lung Ultrasound on Diagnosis and Management of Patients Admitted to ICU: A Prospective Observational Study
Section snippets
Methods
This prospective observational study was conducted with approval from the Human Research and Ethics Committee at Peninsula Health (HREC/12/PH/34) and written consent was obtained from all participants or from next of kin.
The study site was a University tertiary referral hospital medical and surgical ICU at Frankston Hospital in Australia. This ICU does not receive cardiothoracic surgery, trauma, spinal injury, or burns patients. Participants were screened for eligibility when the investigating
Results
Ninety-nine participants were screened and 93 were recruited between August 2012 and December 2013. Six participants were not included due to inability to obtain consent3 or very poor patient prognosis where palliative management was already decided.3 The participant characteristics are shown in Table 1. The most common admission diagnoses were sepsis (39%) and out-of-hospital cardiac arrest (14%). Limited TTE was performed on all participants, but imaging was inadequate to assess the
Discussion
The authors have shown a “proof of concept” that adding routinely performed combined limited TTE and lung ultrasound as an adjunct to clinical evaluation led to a high incidence of change in diagnosis and management. Feasibility was demonstrated by interpretable images being obtained in the majority of participants and good inter-observer agreement. Importantly, very few diagnostic errors in the ultrasound examinations were detected by an independent observer.
Changes in diagnosis occurred in 2
Conclusion
Routine screening of patients with combined limited TTE and lung ultrasound on admission to intensive care is feasible and frequently alters diagnosis and management.
Acknowledgments
We are grateful for the assistance of many staff at Frankston Hospital who helped in this study. We also thank Sandy Clarke, PhD (statistical consulting, The University of Melbourne) who assisted with the statistical analysis.
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