ICU Ultrasounds Reveal Abnormalities, Change Diagnoses

Troy Brown

September 25, 2012

September 25, 2012 — Head-to-toe bedside ultrasound within 12 hours of intensive care unit (ICU) admission modified the admitting diagnosis in more than one quarter of the patients studied and confirmed it in more than half of the patients studied, according to a study published in the October issue of Anesthesiology.

Emilpaolo Manno, MD, head of the Emergency Department and Intensive Care Unit at Maria Vittoria Hospital in Torino, Italy, and colleagues prospectively analyzed data from 125 consecutive patients admitted to the ICU between March 2009 and January 2010 to see whether routine ultrasound would improve diagnosis and treatment.

"Safe, accurate, rapid and repeatable at the bedside, the use of ultrasound in the ICU has been extensively validated as it provides data that may not be obtained with other routine methods. Furthermore, because of the patient's critical condition, diagnostic accuracy is essential at ICU admittance," the authors write.

Within 12 hours of admission to a general ICU, patients underwent a head-to-toe systematic ultrasound examination of the optic nerve, thorax, heart, abdomen, and venous system at the bedside by a physician other than the admitting physician.

Ultrasonographic findings resulted in modifications to the diagnosis in 32/125 patients (25.6%), confirmed it in 73/125 patients (58.4%), were ineffective in confirming or modifying it in 17/125 patients (13.6%), and missed it in 3/125 patients (2.4%).

Ultrasonographic findings led to additional testing in 23/125 patients (18.4%; 95% confidence interval [CI], 12.0% - 26.3%), resulted in changes in medical therapy in 22/125 patients (17.6%; 95% CI, 11.4% - 25.4%), and led to invasive procedures in 27/125 patients (21.6%; 95% CI, 14.7% - 29.8%).

Lung sonography was very effective at distinguishing cardiogenic respiratory failure from acute airflow limitation, consolidation, pleural effusion, or pulmonary embolism in patients with an admitting diagnosis of acute respiratory failure.

"Combining the data from lung sonography and echocardiography can enhance the diagnostic accuracy in differentiating respiratory insufficiency," the authors write.

Findings were normal in 18/125 patients (14.4%), and ultrasound abnormalities were seen in 107/125 patients (85.6%).

In the 107 patients with ultrasound abnormalities, examination revealed 254 pathological findings, 136 of which were classified as "new pathological findings." Patients could have had more than 1 abnormal finding.

Limitations resulting from patient- and environment-related issues had little effect on most of the examinations.

"In this series of patients consecutively admitted to an intensive care unit, ultrasound examination revealed a high prevalence of unsuspected clinical abnormalities, with the highest number of new ultrasound abnormalities detected in patients with septic shock," the authors write.

"The major finding of this study is the discovery of a high prevalence of unsuspected clinical abnormalities in ICU patients. Ultrasound examination permitted us to modify the diagnosis and to improve the treatment, with prompt changes in therapeutic strategy," the authors conclude.

The authors have disclosed no relevant financial relationships.

Anesthesiology. 2012;117:801-809. Full text