SonoStudy: The “ICU-sound” Protocol – Ultrasound revealed unsuspected clinical anomalies, changed management

You have to love the Italians! They are one of the best users and researchers of bedside ultrasound, particularly in the emergency department and ICUs. This was the newest study in the journal of Anesthesiology. In a prior post, we discussed how bedside ultrasound of the heart and IVC changed medical management of septic patients, and the studies just keep on coming….

Medscape has done a nice interview and assessment of this study as well: “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”

As Monno et al state so well : “Ultrasound can influence the diagnosis and impact the treatment plan in critical patients. The aim of this study was to determine whether, without encountering major environment- or patient-related limitations, ultrasound examination under a critical care ultrasonography protocol can be performed to detect occult anomalies, to prompt urgent changes in therapy or induce further testing or interventions, and to confirm or modify diagnosis.

The Methods: 125 consecutive patients admitted to a general intensive care unit were assessed under a critical care ultrasonography protocol, and the data were analyzed prospectively. Systematic ultrasound examination of the optic nerve, thorax, heart, abdomen, and venous system was performed at the bedside.

The Results: (and this is where I get excited) “Ultrasonographic findings modified the admitting diagnosis in 32/125 patients (25.6%), confirmed it in 73/125 patients (58.4%), were not effective in confirming or modifying it in 17/125 patients (13.6%), and missed it in 3/125 patients (2.4%) -( the last part not so exciting….) Ultrasonographic findings prompted further testing in 23/125 patients (18.4%), led to changes in medical therapy in 22/125 patients (17.6%), and to invasive procedures in 27/125 patients (21.6%).

Conclusions: 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. As part of rapid global assessment of the patient on admission, our ultrasound protocol holds potential for improving healthcare quality.”

As I always say – why would you drive in the dark when you have headlights?