Emergency Department and Intensive Care Unit, Maria Vittoria Hospital, Torino, Italy.
Anesthesiology. 2012 Oct;117(4):801-9. doi: 10.1097/ALN.0b013e318264c621.
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.
One hundred and twenty-five 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.
Environmental conditions hampered the examination slightly in 101/125 patients (80.8%), moderately in 20/125 patients (16%), and strongly in 4/125 patients (3.2%). 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%). 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%).
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.
超声检查可以影响危急患者的诊断并影响治疗计划。本研究旨在确定在没有遇到主要与环境或患者相关的限制的情况下，是否可以根据重症监护超声协议进行超声检查以发现隐匿性异常，促使紧急改变治疗方案或进行进一步检查或干预，并确认或修改诊断。
对 125 例连续收入普通重症监护病房的患者进行了重症监护超声协议评估，并进行了前瞻性数据分析。在床边对视神经、胸部、心脏、腹部和静脉系统进行了系统超声检查。
环境条件在 101/125 例（80.8%）患者中略有妨碍，在 20/125 例（16%）患者中中度妨碍，在 4/125 例（3.2%）患者中严重妨碍。超声检查结果改变了 32/125 例（25.6%）患者的入院诊断，确认了 73/125 例（58.4%）患者的诊断，对 17/125 例（13.6%）患者的诊断既未确认也未修改，漏诊了 3/125 例（2.4%）患者。超声检查结果促使 23/125 例（18.4%）患者进行了进一步检查，导致 22/125 例（17.6%）患者改变了药物治疗，导致 27/125 例（21.6%）患者进行了有创操作。
在本系列连续收入重症监护病房的患者中，超声检查发现了大量未被怀疑的临床异常，其中感染性休克患者的新超声异常数量最多。作为患者入院时快速全面评估的一部分，我们的超声协议有可能提高医疗质量。
