Bernier-Jean Amélie, Albert Martin, Shiloh Ariel L, Eisen Lewis A, Williamson David, Beaulieu Yanick
1 Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada.
2 Hôpital du Sacré-Coeur de Montréal Research Center, University of Montreal, Montreal, Canada.
J Intensive Care Med. 2017 Mar;32(3):197-203. doi: 10.1177/0885066615606682. Epub 2016 Jul 9.
In light of point-of-care ultrasonography's (POCUS) recent rise in popularity, assessment of its impact on diagnosis and treatment in the intensive care unit (ICU) is of key importance.
Ultrasound examinations were collected through an ultrasound reporting software in 6 multidisciplinary ICU units from 3 university hospitals in Canada and the United States. This database included a self-reporting questionnaire to assess the impact of the ultrasound findings on diagnosis and treatment. We retrieved the results of these questionnaires and analyzed them in relation to which organs were assessed during the ultrasound examination.
One thousand two hundred and fifteen ultrasound studies were performed on 968 patients. Intensivists considered the image quality of cardiac ultrasound to be adequate in 94.7% compared to 99.7% for general ultrasound ( P < .001). The median duration of a cardiac examination was 10 (interquartile range [IQR] 10) minutes compared to 5 (IQR 8) minutes for a general examination ( P < .001). Overall, ultrasound findings led to a change in diagnosis in 302 studies (24.9%) and to a change in management in 534 studies (44.0%). A change in diagnosis or management was reported more frequently for cardiac ultrasound than for general ultrasound (108 [37.1%] vs 127 [16.5%], P < .001) and (170 [58.4%] vs 270 [35.1%], P < .001). Assessment of the inferior vena cava for fluid status emerged as the critical care ultrasound application associated with the greatest impact on management.
Point-of-care ultrasonography has the potential to optimize care of the critically ill patients when added to the clinical armamentarium of the intensive care physician.
鉴于即时超声检查（POCUS）近来日益普及，评估其对重症监护病房（ICU）诊断和治疗的影响至关重要。
通过超声报告软件收集了来自加拿大和美国3所大学医院6个多学科ICU病房的超声检查资料。该数据库包含一份自我报告问卷，以评估超声检查结果对诊断和治疗的影响。我们检索了这些问卷的结果，并根据超声检查期间评估的器官进行了分析。
对968例患者进行了1215次超声检查。重症监护医生认为心脏超声的图像质量足够的占94.7%，而普通超声为99.7%（P <.001）。心脏检查的中位持续时间为10分钟（四分位间距[IQR]为10），而普通检查为5分钟（IQR为8）（P <.001）。总体而言，超声检查结果导致302项研究（24.9%）的诊断发生改变，534项研究（44.0%）的治疗发生改变。与普通超声相比，心脏超声报告的诊断或治疗改变更为频繁（108例[37.1%]对127例[16.5%]，P <.001）以及（170例[58.4%]对270例[35.1%]，P <.001）。评估下腔静脉的液体状态成为对治疗影响最大的重症监护超声应用。
即时超声检查添加到重症监护医生的临床手段中时，有潜力优化危重症患者的护理。
