Department of Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
Crit Care. 2021 Nov 24;25(1):405. doi: 10.1186/s13054-021-03811-2.
The use of ultrasonography in the intensive care unit (ICU) is steadily increasing but is usually restricted to examinations of single organs or organ systems. In this study, we combine the ultrasound approaches the most relevant to ICU to design a whole-body ultrasound (WBU) protocol. Recommendations and training schemes for WBU are sparse and lack conclusive evidence. Our aim was therefore to define the range and prevalence of abnormalities detectable by WBU to develop a simple and fast bedside examination protocol, and to evaluate the value of routine surveillance WBU in ICU patients.
A protocol for focused assessments of sonographic abnormalities of the ocular, vascular, pulmonary, cardiac and abdominal systems was developed to evaluate 99 predefined sonographic entities on the day of admission and on days 3, 6, 10 and 15 of the ICU admission. The study was a clinical prospective single-center trial in 111 consecutive patients admitted to the surgical ICUs of a tertiary university hospital.
A total of 3003 abnormalities demonstrable by sonography were detected in 1275 individual scans of organ systems and 4395 individual single-organ examinations. The rate of previously undetected abnormalities ranged from 6.4 ± 4.2 on the day of admission to 2.9 ± 1.8 on day 15. Based on the sonographic findings, intensive care therapy was altered following 45.1% of examinations. Mean examination time was 18.7 ± 3.2 min, or 1.6 invested minutes per detected abnormality.
Performing the WBU protocol led to therapy changes in 45.1% of the time. Detected sonographic abnormalities showed a high rate of change in the course of the serial assessments, underlining the value of routine ultrasound examinations in the ICU. Trial registration The study was registered in the German Clinical Trials Register (DRKS, 7 April 2017; retrospectively registered) under the identifier DRKS00010428.
超声检查在重症监护病房（ICU）中的应用正在稳步增加，但通常仅限于单个器官或器官系统的检查。在这项研究中，我们结合了与 ICU 最相关的超声检查方法，设计了全身超声（WBU）检查方案。目前，WBU 的推荐意见和培训方案很少，且缺乏确凿的证据。因此，我们的目的是确定通过 WBU 可检测到的异常范围和发生率，制定一种简单、快速的床边检查方案，并评估 ICU 患者常规监测 WBU 的价值。
我们制定了一项针对眼部、血管、肺部、心脏和腹部系统超声异常的重点评估方案，以评估 99 个预先设定的超声实体，评估时间为入院当天以及入院后第 3、6、10 和 15 天。该研究是一项在一家三级大学医院外科 ICU 中进行的临床前瞻性单中心试验，共纳入了 111 例连续患者。
在对器官系统的 1275 次和单个器官的 4395 次超声检查中，共发现了 3003 个可通过超声显示的异常。入院时未检出的异常率为 6.4±4.2，入院第 15 天为 2.9±1.8。根据超声检查结果，45.1%的检查改变了重症监护治疗。平均检查时间为 18.7±3.2 分钟，或每发现 1 个异常投入 1.6 分钟。
WBU 方案的实施导致 45.1%的时间改变了治疗方案。在连续评估过程中，检测到的超声异常有很高的变化率，这强调了 ICU 中常规超声检查的价值。
该研究于 2017 年 4 月 7 日在德国临床试验注册中心（DRKS）注册（回顾性注册），登记号为 DRKS00010428。
