Key result
Point-of-care ultrasound demonstrated excellent agreement with CT for diagnosing pleural effusion (Kappa 0.85) and pneumonia (Kappa 0.84), and accurate diagnosis was associated with significantly decreased ICU length of stay.
Why the study?
Point of care ultrasonography (POCUS) may improve management and outcomes of deteriorating patients in the respiratory intensive care unit by enabling earlier diagnosis and targeted therapy.
Does point of care ultrasonography (POCUS) improve clinical outcomes such as length of stay and 30-day mortality in deteriorating patients in the respiratory intensive care unit?
Cohort (n=126)
No
Does point of care ultrasonography (POCUS) improve clinical outcomes such as length of stay and 30-day mortality in deteriorating patients in the respiratory intensive care unit?
Effect estimate: Kappa 0.85
p-value: p=<0.001
The use of POCUS in deteriorating respiratory ICU patients is an effective diagnostic modality that can significantly reduce ICU and in-hospital length of stay.
May shorten ICU and hospital stays in respiratory ICU patients; leaves open mortality effects and need for randomized trials before practice change.
Background Point of care ultrasonography (POCUS) is a real time examination that can be used in the emergency room and intensive care unit (ICU). It can provide low-cost modality in short period of time that can help the clinician in better management the ICU patients. The aim of the current work was to evaluate the impact of POCUS (focused heart, lung, IVC and Doppler lower limb) in improving the outcome of deteriorating patients in the respiratory intensive care unit (RICU), via narrowing differential diagnosis and earlier start of target therapy. Methods This prospective study included 126 deteriorated patients in the RICU. The POCUS was performed to all included patients, together with the indicated laboratory and radiological investigations (Chest x-ray, computerized tomography, and conventional echocardiography) to detect the agreement between POCUS and the gold standard techniques to assess the POCUS effectiveness. The impact of applying POCUS on the outcome of the studied patients was evaluated regarding ICU and in hospital length of stay and the 30-day mortality. Results The included patients were 51 males (40.5%) and 75 females (59.5%) with a mean ±SD of age 45.4 ± 15.7 years. POCUS showed a good agreement with the gold standard techniques. There was significant improvement in outcome of the studied patients as regard ICU and in hospital stay with early using of POCUS examination but no significant difference in 30 days mortality rate of the studied patients. Conclusion POCUS is an effective modality in the management of deteriorating patients in the RICU with a good impact on the patient outcome.
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Elgabry et al. (2024) conducted a cohort in Clinical deterioration in the respiratory intensive care unit (n=126). Point of care ultrasonography (POCUS) vs. Computed tomography (CT) and conventional echocardiography was evaluated on Agreement of lung POCUS with CT for diagnosis of pleural effusion (Kappa 0.85, p=<0.001). Point-of-care ultrasound demonstrated excellent agreement with CT for diagnosing pleural effusion (Kappa 0.85) and pneumonia (Kappa 0.84), and accurate diagnosis was associated with significantly decreased ICU length of stay.
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