Focused Ultrasound in Critical Care Outreach for acutely ill and deteriorating patients on the wards
Journal of the Intensive Care Society
; 23(1):78-79, 2022.
Artigo
em Inglês
| EMBASE | ID: covidwho-2042978
ABSTRACT
Introduction:
Focused Ultrasound in Intensive Care (FUSIC) refers to the use of ultrasound by a trained bedside clinician to guide patient management in real-time. Ultrasound is widely applied in practice and there is growing consensus that it is an essential tool for managing acutely ill patients in the intensive care unit (ICU). The Critical Care Outreach Team uses FUSIC as an additional assessment tool to guide management and decision-making plan for deteriorating patients on the wards.Objectives:
To investigate whether how often information gained fromFUSICimaging had an impact on patient care and management decisions in a critical care outreach setting.Methods:
A single-centre observational study at an academic tertiary referral institution. We included all patients reviewed by critical care outreach who were assessed by ultrasound during a 12-month period. Routine procedures for teaching purposes were not included.Results:
Forty-six patients were assessed and supported by a combined focused lung and heart ultrasound performed at the patient bedside on the wards. In 46 patients FUSIC was instrumental in the differential diagnostic workup and in guiding the clinical management. In 32 (70%) patients FUSIC aided fluid therapy or diuresis (in case of pulmonary oedema) and helped targeting fluid balance. In three patients though to have consolidation on chest x-ray we were able to identify significant pleural effusions without needing an additional CT scan. In four patients with hypotension, an additional CT-PA was warranted due to dilated right ventricle (RV) with abnormal septal motion and decreased left ventricle (LV) size ratio (i.e. sign of right heart strain) as highly suspicious of pulmonary embolus. In two young patients with Coronavirus disease 2019 (COVID-19), using FUSIC we identified severe LV dysfunction which was subsequentially diagnosed as myocarditis and Angiotensin-converting enzyme (ACE) inhibitors therapy was commenced within 24 hours. Further diagnosis included cardiac tamponade (n = 2) requiring pericardiocentesis and pneumothorax (n =1). In all cases, the use of ultrasound helped in promptly referring patients to the specialist team (i.e. respiratory or cardiology) and to the ICU consultant.Conclusions:
In our critical care outreach practice, FUSIC is considered an indispensable tool for safe and accurate management of acutely ill and deteriorating patients on the wards.
dipeptidyl carboxypeptidase; dipeptidyl carboxypeptidase inhibitor; endogenous compound; acutely ill patient; adult; cardiology; case report; clinical article; clinical assessment; conference abstract; consultation; coronavirus disease 2019; diagnosis; diuresis; drug therapy; female; fluid balance; fluid therapy; focused ultrasound therapy; heart left ventricle failure; heart right ventricle; heart tamponade; human; hypotension; intensive care; intensive care unit; lung edema; lung embolism; male; motion; myocarditis; observational study; patient care; patient referral; pericardiocentesis; pleura effusion; pneumothorax; surgery; teaching; thorax radiography; x-ray computed tomography
Texto completo:
Disponível
Coleções:
Bases de dados de organismos internacionais
Base de dados:
EMBASE
Idioma:
Inglês
Revista:
Journal of the Intensive Care Society
Ano de publicação:
2022
Tipo de documento:
Artigo
Similares
MEDLINE
...
LILACS
LIS