Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study

Laurent Zieleskiewicz, Laurent Muller, Karim Lakhal, Zoe Meresse, Charlotte Arbelot, Pierre-Marie Bertrand, Belaid Bouhemad, Bernard Cholley, Didier Demory, Serge Duperret, Jacques Duranteau, Christophe Guervilly, Emmanuelle Hammad, Carole Ichai, Samir Jaber, Olivier Langeron, Jean-Yves Lefrant, Yazine Mahjoub, Eric Maury, Eric Meaudre, Fabrice Michel, Michel Muller, Cyril Nafati, Sébastien Perbet, Hervé Quintard, Béatrice Riu, Coralie Vigne, Kathia Chaumoitre, François Antonini, Bernard Allaouchiche, Claude Martin, Jean-Michel Constantin, Daniel De Backer, Marc Leone, CAR'Echo and AzuRea Collaborative Networks, Marc-Olivier Fischer, Marc Rinaudo, Ellisabeth Hugon-Vallet, Guillaume Marcotte, Florence Lallemant, Géraldine Dessertaine, Olivier Brissaud, Emmanuel Novy, Adrien Robine, Christophe Giacardi, Pierre Bouzat, Clement Delmas, Kamel Toufik, Emmanuel Vivier, François Brenas, Zakia Machroub, Julien Amour, Jean Bergounioux, Christophe De La Vega, Andres Jurado, Romain Barthelemy, Frédéric Bussienne, Sébastien Mirek, Nadya Youssef, Thierry Blanc, Pierre-Louis Leger, Pierre-Marie Bertrand, Etienne Gayat, Hélène Brisson, Toufic Finge, Jean Claude Rigaud, Julien Picard, Jean Paul Brun, Claire Contargyris, Dominique Prat, Christian LaPlace, M O Marcoux, Pierrick Cronier, Hervé Zender, Frédéric Bellec, Isabelle Ligi, Thierry Fumeaux, Pierre-Eric Danin, Djilali Elaroussi, Michel Comandini, Laurent Papazian, Vincent Peigne, Aben Essid, Benjamin Dusang, Patrick Guinet, Vincent Gregoire, Laurent Argaud, Tài Pham, Nadia Savy, Marc Vinclair, Emmanuelle Begot, Jean-Luc Baudel, Eric Boulet, Elie Zogheib, Mathieu Guilbart, Astrid Botte, Gwénaël Prat, Mircea Cristinar, Agnès Almayrac, Damien Tagan, Marie Isabelle Steinbach, Sophie Ketterer-Martinon, Sabri Soussi, Gérald Boussicault, Xavier Fabre, Mickael Afanetti, Benoît Colomb, Frédérique Beringue, Gaëlle Mourissoux, Denis Doyen, Théophile Gaillot, Francis Remerand, Georges Simon, Elodie Masseret, Tristan Morichau-Beauchant, Gaël Pradel, Walter Picard, Thomas Kerfone, Armelle Garenne, Benoit Voisin, Julie Francis-Moussi, Romain Gomert, Axel Maurice-Szamburski, Nicolas Bruder, Sandrine Wiramus, Jacques Albanese, Gaston Grossmith, François Xeridat, Mathias Castanier, Laurent Zieleskiewicz, Laurent Muller, Karim Lakhal, Zoe Meresse, Charlotte Arbelot, Pierre-Marie Bertrand, Belaid Bouhemad, Bernard Cholley, Didier Demory, Serge Duperret, Jacques Duranteau, Christophe Guervilly, Emmanuelle Hammad, Carole Ichai, Samir Jaber, Olivier Langeron, Jean-Yves Lefrant, Yazine Mahjoub, Eric Maury, Eric Meaudre, Fabrice Michel, Michel Muller, Cyril Nafati, Sébastien Perbet, Hervé Quintard, Béatrice Riu, Coralie Vigne, Kathia Chaumoitre, François Antonini, Bernard Allaouchiche, Claude Martin, Jean-Michel Constantin, Daniel De Backer, Marc Leone, CAR'Echo and AzuRea Collaborative Networks, Marc-Olivier Fischer, Marc Rinaudo, Ellisabeth Hugon-Vallet, Guillaume Marcotte, Florence Lallemant, Géraldine Dessertaine, Olivier Brissaud, Emmanuel Novy, Adrien Robine, Christophe Giacardi, Pierre Bouzat, Clement Delmas, Kamel Toufik, Emmanuel Vivier, François Brenas, Zakia Machroub, Julien Amour, Jean Bergounioux, Christophe De La Vega, Andres Jurado, Romain Barthelemy, Frédéric Bussienne, Sébastien Mirek, Nadya Youssef, Thierry Blanc, Pierre-Louis Leger, Pierre-Marie Bertrand, Etienne Gayat, Hélène Brisson, Toufic Finge, Jean Claude Rigaud, Julien Picard, Jean Paul Brun, Claire Contargyris, Dominique Prat, Christian LaPlace, M O Marcoux, Pierrick Cronier, Hervé Zender, Frédéric Bellec, Isabelle Ligi, Thierry Fumeaux, Pierre-Eric Danin, Djilali Elaroussi, Michel Comandini, Laurent Papazian, Vincent Peigne, Aben Essid, Benjamin Dusang, Patrick Guinet, Vincent Gregoire, Laurent Argaud, Tài Pham, Nadia Savy, Marc Vinclair, Emmanuelle Begot, Jean-Luc Baudel, Eric Boulet, Elie Zogheib, Mathieu Guilbart, Astrid Botte, Gwénaël Prat, Mircea Cristinar, Agnès Almayrac, Damien Tagan, Marie Isabelle Steinbach, Sophie Ketterer-Martinon, Sabri Soussi, Gérald Boussicault, Xavier Fabre, Mickael Afanetti, Benoît Colomb, Frédérique Beringue, Gaëlle Mourissoux, Denis Doyen, Théophile Gaillot, Francis Remerand, Georges Simon, Elodie Masseret, Tristan Morichau-Beauchant, Gaël Pradel, Walter Picard, Thomas Kerfone, Armelle Garenne, Benoit Voisin, Julie Francis-Moussi, Romain Gomert, Axel Maurice-Szamburski, Nicolas Bruder, Sandrine Wiramus, Jacques Albanese, Gaston Grossmith, François Xeridat, Mathias Castanier

Abstract

Objective: To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU).

Background: POCUS is of growing importance in the ICU. Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown.

Methods: Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified.

Results: Among 1954 patients hospitalized during the study period, 1073 (55%) POCUS/day were performed in 709 (36%) patients. POCUS served for diagnostic assessment in 932 (87%) cases and procedural guidance in 141 (13%) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16% of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69%, respectively. Ultrasound guidance was used in 54 and 15% of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts.

Conclusions: With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.

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