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Study: ICU Docs Should Do Ultrasound Scans

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Intensive care physicians should perform head-to-toe bedside ultrasound scans for every critical-care patient admitted to an intensive care unit, a new study suggests. For significant numbers of patients, the study found, the scans can detect hidden problems and lead to changes in treatment.

Researchers at Maria Vittoria Hospital in Torino, Italy, performed ultrasound scans on 125 consecutive patients admitted to a general intensive care unit. The scans were done under a critical care ultrasonography protocol. They covered the optic nerve (for comatose or heavily sedated patients only), thorax, heart, abdomen, and venous system.

Ultrasound findings modified the diagnosis in 26 percent of the patients. Ultrasound confirmed the diagnosis in 58 percent. The scans also led to changes in medical therapy for 18 percent of the patients, further testing for 18 percent, and new invasive procedures for 22 percent.

Emilpaolo Manno, MD, PhD, lead author of the study and head of the hospital’s emergency department and intensive care unit, said:

The findings support the use of ultrasound in critical-care patients. Systematic ultrasound examinations upon admission are beneficial for not only establishing accurate diagnosis, but providing appropriate and effective treatment.

Dr. Manno was quoted in an American Society of Anesthesiologists news release. The study has been published in the October issue of Anesthesiology and is accessible free.

The authors’ recommendations mark another step in the continuing expansion of the use of ultrasound by physicians—specifically, physicians who are not radiologists. As the study says, “The approach is based on the assumption that intensive care physicians with enough expertise can interpret sonographic images.”

The authors don’t seem entirely sure that enough intensive care physicians do possess “enough expertise.” They suggest: “Ultrasound use in the ICU could be optimized by making ultrasonography a routine part of intensive care training during residency.”

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