Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice.
BACKGROUND
Echocardiography has been shown to positively impact on the management of the critically ill patient. However, many published studies have a significant bias towards inclusion of cardiothoracic patients. We present an audit of the impact of echocardiography on the management of patients in a district general hospital intensive care unit (ICU).


METHODS
We conducted a prospective audit of all echocardiograms, both transthoracic (TTE) and transoesophageal (TOE), performed on our ICU between October 1, 2005, and December 31, 2007. In addition to patient characteristics, we recorded the indication for the echocardiogram, and any change in management that occurred as a result of the study.


RESULTS
Two hundred and fifty-eight echocardiograms were performed in 217 patients, of which 224 (86.8%) were performed by intensive care consultants. One hundred and eighty-seven studies (72.4%) were TTEs and 71 (27.8%) were TOEs. TTE provided diagnostic images in 91.3% of spontaneously breathing and 84.2% of mechanically ventilated patients. Management was changed directly as a result of information provided in 51.2% of studies. Changes included fluid administration, inotrope or drug therapy, and treatment limitation.


CONCLUSIONS
Echocardiography may have a significant impact on the management of patients in the general ICU. We recommend that appropriate training in echocardiography should be incorporated into the intensive care curriculum in the UK.
Orme
R M L'E
RM
Intensive Care Unit, Cheltenham General Hospital, Sandford Road, Cheltenham GL53 7AN, UK. robert.orme@glos.nhs.uk
Oram
M P
MP
McKinstry
C E
CE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D004452:Echocardiography / Q000706:statistics & numerical data*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011364:Professional Practice / Q000706:statistics & numerical data; D011446:Prospective Studies; D055815:Young Adult