title: Deep impact of ultrasound in the intensive care unit: the "ICU-sound" protocol.
abstract: BACKGROUND
  Ultrasound can influence the diagnosis and impact the treatment plan in critical patients. The aim of this study was to determine whether, without encountering major environment- or patient-related limitations, ultrasound examination under a critical care ultrasonography protocol can be performed to detect occult anomalies, to prompt urgent changes in therapy or induce further testing or interventions, and to confirm or modify diagnosis.
  
  
  METHODS
  One hundred and twenty-five consecutive patients admitted to a general intensive care unit were assessed under a critical care ultrasonography protocol, and the data were analyzed prospectively. Systematic ultrasound examination of the optic nerve, thorax, heart, abdomen, and venous system was performed at the bedside.
  
  
  RESULTS
  Environmental conditions hampered the examination slightly in 101/125 patients (80.8%), moderately in 20/125 patients (16%), and strongly in 4/125 patients (3.2%). Ultrasonographic findings modified the admitting diagnosis in 32/125 patients (25.6%), confirmed it in 73/125 patients (58.4%), were not effective in confirming or modifying it in 17/125 patients (13.6%), and missed it in 3/125 patients (2.4%). Ultrasonographic findings prompted further testing in 23/125 patients (18.4%), led to changes in medical therapy in 22/125 patients (17.6%), and to invasive procedures in 27/125 patients (21.6%).
  
  
  CONCLUSIONS
  In this series of patients consecutively admitted to an intensive care unit, ultrasound examination revealed a high prevalence of unsuspected clinical abnormalities, with the highest number of new ultrasound abnormalities detected in patients with septic shock. As part of rapid global assessment of the patient on admission, our ultrasound protocol holds potential for improving healthcare quality.
authors.affiliation: Emergency Department and Intensive Care Unit, Maria Vittoria Hospital, Torino, Italy. manno@aslto2.it
authors.forename: Emilpaolo
authors.initials: E
authors.lastname: Manno
authors.forename: Mauro
authors.initials: M
authors.lastname: Navarra
authors.forename: Luciana
authors.initials: L
authors.lastname: Faccio
authors.forename: Mohsen
authors.initials: M
authors.lastname: Motevallian
authors.forename: Luca
authors.initials: L
authors.lastname: Bertolaccini
authors.forename: Abdou
authors.initials: A
authors.lastname: Mfochivè
authors.forename: Marco
authors.initials: M
authors.lastname: Pesce
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
mesh_terms: D018806:APACHE; D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging; D016017:Odds Ratio; D009900:Optic Nerve / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012772:Shock, Septic; D013909:Thorax / Q000000981:diagnostic imaging; D014463:Ultrasonography