title: Impact of lung ultrasound on clinical decision making in critically ill patients.
abstract: OBJECTIVE
  To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients.
  
  
  METHODS
  One hundred and eighty-nine patients took part in this prospective study. The patients were enrolled in the study when LU was requested by the primary physician for (1) unexplained deterioration of arterial blood gases and (2) a suspected pathologic entity [pneumothorax, significant pleural effusion (including parapneumonic effusion, empyema, or hemothorax), unilateral atelectasis (lobar or total), pneumonia and diffuse interstitial syndrome (pulmonary edema)].
  
  
  RESULTS
  Two hundred and fifty-three LU examinations were performed; 108 studies (42.7%) were performed for unexplained deterioration of arterial blood gases, and 145 (57.3%) for a suspected pathologic entity (60 for pneumothorax, 34 for significant pleural effusion, 22 for diffuse interstitial syndrome, 15 for unilateral lobar or total lung atelectasis, and 14 for pneumonia). The net reclassification index was 85.6%, indicating that LU significantly influenced the decision-making process. The management was changed directly as a result of information provided by the LU in 119 out of 253 cases (47%). In 81 cases, the change in patient management involved invasive interventions (chest tube, bronchoscopy, diagnostic thoracentesis/fluid drainage, continuous venous-venous hemofiltration, abdominal decompression, tracheotomy), and in 38 cases, non-invasive (PEEP change/titration, recruitment maneuver, diuretics, physiotherapy, change in bed position, antibiotics initiation/change). In 53 out of 253 cases (21%), LU revealed findings which supported diagnoses not suspected by the primary physician (7 cases of pneumothorax, 9 of significant pleural effusion, 9 of pneumonia, 16 of unilateral atelectasis, and 12 of diffuse interstitial syndrome).
  
  
  CONCLUSIONS
  Our study shows that LU has a significant impact on decision making and therapeutic management.
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.
authors.forename: Nektaria
authors.initials: N
authors.lastname: Xirouchaki
authors.forename: Eumorfia
authors.initials: E
authors.lastname: Kondili
authors.forename: George
authors.initials: G
authors.lastname: Prinianakis
authors.forename: Polychronis
authors.initials: P
authors.lastname: Malliotakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgopoulos
mesh_terms: D001784:Blood Gas Analysis; D016638:Critical Illness; D003657:Decision Making; D003937:Diagnosis, Differential; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017563:Lung Diseases, Interstitial / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D053717:Pneumonia, Ventilator-Associated / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D011654:Pulmonary Edema / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D012121:Respiration, Artificial; D014463:Ultrasonography