The Impact of Fellow-performed Cardiopulmonary Ultrasound Exams on the Diagnosis and Management of Shock and Respiratory Failure
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 112
- 试验地点
- 1
- 主要终点
- Diagnosis change
研究概览
简要总结
Shock and respiratory failure are common reasons for admission to the intensive care unit (ICU) at our institution. The various causes of acute shock and respiratory failure are traditionally assessed with the use of history, physical examination, chest x-ray, EKG and laboratory studies. Unfortunately, much of this clinical information is either insensitive or non-specific. 1 Critical care ultrasound (CCUS) is a rapid and non-invasive tool, which has been shown to be useful in the intensive care unit to assist in the diagnosis and management of patients in shock or respiratory failure.2
The investigators hypothesize that the trained fellow's interpretation of critical care ultrasound images will be accurate when compared to experts and that ultrasounds will change diagnosis and management of the patient in shock and respiratory failure.
详细描述
In recent years, CCUS has become widely used by clinicians in the field of critical care as a rapid and non-invasive tool for providing diagnostic information. At Beth Israel Medical Center, CCUS has been routinely used for over a decade on a daily basis by both fellows and attending to aid in the diagnosis and management of shock and respiratory failure.
Numerous studies have described the accuracy and speed of clinician-performed critical care ultrasound. Recently it was shown that early critical care ultrasound by attendings can modify admitting diagnosis and in many cases change management. This study was done by expert practitioners and not by trainees. The accuracy of fellow image interpretation or the proportion of time that a fellow-performed ultrasound exam changes diagnosis or management has not been studied.
The protocol used in this study has already been implemented as part of the diagnostic assessment of a critically ill patients in our care and as an educational tool to help fellows learn ultrasound. The goal of this study is organize the existing clinical data to determine the accuracy of fellow interpretation along with the diagnostic impact of fellow performed CCUS.
Methods:
This is an observational study to see how accurately subjects (fellows) perform CCUS and what impact CCUS has on the early diagnosis of shock and respiratory failure in our ICU. This study involves collection and analysis of ultrasound exam results that are already being performed and documented as standard practice in our institution.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Newly admitted to the medical ICU.
- •Clinical diagnosis of shock including systolic blood pressure less than 90 mmhg, patients requiring vasopressors or indication of organ hypoperfusion.
- •Clinical diagnosis of respiratory failure including need for invasive or non-invasive mechanical ventilation, needing supplemental oxygen more than 50% face mask, clinical impression of respiratory failure with respiratory rate greater than 25.
排除标准
- •Patients not in shock or respiratory failure based on the above criteria.
- •Patients in shock but with obvious cause of bleeding.
结局指标
主要结局
Diagnosis change
时间窗: 5 minutes
The proportion of times that clinical diagnosis changes following performance of a bedside ultrasound.
Management changes
时间窗: 5 minutes
The frequency and type of management changes that are made after performance of a critical care ultrasound.
Volume responsiveness agreement
时间窗: 5 minutes
The proportion of time that post-ultrasound assessment of volume responsiveness agrees with the volume responsiveness conclusion made by a cheetah monitor immediately after ultrasound is performed.
次要结局
- Ultrasound diagnosis agreement with final diagnosis(72 hours following admission to the ICU)