Effects of Lung Ultrasonography-Guided Management on Cumulative Fluid Balance and Other Clinical Outcomes: A Systematic Review

Heldeweg, Micah L A; Jagesar, Ameet R.; Haaksma, Mark E.; Smit, Jeff M.; Paulus, Frederique; Schultz, Marcus J.; Tuinman, Pieter R.

doi:10.1016/j.ultrasmedbio.2021.01.024

Cited by 6 publications

(6 citation statements)

References 62 publications

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“…The methodology and quality assessment tables highlight weaknesses in current lung ultrasound research. Methodological inconsistencies are frequent amongst lung ultrasound investigations, may impact findings, and limit clinical reproducibility or generalizability [ 8 , 9 , 34 ]. The lack of comparator for any of the studies may be intrinsic to the selected outcome, but emphasizes the need for controlled and well-designed studies to study the effect of lung ultrasound beyond clinician behavior: patient-centered and hospital level outcomes.…”

Section: Discussionmentioning

confidence: 99%

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

et al. 2022

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Background Lung ultrasound has established itself as an accurate diagnostic tool in different clinical settings. However, its effects on clinical-decision making are insufficiently described. This systematic review aims to investigate the impact of lung ultrasound, exclusively or as part of an integrated thoracic ultrasound examination, on clinical-decision making in different departments, especially the emergency department (ED), intensive care unit (ICU), and general ward (GW). Methods This systematic review was registered at PROSPERO (CRD42021242977). PubMed, EMBASE, and Web of Science were searched for original studies reporting changes in clinical-decision making (e.g. diagnosis, management, or therapy) after using lung ultrasound. Inclusion criteria were a recorded change of management (in percentage of cases) and with a clinical presentation to the ED, ICU, or GW. Studies were excluded if examinations were beyond the scope of thoracic ultrasound or to guide procedures. Mean changes with range (%) in clinical-decision making were reported. Methodological data on lung ultrasound were also collected. Study quality was scored using the Newcastle–Ottawa scale. Results A total of 13 studies were included: five studies on the ED (546 patients), five studies on the ICU (504 patients), two studies on the GW (1150 patients), and one study across all three wards (41 patients). Lung ultrasound changed the diagnosis in mean 33% (15–44%) and 44% (34–58%) of patients in the ED and ICU, respectively. Lung ultrasound changed the management in mean 48% (20–80%), 42% (30–68%) and 48% (48–48%) of patients in the ED, in the ICU and in the GW, respectively. Changes in management were non-invasive in 92% and 51% of patients in the ED and ICU, respectively. Lung ultrasound methodology was heterogeneous across studies. Risk of bias was moderate to high in all studies. Conclusions Lung ultrasound, exclusively or as a part of thoracic ultrasound, has substantial impact on clinical-decision making by changing diagnosis and management in the EDs, ICUs, and GWs. The current evidence level and methodological heterogeneity underline the necessity for well-designed trials and standardization of methodology.

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Section: Discussionmentioning

confidence: 99%

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

et al. 2022

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“…Furthermore, cardiac ultrasound requires a high level of expertise along with availability of cardiac windows during suboptimal ICU positioning, decreasing its feasibility. Lung ultrasound, by comparison, requires few examinations to obtain basic proficiency, does not rely on specific thoracic windows, and may readily detect fluid overload as a surrogate for cardiac function (20, 21).…”

Section: Discussionmentioning

confidence: 99%

“…Both negative and positive fluid balance may be associated with increased morbidity and mortality (22). A recent systematic review showed that TUS may facilitate further optimization of volume status (21, 23). This current study’s result emphasizes the important role of TUS in this matter and demonstrates that TUS-guided fluid management induces appropriate and feasible changes in fluid balance that distinctly reflect clinicians’ intent and may not have been produced as readily by the standard diagnostic pathway alone.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study*

Heldeweg

Matta

Pisani

et al. 2022

Critical Care Medicine

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“…Randomised controlled trials (RCT) consistently show that guiding fluid management with LUS is associated with a lower CFB [ 19 ]. In addition, LUS frequently changes patient treatment in the emergency department, ICU and medical ward [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE): protocol for a multicentre randomised controlled trial

Blok

Mousa

Brouwer

et al. 2023

Trials

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Background Fluid therapy is a common intervention in critically ill patients. It is increasingly recognised that deresuscitation is an essential part of fluid therapy and delayed deresuscitation is associated with longer invasive ventilation and length of intensive care unit (ICU) stay. However, optimal timing and rate of deresuscitation remain unclear. Lung ultrasound (LUS) may be used to identify fluid overload. We hypothesise that daily LUS-guided deresuscitation is superior to deresuscitation without LUS in critically ill patients expected to undergo invasive ventilation for more than 24 h in terms of ventilator free-days and being alive at day 28. Methods The “effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients” (CONFIDENCE) is a national, multicentre, open-label, randomised controlled trial (RCT) in adult critically ill patients that are expected to be invasively ventilated for at least 24 h. Patients with conditions that preclude a negative fluid balance or LUS examination are excluded. CONFIDENCE will operate in 10 ICUs in the Netherlands and enrol 1000 patients. After hemodynamic stabilisation, patients assigned to the intervention will receive daily LUS with fluid balance recommendations. Subjects in the control arm are deresuscitated at the physician’s discretion without the use of LUS. The primary endpoint is the number of ventilator-free days and being alive at day 28. Secondary endpoints include the duration of invasive ventilation; 28-day mortality; 90-day mortality; ICU, in hospital and total length of stay; cumulative fluid balance on days 1–7 after randomisation and on days 1–7 after start of LUS examination; mean serum lactate on days 1–7; the incidence of reintubations, chest drain placement, atrial fibrillation, kidney injury (KDIGO stadium ≥ 2) and hypernatremia; the use of invasive hemodynamic monitoring, and chest-X-ray; and quality of life at day 28. Discussion The CONFIDENCE trial is the first RCT comparing the effect of LUS-guided deresuscitation to routine care in invasively ventilated ICU patients. If proven effective, LUS-guided deresuscitation could improve outcomes in some of the most vulnerable and resource-intensive patients in a manner that is non-invasive, easy to perform, and well-implementable. Trial registration ClinicalTrials.gov NCT05188092. Registered since January 12, 2022

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Effects of Lung Ultrasonography-Guided Management on Cumulative Fluid Balance and Other Clinical Outcomes: A Systematic Review

Cited by 6 publications

References 62 publications

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

The impact of lung ultrasound on clinical-decision making across departments: a systematic review

The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study*

Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE): protocol for a multicentre randomised controlled trial

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