Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study

Zieleskiewicz, Laurent; Lopez, Alexandre; Hraiech, Sami; Baumstarck, Karine; Pastene, Bruno; Di Bisceglie, Mathieu; Coiffard, Benjamin; Duclos, Gary; Boussuges, Alain; Bobbia, Xavier; Einav, Sharon; Papazian, Laurent; Leone, Marc

doi:10.1186/s13054-021-03466-z

Critical Care

Table 1 Baseline participants characteristics^a

From: Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study

Variables	Control group n = 82	POCUS group n = 83	P value
Men	48 (59)	55 (66)	0.31
Age, median [IQR] years	67 [57–77]	70 [59–81]	0.49
Indication for placing the call to the RRTs
Respiratory	56 (68)	61 (74)	0.46
Circulatory	26 (32)	22 (26)
Indication for hospital admission
Cardiac	10 (12)	3 (4)	0.27
Respiratory	30 (37)	23 (28)
Neurologic	2 (2)	7 (9)
Digestive	8 (10)	8 (10)
Obstetrical	1 (1,5)	0
Infectious	2 (2,5)	2 (2)
General	4 (5)	4 (5)
Surgery	24 (29)	28 (34)
Urologic	0	2 (2)
Vascular	1 (1)	3 (4)
Traumatic	0	3 (4)
BMI (> 25), kg/m²
	41 (50)	39 (47)	0.70
ASA score
I-II	23 (28)	23 (28)	0.99
III	47 (57)	48 (58)
IV–V	12 (15)	12 (14)
SAPS II^b, median [IQR]
	46 [34–57]	40 [33–52]	0.51
Comorbidities
Allergy	9 (11)	8 (10)	0.78
Coronary disease	22 (27)	23 (28)	0.89
Heart failure	19 (23)	27 (32)	0.18
Chronic kidney disease	11 (13)	19 (22)	0.16
Cancer	28 (34)	26 (31)	0.70
Immunodepression	10 (12)	13 (15)	0.52
Dementia	5 (6)	3 (4)	0.49
Stroke	8 (9,8)	9 (11)	0.82
Epilepsy	5 (6)	1 (1)	0.12
Diabetes	13 (16)	21 (25)	0.13
Liver disease	6 (7)	6 (7)	0.98
COPD	36 (44)	30 (36)	0.31
Habitual smoker	42 (51)	34 (41)	0.19
Definitive diagnosis^c
Exacerbation of asthma	3 (5)	3 (5)	0.60
Septic shock	14 (17)		14 (17)
Pneumonia	18 (22)	7 (8)
Cardiogenic edema	10 (12)	13 (16)
Hemorrhagic shock	7 (8)	4 (5)
Atelectasis	1 (1)	4 (5)
Exacerbation of COPD	5 (6)	6 (7)
Pneumothorax	1 (1)	1 (1)
Pleural effusion	3 (5)	4 (5)
Acute interstitial lung disease (non-cardiogenic edema)	4 (5)	7 (8)
Pulmonary embolism	2 (2)	2 (2)
Cardiogenic shock	2 (2)	2 (2)
Hypovolemic shock	1 (1)	1 (1)
Tamponade	1 (1)	2 (2)
Exacerbation of COPD/cardiogenic edema	0	1 (1)
Pneumonia/cardiogenic edema	0	1 (1)
Pneumonia/acute interstitial lung disease (non-cardiogenic edema)	1 (1)	3 (5)
Exacerbation of COPD/pneumothorax	2 (2)	0
Normal	0	2 (2)
Other†	7 (9)	6 (8)
Urine volume 24 h before inclusion (ml/day)
< 200	6 (7)	4 (5)	0.58
< 500	29 (35)	24 (29)
> 500	37 (45)	40 (48)
> 1000	10 (12)	15 (18)
Mottling^d	22 (27)	10 (12)	0.02
Respiratory distress syndrome	49 (60)	54 (65)	0.48
Abnormal chest auscultation^e	62 (76)	59 (71)	0.51
Thorax X-ray < 24 h	35 (42)	38 (46)	0.69
MAP, median [IQR], mmHg	82 [70–100]	93 [72–113]	0.02
Heart rate, median [IQR], bpm*	100 [80–120]	107 [85–130]	0.46
Serum lactate median [IQR], mmol/l	2 [1–3]	2 [1–3]	0.95
Hemoglobin, median [IQR], g/dl	11 [9–13]	11 [9–12]	0.18
Serum creatinine, median [IQR],mmol/L	79 [52–125]	82 [62 -132]	0.51
Total bilirubin, median [IQR] umol/l	10 [8–16]	10 [8–16]	0.91
Serum potassium, median [IQR], mmol/L	4 [4, 5]	4 [4, 5]	0.41
Volemic expansion at the bedside, median [IQR], ml/kg	3 [0–10]	4 [0 -12]	0.73
Respiratory rate, median [IQR] bpm**	27 [20–35]	25 [20–35]	0.51
SpO2, median [IQR], %	92 [89–96]	94 [90–97]	0.16
PaO2/FiO2 ratio, median [IQR]	186 [121–284]	203 [136–355]	0.28
Glasgow score, median [IQR]	15 [2–15]	15 [14, 15]	0.08
BNP, median [IQR] pg/ml	306 [129–584]	188 [62–833]	0.61
Oxygen rate flow, median [IQR], L/min	12 [5–15]	6 [2–15]	0.003
Orientation after inclusion
Immediate ICU	59 (72)	49 (55)	0.15
Operative room	5 (6)	7 (8)
Emergency room	4 (5)	9 (12)
Ward	14 (17)	21 (25)

BMI, body mass index; ASA, Score of American Society of Anesthesiologists; SAPS II, Simplified Acute Physiology Score II; COPD, chronic obstructive pulmonary disease; MAP, median arterial pressure; SpO2, pulse oximetry; PaO2/FiO2 ratio, ratio of arterial oxygen partial to fractional inspired oxygen; BNP, brain natriuretic peptide; bpm*: beats per minute; bpm**: breaths per minute; IQR, interquartile range; RRT, rapid response team
^aData are expressed as No (%) of participants unless otherwise indicated. At the bedside
^bThe SAPS II ranges from 0 to 163, with higher scores indicating higher risk of mortality. A patient with a score of 40 has an estimated mortality risk of 30%
^cDiagnosis established after medical files and supplementary workup
^dOnly presence or absence of mottlings
^eAbnormal was defined like pathological auscultation
^†Panic attack (1), anaphylaxia (2), bronchospasm (1), hemoptysis (1), intraalveolar hemorrhage (1), laryngeal dyspnea (1), morphine surdosage (1), pulmonary hypertension crisis (1), tracheal decannulation (1), neurological failure (1) and valve thrombosis (1)

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