Update on point of care ultrasound in the care of the critically ill patient

One of the most exciting developments to come to the aid of the critically ill patient in recent years is not new at all, but rather has been repackaged and evolved to a level where point-of-care use by critical care physicians has been made possible. Critical care or point-of-care ultrasound dates back more than twenty years, but has come to prominence in the last 5 years and is spreading quickly. Multiple critical care societies have taken up ultrasound policy and training and one organization has been formed that concentrates only on point-of-care ultrasound in critical settings and interventions. The amount of literature generated on the topic is increasing rapidly and hardly a major clinical journal exists that has not published ultrasound related topics.     

Assessment of five different probes for lung ultrasound in critically ill patients: A pilot study

Introduction

The present study was aimed at comparing the diagnosis concordance of five echo probes of lung ultrasound (LUS) with CT scans in intensive care and emergency patients with acute respiratory failure.

Feasibility of correlating the pulse check with focused point-of-care echocardiography during pediatric cardiac arrest: a case series

Rapidly determining whether an unresponsive child is in cardiac arrest or in shock, and requiring cardiopulmonary resuscitation can be problematic. The pulse check in children has been shown to be unreliable, not only for laypersons, but also for healthcare providers. The recommendation for checking the pulse in unresponsive children has been eliminated for laypersons in the latest edition of the Emergency Cardiovascular Care guidelines. Thus the decision to initiate cardiopulmonary resuscitation in children, with the goal of delivering effective chest compressions, can be fraught with uncertainty. Despite the use of pediatric advanced life support guidelines developed by the American Heart Association and the American Academy of Pediatrics, management and decision making during resuscitation of children in cardiac arrest can be challenging. Outcomes for out-of-hospital pediatric cardiac arrest remain poor. The decision to end resuscitation in children, often an emotionally charged situation, can also be particularly difficult for physicians. Information from focused point-of-care echocardiography that allows for correlation with the presence or absence of a pulse and real time assessment of resuscitation may help direct and optimize the delivery of resuscitative interventions. We report our preliminary clinical observations of using focused point-of-care echocardiography to correlate with the pulse check during resuscitation in a series of pediatric cardiac arrests.     

心肺超声在急性呼吸窘迫综合征的应用

肺部影像学检查在急性呼吸窘迫综合征（ ARDS）的诊断、治疗策略的制定及预后的判断上起着至关重要的作用。肺部超声可以通过各种超声征象对肺脏病理变化进行准确地评价;肺部超声联合心脏超声能准确地鉴别ARDS和心源性肺水肿,可在肺复张治疗中提供右心状态的准确评估。作为一种简易的、无创的、无放射累积的床旁诊断ARDS的工具,心肺超声在临床上已经获得了越来越多的认同。本文将对心肺超声在ARDS临床应用的研究现状做一简要综述。     

心肺联合超声与PICCO对急危重症患者监测结果的相关性

目的分析心肺联合超声与脉搏指数连续心输出量（PICCO）对急危重症患者监测结果的相关性。 方法采用前瞻性自身对照研究方法,选取2020年4至6月入住上海市第十人民医院急诊ICU的患者,采用PICCO监测患者心输出量（CO）和血管外肺水指数（ELWI）,同时使用心肺联合超声监测患者CO、左心室流出道（LVOT）血流的速度时间积分（VTI）和肺部超声B线情况,分析两种方法监测结果的相关性。 结果共入选41例患者,其中男∶女为26∶15,年龄（73.6±8.85）岁。超声和PICCO两种方法下监测的CO值结果比较,差异无统计学意义［（4.87±1.04）L/min vs （5.11±1.05）L/min,t=1.01,P=0.316］,Pearson相关性分析提示两者之间存在显著相关性（r=0.911,95%CI：0.82~0.96,P＜0.001）;肺部超声B线与ELWI存在显著相关性（r=0.770,95%CI：0.58~0.88,P＜0.001）。 结论心肺联合超声监测急危重症患者与PICCO监测结果存在相关性。     

A sensible approach to the nutritional support of mechanically ventilated critically ill patients

Objectives The goal of this review is to educate physicians in the details of nutritional support of mechanically ventilated critically ill patients.Design The subtopics of this review include: introduction, goals of nutritional treatment, assessment of nutritional status, estimation of nutritional requirements, estimation of protein requirements, recommended approach to the initial nutritional regimen, routs of nutrition, and monitoring the response to nutrition.Setting The information is primarily germane to the medical management of patients with acute respiratory failure superimposed on chronic lung disease and malnutrition.Conclusion Malnutrition is prevalent in mechanically ventilated critically ill patients. Undernutrition is associated with respiratory muscle weakness and may contribute to ventilator dependency. Overnutrition may increase CO₂ production and increase ventilatory demands. This review advocates a titrated approach to nutritional management based on protein balance. Careful monitoring is necessary to ensure a regimen which maintains or improves body protein composition. Preliminary data exists which indicates that careful nutritional support may improve clinical outcome but more information is needed to recommend a universal approach.     

膈肌超声联合超声心动图预测ICU机械通气患者脱机结果的价值

目的探讨膈肌超声联合超声心动图在重症机械通气患者脱机中的价值。 方法筛选2019年6月至2020年6月间入住山西医科大学第一医院ICU并进行机械通气的56例准备脱机拔管的患者。满足脱机条件后,进行30 min自主呼吸试验（SBT）,在SBT期间进行膈肌活动度（DE）及超声心动图的检查。根据脱机结果分为脱机成功组和脱机失败组。将单因素分析中有统计学意义的变量纳入多因素Logistic回归模型中探讨结局的独立影响因素,绘制受试者工作特征曲线（ROC）,并结合曲线下面积（AUC）进行统计分析。 结果56例患者中有15例患者脱机失败,DE的ROC的AUC为0.797,截断值≤12.4 mm诊断准确率最高,其敏感度为88%,特异度为67%;E/e'的ROC的AUC为0.787,以11.9为截断值具有最佳的敏感度与特异度（95%,67%）。DE值越大,E/e'越小,脱机成功率越高。二者联合的ROC的AUC为0.886,灵敏度为83%,特异度为87%。 结论DE及E/e'可作为预测脱机结局的临床指标,将二者联合可提高对脱机失败的预测价值。     

膈肌超声在危重症中的临床应用

膈肌是人体最重要的呼吸肌,而脓毒症、机械通气、营养不良等因素可导致膈肌功能障碍。超声因具有安全、无创、可重复性强等优点,近几年已被广泛应用于危重症患者的诊断及治疗。膈肌超声通过对膈肌结构和功能的评估,起到预测机械通气患者撤机结果、鉴别膈肌萎缩和膈肌麻痹、判断慢性阻塞性肺病严重程度以及评估人机同步性等多种作用,可用于临床危重患者膈肌功能障碍的诊断及治疗效果评估。     

肾脏超声联合指标对非脓毒症危重患者急性肾损伤的预测价值

目的:探讨肾动脉阻力指数（renal resistive index,RRI）和肾能量多普勒超声（power Doppler ultrasound,PDU）半定量评分联合指标对入住重症监护室（intensive care unit,ICU）的非脓毒症患者发生急性肾损伤（acute kidney injury,AKI）的预测价值。方法:采用前瞻性观察性研究的方法,纳入2018年1月至2019年8月期间于沧州市中心医院急诊ICU住院的非脓毒症危重患者作为研究对象。记录一般资料;于入ICU 6 h内应用医学超声仪完成RRI和PDU半定量评分测量。入ICU第5天依据改善全球肾脏病预后组织（KDIGO）标准评估肾功能,按肾功能情况分为AKI 3期组（入ICU 5 d内进展为AKI 3期）和AKI 0~2期组（未发生AKI或发生AKI 1或2期）。分别在非脓毒症和急性心力衰竭患者中比较不同AKI分期两组间各指标的差异。计量资料两组间比较采用独立样本 t检验或Mann-Whiney秩和检验。计数资料两组间比较采用卡方检验。绘制受试者工作特征曲线（receiver operator characteristic,ROC）分析RRI、PDU评分、RRI-RDU/10、RRI/PDU和RRI+PDU对AKI 3期的预测价值。使用Delong检验方法比较每个预测因子之间ROC曲线下面积的差异。 结果:共纳入110例非脓毒症危重患者（无AKI 51例,AKI 1期21例,AKI 2期11例,AKI 3期27例）,其中急性心力衰竭患者63例（无AKI 21例,AKI 1期15例,AKI 2期7例,AKI 3期20例）。在非脓毒症患者及急性心力衰竭患者中,AKI 3期患者的急性生理学与慢性健康状况（APACHEⅡ）评分、序贯器官衰竭（sequential organ failure assessment,SOFA）评分、动脉乳酸水平、机械通气比例、血管活性药物比例、28 d病死率、肌酐、RRI、RRI-PDU/10、RRI/PDU、RRI+PDU及连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）比例均明显高于AKI 0~2期患者（ P<0.05）;而尿量和PDU评分明显低于AKI 0~2期患者（ P<0.05）。非脓毒症患者中,RRI/PDU[曲线下面积(AUC)=0.915,95%可信区间( CI)：0.846~0.959, P<0.01）及RRI+PDU（AUC=0.914,95% CI：0.845~0.959, P<0.01）对AKI 3期的预测价值最高,且两者与RRI（AUC=0.804,95% CI：0.718~0.874, P<0.01）和PDU评分（AUC=0.868,95% CI：0.791~0.925, P<0.01）,差异均有统计学意义（均 P<0.05）;RRI/PDU预测AKI 3期的最佳临界值为0.355（灵敏度92.6%,特异度81.9%,约登指数0.745）;RRI-PDU/10（AUC=0.899,95% CI：0.827~0.948, P<0.01）对AKI 3期的预测价值亦优于RRI和PDU评分,但较RRI/PDU和RRI+PDU略差,仅RRI与RRI-PDU/10之间差异有统计学意义（ P<0.05）。在急性心力衰竭患者中,RRI/PDU（AUC=0.962,95% CI：0.880~0.994, P<0.01）及RRI+PDU（AUC=0.962,95% CI：0.880~0.994, P<0.01）对AKI 3期的预测价值亦最高,且两者与RRI（AUC=0.845,95% CI：0.731~0.924, P<0.01）和PDU评分（AUC=0.913,95% CI：0.814~0.969, P<0.01）两两间均差异有统计学意义（均 P<0.05）;RRI/PDU预测AKI 3期的最佳临界值为0.360（灵敏度95.0%,特异度90.7%,约登指数0.857）;RRI-PDU/10（AUC=0.950,95% CI:0.864~0.989, P<0.01）对AKI 3期的预测价值亦优于RRI和PDU评分,但较RRI/PDU和RRI+PDU略差,仅RRI与RRI-PDU/10之间差异有统计学意义（ P<0.05）。 结论:RRI和PDU评分的联合指标可有效预测非脓毒症患者发生AKI 3期,尤其在急性心力衰竭患者中表现更优。RRI与PDU评分的比值对AKI 3期的预测价值以及实用价值最好,建议临床推广应用。     

肾脏超声联合指标对非脓毒症危重患者急性肾损伤的预测价值

目的:探讨肾动脉阻力指数（renal resistive index,RRI）和肾能量多普勒超声（power Doppler ultrasound,PDU）半定量评分联合指标对入住重症监护室（intensive care unit,ICU）的非脓毒症患者发生急性肾损伤（acute kidney injury,AKI）的预测价值。方法:采用前瞻性观察性研究的方法,纳入2018年1月至2019年8月期间于沧州市中心医院急诊ICU住院的非脓毒症危重患者作为研究对象。记录一般资料;于入ICU 6 h内应用医学超声仪完成RRI和PDU半定量评分测量。入ICU第5天依据改善全球肾脏病预后组织（KDIGO）标准评估肾功能,按肾功能情况分为AKI 3期组（入ICU 5 d内进展为AKI 3期）和AKI 0~2期组（未发生AKI或发生AKI 1或2期）。分别在非脓毒症和急性心力衰竭患者中比较不同AKI分期两组间各指标的差异。计量资料两组间比较采用独立样本 t检验或Mann-Whiney秩和检验。计数资料两组间比较采用卡方检验。绘制受试者工作特征曲线（receiver operator characteristic,ROC）分析RRI、PDU评分、RRI-RDU/10、RRI/PDU和RRI+PDU对AKI 3期的预测价值。使用Delong检验方法比较每个预测因子之间ROC曲线下面积的差异。 结果:共纳入110例非脓毒症危重患者（无AKI 51例,AKI 1期21例,AKI 2期11例,AKI 3期27例）,其中急性心力衰竭患者63例（无AKI 21例,AKI 1期15例,AKI 2期7例,AKI 3期20例）。在非脓毒症患者及急性心力衰竭患者中,AKI 3期患者的急性生理学与慢性健康状况（APACHEⅡ）评分、序贯器官衰竭（sequential organ failure assessment,SOFA）评分、动脉乳酸水平、机械通气比例、血管活性药物比例、28 d病死率、肌酐、RRI、RRI-PDU/10、RRI/PDU、RRI+PDU及连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）比例均明显高于AKI 0~2期患者（ P<0.05）;而尿量和PDU评分明显低于AKI 0~2期患者（ P<0.05）。非脓毒症患者中,RRI/PDU[曲线下面积(AUC)=0.915,95%可信区间( CI)：0.846~0.959, P<0.01）及RRI+PDU（AUC=0.914,95% CI：0.845~0.959, P<0.01）对AKI 3期的预测价值最高,且两者与RRI（AUC=0.804,95% CI：0.718~0.874, P<0.01）和PDU评分（AUC=0.868,95% CI：0.791~0.925, P<0.01）,差异均有统计学意义（均 P<0.05）;RRI/PDU预测AKI 3期的最佳临界值为0.355（灵敏度92.6%,特异度81.9%,约登指数0.745）;RRI-PDU/10（AUC=0.899,95% CI：0.827~0.948, P<0.01）对AKI 3期的预测价值亦优于RRI和PDU评分,但较RRI/PDU和RRI+PDU略差,仅RRI与RRI-PDU/10之间差异有统计学意义（ P<0.05）。在急性心力衰竭患者中,RRI/PDU（AUC=0.962,95% CI：0.880~0.994, P<0.01）及RRI+PDU（AUC=0.962,95% CI：0.880~0.994, P<0.01）对AKI 3期的预测价值亦最高,且两者与RRI（AUC=0.845,95% CI：0.731~0.924, P<0.01）和PDU评分（AUC=0.913,95% CI：0.814~0.969, P<0.01）两两间均差异有统计学意义（均 P<0.05）;RRI/PDU预测AKI 3期的最佳临界值为0.360（灵敏度95.0%,特异度90.7%,约登指数0.857）;RRI-PDU/10（AUC=0.950,95% CI:0.864~0.989, P<0.01）对AKI 3期的预测价值亦优于RRI和PDU评分,但较RRI/PDU和RRI+PDU略差,仅RRI与RRI-PDU/10之间差异有统计学意义（ P<0.05）。 结论:RRI和PDU评分的联合指标可有效预测非脓毒症患者发生AKI 3期,尤其在急性心力衰竭患者中表现更优。RRI与PDU评分的比值对AKI 3期的预测价值以及实用价值最好,建议临床推广应用。     

动态肺超声、膈肌和左心功能评估对重症机械通气患者撤机预测价值

[摘要] 目的：评估肺超声动态监测肺水变化联合膈肌功能对重症机械通气（MV）患者撤机的预测价值。 方法：选取重症医学科112例接受MV＞48h并符合撤机条件患者,于自主呼吸试验（SBT）0min采用床旁超声测量左室射血分数（LVEF）、左室短轴缩短率（LVFS）、舒张功能指标和胸前区肺超声水肿评分（A-LUES 0min）;于SBT 15min测量膈肌移动度（DE）及A-LUES 15min,并计算△A-LUES。采用ROC曲线评价各指标预测撤机结果的价值。 结果：64例撤机成功（成功组）,48例撤机失败（失败组）,失败组LVEF、DE、e’明显低于成功组,E/e’、A-LUES 15min、△A-LUES明显高于成功组（P＜0.05）;分别以51.50%、6.48cm/s、10.36、10.35mm、1.50分作为LVEF、e’、E/e’、DE和△A-LUES的阈值,预测撤机结果的敏感度分别为 93.75%、90.63%、62.50%、85.94%和77.08%,特异度分别为27.08%、52.08%、75.00%、56.25%和67.19%,AUC分别为0.613、0.735、0.652、0.786和0.793;△A-LUES联合DE对预测撤机结果的敏感度为89.58%,特异度为82.81%,AUC为0.909。 结论：超声监测肺水动态变化、膈肌功能和左心功能对撤机成败有较好的预测价值。     

新型冠状病毒肺炎危重症患者序贯超声检查价值

摘要：目的：探讨序贯超声检查对2019新型冠状病毒肺炎（Corona Virus Disease 2019,COVID-19）危重症患者的临床价值。方法：筛选2020年1月1日—2020年4月15日间武汉金银潭医院收治的232例行过超声检查的新冠肺炎重症患者,回顾性分析其这段病程内超声检查的项目及检查结果。结果：新冠肺炎重症患者做过的超声检查项目包括：床旁心脏心功能彩超（181例）、胸腔超声（131例）、肝胆胰脾、门静脉超声（134例）、双肾、输尿管超声（125例）、双下肢动脉、深静脉超声（75例）、腹部大血管超声（51例）、颈部血管超声（14例）、子宫及其附件超声（4例）、颌下腺超声（2例）、膀胱、前列腺超声（2例）、甲状腺超声（24例）、肾上腺超声（22例）、睾丸及附睾超声（1例）。阳性率分别是： 92%、100%、87%、68%、81%、61%、43%、75%、50%、50%、75%、9%、100%。结论：序贯超声对COVID-19危重症患者的诊治具有重要作用,贯穿危重症患者诊治全程,临床－序贯超声将以COVID-19为契机,拉开超声医学的新篇章。     

Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity

Objective In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsiveness is a difficult challenge since the respiratory variation in arterial pressure cannot be used. Our objective was to test whether volume responsiveness can be predicted by the response of stroke volume measured with transthoracic echocardiography to passive leg raising in patients with spontaneous breathing activity. We also examined whether common echocardiographic indices of cardiac filling status are valuable to predict volume responsiveness in this category of patients. Design and setting Prospective study in the medical intensive care unit of a university hospital. Patients 24 patients with spontaneously breathing activity considered for volume expansion. Measurements We measured the response of the echocardiographic stroke volume to passive leg raising and to saline infusion (500 ml over 15 min). The left ventricular end-diastolic area and the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/Ea) were also measured before and after saline infusion. Results A passive leg raising induced increase in stroke volume of 12.5% or more predicted an increase in stroke volume of 15% or more after volume expansion with a sensitivity of 77% and a specificity of 100%. Neither left ventricular end-diastolic area nor E/Ea predicted volume responsiveness. Conclusions In our critically ill patients with spontaneous breathing activity the response of echocardiographic stroke volume to passive leg raising was a good predictor of volume responsiveness. On the other hand, the common echocardiographic markers of cardiac filling status were not valuable for this purpose. This article is discussed in the editorial available at:     

Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction

ObjectivesTo compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA).BackgroundDespite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known.Methods and resultsIn a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9 mmol/l (SD 6) vs. 6 mmol/l (SD 4) p < 0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR) = 1.02 [CI 1.00–1.03], p = 0.01) and lactate at admission (HR = 1.06 [CI 1.03–1.09], p < 0.001), but not OHCA (HR = 1.1 [CI 0.8–1.4], p = NS) was associated with mortality. In multivariate analysis, only age (HR = 1.02 [CI 1.01–1.04], p = 0.003) and lactate level at admission (HR = 1.06 [1.03–1.09], p < 0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p = NS.ConclusionOHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.     

Noninvasive assessment of hemodynamic response to a fluid challenge using femoral Doppler in critically ill ventilated patients

Purpose

The purpose of the study is to determine if femoral artery blood flow Doppler parameters can assess cardiac response to a fluid challenge (FC).

Materials and Methods

We prospectively recorded in 52 critically ill ventilated patients' velocity time integral variation (%VTIf) and maximal systolic velocity variation (%Vfmax) derived from femoral Doppler analysis and aortic velocity time integral variation registered on transthoracic echocardiography before and after an FC of 500-mL saline.

Results

According to Pearson coefficient, %Vfmax and %VTIf were found to be positively correlated with aortic velocity time integral variation (r² = 0.46 and 0.51, respectively; P < .0001) and were significantly different between responder patients and nonresponders (11% ± 3.4% vs 5.9% ± 4.3% and 14.9% ± 4.2% vs 5.5% ± 5.5%, respectively; P < .0001). Increase of %VTIf 10% or higher and %Vfmax 7% or higher after an FC showed a sensitivity of 80% and 84%, a specificity of 85% and 73%, and an area under the curve of 0.905 and 0.851, respectively, for discriminating responder and nonresponder patients.

Conclusion

Variation of femoral Doppler parameters before and after FC mirrors cardiac response to fluid loading. This tool could be considered as an alternative to transthoracic echocardiography in case of poor thoracic insonation.     

Transthoracic ultrasound approach of thoracic aorta in critically ill patients with lung consolidation

PURPOSE: Normally, the aortic arch and the descending aorta are not visible using transthoracic ultrasonography. We hypothesize that lung consolidation of upper and lower lobes, by opening an acoustic window, may allow the ultrasound examination of the thoracic aorta. METHODS: During a 2-month period, 18 consecutive patients hospitalized in the intensive care unit with consolidation of upper and/or lower lobes diagnosed by lung ultrasound were studied. The ascending and descending aorta and the aortic arch were systematically searched for by positioning the probe on the anterior, lateral, and posterior regions of the chest wall. RESULTS: Among the 16 patients with left lower lobe consolidation, the descending aorta was always visible by positioning the probe on lateral and posterior parts of the chest wall. In the 4 patients with consolidation of the left upper lobe, the aortic arch was visible when positioning the probe on anterior and upper parts of the left chest wall. In the patient with right upper lobe consolidation, both the ascending aorta and the aortic arch were visible when positioning the probe on anterior and upper parts of the right chest wall. CONCLUSIONS: In critically ill patients, the presence of consolidated upper and left lower lobes may allow the ultrasound examination of the different parts of the thoracic aorta.     

肺超声动态监测评估重症休克患者容量复苏效果的价值分析

目的探讨肺超声动态监测对评估重症休克患者容量复苏效果的价值。方法选取因休克需要进行容量复苏患者50例,自入住ICU起动态观察左心收缩功能,测定血清BNP水平以评估是否出现心衰,同时观察复苏期间的CVP、血清肌酐及液体平衡情况。结果 50例患者中存活41例,病死9例,共进行床旁心肺超声监测360次。存活患者的肺超声B线阳性切面数在(22.2±4.7)h达到高峰值,最高阳性切面数量为(3.4±0.9)。病死患者的液体正平衡量大,肺超声B线阳性切面数较存活组显著增多(P0.05)。结论容量复苏患者在复苏后期存在容量超负荷现象,肺部超声动态监测B线变化能精确地反映机体的容量变化。     

A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients

Aim

To determine whether the introduction of a multi-faceted intervention (newly designed ward observation chart, a track and trigger system and an associated education program, COMPASS^©) to detect clinical deterioration in patients would decrease the rate of predefined adverse outcomes.

Methods

A prospective, controlled before-and-after intervention of trial was conducted in all consecutive adult patients admitted to four medical and surgical wards during a 4 month period, 1157 and 985, respectively. A sub-group of patients underwent vital sign and medical review analysis pre-intervention (427) and post-intervention (320). The outcome measures included: number of unplanned admissions to the intensive care unit (ICU), Medical Emergency Team (MET) reviews and unexpected hospital deaths, vital sign documentation frequency and incidence of a medical review following clinical deterioration. This study is registered, ACTRN12609000808246.

Results

Reductions were seen in unplanned admissions to ICU (21/1157 [1.8%] vs. 5/985 [0.5%], p = 0.006) and unexpected hospital deaths (11/1157 [1.0%] vs. 2/985 [0.2%], p = 0.03) during the intervention period. Medical reviews for patients with significant clinical instability (58/133 [43.6%] vs. 55/79 [69.6%] p < 0.001) and number of patients receiving a MET review increased (25/1157 [2.2%] vs. 38/985 [3.9%] p = 0.03) during the intervention period. Mean daily frequency of documentation of all vital signs increased during the intervention period (3.4 [SE 0.22] vs. 4.5 [SE 0.17], p = 0.001).

Conclusion

The introduction of a multi-faceted intervention to detect clinical deterioration may benefit patients through increased monitoring of vital signs and the triggering of a medical review following an episode of clinical instability.