Ultrasound can impact the analysis and affect the treatment
design in critical patients. The purpose of this study was to decide if
whether, without encountering major environment or patient-related constraints,
ultrasound examination under a serious care ultrasonography convention can be
performed to discover occult anomalies, to incite critical changes in treatment
or induce additional testing or mediations, and to confirm or adapt the
patient’s diagnosis (Emilpaolo Manno, 2012).
The study used one hundred and twenty-five successive patients
who has been admitted to an intensive care unit were evaluated under a critical
care ultrasonography convention.
Methodical ultrasound examination of the optic nerve, heart,
thorax, venous system and the abdomen was performed at the bedside. The
“ICU-sound” Protocol holds potential to improve healthcare quality (Emilpaolo
The introduction of the article
orientates the reader to the title of the research article because it clearly
states in the introduction that the use of ultrasound in the intensive care
unit has been widely approved as it offers information that may not be acquired
with other routine strategies. Therefore, ultrasound has a deep impact in the
ICU (Emilpaolo Manno, 2012).
Firstly, the operators in this study were not blinded to the
patient’s ultrasound image which created a potential for bias. Secondly, abnormalities
in the heart’s ultrasound image might have been underestimated since the study
relied only on transthoracic echocardiography. Thirdly, due to the formula
used, a patient present with pleural effusion might be misdiagnosed if only a
small or moderate amount of fluid is present (Emilpaolo Manno, 2012).
Patients admitted to the intensive care unit are in need of
quick and precise diagnosis and treatment which can be problematic. Reports
show the inaccuracy of patients physical examination once admitted to the ICU.
Other imaging modalities used on ICU patients lack availability, sensitivity
and portability (Emilpaolo Manno, 2012).
The hypothesis of the study states that a well performed
“ICU-sound” protocol evaluation of the patient admitted to the intensive care
unit could rise diagnostic accuracy (Emilpaolo Manno, 2012).
Aim of the Study
The purpose of this study was to decide if whether, without
encountering major environment or patient-related constraints, ultrasound
examination under a serious care ultrasonography convention can be performed to
discover occult anomalies, to incite critical changes in treatment or induce
additional testing or mediations, and to confirm or adapt the patient’s diagnosis.
Therefore, the key objective is to prove that the “ICU-sound” protocol could
increase diagnostic accuracy on ICU patients (Emilpaolo Manno, 2012).
A quantitative research paradigm was used to conduct the study.
The results or findings of the study show information about quantities. In
other words, the findings are written down and measured in numbers (Emilpaolo Manno, 2012).
The study population consisted out of 125 patients. Table 3
shows the demographic variables of the patient. Table 4 provides us with
information about the distribution of admitting diagnoses and SAPS II scores.
The collected data were subdivided into three categories. The distribution of
the abnormal findings is reported in Table 5. Illustrated in Table 6 is the number
of pathological findings observed as well as the related ICU morality (Emilpaolo Manno, 2012).
The data of the findings is in numerical form such as statistics
and percentages and therefore we conclude to say that the study used a
quantitative research paradigm (Emilpaolo Manno, 2012).
The following two ultrasound systems were used to collect
data for the research study:
CX50(Philips Healthcare, Andover,MA) equipped with a 3-12 MHz
linear probe, a 1-5 MHz sector probe, and a 1-5 MHz convex probe.
Philips EnVisor C HD (Philips Healthcare) equipped a with a
5-8 MHz micro-convex probe, a 2-4 MHz sector probe and a 2-5 MHz convex probe.
(Emilpaolo Manno, 2012)
Relation between research
instruments and hypothesis
The tools/instruments are used in the ICU-sound protocol
examinations of the optic nerve, chest, heart, abdomen and venous system.
The 3-12 MHz linear probe can be used for the optic nerve
ultrasound examination because the optic nerve sheath diameter is measured 3 mm
posterior to the papilla (Ophthalmol, 2002). The 3-12 MHz Linear probe is suitable
for imaging of the thoracic walls (Mathis, 2017). A 2-5 MHz convex probe can be used to
penetrate the lung for sufficient depth (Mathis, 2017). For the heart, a 1-5 MHz sector probe
can be used to perform a goal directed transthoracic echocardiography because,
the typical frequency range for adult echo of the heart is 1-5 MHz (Beraud, n.d.). The 1-5 MHz convex
probe can be used to view 6 abdominal areas (Anon., 2018)
Therefore, the research tools/instruments have bearing on the
research hypothesis for the study. Figure 1 below
show how the instrumentation are used to collect data to eventually make
conclusions and prove the hypothesis.
Fig. 1. (A) Chest radiograph suggested a pleural effusion (1); (B)
ultrasonography evidenced a small pleural effusion (2) and an important lung
consolidation (3) (Emilpaolo Manno, 2012).
Interpretation of findings
The findings of the study suggest that the “ICU-sound” protocol
hold potential for improving healthcare quality. I agree because the study
found that ultrasound examinations revealed a high prevalence of unsuspected
clinical abnormalities like optic sheath enlargement, anterior pneumothorax (not
detected by a supine anteroposterior chest radiograph) and deep venous
thrombosis. Therefore I agree with the interpretation of the findings since the
use of the “ICU –sound” protocol will lead to better diagnosis of ICU patients
ensuring better healthcare quality. (Emilpaolo Manno, 2012)
Relation between the findings and the
The findings of the study reveals that the usage of ultrasound
on ICU patients can detect more clinical abnormalities than other imaging
modalities and therefore providing a more accurate patient diagnosis. The
findings of the study relate to the hypothesis which states that the
“ICU-sound” protocol could rise diagnostic accuracy. Therefore the hypothesis
is stated as true. (Emilpaolo Manno, 2012)
The “ICU-sound” protocol can be achieved by the attending ICU
doctor with a nominal risk of misinterpretation or overuse. Furthermore, the
use of ultrasound in the ICU could be advanced by making ultrasonography a
standard routine of intensive care training during internship. The researcher
recommend by using this ultrasound protocol will improve healthcare quality. (Emilpaolo Manno, 2012)
Firstly, the study proved to the
reader that ultrasound examinations reveals a high prevalence of unsuspected
clinical abnormalities. Furthermore, we can see that new ultrasound
abnormalities were mostly detected in patients with septic shock. The study
provided us with evidence that the “ICU-sound” protocol can be used in the
intensive care unit to make accurate diagnoses and avoid misinterpretations.
Finally, the “ICU-sound” protocol holds significant potential to improve
everyday healthcare quality. (Anon., 2016)
ultrasound in the intensive care unit: A new role for an aged technique
The introduction of the article orientates the reader of
the research article as it clearly states in the introduction that ultrasound
is an aged technique, introduced in the 1950s, but its many applications in the
intensive care unit became apparent recently. Furthermore, the introduction
outline that the philosophy of whole-body ultrasound will be adapted to the
intensive care setting.
Important aspects about the research include the unique management
of critically sick patients that require quick and safe diagnostic techniques. Firstly,
ultrasonography has revolved into a fundamental apparatus that supplements
physical examination in the intensive care unit. It empowers early
acknowledgment of neurological crises, helps the analysis of lung and abdominal
pathologies, and gives continuous data on the cardiac execution of critically sick
patients. Moreover, it detects infectious sites and make therapeutic invasive
procedures more useful and easier to use.
The research states that ultrasonography is an effective
apparatus to be used by modern professionals. In conclusion, whole-body
ultrasound in the hands of trained professionals can revive the physical
examination, without subjecting the patient to exorbitant irradiation and the
dangers of patient transport.