The INSIGHT Feasibility Study Ultrasound in the Intensive Care Unit: A Randomised Controlled Feasibility Trial (INSIGHT)
Critical Illness, Cardiac Complication, Pleural Effusion
About this trial
This is an interventional diagnostic trial for Critical Illness
Eligibility Criteria
Patient Inclusion Criteria:
- Patients 18 years of age or more
- Critically ill patient requiring level 2/3 care
- Provides consent to participate (or consent given by substitute decision maker)
- Anticipated to be admitted to ICU for at least 72 hours from time of admission
Patient Exclusion Criteria:
Injuries that prevent probe positioning:
- Dressings that restrict the INSIGHT window views
- Flail chest
- Other unstable fractures that might prevent scanning
- Open abdominal/thorax wounds
- Surgical emphysema
- Uncontrolled agitation or pain: this will make scanning more challenging and affect image acquisition
- Clinical instability requiring prioritisation of stabilising or resuscitative care
- Allergy to ultrasound gel
- Anticipated withdrawal of care in the next 24 hours
Staff Inclusion Criteria
i. Nurse, ACCP, physiotherapist, or doctor ii. Completion of an advanced course in ICU nursing, ACCP course, ICU physiotherapy or medicine iii. Working in a participating ICU for a minimum of 6 months before enrolment on training course iv. Competent or undergoing training in the INSIGHT Scan
ICU staff exclusion criteria
i. Any injuries or musculoskeletal conditions that would be exacerbated by performing ultrasound ii. On rotation or planning on leaving ICU role in 6 or less months
Sites / Locations
- King's College Hospital NHS Foundation Trust
Arms of the Study
Arm 1
Arm 2
No Intervention
Experimental
Standard care
Standard care + the INSIGHT intervention
Thirty patients will receive standard care (regular ICU treatment without any restriction to usual medical care). INSIGHT scans will not be performed on these patients. However, other forms of ultrasound scanning will be permitted in this group. For example, departmental ultrasound scans (full echocardiography, liver, or vascular ultrasound assessment); transoesophageal echocardiography; transcranial doppler; any form of PoCUS other than the INSIGHT scan.
Thirty patients will receive standard care + the INSIGHT intervention. The INSIGHT intervention is described in detail in section 5.7.1. INSIGHT scans will be performed by staff trained in the INSIGHT Training and Competency Programme on days 1 (0-36 hours), 3 (72-96 hours) and 7 (6 to 8 days) from ICU admission. Scans will only be performed at these timepoints if the patient is still admitted to the ICU.