# Thoracic Ultrasound–Related Management Change: Predictors and the Role of Operator Certification (Secondary Analysis of UltraMAN)

## TL;DR

Thoracic ultrasound often changed how ICU patients were treated, especially for those with heart disease or low blood volume, and not based on operator certification.

## Contribution

Identified patient and ultrasound findings associated with management changes, and found no link to operator certification.

## Key findings

- TUS led to management changes in 44.6% of ICU patients.
- Cardiovascular disease and hypovolemia were significantly associated with management changes.
- Operator certification level did not significantly affect management changes.

## Abstract

To investigate which patient characteristics, ultrasound operator certification level, and thoracic ultrasound (TUS) examination findings are associated with a TUS‐induced change in clinical management in adult intensive care unit (ICU) patients.

Post hoc analysis of a prospective international observational study (UltraMan study) on the impact of thoracic ultrasound on clinical management of critically ill patients. The first TUS examinations of each patient included in the study were included in this analysis. Multivariable logistic regression was performed to identify which patient characteristic(s), operator certification level, or TUS‐related factors were significantly associated with a change in management.

None.

The first TUS examinations of each of the 534 patients were included in this analysis. TUS led to management changes in almost half of the patients in whom a TUS was performed (44.6%). TUS‐induced management changes were significantly associated with patient characteristics. Specifically, a medical history of cardiovascular disease demonstrated a significant association (OR: 1.73; 95% CI: 1.12–2.68). In terms of TUS examination findings, hypovolemia demonstrated a significant association with a change in management (OR: 2.05; 95% CI: 1.10–3.80). No significant association was found between ultrasound operator certification level and changes in management driven by TUS.

This study indicates that TUS was associated with management changes in 44.6% of ICU patients, with stronger associations in those with cardiovascular disease and hypovolemia, and no detectable effect of operator certification in adjusted analyses. As a post hoc analysis of an observational cohort, these findings warrant cautious interpretation and underscore the importance of competency‐based training and quality assurance.

Thoracic ultrasound frequently altered ICU management decisions. Changes were more likely in patients with cardiovascular disease or hypovolemia and occurred independently of operator certification. These findings support the routine use of TUS in critically ill patients, even when performed by less‐experienced but supervised operators.