Lung ultrasound in critically ill patients: comparison with bedside chest radiography
- 2.6k Downloads
To compare the diagnostic performance of lung ultrasound and bedside chest radiography (CXR) for the detection of various pathologic abnormalities in unselected critically ill patients, using thoracic computed tomography (CT) as a gold standard.
Forty-two mechanically ventilated patients scheduled for CT were prospectively studied with a modified lung ultrasound protocol. Four pathologic entities were evaluated: consolidation, interstitial syndrome, pneumothorax, and pleural effusion. Each hemithorax was evaluated for the presence or absence of each abnormality.
Eighty-four hemithoraces were evaluated by the three imaging techniques. The sensitivity, specificity, and diagnostic accuracy of CXR were 38, 89, and 49% for consolidation, 46, 80, and 58% for interstitial syndrome, 0, 99, and 89% for pneumothorax, and 65, 81, and 69% for pleural effusion, respectively. The corresponding values for lung ultrasound were 100, 78, and 95% for consolidation, 94, 93, and 94% for interstitial syndrome, 75, 93, and 92% for pneumothorax, and 100, 100, and 100% for pleural effusion, respectively. The relatively low sensitivity of lung ultrasound for pneumothorax could be due to small number of cases (n = 8) and/or suboptimal methodology.
In our unselected general ICU population lung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT.
KeywordsIntensive care unit Ultrasonography Pneumothorax Pleural effusion Consolidation Interstitial syndrome
- 6.Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q, Grenier P (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS severity score: CT Scan ARDS Study Group. Intensive Care Med 26:1046–1056PubMedCrossRefGoogle Scholar
- 16.Volpicelli G (2011) Sonographic diagnosis of pneumothorax. Intensive Care Med 37:224–232Google Scholar
- 26.Galbois A, Ait-Oufella H, Baudel JL, Kofman T, Bottero J, Viennot S, Rabate C, Jabbouri S, Bouzeman A, Guidet B, Offenstadt G, Maury E (2010) Pleural ultrasound compared to chest radiographic detection of pneumothorax resolution after drainage. Chest 138:648–655Google Scholar