Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.
Objective In clinical intensive care practice, weaning from mechanical ventilation is
accompanied by concurrent early patient mobilization. The aim of this study was to
compare the success of extubation performed with patients seated in an armchair
compared to extubation with patients in a supine position.Methods A retrospective study, observational and non-randomized was conducted in a
mixed-gender, 23-bed intensive care unit. The primary study outcome was success of
extubation, which was defined as the patient tolerating the removal of the
endotracheal tube for at least 48 hours. The differences between the study groups
were assessed using Student's t-test and chi-squared
analysis.Results Ninety-one patients were included from December 2010 and June 2011. The study
population had a mean age of 71 years ± 12 months, a mean APACHE II score of
21±7.6, and a mean length of mechanical ventilation of 2.6±2 days. Extubation was
performed in 33 patients who were seated in an armchair (36%) and in 58 patients
in a supine position (64%). There were no significant differences in age, mean
APACHE II score or length of mechanical ventilation between the two groups, and a
similar extubation success rate was observed (82%, seated group versus 85%, supine
group, p>0.05). Furthermore, no significant differences were found between the
two groups in terms of post-extubation distress, need for tracheostomy, duration
of mechanical ventilation weaning, or intensive care unit stay.Conclusion Our results suggest that the clinical outcomes of patients extubated in a seated
position are similar to those of patients extubated in a supine position. This new
practice of seated extubation was not associated with adverse events and allowed
extubation to occur simultaneously with early mobilization.
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