Absence of lung sliding is not a reliable sign of pneumothorax in patients with high positive end-expiratory pressure

Markota, Andrej; Golub, Jerneja; Stožer, Andraž; Fluher, Jure; Prosen, Gregor; Bergauer, Andrej; Svenšek, Franci; Sinkovič, Andreja

doi:10.1016/j.ajem.2016.07.032

Cited by 20 publications

(12 citation statements)

References 12 publications

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“…7 Similarly, this phenomenon also occurs in patients undergoing mechanical ventilation who are receiving high levels of positive end-expiratory pressure. 8 The second mechanism preserves B-lines but can create a visible lung point as well, as was the case with our patient. The presence of air-filled or even solid lesions abutting the visceral pleura (including lung masses, subpleural blebs, or intraparenchymal cysts) can cause this phenomenon.…”

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confidence: 64%

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A Subpleural Cyst Mimicking Pneumothorax

Lanks

2018

J of Ultrasound Medicine

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confidence: 64%

“…Consequently, the specificity of absent apical lung sliding for diagnosing pneumothorax in patients with chronic obstructive pulmonary disease is diminished as well . Similarly, this phenomenon also occurs in patients undergoing mechanical ventilation who are receiving high levels of positive end‐expiratory pressure …”

mentioning

confidence: 99%

A Subpleural Cyst Mimicking Pneumothorax

Lanks

2018

J of Ultrasound Medicine

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“…Lung ultrasonography also provides dynamic information: a severely decreased or abolished lung sliding suggests impaired regional ventilation. This can be associated with high PEEP setting [76], thus suggesting PEEP-induced hyperinflation in non-dependent lung regions, especially if lung sliding reappears when PEEP is decreased [48].…”

Section: Lung Ultrasonography For Management Of the Patient On Mechanmentioning

confidence: 99%

Thoracic ultrasonography: a narrative review

et al. 2019

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This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the "go to" modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.

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“…LUS can easily characterize morphologic features of ARDS [ 20 ], discriminate between focal and diffuse ARDS , and provide a picture of the heterogeneity of aeration distribution [ 21 ]: focal ARDS is characterized by a normal LUS pattern in upper anterior and lateral lung regions and consolidation or B-lines in lower posterior and lateral ones (dependent lung regions in supine position); in diffuse ARDS, which is present in a minority of patients, aeration loss is homogeneously distributed among lung regions, with a diffuse ubiquitous LUS B-pattern. Overdistention cannot be directly measured by LUS and this represents its greatest limitation, although a reduction of physiological lung sliding in anterior regions may be observed when airway pressure is too high [ 22 ].…”

Section: Lung Ultrasound (Lus) Monitoring In the Mechanically Ventilamentioning

confidence: 99%

Combined lung and brain ultrasonography for an individualized “brain-protective ventilation strategy” in neurocritical care patients with challenging ventilation needs

et al. 2018

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When intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may positively or negatively affect intracranial pressure, based on the final repercussions on PaO2 and cerebral perfusion pressure (through changes in cardiac output, mean arterial pressure, venous return, PaO2 and PaCO2), also according to the baseline conditions of cerebral autoregulation. Lung ultrasound (LUS) and brain ultrasound (BUS, as a combination of optic nerve sheath diameter assessment and cerebrovascular Doppler ultrasound) have independently proven their potential in respectively monitoring lung aeration and brain physiology at the bedside. In this narrative review, we describe how the combined use of LUS and BUS on neurocritical patients with demanding mechanical ventilation needs can contribute to ventilation management, with the aim of a tailored “brain-protective ventilation strategy.”

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Absence of lung sliding is not a reliable sign of pneumothorax in patients with high positive end-expiratory pressure

Cited by 20 publications

References 12 publications

A Subpleural Cyst Mimicking Pneumothorax

A Subpleural Cyst Mimicking Pneumothorax

Thoracic ultrasonography: a narrative review

Combined lung and brain ultrasonography for an individualized “brain-protective ventilation strategy” in neurocritical care patients with challenging ventilation needs

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