Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome

Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol

“…, 15 , 22 Interested emergency physicians subsequently simplified and transferred the technique to selected emergency presentations, using the more ubiquitous curved abdominal (3–5MHz) probe 2 5 – 7 , 23 , 24 At this point, controversy has arisen, with some groups recommending the extended tangential view of pleura7,23,25and others a longitudinal view that includes a rib shadow, counting B‐lines within a single interspace2 or in the whole field 5 …”

“…The protocol is used in recent studies, 2 , 5 – 7 with minor adaptions to suit the resources 5 . Probe placement on the chest wall is illustrated in Figure 1 in the next article.…”

“…This protocol has been tested in exclusive groups with high rates of pulmonary oedema 2 – 7 but has yet to be challenged by a widened spectrum of disease. If specificity remains high it can guide diuresis and non‐invasive ventilation in the acutely ill, and if sensitivity is better than current measures it may reduce unnecessary investigation or inappropriate medical therapy in the elderly.…”

“…Controversy arises between those who seek a test that clearly separates the target condition from background disease, 13 , 14 and pragmatists who accept some imprecision providing that there is improvement on current practice 2 4 , 7 …”

“…Specificity is likely to reduce when the target condition changes from radiographically defined ‘interstitial syndrome’ to the more clinically relevant ‘pulmonary oedema.’ 2 , 4 – 7 , 15 This study challenges the protocol and generates robust test characteristics by using practitioners with varying skill, asking the most relevant question of an inclusive population.…”