Could chest ultrasonography replace routine chest X-rays in mechanically ventilated patients?

Abstract

Background: Although conventional chest radiography remains the first routine radiologic examination in mechanically ventilated patients, chest ultrasound provides more accurate information, with less ionizing radiation and less time delay.Objective: To compare between sensitivity of chest ultrasound and routine daily chest X-ray in diagnosis and follow up of diseases in mechanically ventilated patients admitted at Respiratory ICU of the Ain Shams University Hospital.Design:The study was carried out as a prospective analytical study.Patients and methods: The study was conducted upon twenty-five mechanically ventilated patients (16 male patients and 9 female patients), with a mean age of 58.8 years (SD ± 15.64) who were admitted at the Respiratory Intensive Care Unit of the Ain Shams University Hospital during the period from October 2012 to May 2013. Chest ultrasound examination was done for patients on mechanical ventilation on the first day of enrollment prior to seeing their chest Xray, then follow up daily chest ultrasound examination was done over the entire period of mechanical ventilation with comparison of examination results with that of chest X-ray.Results: Initial chest ultrasound was more sensitive in the detection of pleural effusion (40% of cases) than chest X-ray (8% of cases). This superiority of chest ultrasound over chest X-ray persisted in follow up studies (44%, 8% respectively). As regards consolidation, there was no statistically significant difference between chest ultrasound (consolidation was detected in 16 out of 25 cases) and chest X-ray (consolidation was detected in 15 out of 25 cases) in the initial studies, and also along the follow up period, chest ultrasound detected consolidation in 17/25 patients, while CXR detected consolidation in 18/25 patients.

The Diagnostic Performance of Chest Ultrasonography in the Up-to-date Workup in Patients with Chest Diseases

“…diffuse parenchymal lung infection) or may act as a guide for the following diagnostic or therapeutic options [e.g. computed tomography (CT), bronchoscopy, or thoracentesis] [11]. Rather than CT, chest US is non-invasive and does not utilize radiation and contrast materials.…”

“…Rather than CT, chest US is non-invasive and does not utilize radiation and contrast materials. At long last, portable US permits patient assessment at bed side and can be repeated when needed without significant side effects [11].…”

“…An adjustment to the gain and profundity of a convex abdominal (3.5 MHz) sample can be used. Practitioners can also use a linear HF US (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) or a cardiac sample [5].…”

Diagnostic Value of Lung Ultrasound Versus Chest X-Ray in Surgical ICU Patients Alrefaey K Alrefaey, Ahmed S Marwa, Yassen M Amr, Zaghloul A Amgad

“…Despite lung CT is the gold standard for chest radiology, decision to perform the test must be balanced against the risk of patient transfer and the high radiation exposure. CT is mostly considered when inherent limitations of CXR result in unclear diagnosis (4,12) . Consequently, chest X ray was used for screening, diagnosis and follow up of pulmonary complications in critically ill patients especially if attached to ventilator (5) .…”

“…In addition to the above clinical conditions, LUS was employed and compared to CXR for the assessment of pneumothorax, pulmonary edema, and ARDS (12,15,(27)(28)(29) . Based on the high efficacy of LUS in the diagnosis of pneumothorax, the Eastern Association for the Surgery of Trauma gave a level 2 recommendation for the use of ultrasound to identify traumatic pneumothorax in its practice management guidelines (30) .…”