Current practice of lung ultrasonography (LUS) in the diagnosis of pneumothorax: a survey of physician sonographers in Germany

Background. Pneumothorax (PTX) still remains a common cause of morbidity in critically ill and ventilated neonates. At the present time, lung ultrasound (LUS) is not included in the diagnostic work-up of PTX in newborns despite of excellent evidence of reliability in adults. The aim of this study was to compare LUS, chest X-ray (CXR), and chest transillumination (CTR) for PTX diagnosis in a group of neonates in which the presence of air in the pleural space was confirmed. Methods. In a 36-month period, 49 neonates with respiratory distress were enrolled in the study. Twenty-three had PTX requiring aspiration or chest drainage (birth weight 2120 ± 1640 grams; gestational age = 36 ± 5 weeks), and 26 were suffering from respiratory distress without PTX (birth weight 2120 ± 1640 grams; gestational age = 34 ± 5 weeks). Both groups had done LUS, CTR, and CXR. Results. LUS was consistent with PTX in all 23 patients requiring chest aspiration. In this group, CXR did not detect PTX in one patient while CTR did not detect it in 3 patients. Sensitivity and specificity in diagnosing PTX were therefore 1 for LUS, 0.96 and 1 for CXR, and 0.87 and 0.96 for CTR. Conclusions. Our results confirm that also in newborns LUS is at least as accurate as CXR in the diagnosis of PTX while CTR has a lower accuracy.

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“…In adults, the gold standard for PTX diagnosis is CT scan [ 5 , 7 ]. Obviously, this criterion cannot be applied in a neonatal context.…”

Section: Methodsmentioning

confidence: 99%

Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax

Cattarossi

Copetti

Brusa

et al. 2016

Canadian Respiratory Journal

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“…Numerous authors have documented the useful role of LUS in the diagnosis of pneumothorax [8,[14][15][16]. The trauma FAST protocol has been recently augmented, e-FAST, and contains an evaluation for pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

“…Lung ultrasound (LUS) is well-suited for the diagnosis of pneumothorax, yielding better results than conventional chest X-ray [7]. Despite its proven efficacy, controversy regarding diagnostic accuracy continues and there seems to be a narrow knowledge base regarding technical aspects of LUS [8].…”

Section: Introductionmentioning

confidence: 99%

High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous pneumothorax: can we omit X-rays for tube management?

et al. 2015

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High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous 175 1 3 Summary Background Primary spontaneous pneumothorax (PSP) is a common medical condition in the emergency department. Clinically stable patients with large pneumothoraces usually undergo chest tube drainage. During the course of hospital stay, several chest X-rays are ordered at various time points. Because the number of chest X-rays during diagnosis and management of PSP can be quite high and lung ultrasound has a proven efficacy for the assessment of lung re-expansion, we decided to investigate the use of lung ultrasound for the management and decision-making regarding chest drains for PSP.Material and methods A total of 25 patients with PSP were evaluated. A comparison between chest X-rays and lung ultrasound was made at four different time points during patient hospitalization (T1-immediately after drainage, T2-third or fourth post-drainage day, T3-before chest tube removal, T4-after chest tube removal). The rate of agreement between the two investigations was analyzed, as their result impacts decision-making regarding chest tube management and removal.Results Overall, positive and negative agreements were high in all time points, except time point 3. Calculated p values using Fisher's and Barnard's test were also good for time points 1, 2, and 4 (< 0.05).Conclusions For all time points except the third, we can safely reject the null hypothesis, thereby arriving at the conclusion that lung ultrasound can substitute chest X-rays after tube drainage of PSP.

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“…Previous studies assessed the implementation of POCUS in critical care [ 5 , 8 – 10 ]. Methodologies for collecting data were varied: while some authors applied electronic mailing and waited for spontaneous return, or based their findings on self-reported previous experience, others adopted cross-sectional epidemiological sampling consisting of punctual observations [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasonography in Brazilian intensive care units: a national survey

Pellegrini

Cordioli

Grumann

et al. 2018

Ann. Intensive Care

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BackgroundPoint-of-care ultrasonography (POCUS) has recently become a useful tool that intensivists are incorporating into clinical practice. However, the incorporation of ultrasonography in critical care in developing countries is not straightforward.MethodsOur objective was to investigate current practice and education regarding POCUS among Brazilian intensivists. A national survey was administered to Brazilian intensivists using an electronic questionnaire. Questions were selected by the Delphi method and assessed topics included organizational issues, POCUS technique and training patterns, machine availability, and main applications of POCUS in daily practice.ResultsOf 1533 intensivists who received the questionnaire, 322 responded from all of Brazil’s regions. Two hundred and five (63.8%) reported having access to an ultrasound machine dedicated to the intensive care unit (ICU); however, this was more likely in university hospitals than in non-university hospitals (80.6 vs. 59.6%; risk ratio [RR] = 1.35 [1.16–1.58], p = 0.002). The main applications of POCUS were ultrasound-guided central vein catheterization (49.4%) and bedside echocardiographic assessment (33.9%). Two hundred and fifty-eight (80.0%) reported having at least one POCUS-trained intensivist in their staff (trained units). Trained units were more likely to perform routine ultrasound-guided jugular vein catheterization than non-trained units (38.6 vs. 16.4%; RR = 2.35 [1.31–4.23], p = 0.001). The proportion of POCUS-trained intensivists and availability of a dedicated ultrasound machine were both independently associated with performing ultrasound-guided jugular vein catheterization (RR = 1.91 [1.32–2.77], p = 0.001) and (RR = 2.20 [1.26–3.29], p = 0.005), respectively.ConclusionsA significant proportion of Brazilian ICUs had at least one intensivist with POCUS capability in their staff. Although ultrasound-guided central vein catheterization constitutes the main application of POCUS, adherence to guideline recommendations is still suboptimal.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0397-3) contains supplementary material, which is available to authorized users.

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Current practice of lung ultrasonography (LUS) in the diagnosis of pneumothorax: a survey of physician sonographers in Germany

Cited by 5 publications

References 6 publications

Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax

Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax

High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous pneumothorax: can we omit X-rays for tube management?

Point-of-care ultrasonography in Brazilian intensive care units: a national survey

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