Diagnostic accuracy of portable chest radiograph in mechanically ventilated patients when compared with autopsy findings

Panizo-Alcañiz, Julián; Frutos‐Vivar, Fernando; Thille, Arnaud W.; Peñuelas, Óscar; Aguilar-Rivilla, Eva; Muriel, Alfonso; Rodríguez-Barbero, J.M.; Jaramillo, Carlos; Nín, Nicolás; Esteban, Andrés

doi:10.1016/j.jcrc.2020.06.015

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Third, as high values of pulmonary wedge pressure are commonly observed in patients with ARDS [ 18 , 19 ] and since the routine use of pulmonary artery catheter is pointless for hemodynamic management [ 20 ], the Berlin definition stated that respiratory failure must not be fully explained by cardiac failure of fluid overload as judged by the clinician or confirmed by echocardiography. Fourth, as chest radiographs have only moderate inter-observer reliability [ 21 , 22 ], the Berlin definition considered radiological findings as bilateral opacities not only on chest X-ray, but also on CT-scan. Using the Berlin definition, the large international observational LUNG SAFE study reported that ARDS represented around 10% of ICU admissions and 23% of patients requiring invasive mechanical ventilation [ 8 ].…”

Section: Definition Of Ardsmentioning

confidence: 99%

Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

2021

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Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up.

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Section: Definition Of Ardsmentioning

confidence: 99%

Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

2021

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“…Because of the high prevalence of VAP in intensive care units, plain chest radiographs are often performed to screen for pneumonia in ventilated patients. However, the diagnostic performance of plain radiographs for VAP is poor, with a sensitivity of 24-60%, and specificity of 29-91% [41,42]. This means that plain chest radiographs are insufficiently sensitive to detect VAP.…”

Section: Definition Of Vap/vatmentioning

confidence: 99%

A Narrative Review on the Approach to Antimicrobial Use in Ventilated Patients with Multidrug Resistant Organisms in Respiratory Samples—To Treat or Not to Treat? That Is the Question

et al. 2022

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Multidrug resistant organisms (MDRO) are commonly isolated in respiratory specimens taken from mechanically ventilated patients. The purpose of this narrative review is to discuss the approach to antimicrobial prescription in ventilated patients who have grown a new MDRO isolate in their respiratory specimen. A MEDLINE and PubMed literature search using keywords “multidrug resistant organisms”, “ventilator-associated pneumonia” and “decision making”, “treatment” or “strategy” was used to identify 329 references as background for this review. Lack of universally accepted diagnostic criteria for ventilator-associated pneumonia, or ventilator-associated tracheobronchitis complicates treatment decisions. Consideration of the clinical context including signs of respiratory infection or deterioration in respiratory or other organ function is essential. The higher the quality of respiratory specimens or the presence of bacteremia would suggest the MDRO is a true pathogen, rather than colonization, and warrants antimicrobial therapy. A patient with higher severity of illness has lower safety margins and may require initiation of antimicrobial therapy until an alternative diagnosis is established. A structured approach to the decision to treat with antimicrobial therapy is proposed.

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“…This study suggested a limited diagnostic sensitivity of 0.73, specificity of 0.70, positive and negative predictive values of 0.88 and 0.47. In another study, Julián et al presented a sensitivity of 68% and a specificity of 74%, respectively [ 13 ]. This under-recognition may be attributed to the poor detection of the pulmonary lesions on CXR and its subjective interpretation.…”

Section: Imaging Of Ardsmentioning

confidence: 99%

Advances in medical imaging to evaluate acute respiratory distress syndrome

Huang

Wang

2021

Chin J Acad Radiol

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Acute respiratory distress syndrome is a refractory respiratory syndrome with a high prevalence in the Intensive Care Unit. Though much improvement has been achieved over the last 50 decades, the disease continues to be under-recognized and under-treated, and its mortality remains high. Since the first report, the radiologic examination has been an essential part in evaluating this disease. Chest X-ray radiography and computed tomography are conventional imaging techniques in routine clinical practice. Other image modalities, including lung ultrasound, electrical impedance tomography, positron emission tomography, have demonstrated their respective advantages over recent years but have not yet been broadly applied in clinical practice. Among these modalities, computed tomography and its quantitative analysis have shown an irreplaceable power in diagnosis, intervention evaluation and prognostic prediction. In this review, we briefly introduced the basics of acute respiratory distress syndrome and summarized imaging advances. In addition, we focused on the computed tomography modality and highlighted the value of its quantitative assessment.

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Diagnostic accuracy of portable chest radiograph in mechanically ventilated patients when compared with autopsy findings

Cited by 5 publications

References 31 publications

Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

A Narrative Review on the Approach to Antimicrobial Use in Ventilated Patients with Multidrug Resistant Organisms in Respiratory Samples—To Treat or Not to Treat? That Is the Question

Advances in medical imaging to evaluate acute respiratory distress syndrome

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