Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia

Abstract

Background: In the setting of a coronary care unit (CCU), the early detection of pneumonia is of paramount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia and compared with chest X-ray (CXR). Method: We enrolled 110 consecutive patients admitted to the CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs. no pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n = 34). Results: The mean age was 70 ± 11 years old, and 68% were males. Pneumonia was clinically diagnosed in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92%, specificity 81%). Chest radiography was positive for pneumonia in nine patients (sensitivity 43%, specificity 95%). Using CT scan as a reference, LUS exhibited 92% sensitivity and a specificity of 96%. In ROC curve analysis, the diagnostic accuracy of CXR and LUS for the diagnosis of pneumonia was 0.86 (95% CI 0.77–0.94), which was higher than CXR 0.68 (95% CI 0.55–0.84), p < 0.05. Conclusion: Based on the findings of the present study, the accuracy of LUS in the detection of pneumonia was significantly higher than chest X-ray with comparable sensibility to CT scan.

Lung ultrasound training: how short is too short? observational study on the effects of a focused theoretical training for novice learners

“…Moreover, we didn’t explore if images’ recognition skills persisted at different time intervals (e.g., after 1 day, 1 week, 1 month). A limited number of basic signs were tested (B-lines and pleural movements), thus excluding other significant lung ultrasound findings as consolidations [ 38 ] or air-bronchogram within consolidations [ 39 ] that help in the diagnosis of pneumonia in the critically ill. Finally, a reference standard for the test was not available (i.e., the total score reported by a sample of experts in the field); however, the clips used for the tests were good quality images, with findings that are considered basic [ 40 ], so the percentage of correct answers by a pool of experts was expected to be near to 100%.…”

Lung ultrasound at discharge predicts outcomes in heart failure: a pilot study

“…In this setting, the cardiac rehabilitation unit further strengthens the importance of not discharging the patient until the best possible decongestion has been achieved. LUS is an easy, feasible, and fast evaluation method that adds significant value to the base characteristics of patients with heart failure 6,7 . The correlation of LUS with eGFR and hemoglobin indicates the ability to select more fragile heart failure patients, like the cardiorenal syndrome phenotype 8 and iron-deficiency phenotype, 9 at higher risk of cardiovascular events.…”

“…LUS is an easy, feasible, and fast evaluation method that adds significant value to the base characteristics of patients with heart failure. 6 , 7 The correlation of LUS with eGFR and hemoglobin indicates the ability to select more fragile heart failure patients, like the cardiorenal syndrome phenotype 8 and iron-deficiency phenotype, 9 at higher risk of cardiovascular events. This is further proved by its correlation with 3-month new-onset or worsening dyspnea.…”