Point-of-Care Lung Ultrasound in Critically ill Patients

Shrestha, Gentle Sunder; Weeratunga, Dameera; Baker, Kylie

doi:10.2174/1574887112666170911125750

Cited by 42 publications

(39 citation statements)

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“…This demonstrates that it only takes a few minutes for patients with COVID-19 to undergo a bedside ultrasound examination and that such examinations are easy to perform without increasing the risk of infection for the examining physician. Moreover, the application of the LUS score for assessing the severity of diseases such as ARDS and severe pneumonia has been clinically approved [15,16]. Based on US signs and score methods that can quantify the extent of lung lesions, the LUS score can show the progression of lung lesions.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound

et al. 2020

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Purpose This study was conducted to explore the clinical value of noninvasive assessment of bedside ultrasound in the diagnosis of lung lesions of Coronavirus Disease-19. Methods In this retrospective study, 30 patients with Coronavirus Disease-19 admitted to our hospital from January 18 to February 5, 2020, were selected as the research subjects. All cases were examined by lung ultrasound and CT. Lung lesions were reviewed by blinded observers, with imaging scores being used to analyze the ultrasound findings of lung lesions in patients with Coronavirus Disease-19 and with chest CT being used as the reference standard. The clinical value of ultrasound in the noninvasive assessment of lung lesions was evaluated. Results Lung ultrasound signs in patients with Coronavirus Disease-19 were mainly manifested as interstitial pulmonary edema (90.0 %, 27/30) and pulmonary consolidations (20.0 %, 6/30). The lung lesions were mainly distributed in the subpleural and peripheral pulmonary zones. The lower lobe and the dorsal region had a greater tendency to be involved. There was moderate agreement (Kappa = 0.529) between the noninvasive assessment of bedside ultrasound for lung lesions in patients with Coronavirus Disease-19 and CT. The ultrasound scores to evaluate mild, moderate and severe lung lesions exhibited sensitivity of 68.8 % (11/16), 77.8 % (7/9), 100.0 % (2/2), specificity of 85.7 % (12/14), 76.2 % (16/21), 92.9 % (26/28), and diagnostic accuracy of 76.7 % (23/30), 76.7 % (23/30), 93.3 % (28/30), respectively. The follow-up dynamic ultrasound examination showed that the condition of all patients worsened gradually, with the ultrasound scores of lung lesions increasing to varying degrees. Conclusion Though the diagnostic efficacy of bedside ultrasound is relatively low for mild to moderate patients, it is high for severe patients. Bedside ultrasound has important clinical significance for noninvasive assessment and dynamic observation of lung lesions in patients with Coronavirus Disease-19, which is worth further consideration.

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Section: Discussionmentioning

confidence: 99%

A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound

et al. 2020

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“…Chest X-ray and CT are other diagnostic methods that are frequently used for the assessment of pulmonary edema. However, previous studies have suggested that LUS is superior to chest X-ray and comparable to chest CT scan for diagnosing pulmonary edema [3,8]. Therefore, we decided not to use these modalities as a reference standard and only included a sensitivity analysis of chest X-ray.…”

Section: Limitationsmentioning

confidence: 99%

“…Crepitations and rhonchi can be present in patients with pulmonary edema [1]. In recent years, clinicians have started to consider lung ultrasound (LUS) as a useful diagnostic tool for a variety of pulmonary pathologies [2][3][4]. An increasing body of evidence supports the use of LUS in diagnosing pulmonary edema and/or pneumonia [5].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have shown the diagnostic value of LUS in patients with dyspnea or specific diagnoses, such as pneumothorax, high-altitude pulmonary edema, and cardiogenic pulmonary edema [6][7][8][9][10]. LUS has even been suggested to be superior to chest radiography (X-ray) and comparable to chest computed tomography (CT) scan for the diagnosis of pulmonary edema and increased alveolar fluid (commonly referred to as interstitial syndrome) [3,8]. However, few studies have compared LUS to pulmonary auscultation, even while the stethoscope still constitutes the majority of contemporary practice [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill

et al. 2020

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Background: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. Methods: This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. Results: The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in nonventilated than in ventilated patients. Conclusion: The agreement between lung ultrasound and auscultation is poor.

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“…There is an added need to mobilize patients for CT and expose them to higher radiation, in addition to poor repeatability and high cost [ 7 , 8 ]. A superior imaging option is lung ultrasound, which has many advantages, including easy bedside accessibility and reproducibility without invasive and radiative features [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Pneumoperitoneum-induced pneumothorax during laparoscopic living donor hepatectomy: a case report

et al. 2020

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Background We present a living donor case with an unexpected large-volume pneumothorax diagnosed using lung ultrasound during a laparoscopic hepatectomy for liver transplantation (LT). Case presentation A 38-year-old healthy female living donor underwent elective laparoscopic right hepatectomy. The preoperative chest radiography (CXR) and computed tomography images were normal. The surgery was uneventfully performed with tolerable CO2 insufflation and the head-up position. SpO2 decreased and airway peak pressure increased abruptly after beginning the surgery. There were no improvements in the SpO2 or airway pressure despite adjusting the endotracheal tube. Eventually, lung ultrasound was performed to rule out a pneumothorax, and we verified the stratosphere sign as a marker for the pneumothorax. The surgeon was asked to temporarily hold the surgery and cease with the pneumoperitoneum. Portable CXR verified a large right pneumothorax with a small degree of left lung collapse; thus, a chest tube was inserted on the right side. The hemodynamic parameters fully recovered and were stable, and the surgery continued laparoscopically. The surgeon explored the diaphragm and surrounding structures to detect any defects or injuries, but there were no abnormal findings. The postoperative course was uneventful, and a follow-up CXR revealed complete resolution of the two-sided pneumothorax. Conclusion This living donor case suggests that a pneumothorax can occur during laparoscopic hepatectomy due to the escape of intraperitoneal CO2 gas into the pleural cavity. Because missing the chance to identify a pneumothorax early significantly decreases the safety for living donors, point-of-care lung ultrasound may help attending physicians reach the final diagnosis of an intraoperative pneumothorax more rapidly and to plan the treatment more effectively.

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Point-of-Care Lung Ultrasound in Critically ill Patients

Abstract: Bedside lung ultrasound in critically ill patients can serve as a tool to diagnose common lung pathologies, monitor its course and guide clinical management.

Cited by 42 publications

References 0 publications

A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound

A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound

Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill

Pneumoperitoneum-induced pneumothorax during laparoscopic living donor hepatectomy: a case report

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