The diagnostic performance of chest ultrasonography in the up-to-date work-up of the critical care setting

Abstract

Background: Management of patients in the critical care setting is crucial. The availability, the absence of ionizing radiation and the non invasive nature of chest ultrasonography (US) have currently increased its use in the up-to-date work-up of various pleuropulmonary abnormalities in the critical care setting. Objective: To evaluate the sensitivity, specificity and diagnostic accuracy of chest US for various pleuropulmonary abnormalities in intensive care unit (ICU) patients. Materials and methods: Ninety consecutive patients admitted in chest ICU with respiratory distress were assessed clinically and by chest radiography (CXR). They were suspected to have a provisional diagnosis of any of the following pathological entities: pneumonic consolidation, bronchogenic carcinoma, metastatic pulmonary nodules, pleural effusion, pneumothorax, hydropneumothorax and mesothelioma. These patients were scheduled for chest computed tomography (CT) and prospectively reviewed using chest US. The results of chest US were compared with these of chest CT for each encountered pathological entity using chest CT as the diagnostic standard of reference to subsequently calculate the sensitivity, specificity and diagnostic accuracy of chest US. Results: The sensitivity, specificity and diagnostic accuracy of chest US were 100%, 96% and 97% for pneumonic consolidation, 71%, 100% and 98% for bronchogenic carcinoma and 92%, 100% and 99% for pneumothorax respectively. The sensitivity, specificity and diagnostic accuracy of 100% for the rest of the included pathological entities were obtained. Conclusion: Chest ultrasonography has a considerable diagnostic performance for various pleuropulmonary pathological conditions that may be encountered in the ICU patients making it as an adjunct tool in the up-to-date work-up of the ICU setting.

The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review

“…Selection: Recruitment was consecutive and exclusions were reasonable, giving a low risk of selection bias. 21 The aetiological diagnoses in this patient group were restricted to a subgroup of respiratory failure aetiologies, causing high applicability concerns.…”

“…Note different units of analyses which preclude pooling of studies: lung regions (12 per patient) in Lichtenstein et al 2004; 18 lungs (2 per patient) in Lichtenstein et al 2004 19 and Xirouchaki et al 2011; 20 and individual patients in Refaat, Abdurrahman 2013. 21 …”

“…Only one study used the patient as a unit of analysis. 21 A second study 19 used only the lung (two per patient), and a third 18 used only lung regions (12 per patient).…”

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

“…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].…”

Lung ultrasound for severe acute dyspnea evaluation in critical care patients

“…Acute dyspnea is a very common cause of hospitalisation, especially in intensive care units, and it can be precipitated by heart failure, exacerbation of chronic obstructive pulmonary disease, pulmonary embolism, pleural effusions and many other causes. The differentiation of cardiac from non-cardiac causes of dyspnoea poses a huge clinical challenge, since an accurately established diagnosis is the precondition for an adequate therapy, as well as for disease prognosis 1 .…”