Ultrassom pulmonar em pacientes críticos: uma nova ferramenta diagnóstica

Neto, Felippe Leopoldo Dexheimer; Dalcin, Paulo de Tarso Roth; Teixeira, Cassiano; Beltrami, Flávia Gabe

doi:10.1590/s1806-37132012000200015

Cited by 25 publications

(10 citation statements)

References 28 publications

(72 reference statements)

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“…Indeed, bedside LUS has been shown to have superior accuracy when evaluating patients with atelectasis, pneumothorax, pneumonia, or acute respiratory distress syndrome, compared with chest X-ray. ( 2 , 4 , 9 , 14 , 21 )…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients,

et al. 2015

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Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.

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Section: Discussionmentioning

confidence: 99%

“…A B profile characterized by symmetric bilateral B-lines suggested hemodynamic lung edema. ( 3 , 9 , 15 ) However, B-line predominance without lung sliding could also be suggestive of pneumonia.…”

Section: Study Design and Lus Assessmentmentioning

confidence: 99%

Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients,

et al. 2015

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“…Various imaging technologies have emerged to help clinicians diagnose patient condition. These technologies, such as EIT [ 174 ], ultrasound [ 175 – 177 ], or low dose CT [ 178 ], provide potential means to measure lung condition. These imaging techniques are comparatively non-invasive, and can be applied frequently in MV patients to potentially improve MV delivery.…”

Section: The Path Forward For Mechanical Ventilation and The Role Of mentioning

confidence: 99%

Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation

et al. 2018

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BackgroundMechanical ventilation is an essential therapy to support critically ill respiratory failure patients. Current standards of care consist of generalised approaches, such as the use of positive end expiratory pressure to inspired oxygen fraction (PEEP–FiO2) tables, which fail to account for the inter- and intra-patient variability between and within patients. The benefits of higher or lower tidal volume, PEEP, and other settings are highly debated and no consensus has been reached. Moreover, clinicians implicitly account for patient-specific factors such as disease condition and progression as they manually titrate ventilator settings. Hence, care is highly variable and potentially often non-optimal. These conditions create a situation that could benefit greatly from an engineered approach. The overall goal is a review of ventilation that is accessible to both clinicians and engineers, to bridge the divide between the two fields and enable collaboration to improve patient care and outcomes. This review does not take the form of a typical systematic review. Instead, it defines the standard terminology and introduces key clinical and biomedical measurements before introducing the key clinical studies and their influence in clinical practice which in turn flows into the needs and requirements around how biomedical engineering research can play a role in improving care. Given the significant clinical research to date and its impact on this complex area of care, this review thus provides a tutorial introduction around the review of the state of the art relevant to a biomedical engineering perspective.DiscussionThis review presents the significant clinical aspects and variables of ventilation management, the potential risks associated with suboptimal ventilation management, and a review of the major recent attempts to improve ventilation in the context of these variables. The unique aspect of this review is a focus on these key elements relevant to engineering new approaches. In particular, the need for ventilation strategies which consider, and directly account for, the significant differences in patient condition, disease etiology, and progression within patients is demonstrated with the subsequent requirement for optimal ventilation strategies to titrate for patient- and time-specific conditions.ConclusionEngineered, protective lung strategies that can directly account for and manage inter- and intra-patient variability thus offer great potential to improve both individual care, as well as cohort clinical outcomes.

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“…Suggestion - Chest ultrasound can be used to estimate alveolar re-aeration in patients treated for VAP, to assess pulmonary edema, to detect post-extubation atelectasis, and to estimate PEEP-induced pulmonary recruitment. ( 101 - 103 )…”

Section: Monitoring the Patient Under Ventilatory Supportmentioning

confidence: 99%

“…Sugestão - Pode ser utilizada para estimar reaeração alveolar em pacientes tratados para pneumonia associada a VM, avaliação de edema pulmonar, para detectar atelectasia pós-extubação e para estimar o recrutamento pulmonar induzido por PEEP. ( 101 - 103 )…”

Section: Monitorização Do Paciente Com Suporte Ventilatóriounclassified

Brazilian recommendations of mechanical ventilation 2013. Part I

2014

J. bras. pneumol.

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Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

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Ultrassom pulmonar em pacientes críticos: uma nova ferramenta diagnóstica

Cited by 25 publications

References 28 publications

Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients,

Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients,

Biomedical engineer’s guide to the clinical aspects of intensive care mechanical ventilation

Brazilian recommendations of mechanical ventilation 2013. Part I

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