Fast differential diagnostics of acute respiratory insufficiency using ultrasound
Authors:
V. Zoľák 1; S. Nosáľ 1; B. Zoľáková 2; M. Minárik 3; H. Poláček 4
Authors‘ workplace:
Klinika detskej anestéziológie a intenzívnej medicíny JLF UK a UNM, Martin, Slovenská republika
1; Neonatologická klinika JLF UK a UNM, Martin, Slovenská republika
2; Klinika anestéziológie a intenzívnej medicíny JLF UK a UNM, Martin, Slovenská republika
3; Rádiologická klinika JLF UK a UNM, Martin, Slovenská republika
4
Published in:
Anest. intenziv. Med., 26, 2015, č. 6, s. 333-341
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
Lung ultrasound (LUS) is a modern alternative method for imaging the lungs that can be used in intensive care units not only for fast differential diagnosis of acute respiratory insufficiency but also for dynamic monitoring of the lungs. Our aims were: To validate the usability of LUS in healthy and critically ill children, to find out if there is a difference in the LUS image between non-ventilated and ventilated patients; to analyze time to diagnosis by lung auscultation, chest X-ray and lung ultrasound; to perform inter-observer analysis of these methods and to calculate the sensitivity and specificity of LUS for selected diseases.
Design:
Prospective clinical study.
Setting:
Paediatric intensive care unit of a university hospital.
Materials and methods:
Total 135 children were included in this study. Group I consisted of 45 critically ill children with respiratory insufficiency, Group II included 90 children without respiratory pathology. Times to disease diagnosis by auscultation, chest X-ray and LUS were recorded.
Results:
“Physiological” variants of the B-lines were detected in about 30% of children in Group II. We did not find any significant difference between artifact occurrence in ventilated and non-ventilated children (concordance 95%, κ coefficient 0.9). We determined a statistically significant difference in time to diagnosis by the different diagnostic methods (p < 0.001). Time to diagnosis by auscultation and LUS positively correlated with present lung pathology and negatively correlated with the age of the child. In inter-observer analysis of the three methods we stated inferior concordance of both auscultation and X-ray compared with LUS. We also calculated the sensitivity and specifity in selected diagnoses – i.e. pneumonia (94.7% and 98%, respectively) with the best values achieved using LUS.
Conclusion:
Lung ultrasound is a reliable method for differential diagnostics of acute respiratory insufficiency.
Keywords:
lung ultrasound – acute respiratory insuficiency – bedside diagnostics – critically ill children – pneumonia – ARDS – bronchiolitis – lung contusions – lung atelectasis
Sources
1. Lichtenstein, D. et al. Comparative diagnostic performances of auscultation, chest radiography and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology, 2004, 100, p. 9–15.
2. Mayo, P. et al. ACCP/SRLF (American College of Chest Physicians/La Société de Réanimation de Langue Française) Statement on competence in critical care ultrasonography. Chest, 2009, 4, p. 1050–1060.
3. Tomà, P., Owens, C. Chest ultrasound in children: critical appraisal. Pediatr Radiol., 2013, 43, p. 1427–1434.
4. Bekemeyer, W. B. Efficacy of chest radiography in a respiratory intensive care unit. A prospective study. Chest, 1985, 88, 5, p. 691–696.
5. Rouby, J. J. et al. Mechanical ventilation in patients with ARDS. Anesthesiology, 2004, 101, p. 228–234.
6. Xirouchaki, N. et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med., 2011, 37, 9, p. 1488–1493.
7. Mong, A. et al. Ultrasound of the pediatric chest. Pediatr. Radiol., 2012, 42, p. 1287–1297.
8. Webb, W. R. Thin-section CT of the secondary pulmonary lobule: anatomy and the image-the 2004 Eleischner lecture. Radiology, 2006, 239, p. 322–338.
9. Lichtenstein, D., Mezičre, G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUEprotocol. Chest, 2008, 134, p. 117–210.
10. Cibinel, G. A. et al. Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department. Intern. Emerg. Med., 2012,17, p. 65–70.
11. Volpicelli, G., Elbarbary, M., Blaivas, M., Lichtenstein, D. A., Mathis, G. International evidence-based recommendations for point-of-care lung ultrasound. International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). Intensive Care Med., 2012, 38, 4, p. 577.
12. Zanobetti, M., et al. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest, 2011, 139, p. 1140–1147.
13. Zechner, P. M. et al. Lung ultrasound in acute and critical care medicine. Anaesthesist, 2012, 61, 7, p. 608–617.
14. Lichtenstein, D., Courret, J. P. Feasibility of ultrasound in the helicopter. Intensive Care Med., 1998, 4, p.1119.
15. Lichtenstein, D. Lung ultrasound: a method of the future in intensive care? Rev. Pneumol. Clin., 1997, 53, p. 63–68.
16. Gargani, L., Volpicelli, G. How I do it: Lung ultrasound. Cardiovascular Ultrasound, 2014, 4, 12, p. 25.
17. Lichtenstein, D. Whole Body Ultrasonography in the Critically Ill. 2. vyd. Springer-Verlag Berlin Heidelberg, 2010, ISBN: 978-3-642-05327-6.
18. Cortellaro, F. et al. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg. Med. J., 2012, 29, p. 19–23.
19. Arberlot, C. H. et al. Lung ultrasound in acute respiratory distress syndrome and acute lung injury. Cur. Opin. Crit. Care, 2008, 14, p. 70–74.
20. Chavez, M. A. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir. Res., 2014, 23, 15, p. 50.
21. Caiulo, V.A. et al. Lung ultrasound in bronchiolitis: comparison with chest x-ray. Eur. J. Pediatr., 2011, 170, p. 1427–1433.
22. Copetti, R., Cattarossi, L. Ultrasound diagnosis of pneumonia in children. Radiol. Med., 2008, 113, p. 190–198.
23. Iuri, D. et al. Evaluation of the lung in children with suspected pneumonia: usefulness of ultrasonography. Radiol. Med., 2009, 114, p. 321–330.
24. Harris, M. et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax, 2011, 66, p. 23.
25. Blaivas, M. et al. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad. Emerg. Med., 2005, 12, 9, p. 844–849.
26. Volpicelli, G. Sonographic diagnosis of pneumothorax. Intensive Care Med., 2011, 37, p. 224–232.
27. Scaife, E. R. et al. Use of focused abdominal sonography for trauma at pediatric and adult trauma centers: a survey. J. Pediatr. Surg., 2009, 44, p. 1746–1749.
28. Soldati, G. et al. Chest ultra-sonography in lung contusion. Chest, 2006, 130, p. 533–538.
29. Rocco, M. et al. Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma. Acta Anaesthesiol. Scand., 2008, 52, p. 776–784.
30. Hyacinthe, A. C. et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest, 2012, 141, p. 1177–1183.
31. Acosta, C. M. et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology, 2014, 120, 6, p. 1370–1379.
32. Terragni, P. P. et al. Tidal hyperinflation during low tidal volume ventilation in ARDS. Am. J. Respir. Crit. Care Med., 2007, 175, p. 160–166.
33. Rouby, J.J. et al. ARDS: lessons from computed tomography of the whole lung. Crit. Care Med., 2003, 31, S285–S295.
34. Carvalho, A. R. et al. Positive end.expiratory pressure at minimal respiratory elastance corresponds to the best compromise between mechanical stress and lung aeriation in oleic acid-induced lung injury. Crit. Care, 2007, 11, R86.
35. Bouhemad, B. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am. J. Respir. Crit. Care Med., 2011, 183, p. 341–347.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2015 Issue 6
Most read in this issue
- Echocardiographic evaluation of the aortic valve in the unstable patient – basic considerations
- Fast differential diagnostics of acute respiratory insufficiency using ultrasound
- Can we decrease incidence of postoperative delirium in children by changing premedication?
- Effect of implementation of a new preventive measure bundle on the incidence of ventilator associated pneumonia