OBJECTIVE: The aim of this study was to evaluate a postural change test during sinus ultrasound, compared with CT scan, in case of partial sinusogram to differentiate air-fluid level from mucosal thickening. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit. PATIENTS: 150 intubated patients. INTERVENTIONS: Patients were examined by sinus ultrasound in half-sitting position. A partial sinusogram was defined as the sole visualization of the hyperechogenic posterior wall of the sinus. In this situation, a postural change was performed and ultrasound was achieved in supine position. If the partial sinusogram disappeared when the patient was placed in a supine position (positive test), the partial sinusogram was an air-fluid level. If the partial sinusogram did not disappear (negative test), we considered it as a mucosal thickening. The CT and ultrasound were performed on the same day. Radiological maxillary sinusitis (RMS) on CT was defined as the presence of an air-fluid level. Absence of RMS on CT was defined as normal sinus or as the presence of mucosal thickening. MEASUREMENTS AND RESULTS: 300 sinuses were examined. A partial sinusogram was found in 90 sinuses and CT scan confirmed the presence of RMS in 55 sinuses (61%). Sensitivity, specificity, positive predictive value, and negative predictive value of postural change test compared with CT were, respectively, 94.6, 85.6, 91.2 and 90.9%. The positive predictive value increased from 61 to 91.2% after the postural change test. CONCLUSIONS: In case of a partial sinusogram, a postural change increases the accuracy of ultrasound to diagnose RMS.
OBJECTIVE: The aim of this study was to evaluate a postural change test during sinus ultrasound, compared with CT scan, in case of partial sinusogram to differentiate air-fluid level from mucosal thickening. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit. PATIENTS: 150 intubated patients. INTERVENTIONS:Patients were examined by sinus ultrasound in half-sitting position. A partial sinusogram was defined as the sole visualization of the hyperechogenic posterior wall of the sinus. In this situation, a postural change was performed and ultrasound was achieved in supine position. If the partial sinusogram disappeared when the patient was placed in a supine position (positive test), the partial sinusogram was an air-fluid level. If the partial sinusogram did not disappear (negative test), we considered it as a mucosal thickening. The CT and ultrasound were performed on the same day. Radiological maxillary sinusitis (RMS) on CT was defined as the presence of an air-fluid level. Absence of RMS on CT was defined as normal sinus or as the presence of mucosal thickening. MEASUREMENTS AND RESULTS: 300 sinuses were examined. A partial sinusogram was found in 90 sinuses and CT scan confirmed the presence of RMS in 55 sinuses (61%). Sensitivity, specificity, positive predictive value, and negative predictive value of postural change test compared with CT were, respectively, 94.6, 85.6, 91.2 and 90.9%. The positive predictive value increased from 61 to 91.2% after the postural change test. CONCLUSIONS: In case of a partial sinusogram, a postural change increases the accuracy of ultrasound to diagnose RMS.
Authors: Frédéric Vargas; Hoang Nam Bui; Alexandre Boyer; Cécile Marie Bébear; Stéphane Lacher-Fougére; Bertillle Marie De-Barbeyrac; Louis Rachid Salmi; Louis Traissac; Georges Gbikpi-Benissan; Didier Gruson; Gilles Hilbert Journal: Intensive Care Med Date: 2006-04-14 Impact factor: 17.440
Authors: J J Rouby; P Laurent; M Gosnach; E Cambau; G Lamas; A Zouaoui; J L Leguillou; L Bodin; T D Khac; C Marsault Journal: Am J Respir Crit Care Med Date: 1994-09 Impact factor: 21.405
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Johan Groeneveld; Goran Hedenstierna; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Philipp Metnitz; Jerme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2008-01-31 Impact factor: 17.440