Stein Silva1, Caroline Biendel2, Jean Ruiz3, Michel Olivier3, Benoit Bataille4, Thomas Geeraerts5, Arnaud Mari3, Beatrice Riu3, Olivier Fourcade5, Michele Genestal3. 1. Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan; Equipe d'Accueil, MATN, IFR 150, Université Paul Sabatier, Toulouse, France. Electronic address: silvastein@me.com. 2. Pôle Cardiovasculaire et Métabolique, CHU Rangueil. 3. Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan. 4. Pôle Anesthésie-Réanimation, CHU Purpan. 5. Pôle Anesthésie-Réanimation, CHU Purpan; Equipe d'Accueil, MATN, IFR 150, Université Paul Sabatier, Toulouse, France.
Abstract
BACKGROUND: This study investigated the clinical relevance of early general chest ultrasonography (ie, heart and lung recordings) in patients in the ICU with acute respiratory failure (ARF). METHODS: We prospectively compared this diagnostic approach (ultrasound) to a routine evaluation established from clinical, radiologic, and biologic data (standard). Subjects were patients consecutively admitted to the ICU of a university teaching hospital during a 1-year period. Inclusion criteria were age ≥ 18 years and the presence of severe ARF criteria to justify ICU admission. We compared the diagnostic approaches and the final diagnosis determined by a panel of experts. RESULTS: Seventy-eight patients were included (age, 70 ± 18 years; sex ratio, 1). Three patients given two or more simultaneous diagnoses were subsequently excluded. The ultrasound approach was more accurate than the standard approach (83% vs 63%, respectively; P < .02). Receiver operating characteristic curve analysis showed greater diagnostic performance of ultrasound in cases of pneumonia (standard, 0.74 ± 0.12; ultrasound, 0.87 ± 0.14; P < .02), acute hemodynamic pulmonary edema (standard, 0.79 ± 0.11; ultrasound, 0.93 ± 0.08; P < .007), decompensated COPD (standard, 0.8 ± 0.09; ultrasound, 0.92 ± 0.15; P < .05), and pulmonary embolism (standard, 0.65 ± 0.12; ultrasound, 0.81 ± 0.17; P < .04). Furthermore, we found that the use of ultrasound data could have significantly improved the initial treatment. CONCLUSIONS: The use of cardiothoracic ultrasound appears to be an attractive complementary diagnostic tool and seems able to contribute to an early therapeutic decision based on reproducible physiopathologic data.
BACKGROUND: This study investigated the clinical relevance of early general chest ultrasonography (ie, heart and lung recordings) in patients in the ICU with acute respiratory failure (ARF). METHODS: We prospectively compared this diagnostic approach (ultrasound) to a routine evaluation established from clinical, radiologic, and biologic data (standard). Subjects were patients consecutively admitted to the ICU of a university teaching hospital during a 1-year period. Inclusion criteria were age ≥ 18 years and the presence of severe ARF criteria to justify ICU admission. We compared the diagnostic approaches and the final diagnosis determined by a panel of experts. RESULTS: Seventy-eight patients were included (age, 70 ± 18 years; sex ratio, 1). Three patients given two or more simultaneous diagnoses were subsequently excluded. The ultrasound approach was more accurate than the standard approach (83% vs 63%, respectively; P &lt; .02). Receiver operating characteristic curve analysis showed greater diagnostic performance of ultrasound in cases of pneumonia (standard, 0.74 ± 0.12; ultrasound, 0.87 ± 0.14; P &lt; .02), acute hemodynamic pulmonary edema (standard, 0.79 ± 0.11; ultrasound, 0.93 ± 0.08; P &lt; .007), decompensated COPD (standard, 0.8 ± 0.09; ultrasound, 0.92 ± 0.15; P &lt; .05), and pulmonary embolism (standard, 0.65 ± 0.12; ultrasound, 0.81 ± 0.17; P &lt; .04). Furthermore, we found that the use of ultrasound data could have significantly improved the initial treatment. CONCLUSIONS: The use of cardiothoracic ultrasound appears to be an attractive complementary diagnostic tool and seems able to contribute to an early therapeutic decision based on reproducible physiopathologic data.
Authors: P Mayo; R Arntfield; M Balik; P Kory; G Mathis; G Schmidt; M Slama; G Volpicelli; N Xirouchaki; A McLean; A Vieillard-Baron Journal: Intensive Care Med Date: 2017-03-07 Impact factor: 17.440
Authors: Felippe Leopoldo Dexheimer Neto; Juliana Mara Stormovski de Andrade; Ana Carolina Tabajara Raupp; Raquel da Silva Townsend; Fabiana Gabe Beltrami; Hélène Brisson; Qin Lu; Paulo de Tarso Roth Dalcin Journal: J Bras Pneumol Date: 2015 Jan-Feb Impact factor: 2.624