Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units

Singh, G.; Dhawan, Jonny

doi:10.5005/jp-journals-10071-24283

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…В диагностике пневмонии УЗИ легких может достигать 75-90 % специфичности и 65-95 % чувствительности [30][31][32][33]. Ультразвуковой метод исследования показал более высокие чувствительность, специфичность и точность диагностики поражения легких по сравнению с рентгеногра фией грудной клетки [34,35]. В Кокрейновском систематическом обзоре чувствительность КТ при диагностике COVID-19 поражения легких составила 86,9 % (95 %-й доверительный интервал [95% ДИ] 83,6-89,6), специфичность -78,3 % (95% ДИ 73,7-82,3).…”

Section: Discussionunclassified

Comparison of ultrasound signs, computed tomography data and morphological examination of the lungs in patients with coronavirus infection: post hoc analysis

Lakhin,

Zhirnova,

Shchegolev

et al. 2023

Annals of Critical Care

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INTRODUCTION: Ultrasound examination (US) of the lungs has shown high efficiency in the diagnosis of COVID-19 pneumonia. The aim of the research was studying the correspondence of computed tomography (CT) US signs of the lungs and morphological data in patients with COVID-19 pneumonia. MATERIALS AND METHODS: The post hoc analysis included 388 patients who simultaneously underwent ultrasound and CT of the lungs. Lung ultrasound was performed according to the 16-zone “Russian Protocol”. Morphological data were obtained from the results of pathoanatomic examination of deceased patients. RESULTS: The comparison of signs detected by CT and ultrasound of the lungs was performed during a multidimensional correspondence analysis. The analysis was carried out using a three-dimensional solution that explained 64.9 % of inertia (p < 0.001). CT signs of “ground glass opacity” (100 %) corresponded to the B-line at ultrasound (100 %), CT of the consolidation sign (44.8 %) — ultrasound signs of consolidation (46.9 %), aerobronchogram of CT (34 %) — aerobronchogram of ultrasound (36.9 %), free liquid CT (11.1 %) — free liquid Ultrasound (13.9 %). CT signs of reticular changes (29.6 %) and “cobblestone pavement” (12.4 %) corresponded to various combinations of ultrasound signs of subpleural consolidation and B-lines. The B-lines were caused by the exudation of fluid and protein molecules into the intraalveolar space against the background of massive death of alveolocytes and formed by the development of intraalveolar edema and the formation of hyaline membranes. The ultrasonic sign of consolidation appeared in the airless zone of the lungs. Subpleural consolidation are caused by thickening and inflammatory infiltration of the pleura, diffuse alveolar damage, with intraalveolar edema, death and decay of alveolocytes, perivascular inflammatory cell reaction/ During treatment for more than 7 days, consolidation in the lung tissue developed due to the disorganization of the organ structure due to the progression of fibrosis. CONCLUSION: Multivariate correspondence analysis showed correlation of CT signs and US signs of the lungs. Morphological analysis showed polymorphism of histological data that caused the formation of ultrasound signs.

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Section: Discussionunclassified

Comparison of ultrasound signs, computed tomography data and morphological examination of the lungs in patients with coronavirus infection: post hoc analysis

Lakhin,

Zhirnova,

Shchegolev

et al. 2023

Annals of Critical Care

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“…2 Diagnosing pneumonia is challenging because of multiple differential diagnosis. 3 Community-acquired pneumonia (CAP) can be defined as an acute infection of the lungs that involves the alveoli and that occurs in patients without any prior healthcare exposure history. The patients suffering from CAP may present with a wide clinical spectrum of the disease ranging from walking pneumonia in otherwise healthy individuals to life threatening necrotizing or multi-lobar disease leading to septic shock.…”

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confidence: 99%

A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital

Chauhan,

Majmundar,

Lakhani

et al. 2024

IJCA

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Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.

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Community-Acquired Pneumonia

Vaughn,

Dickson,

Horowitz

et al. 2024

JAMA

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ImportanceCommunity-acquired pneumonia (CAP) results in approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually.ObservationsCommunity-acquired pneumonia can be diagnosed in a patient with 2 or more signs (eg, temperature &gt;38 °C or ≤36 °C; leukocyte count &lt;4000/μL or &gt;10 000/μL) or symptoms (eg, new or increased cough or dyspnea) of pneumonia in conjunction with consistent radiographic findings (eg, air space density) without an alternative explanation. Up to 10% of patients with CAP are hospitalized; of those, up to 1 in 5 require intensive care. Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death. Only 38% of patients hospitalized with CAP have a pathogen identified. Of those patients, up to 40% have viruses identified as the likely cause of CAP, with Streptococcus pneumoniae identified in approximately 15% of patients with an identified etiology of the pneumonia. All patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community because their diagnosis may affect treatment (eg, antiviral therapy) and infection prevention strategies. If test results for influenza and COVID-19 are negative or when the pathogens are not likely etiologies, patients can be treated empirically to cover the most likely bacterial pathogens. When selecting empirical antibacterial therapy, clinicians should consider disease severity and evaluate the likelihood of a bacterial infection—or resistant infection—and risk of harm from overuse of antibacterial drugs. Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality.ConclusionsCommunity-acquired pneumonia is common and may result in sepsis, acute respiratory distress syndrome, or death. First-line therapy varies by disease severity and etiology. Hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days.

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Bedside Lung Ultrasound as an Independent Tool to Diagnose Pneumonia in Comparison to Chest X-ray: An Observational Prospective Study from Intensive Care Units

Cited by 5 publications

References 23 publications

Comparison of ultrasound signs, computed tomography data and morphological examination of the lungs in patients with coronavirus infection: post hoc analysis

Comparison of ultrasound signs, computed tomography data and morphological examination of the lungs in patients with coronavirus infection: post hoc analysis

A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital

Community-Acquired Pneumonia

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