Current Trends in the Use of Ultrasound Over Chest X-Ray to Identify Pneumothoraces in ICU, Trauma, and ARDS Patients

Abstract

Pneumothoraces are a common and potentially fatal complication for critically ill patients in the trauma and intensive care units. Since its use for pneumothorax detection was first reported in 1987, ultrasound has been increasingly used for the detection of thoracic injuries. As ultrasound imaging has improved and operators have potentially become more proficient, it is important to analyze more recent trends in the sensitivities and specificities of ultrasound for the detection of pneumothorax. This literature review and meta-analysis identifies 17 studies that directly compare the sensitivity and specificity of ultrasound and anterior-posterior chest x-ray in the identification of pneumothorax among 2955 patients who developed 793 pneumothoraces as detected by gold standard CT scanning. For the 17 articles analyzed, the pooled sensitivity of trans-thoracic ultrasound was 75.07% (64.92%-85.22%), and the pooled specificity was 98.36% (97.45%-99.26%). The pooled sensitivity of CXR was 45.65% (36.04%-55.26%), and pooled specificity was 99.62% (99.00%-100%). While this review demonstrates an improved sensitivity in the detection of pneumothorax with ultrasound over AP chest x-rays, it did not find a significant trend or improvement in the sensitivity or specificity of ultrasound for detecting pneumothorax over time.

New International Guidelines and Consensus on the Use of Lung Ultrasound

“…Experience with LUS in assessing COVID‐19 patients shows, however, that the alterations visualized in the posterior areas are the most significant 101 . Assessing each intercostal space along its entire length is time‐consuming, so reasonably simplified protocols have been suggested for COVID‐19 patients as well, such as 18 28–55,57–151 and 14 scan protocols 24,101 . Lately one interesting study on the correlation between LUS and laboratory results also described a protocol of 12 scans (quick COVID‐19 severity index [qCSI]), 6 for each half of the chest (upper and lower areas of the anterior, lateral and posterior surfaces, respectively), for assessing the presence of B‐line and/or consolidation 152 .…”

“…Going beyond its established role in the management of pleural effusion, 103 US has been widely applied in the approach to the patient with various pleuro‐pulmonary conditions, such as pneumonia, 104 , 105 , 106 , 107 pneumothorax, 108 , 109 , 110 , 111 cardiogenic and non‐cardiogenic pulmonary edema, 53 , 95 , 112 , 113 acute respiratory distress syndrome. 64 , 114 , 115 , 116 , 117 , 118 Furthermore, US can be used to study diaphragmatic function.…”

Confiabilidad del ultrasonido para diagnóstico de neumotórax

“…En metaanalisis realizados se encontró una sensibilidad del ultrasonido para diagnóstico de neumotórax entre 25-100% y una especificidad entre 89.5%-100% (Ron et al 2022;Tian et al 2023). Sin embargo éstos fueron realizados en ambientes afines a trauma, por lo que Ron et al (2022) alucen que aunque el USG ha demostrado su confiabilidad, su aplicación fuera del ámbito de trauma aún no está del todo definido.…”