Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients

Leblanc, Damien; Bouvet, C.; Degiovanni, Franck; Nedelcu, C.; Bouhours, G; Rineau, Emmanuel; Ridereau-Zins, C.; Beydon, L.; Lasocki, Sigismond

doi:10.1007/s00134-014-3382-9

Cited by 50 publications

(27 citation statements)

References 25 publications

(63 reference statements)

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“…LU also outperformed CR for the diagnosis of pleural effusion, as previously suggested in other settings. 12,25,26 Radiological imaging has progressed toward an all-digital future, improving image presentation of bedside CR, but without major reduction in the radiation dose, as compared with screen film. 27 The particularly poor sensitivity of CR for the detection of condensations (which were mostly basal) and pleural effusion probably highlights limitations of the silhouette sign.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported a similar advantage of LU over CR in patients with pneumonia, 29–31 respiratory distress requiring mechanical ventilation, 32 and those with the acute respiratory distress syndrome. 25,33 The routine use of bedside LU in place of CR may allow reducing radiation exposure in sickle cell disease patients during their lifespan (inasmuch as ACS is typically a relapsing disease), while optimizing lung imaging capabilities. In centers implementing point-of-care ultrasonography, this technique may allow a rapid, readily available, and accurate tool for the follow-up of patients with ACS, as suggested for critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

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Bedside Lung Ultrasound During Acute Chest Syndrome in Sickle Cell Disease

et al. 2016

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Lung ultrasound (LU) is increasingly used to assess pleural and lung disease in intensive care unit (ICU) and emergency unit at the bedside. We assessed the performance of bedside chest radiograph (CR) and LU during severe acute chest syndrome (ACS), using computed tomography (CT) as the reference standard.We prospectively explored 44 ACS episodes (in 41 patients) admitted to the medical ICU. Three imaging findings were evaluated (consolidation, ground-glass opacities, and pleural effusion). A score was used to quantify and compare loss of lung aeration with each technique and assess its association with outcome.A total number of 496, 507, and 519 lung regions could be assessed by CT scan, bedside CR, and bedside LU, respectively. Consolidations were the most common pattern and prevailed in lung bases (especially postero-inferior regions). The agreement with CT scan patterns was significantly higher for LU as compared to CR (κ coefficients of 0.45 ± 0.03 vs 0.30 ± 0.03, P < 0.01 for the parenchyma, and 0.73 ± 0.08 vs 0.06 ± 0.09, P < 0.001 for pleural effusion). The Bland and Altman analysis showed a nonfixed bias of −1.0 (P = 0.12) between LU score and CT score whereas CR score underestimated CT score with a fixed bias of −5.8 (P < 0.001). The specificity for the detection of consolidated regions or pleural effusion (using CT scan as the reference standard) was high for LU and CR, whereas the sensitivity was high for LU but low for CR. As compared to others, ACS patients with an LU score above the median value of 11 had a larger volume of transfused and exsanguinated blood, greater oxygen requirements, more need for mechanical ventilation, and a longer ICU length of stay.LU outperformed CR for the diagnosis of consolidations and pleural effusion during ACS. Higher values of LU score identified patients at risk of worse outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bedside Lung Ultrasound During Acute Chest Syndrome in Sickle Cell Disease

et al. 2016

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“…Promising diagnostic advances have been recently proposed, using ultrasound to rule out a cardiogenic source of lung edema and to predict ARDS in blunt trauma patients (29)(30)(31), and using low-dose chest CT to monitor and redirect the treatment strategy of the ventilator setting (32,33). Along with measurements of SpO 2 /FiO 2 by pulseoximetry, in lack of PaO 2 /FiO 2 measurements (34), lung ultrasound (35) can be extremely appealing in settings with limited ICU resources, as lately proposed by the Kigali modification of the Berlin definition (36).…”

Section: History Of Ards: the Long Path To Define A Syndrome-new Acqumentioning

confidence: 99%

Definition and epidemiology of acute respiratory distress syndrome

Rezoagli¹,

Fumagalli²,

Bellani³

2017

Ann. Transl. Med.

178

127

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Fifty years ago, Ashbaugh and colleagues defined for the first time the acute respiratory distress syndrome (ARDS), one among the most challenging clinical condition of the critical care medicine. The scientific community worked over the years to generate a unified definition of ARDS, which saw its revisited version in the Berlin definition, in 2014. Epidemiologic information about ARDS is limited in the era of the new Berlin definition, and wide differences are reported among countries all over the world. Despite decades of study in the field of lung injury, ARDS is still so far under-recognized, with 2 out of 5 cases missed by clinicians. Furthermore, although advances of ventilator strategies in the management of ARDS associated with outcome improvements-such as protective mechanical ventilation, lower driving pressure, higher PEEP levels and prone positioning-ARDS appears to be undertreated and mortality remains elevated up to 40%. In this review, we cover the history that led to the current worldwide accepted Berlin definition of ARDS and we summarize the recent data regarding ARDS epidemiology.

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“…Particularly in asymptomatic pediatric patients, routine use of CT scans is not recommended for unknown causes of blunt trauma injury [20]. Chest sonography, another option for detecting and estimating the volume of retained hemothorax, can provide rapid and accurate diagnosis of traumatic thoracic injuries, such as lung contusions and pleural collections [21,22]. However, similar to a chest radiograph, ultrasonography is ineffective for diagnosing mediastinal hematoma, which can be easily detected by a CT scan [23].…”

Section: Diagnosis Of Retained Hemothoraxmentioning

confidence: 99%

Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma

Chou

Lin

2015

Current Opinion in Pulmonary Medicine

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Purpose of reviewIn the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be employed in the majority of thoracic injury patients with stable vital signs.Recent findingsIn the past, VATS was used to evacuate traumatic-retained hemothorax. Recent study has revealed further that lung repair during VATS could decrease complications after trauma. Management of fractured ribs could also be assisted by VATS. Early VATS intervention within 7 days after injury can decrease the rate of posttraumatic infection and length of hospital stay. In studies of the pathophysiology of animal models, N-acetylcysteine and methylene blue were used in animals with blunt chest trauma and found to improve clinical outcomes.SummaryRetained hemothorax derived from blunt chest trauma should be managed carefully and rapidly. Early VATS intervention is a well tolerated and reliable procedure that can be applied to manage this complication cost effectively.

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Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients

Abstract: LUS on admission identifies patients at risk of developing ARDS after blunt trauma. In addition, LUS allows rapid and accurate diagnosis of common traumatic thoracic injuries.

Cited by 50 publications

References 25 publications

Bedside Lung Ultrasound During Acute Chest Syndrome in Sickle Cell Disease

Bedside Lung Ultrasound During Acute Chest Syndrome in Sickle Cell Disease

Definition and epidemiology of acute respiratory distress syndrome

Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma

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