Integrated Use of Bedside Lung Ultrasound and Echocardiography in Acute Respiratory Failure

Abstract

This study demonstrated for the first time to our knowledge a significantly better performance of TUS than LUS in the diagnosis of ARF. The value of the TUS approach was particularly important to disambiguate cases of hemodynamic pulmonary edema and pneumonia. We suggest that the bedside use of artificial intelligence methods in this setting could pave the way for the development of new clinically relevant integrative diagnostic models.

The efficacy of bedside chest ultrasound: from accuracy to outcomes

“…In both reviews, the prevalence of acute heart failure was very high at 45%. In contrast, in an intensive care study where pneumonia was more prevalent than cardiogenic pulmonary oedema, the presence of B-lines was neither sensitive nor specific for pulmonary oedema [96].…”

“…Sonography increased diagnostic accuracy from 63% to 83%. Finally, BATAILLE et al [96] showed that echocardiography combined with chest ultrasound had superior diagnostic accuracy to chest ultrasound alone (81% versus 63%).…”

“…Thirdly, chest ultrasound in all studies was coupled to either echocardiography, leg vein ultrasound or both. Only one study reported the yield of chest ultrasound as a single modality (63%), and this was not compared to the diagnostic accuracy of clinical diagnosis without ultrasound [96]. Finally, the reference standard in all studies was expert clinical diagnosis.…”

“…consolidation or pleural effusion). Advanced statistical methods have already been employed to support such algorithms [96] and are likely to enter widespread use. This approach may be especially powerful when there is a specific clinical question to generate a pre-test probability for each differential diagnosis [119].…”

Cardiac bedside ultrasound: is the future now?

“…4 Given the great complexity of patients now treated in the departments of Internal Medicine, often suffering from multiple diseases, an integrated approach with clinical examination and bedside echography is potentially able to quickly dissipate a series of questions that, in the presence of chronic or past diseases, would hardly be dispelled through clinical examination only. 5 Along with these undeniable advantages of a young and exciting procedure, I must also warn against excessive leaps forward. Sometimes one gets the impression that especially younger physicians base their approach almost exclusively on the ultrasound to formulate diagnostic hypotheses and implement the related therapies.…”