Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting?

Ashton-Cleary, David

doi:10.1093/bja/aet076

Cited by 71 publications

(27 citation statements)

References 52 publications

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“…Of interest, we found a higher incidence of atelectasis and pleural effusions detected by lung ultrasound in these patients. This finding could be explained by the higher sensitivity and specificity of lung ultrasound in detecting pleural effusion and atelectasis compared with CXR, when compared with the gold standard for thoracic imaging, computed tomography (CT) scans . Furthermore, our results are comparable with the reported incidence of atelectasis of 90% found with thoracic CT scan in anaesthetised patients .…”

Section: Discussionsupporting

confidence: 79%

“…Cardiac ultrasound has been shown to be valuable in the peri‐operative assessment and therapeutic management of patients undergoing surgery . In non‐cardiothoracic surgery patients, lung ultrasound performed better than CXR in diagnosing pneumonia, pulmonary oedema, pneumothorax and pleural effusion . Until now, however, there have been limited data available for the diagnostic value of lung ultrasound in cardiothoracic surgical patients.…”

Section: Introductionmentioning

confidence: 99%

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Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Touw

Parlevliet²,

Beerepoot³

et al. 2018

Anaesthesia

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SummaryPostoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X‐rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X‐ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single‐centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X‐ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X‐ray. We compared lung ultrasound with chest X‐ray for the detection of postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications. We also assessed inter‐observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically‐relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X‐ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X‐ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X‐ray 7 out of 17 patients (41%) with clinically‐relevant postoperative pulmonary complications (p < 0.001). The clinically‐relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X‐ray (p = 0.024). Overall inter‐observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications than chest X‐ray, and at an earlier time‐point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Touw

Parlevliet²,

Beerepoot³

et al. 2018

Anaesthesia

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“…Lung ultrasound has been proven to be almost as accurate as CT scanning in detecting the presence of pneu-mothorax [4] occult pneumothorax and its extension [5]. In the present study and after analyzing 49 patients (64 hemothoraces) we found that ultrasound had a sensitivity of 92.8%, a specificity of 87.5%, a positive predictive value of 98.1%, and a negative predictive value of 63.6%.…”

Section: Discussionsupporting

confidence: 52%

The Role of Ultrasound and Air Leak Measurement in Assessing Lung Expansion after Thoracic Surgery

Chavarin¹,

Molins²,

Mier³

et al. 2015

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Objective: To determine if lung ultrasound semiology is applicable to the post-surgical hemithorax, and its value in the evaluation of lung expansion in the postoperative period when paired with the use of digital chest drain systems. Methods: Prospective observational study including all patients undergoing thoracic surgery from June 2012 to March 2013. Patients undergoing pleurodesis or hemodynamically unstable were not considered candidates. Final inclusion in the study was based on the availability of digital chest drain system. A transthoracic lung ultrasound evaluation of the anterior and anterolateral windows was performed 20 minutes after chest drain placement. Presence or not of lung sliding and air leak values taken from the digital chest drain system were recorded. Data were submitted to a binomial classification test for analysis. Results: Forty-nine patients were included, yielding a total of 64 hemithoraces. Lung sliding was seen in 53 cases (82.8%), and an air leak value of 20 ml/min or less in 56 cases (87.5%). Sensitivity was 92.8% (95% CI: 82.6% to 97.9%) and specificity 87.5% (95% CI: 47.3% to 97.9%). Positive predictive value was 98.1%, and negative predictive value was 63.6%. Conclusions: Transthoracic lung ultrasound is a useful technique that can complement the use of digital chest drain systems in the evaluation of post-surgical lung expansion. The incorporation of lung ultrasound can greatly reduce the need for chest radiographs in thoracic surgery departments.

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“…Among methods for detecting atelectasis, lung ultrasound is a fast, simple, non‐invasive and radiation‐free technique which has gained increasing popularity, especially in emergency and critical care settings . Furthermore, lung ultrasound has shown reliable sensitivity and specificity for the diagnosis of anaesthesia‐induced atelectasis in children .…”

Section: Introductionmentioning

confidence: 99%

Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia‐induced atelectasis in infants: a randomised, controlled trial

et al. 2016

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Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia-induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume-controlled ventilation with 5 cmH O positive end-expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical ventilation of the lungs and the second at the end of surgery. Patients in the recruitment manoeuvre group received ultrasound-guided recruitment manoeuvres after each lung ultrasound examination. The incidence of significant anaesthesia-induced atelectasis at the second lung ultrasound examination was less in the recruitment manoeuvre group compared with the control group (25% vs. 80%; p = 0.001; odds ratio (OR) 0.083; 95% confidence interval (CI): 0.019-0.370). The median (IQR [range]) lung ultrasound scores for consolidation and B-lines on the second examination were lower in the recruitment manoeuvre group compared with the control group; 6.0 (3.0-9.3 [0.0-14.0]) vs. 13.5 (11.0-16.5 [8.0-23.0]); p < 0.001 and 6.5 (3.0-12.0 [0.0-28.0]) vs. 15.0 (10.8-20.5 [7.0-28.0]); p < 0.001, respectively. The lung ultrasound scores for consolidation on the first and second examinations showed a negative correlation with age (r = -0.340, p = 0.008; r = -0.380, p = 0.003). We conclude that ultrasound-guided recruitment manoeuvres with positive end-expiratory pressure proved useful in reducing the incidence of anaesthesia-induced atelectasis in infants, although 5 cmH O positive end-expiratory pressure alone was not sufficient to eliminate it. In addition, the younger the patient, the more susceptible they were to atelectasis.

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Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting?

Cited by 71 publications

References 52 publications

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

The Role of Ultrasound and Air Leak Measurement in Assessing Lung Expansion after Thoracic Surgery

Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia‐induced atelectasis in infants: a randomised, controlled trial

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