Perioperative care with an ultrasound device is as Michael Jordan with Scotty Pippen: at its best!

Nooitgedacht, Jip S; Haaksma, Mark E.; Touw, H.R.W.; Tuinman, Pieter R.

doi:10.21037/jtd.2018.12.82

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…LUS turned out to be highly accurate for most diagnosis studied in this meta-analysis with a sensitivity and specificity of more than 90% 48,[51][52][53][54][55][56] . There is also evidence showing that LUS detects respiratory problems at an early stage and impacts clinical decision making 54,[57][58][59][60][61] . Therefore, it has been suggested before that LUS should replace lung auscultation 50,51,62 .…”

Section: Further Implicationsmentioning

confidence: 99%

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

Arts

Lim

Ven

et al. 2020

Sci Rep

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The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms. However, there is much debate about the diagnostic accuracy of this instrument. This metaanalysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. Studies concerning adult patients with respiratory symptoms are included. Main outcomes are pooled estimates of sensitivity and specificity with 95% confidence intervals, likelihood ratios (LRs), area under the curve (AUC) of lung auscultation for different pulmonary pathologies and breath sounds. A meta-regression analysis is performed to reduce observed heterogeneity. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR− and specificity are acceptable. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. Results are limited by significant heterogeneity. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. When better diagnostic modalities are available, they should replace lung auscultation. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role.Diagnostic summary measures. The overall pooled sensitivity for lung auscultation is 37% (95% CI: 30-47%) and specificity 89% (95% CI: 85-92%) (see Table 2 and Fig. 2). Table 3 shows the pooled estimates of sensitivity and specificity for the different types of breath sounds: abnormal, decreased or absent breath sounds, crackles, rhonchi, and wheezes. Heterogeneity was significant when considering all outcomes (P < 0.001), but also when restricted to CHF, OLD and pneumonia. Only heterogeneity of study outcomes for HPT was not significant (P = 0.38). Deeks' Funnel Plot for all studies (Fig. 3) suggests publication bias (P = 0.01) when considering all outcomes. Publication bias was not significant, when restricting to CHF (P = 0.18), HPT (P = 0.34), OLD (P = 0.75) and pneumonia (P = 0.99). It must, however, be noted that the estimates of the bias when restricting to CHF and HPT were larger than the estimate of the bias based on all outcomes. Therefore, lack of significance for these pathology groups may be due to the small sample sizes (n = 10 and n = 6, respectively). Estimates of bias in the OLD and pneumonia subgroups were much smaller than the estimate of the bias based on all outcomes and sample sizes were larger compared to other subgroups (n = 22 and n = 29, respectively), suggesting the absence of publication bias for those pathology groups (see e- Fig. 1A-D).Congestive heart failure. Six prospective observational studies included patients with (acute) dyspnoea and compared auscultation with Doppler echocardiography, the Framingham criteria or by an expert panel for CHF [12][13][14][15][16][17] . Considering the res...

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Section: Further Implicationsmentioning

confidence: 99%

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

Arts

Lim

Ven

et al. 2020

Sci Rep

Self Cite

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“…Furthermore, LUS allowed further discrimination of lung abnormalities mainly between atelectasis and pleural effusions. [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study

et al. 2019

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Background Postoperative pulmonary complications after major abdominal surgery are associated with adverse outcome. The diagnostic accuracy of chest X-rays (CXR) to detect pulmonary disorders is limited. Alternatively, lung ultrasound (LUS) is an established evidence-based point-of-care diagnostic modality which outperforms CXR in critical care. However, its feasibility and diagnostic ability for postoperative pulmonary complications following abdominal surgery are unknown. In this prospective observational feasibility study, we included consecutive patients undergoing major abdominal surgery with an intermediate or high risk developing postoperative pulmonary complications according to the Assess Respiratory risk In Surgical patients in CATalonia (ARISCAT) score. LUS was routinely performed on postoperative days 0–3 by a researcher blinded for CXR or other clinical findings. Then, reports were drawn up for LUS concerning feasibility and detection rates of postoperative pulmonary complications. CXRs were performed on demand according to daily clinical practice. Subsequently, we compared LUS and CXR findings. Results A total of 98 consecutive patients with an ARISCAT score of 41 (34–49) were included in the study. LUS was feasible in all patients. In 94 (95%) patients, LUS detected one or more postoperative pulmonary complications during the first four postoperative days. On day 0, LUS detected 31 out of 43 patients (72.1%) with one or more postoperative pulmonary complications, compared to 13 out of 36 patients (36.1%) with 1 or more postoperative pulmonary complications detected with CXR RR 2.0 (95 CI [1.24–3.20]) (p = 0.004). The number of discordant observations between both modalities was high for atelectasis 23 (43%) and pleural effusion 29 (54%), but not for pneumothorax, respiratory infection and pulmonary edema 8 (15%), 3 (5%), and 5 (9%), respectively. Conclusions This study shows that LUS is highly feasible and frequently detects postoperative pulmonary complications after major abdominal surgery. Discordant observations in atelectasis and pleural effusions for LUS and CXR can be explained by a superior diagnostic ability of LUS in detecting these conditions. The effects of LUS as primary imaging modality on patient outcome should be evaluated in future studies.

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“…On the other hand, with particular reference to our country, skills regarded CU are not requested for thoracic surgeons, also if CU use is present in many activities: Endobronchial Ultrasound, ultrasoundguided chest drainage, ultrasound-guided lung resection, ultrasound-guided lung biopsy and many other operative procedures. We are trying to form our residence to the use of CU with frontal lessons, practice and participating Letter to the Editor Chest ultrasonography and X-ray may be perfectly integrated in patients management after thoracic surgery such as Shaq and Kobe Marco Chiappetta 1,2 , Maria Teresa Congedo 1,2 , Andrea Smargiassi 2,3 , Dania Nachira 1,2 , Stefano Margaritora 1,2 to CU courses, with the objective to acquire CU skills and knowledge also for post-operative evaluation. Indeed, together with clinical evaluation, we think that CU if a fundamental instrument for our work, especially for the possibility to have an immediate imaging in case of emergency or to be independent to CX, saving at least a lot of time and permitting to promptly treat the patient.…”

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confidence: 99%

Chest ultrasonography and X-ray may be perfectly integrated in patients management after thoracic surgery such as Shaq and Kobe

et al. 2019

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Perioperative care with an ultrasound device is as Michael Jordan with Scotty Pippen: at its best!

Cited by 7 publications

References 21 publications

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study

Chest ultrasonography and X-ray may be perfectly integrated in patients management after thoracic surgery such as Shaq and Kobe

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