The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review

Hew, Mark; Corcoran, John; Harriss, Elinor; Rahman, Najib M.; Mallett, Susan

doi:10.1136/bmjopen-2015-007838

Cited by 39 publications

(29 citation statements)

References 23 publications

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“…Lung ultrasound has several advantages over traditional radiography, including the ability to rapidly obtain several views of a particular segment or lobe of lung as well adjacent organs; it avoids transporting patients to radiographic imaging suites which is costly and inconvenient; it can differentiate lung consolidation from pleural effusion with high accuracy; and allows physicians to monitor disease states serially with repeat evaluation performed at the discretion of the investigator. Lung ultrasonography has been shown to be a superior diagnostic method compared to chest radiography, as shown in several published meta-analyses [32–34]. In our study, the in-vivo lung ultrasonography had a perfect correlation with the pathological findings identified at the time of necropsy.…”

Section: Discussionsupporting

confidence: 73%

A Non-Human Primate Model of Severe Pneumococcal Pneumonia

Reyes¹,

Restrepo²,

Hinojosa³

et al. 2016

PLoS ONE

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RationaleStreptococcus pneumoniae is the leading cause of community-acquired pneumonia and infectious death in adults worldwide. A non-human primate model is needed to study the molecular mechanisms that underlie the development of severe pneumonia, identify diagnostic tools, explore potential therapeutic targets, and test clinical interventions during pneumococcal pneumonia.ObjectiveTo develop a non-human primate model of pneumococcal pneumonia.MethodsSeven adult baboons (Papio cynocephalus) were surgically tethered to a continuous monitoring system that recorded heart rate, temperature, and electrocardiography. Animals were inoculated with 109 colony-forming units of S. pneumoniae using bronchoscopy. Three baboons were rescued with intravenous ampicillin therapy. Pneumonia was diagnosed using lung ultrasonography and ex vivo confirmation by histopathology and immunodetection of pneumococcal capsule. Organ failure, using serum biomarkers and quantification of bacteremia, was assessed daily.ResultsChallenged animals developed signs and symptoms of pneumonia 4 days after infection. Infection was characterized by the presence of cough, tachypnea, dyspnea, tachycardia and fever. All animals developed leukocytosis and bacteremia 24 hours after infection. A severe inflammatory reaction was detected by elevation of serum cytokines, including Interleukin (IL)1Ra, IL-6, and IL-8, after infection. Lung ultrasonography precisely detected the lobes with pneumonia that were later confirmed by pathological analysis. Lung pathology positively correlated with disease severity. Antimicrobial therapy rapidly reversed symptomology and reduced serum cytokines.ConclusionsWe have developed a novel animal model for severe pneumococcal pneumonia that mimics the clinical presentation, inflammatory response, and infection kinetics seen in humans. This is a novel model to test vaccines and treatments, measure biomarkers to diagnose pneumonia, and predict outcomes.

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Section: Discussionsupporting

confidence: 73%

A Non-Human Primate Model of Severe Pneumococcal Pneumonia

Reyes¹,

Restrepo²,

Hinojosa³

et al. 2016

PLoS ONE

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“…A recent review of the literature suggests that USS is more sensitive than CXR for detection of consolidation [44]. However, differentiating between potential aetiologies (such as pneumonia and pulmonary embolism) is heavily dependent on clinical evaluation and suspicion.…”

Section: Future Directionsmentioning

confidence: 99%

Thoracic Ultrasound: What Non-radiologists Need to Know

et al. 2017

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Purpose of reviewThe aim of this review is to provide the theoretical and practical knowledge essential for non-radiologists to develop the skills necessary to apply thoracic ultrasound as an extension of clinical assessment and intervention.Recent findingsIssues relating to training and competence are discussed and a library of thoracic ultrasound videos is provided to illustrate artefacts, pleural, parenchymal and pneumothorax pathology as well as important pitfalls to consider. Novel and future diagnostic applications of thoracic ultrasound in the setting of acute cardiorespiratory pathology including consolidation, acute interstitial syndromes and pulmonary embolism are explored.SummaryThoracic ultrasound requires an understanding of imaging artefact specific to lung and pleura and a working knowledge of machine knobology for image optimisation and interpretation. Ultrasound is a valuable tool for the practicing chest clinician providing diagnostic information for the assessment of pleural and parenchymal disease and increased safety and cost effectiveness of thoracic interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s13665-017-0164-1) contains supplementary material, which is available to authorized users.

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“…Also, some reviews meta-analysed by patient and others by hemithorax. We have previously found that using different units of analysis can give very different test characteristics [32]. …”

Section: Pneumothoraxmentioning

confidence: 99%

“…A recent systematic review examined the accuracy of ultrasound for consolidation referenced to CT (table 3) [32]. This review focused on the imaging findings of consolidation rather than the underlying aetiology.…”

Section: Lung Consolidationmentioning

confidence: 99%

See 1 more Smart Citation

The efficacy of bedside chest ultrasound: from accuracy to outcomes

Hew

Tay

2016

Eur Respir Rev

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For many respiratory physicians, point-of-care chest ultrasound is now an integral part of clinical practice. The diagnostic accuracy of ultrasound to detect abnormalities of the pleura, the lung parenchyma and the thoracic musculoskeletal system is well described. However, the efficacy of a test extends beyond just diagnostic accuracy. The true value of a test depends on the degree to which diagnostic accuracy efficacy influences decision-making efficacy, and the subsequent extent to which this impacts health outcome efficacy. We therefore reviewed the demonstrable levels of test efficacy for bedside ultrasound of the pleura, lung parenchyma and thoracic musculoskeletal system.For bedside ultrasound of the pleura, there is evidence supporting diagnostic accuracy efficacy, decisionmaking efficacy and health outcome efficacy, predominantly in guiding pleural interventions. For the lung parenchyma, chest ultrasound has an impact on diagnostic accuracy and decision-making for patients presenting with acute respiratory failure or breathlessness, but there are no data as yet on actual health outcomes. For ultrasound of the thoracic musculoskeletal system, there is robust evidence only for diagnostic accuracy efficacy.We therefore outline avenues to further validate bedside chest ultrasound beyond diagnostic accuracy, with an emphasis on confirming enhanced health outcomes. @ERSpublicationsThe next challenge in bedside chest ultrasound is to refocus from diagnostic accuracy toward patient outcomes http://ow.ly/NyNR3027WLU

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The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review

Cited by 39 publications

References 23 publications

A Non-Human Primate Model of Severe Pneumococcal Pneumonia

A Non-Human Primate Model of Severe Pneumococcal Pneumonia

Thoracic Ultrasound: What Non-radiologists Need to Know

The efficacy of bedside chest ultrasound: from accuracy to outcomes

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