Traumatic Pneumothorax Detection with Thoracic US: Correlation with Chest Radiography and CT—Initial Experience

Rowan, Kevin; Kirkpatrick, Andrew W.; Liu, David; Forkheim, Kevin E; Mayo, John R.; Nicolaou, Savvas

doi:10.1148/radiol.2251011102

Cited by 321 publications

(209 citation statements)

References 19 publications

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“…Lung ultrasound is more accurate than CXR particularly in ruling out pneumothorax [1,6,[13][14][15][16][17]. There are some settings where lung ultrasound for pneumothorax is not only recommended but also essential: cardiac arrest/ unstable patient, radio-occult pneumothorax, and limitedresource areas.…”

Section: B-d1-s8 (No Consensus: Level C)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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Background: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. Methods: A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Results: Seventythree proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/ conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. Conclusions: This document reflects the overall results of the first consensus conference on ''point-of-care'' lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

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Section: B-d1-s8 (No Consensus: Level C)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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“…It allows prompt detection of life-threatening conditions, such as hemothorax or pneumothorax, and it has proved to be extremely helpful in accelerating the differential diagnosis of acute respiratory distress in critically ill patients [4][5][6]. It has been shown to have very high sensitivity and specificity in the detection of pneumothorax and outperforms plain chest radiography in emergency settings [4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Riassuntomentioning

confidence: 99%

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

et al. 2013

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Introduction Fiberoptic bronchoscopy is the standard method for verifying the correct position of a double-lumen endotracheal tube (DLET) prior to one-lung ventilation. However, it must be performed by a specially trained anesthesiologist and is often resource consuming. The aim of this study was to compare this approach with thoracic ultrasound done by a nurse anesthetist in terms of sensitivity, specificity, and cost-effectiveness. Methods We conducted a prospective cross-over casecontrol study involving 51 adult patients consecutively undergoing thoracic surgery with one-lung ventilation. After orotracheal intubation with a DLET, correct exclusion of the lung being operated on exclusion was assessed first by a certified anesthesiologist using standard fiberoptic bronchoscopy and then by a trained nurse anesthetist using thoracic ultrasound. The nurse was blinded as to the findings of the anesthesiologist's examination. Results The two approaches proved to be equally sensitive and specific, but the ultrasound examination was more rapid. This factor, together with the fact that ultrasound was performed by a nurse instead of a physician, and the costs of materials and sterilization, had a significant economic impact amounting to a net saving of €37.20 ± 5.40 per case. Conclusions Although fiberoptic bronchoscopy is still the gold standard for checking the position of a DLET, thoracic ultrasound is a specific, sensitive, cost-effective alternative, which can be used to rapidly verify the proper function of the tube based on the demonstration of correct lung exclusion.Keywords Thoracic ultrasound Á Anesthesia Á Thoracic surgery Riassunto Introduzione La fibrobroncoscopia è attualmente la tecnica di scelta per la verifica di un corretto posizionamento del tubo endotracheale a doppio lume, prima dell'esclusione polmonare necessaria alla ventilazione monopolmonare. Tale tecnica richiede tuttavia un medico anestesista specialista adeguatamente formato ed è dunque spesso costosa. Scopo dello studio è di compararla all'ecografia toracica effettuata da infermieri anestesisti, in termini di sensibilità, specificità e costo-efficacia. Metodi Abbiamo dunque realizzato uno studio casocontrollo, cross-over, in effettuata da un infermiere anestesista specificamente formato.una coorte continua di pazienti adulti sottoposti a chirurgia toracica in ventilazione monopolmonare. Dopo intubazione oro-tracheale con tubo doppio lume, ciascun paziente è stato sottoposto dapprima a controllo fibrobroncoscopico effettuato da un medico anestesista e successivamente ad ecografia toracica effettuata da un infermiere anestesista specificamente formato per determinare una corretta esclusione del polmone operato. L'infermiere non era a conoscenza dei risultati del controllo fibrocroncoscopico. Risultati Le due tecniche sono risultate comparabili in termini di sensibilità e specificità. L'ecografia toracica è risultata una tecnica significativamente più rapida da eseguire rispetto alla fibrobroncoscopia. Il tempo di esecuzione, unitament...

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“…Ancak, sırtüstü akciğer grafisinin (SAG), pnömotoraks saptamada duyarlı-lığının düşük olduğu bilinmektedir. [7][8][9][10] Bilgisayarlı tomografi (BT), karıniçi yaralanma ve pnömotoraks saptanmasında, altın standart olmakla birlikte, son yıllarda yapılan çalışmalarla, acil servis hastalarında pnömotoraks değerlendirmesinde, USG'nin duyarlı-lığının yüksek olduğu bilinmektedir. [7][8][9][10][11] Küçük boyutlu olanları, konservatif olarak tedavi edilebilse de, bir çoklu travma hastasında operasyon esnasında veya sonrasında, uygulanacak pozitif basınçlı ventilasyon, pnömotoraksın, tüp torakostomi (TT) gereksinimi yaratabilecek boyutlara veya tansiyon pnömotoraksa dönüşmesine sebep olabilir.…”

Section: Sonuçunclassified

Impact of the practice of "Extended Focused Assessment with Sonography for Trauma" (e-FAST) on clinical decision in the emergency department

Uz¹,

Yürüktümen²,

Boydak³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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Traumatic Pneumothorax Detection with Thoracic US: Correlation with Chest Radiography and CT—Initial Experience

Abstract: In this study, US was more sensitive than supine chest radiography and as sensitive as CT in the detection of traumatic pneumothoraces.

Cited by 321 publications

References 19 publications

International evidence-based recommendations for point-of-care lung ultrasound

International evidence-based recommendations for point-of-care lung ultrasound

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

Impact of the practice of "Extended Focused Assessment with Sonography for Trauma" (e-FAST) on clinical decision in the emergency department

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