Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate.

Autor: Raimondi F; Division of Neonatology, Department of Translational Medical Sciences, Università 'Federico II' di Napoli, Naples, Italy. Electronic address: raimondi@unina.it., Rodriguez Fanjul J; Division of Neonatology, Hospital San Joan de Deú, Barcelona, Spain., Aversa S; Division of Neonatology, Ospedali Civili, Brescia, Italy., Chirico G; Division of Neonatology, Ospedali Civili, Brescia, Italy., Yousef N; Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France., De Luca D; Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France., Corsini I; Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy., Dani C; Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy., Grappone L; Division of Neonatology, Ospedale Rummo, Benevento, Italy., Orfeo L; Division of Neonatology, Ospedale Rummo, Benevento, Italy., Migliaro F; Division of Neonatology, Department of Translational Medical Sciences, Università 'Federico II' di Napoli, Naples, Italy., Vallone G; Division of Pediatric Diagnostics, Department of Biomorphological and Functional Sciences, Università 'Federico II,' Naples, Italy., Capasso L; Division of Neonatology, Department of Translational Medical Sciences, Università 'Federico II' di Napoli, Naples, Italy.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2016 Aug; Vol. 175, pp. 74-78.e1. Date of Electronic Publication: 2016 May 14.
DOI: 10.1016/j.jpeds.2016.04.018
Abstrakt: Objectives: To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient.
Study Design: In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation <65% for more than 40 seconds) and bradycardia or sudden increase of oxygen requirement by at least 50% in less than 10 minutes with a final fraction of inspired oxygen ≥0.7 to keep stable saturations. All eligible patients had an ultrasound scan before undergoing a chest radiograph, which was the reference standard.
Results: Forty-two infants (birth weight = 1531 ± 812 g; gestational age = 31 ± 3.5 weeks) were enrolled in 6 centers; pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases.
Conclusions: Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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