Comparative Performance of Pulmonary Ultrasound, Chest Radiograph, and CT Among Patients With Acute Respiratory Failure
| Autor: | David M. Tierney, Michael B Plunkett, Josh D. Overgaard, Vincent Agboto, Catherine A. St. Hill, Ameet Doshi, Brynn E Weise, Roman Melamed, Katelyn E Madigan, Joshua S. Huelster, Lori L. Boland, Bryce Mikel, Claire S Smith |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Pleural effusion Radiography medicine.medical_treatment Critical Illness Atelectasis Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine medicine Intubation Humans Prospective Studies Prospective cohort study Hospitals Teaching Lung Aged Ultrasonography Aged 80 and over Respiratory Distress Syndrome medicine.diagnostic_test business.industry Ultrasound 030208 emergency & critical care medicine respiratory system Middle Aged medicine.disease Respiration Artificial respiratory tract diseases Intensive Care Units medicine.anatomical_structure 030228 respiratory system Female Radiography Thoracic Radiology Chest radiograph business Tomography X-Ray Computed |
| Zdroj: | Critical care medicine. 48(2) |
| ISSN: | 1530-0293 |
| Popis: | OBJECTIVES The study goal was to concurrently evaluate agreement of a 9-point pulmonary ultrasound protocol and portable chest radiograph with chest CT for localization of pathology to the correct lung and also to specific anatomic lobes among a diverse group of intubated patients with acute respiratory failure. DESIGN Prospective cohort study. SETTING Medical, surgical, and neurologic ICUs at a 670-bed urban teaching hospital. PATIENTS Intubated adults with acute respiratory failure having chest CT and portable chest radiograph performed within 24 hours of intubation. INTERVENTIONS A 9-point pulmonary ultrasound examination performed at the time of intubation. MEASUREMENTS AND MAIN RESULTS Sixty-seven patients had pulmonary ultrasound, portable chest radiograph, and chest CT performed within 24 hours of intubation. Overall agreement of pulmonary ultrasound and portable chest radiograph findings with correlating lobe ("lobe-specific" agreement) on CT was 87% versus 62% (p < 0.001), respectively. Relaxing the agreement definition to a matching CT finding being present anywhere within the correct lung ("lung-specific" agreement), not necessarily the specific mapped lobe, showed improved agreement for both pulmonary ultrasound and portable chest radiograph respectively (right lung: 92.5% vs 65.7%; p < 0.001 and left lung: 83.6% vs 71.6%; p = 0.097). The highest lobe-specific agreement was for the finding of atelectasis/consolidation for both pulmonary ultrasound and portable chest radiograph (96% and 73%, respectively). The lowest lobe-specific agreement for pulmonary ultrasound was normal lung (79%) and interstitial process for portable chest radiograph (29%). Lobe-specific agreement differed most between pulmonary ultrasound and portable chest radiograph for interstitial findings (86% vs 29%, respectively). Pulmonary ultrasound had the lowest agreement with CT for findings in the left lower lobe (82.1%). Pleural effusion agreement also differed between pulmonary ultrasound and portable chest radiograph (right: 99% vs 87%; p = 0.009 and left: 99% vs 85%; p = 0.004). CONCLUSIONS A clinical, 9-point pulmonary ultrasound protocol strongly agreed with specific CT findings when analyzed by both lung- and lobe-specific location among a diverse population of mechanically ventilated patients with acute respiratory failure; in this regard, pulmonary ultrasound significantly outperformed portable chest radiograph. |
| Databáze: | OpenAIRE |
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