Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice.
Chest. 2013 May 9;
Authors: Silva S, Biendel C, Ruiz J, Olivier M, Bataille B, Geeraerts T, Mari A, Riu B, Fourcade O, Genestal M
Abstract
BACKGROUND: This study investigates the clinical relevance of early general chest ultrasonography (i.e. associating heart and lung ultrasound recording) in patients with acute respiratory failure (ARF) admitted to the intensive care unit (ICU). METHODS: We prospectively compared this diagnostic approach ('Ultrasound') to a routine evaluation established from clinical, radiological and biological data ('Standard'). Patients were consecutively admitted to the ICU of a University Teaching Hospital during 1-yr period. Inclusion criteria were age at least 18 years and the presence of criteria of severe ARF justifying ICU admission. We compared the diagnostic approaches and the final diagnosis determined by the panel of experts. RESULTS: Seventy-eight patients were included (age 70 +/- 18 yr; sex ratio 1). Three patients with two or more simultaneous diagnoses were subsequently excluded. The 'Ultrasound' approach was more accurate than the 'Standard' (83 % vs 63 % respectively, p < 0.02). ROC curve analysis showed greater diagnosis performance of 'Ultrasound' in cases of pneumonia (standard: 0.74 +/- 0.12; ultrasound 0.87 +/- 0.14; p < 0.02), acute hemodynamic pulmonary oedema (standard 0.79 +/- 0.11; ultrasound 0.93 +/- 0.08; p < 0.007), decompensated chronic obstructive pulmonary disease (standard 0.8 +/- 0.09; ultrasound 0.92 +/- 0.15; p < 0.05), and pulmonary embolism (standard 0.65 +/- 0.12; ultrasound 0.81 +/- 0.17; p < 0.04). Furthermore, we showed that the use of ultrasound data, could have significantly improved the initial treatment. CONCLUSIONS: The use of cardiothoracic ultrasound appears to be an attractive complementary diagnostic tool and seems able to contribute to an early therapeutic decision based on reproducible physiopathological data.
PMID: 23670087 [PubMed - as supplied by publisher]