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Popat A, Harikrishnan S, Seby N, Sen U, Patel SK, Mittal L, Patel M, Vundi C, Patel Y, Babita, Kumar A, Nakrani AA, Patel M, Yadav S. Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52371. [PMID: 38694948 PMCID: PMC11062642 DOI: 10.7759/cureus.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 05/04/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
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Affiliation(s)
- Apurva Popat
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
| | | | - Niran Seby
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Udvas Sen
- Internal Medicine, Agartala Government Medical College, Agartala, IND
| | - Sagar K Patel
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Lakshay Mittal
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Mitkumar Patel
- Internal Medicine, Mahatma Gandhi Mission (MGM) Medical College, Navi Mumbai, IND
| | - Charitha Vundi
- Internal Medicine, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, IND
| | - Yashasvi Patel
- Internal Medicine, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Babita
- Internal Medicine, Uzhhorod National University, Uzhhorod, UKR
| | - Ashish Kumar
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Akash A Nakrani
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Surat, IND
| | - Mahir Patel
- Medical School, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Sweta Yadav
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
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Tavares J, Ivo R, Gonzalez F, Lamas T, Mendes JJ. Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation. Open Access Emerg Med 2019; 11:133-145. [PMID: 31372068 PMCID: PMC6628156 DOI: 10.2147/oaem.s199137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
Ultrasound technology is an essential tool in the management of critically ill patients. Point-of-care ultrasonography (POCUS) enables data collection from different anatomic areas to achieve the most probable diagnosis and administer the right therapy at the right time. Despite the increasing utilization of POCUS, there is still a lack of standards to establish how to use different bedside ultrasound protocols, and it is imperative to develop a unifying protocol. Thus, the aim of this paper is to establish a new systematized approach that can be adopted by all physicians to implement POCUS for critically ill patient management. To achieve this, we propose a new systematized approach—Global Ultrasound Check for the Critically Ill (GUCCI)—that integrates multiple protocols. This protocol is organized based on three syndromes (acute respiratory failure, shock, and cardiac arrest) and includes ultrasound-guided procedures.
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Affiliation(s)
- João Tavares
- Internal Medicine Department, Hospital da Luz, Lisbon, Portugal
| | - Rita Ivo
- Internal Medicine Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Filipe Gonzalez
- Intensive Care Unit, Hospital Garcia de Orta, Almada, Portugal
| | - Tomás Lamas
- Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal
| | - João João Mendes
- Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal
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Buhumaid RE, St-Cyr Bourque J, Shokoohi H, Ma IWY, Longacre M, Liteplo AS. Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. Am J Emerg Med 2018; 37:298-303. [PMID: 30413369 DOI: 10.1016/j.ajem.2018.10.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/28/2018] [Accepted: 10/28/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The differential diagnoses of patients presenting with chest pain (CP) and shortness of breath (SOB) are broad and non-specific. We aimed to 1) determine how use of point-of-care ultrasound (POCUS) impacted emergency physicians' differential diagnosis, and 2) evaluate the accuracy of POCUS when compared to chest radiograph (CXR) and composite final diagnosis. METHODS We conducted a prospective observational study in a convenience sample of patients presenting with CP and SOB to the Emergency Department (ED). Treating physicians selected possible diagnoses from a pre-indexed list of possible diagnoses of causes of CP and SOB. The final composite diagnosis from a chart review was determined as the reference standard for the diagnosis. The primary analysis involved calculations of sensitivity and specificity for POCUS identifiable diagnoses in detecting cause of CP and SOB. Additional comparative accuracy analysis with CXRs were conducted. RESULTS 128 patients with a mean age of 64 ± 17 years were included in the study. Using a reference standard of composite final diagnoses, POCUS had equal or higher specificity to CXR for all indications for which it was used, except for pneumonia. POCUS correctly identified all patients with pneumothorax, pleural effusion and pericardial effusion. In patients with a normal thoracic ultrasound, CXR never provided any actionable clinical information. Adding POCUS to the initial evaluation causes a significant narrowing of the differential diagnoses in which the median differential diagnosis from 5 (IQR 3-6) to 3 (IQR 2-4) p < 0.001. CONCLUSION In evaluation of patients with CP and SOB, POCUS is a highly feasible diagnostic test which can assist in narrowing down the differential diagnoses. In patients with a normal thoracic ultrasound, the added value of a CXR may be minimal.
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Affiliation(s)
- Rasha E Buhumaid
- Department of Emergency Medicine, Division of Emergency Ultrasound, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Julie St-Cyr Bourque
- Department of Emergency Medicine, Division of Emergency Ultrasound, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mckenna Longacre
- Department of Anesthesia, Perioperative and Pain Medicine - Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Myers M, Cohen J. An Unexpected Cause of Persistent Coughing. Clin Pract Cases Emerg Med 2018; 2:173-174. [PMID: 29849243 PMCID: PMC5965124 DOI: 10.5811/cpcem.2018.2.37443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022] Open
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Abstract
INTRODUCTION Pleural disease encompasses a large range of conditions, is a common presentation to the acute medical take and often requires comprehensive investigation and treatment. Ultrasound is well recognised as a useful investigative tool in pleural disease especially in the field of pleural effusion, pleural thickening and interventional procedures. Thoracic ultrasound (TUS) has gained widespread use by physicians as evidence has shown a reduced rate of complications when performing pleural procedures with ultrasound guidance. Areas covered: This article will review studies assessing the role of TUS in the management of pleural disease and examine ongoing research into how TUS could advance our knowledge and understanding over the next decade. Expert commentary: Physician lead thoracic ultrasound has become commonplace over the last decade, and now represents a minimum standard of safety in conducting the majority of 'bedside' pleural procedures. The current evidence points to important diagnostic and procedural roles of the use of bedside thoracic ultrasound. In the future, research developments are likely to lead to the use of thoracic ultrasound in prognostication, targeted treatment and understanding pathogenesis in pleural disease.
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Affiliation(s)
- Rachel M Mercer
- a University of Oxford Respiratory Trials Unit , Churchill Hospital , Oxford , UK.,b Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK
| | - Ioannis Psallidas
- a University of Oxford Respiratory Trials Unit , Churchill Hospital , Oxford , UK.,b Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK
| | - Najib M Rahman
- a University of Oxford Respiratory Trials Unit , Churchill Hospital , Oxford , UK.,b Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK.,c NIHR Oxford Biomedical Research Centre , University of Oxford , Oxford , UK
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Ianniello S, Miele V. Sonographic diagnosis of pneumonia: it is time to trust—author's reply. Br J Radiol 2017; 90:20160848. [DOI: 10.1259/bjr.20160848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Liccardo B, Martone F, Trambaiolo P, Severino S, Cibinel GA, D’Andrea A. Incremental value of thoracic ultrasound in intensive care units: Indications, uses, and applications. World J Radiol 2016; 8:460-471. [PMID: 27247712 PMCID: PMC4882403 DOI: 10.4329/wjr.v8.i5.460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/14/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly “water-rich” or “air-rich”. The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.
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Wongwaisayawan S, Suwannanon R, Sawatmongkorngul S, Kaewlai R. Emergency Thoracic US: The Essentials. Radiographics 2016; 36:640-59. [PMID: 27035835 DOI: 10.1148/rg.2016150064] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute thoracic symptoms are common among adults visiting emergency departments in the United States. Adults with these symptoms constitute a large burden on the overall resources used in the emergency department. The wide range of possible causes can make a definitive diagnosis challenging, even after clinical evaluation and initial laboratory testing. In addition to radiography and computed tomography, thoracic ultrasonography (US) is an alternative imaging modality that can be readily performed in real time at the patient's bedside to help diagnose many thoracic diseases manifesting acutely and in the trauma setting. Advantages of US include availability, relatively low cost, and lack of ionizing radiation. Emergency thoracic US consists of two main parts, lung and pleura US and focused cardiac US, which are closely related. Acoustic mismatches among aerated lungs, pleura, chest wall, and pathologic conditions produce artifacts useful for diagnosis of pneumothorax and pulmonary edema and help in detection of subpleural, pleural, and chest wall pathologic conditions such as pneumonia, pleural effusion, and fractures. Visual assessment of cardiac contractility and detection of right ventricular dilatation and pericardial effusion at focused cardiac US are critical in patients presenting with acute dyspnea and trauma. Additional US examinations of the inferior vena cava for noninvasive volume assessment and of the groin areas for detection of deep venous thrombosis are often performed at the same time. This multiorgan US approach can provide valuable information for emergency treatment of both traumatic and nontraumatic thoracic diseases involving the lungs, pleura, chest wall, heart, and vascular system. Online supplemental material is available for this article. (©)RSNA, 2016.
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Affiliation(s)
- Sirote Wongwaisayawan
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
| | - Ruedeekorn Suwannanon
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
| | - Sorravit Sawatmongkorngul
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
| | - Rathachai Kaewlai
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
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de la Quintana Gordon FB, Nacarino Alcorta B. [Basic lung ultrasound. Part 1. Normal lung ultrasound and diseases of the chest wall and the pleura]. ACTA ACUST UNITED AC 2015; 62:322-36. [PMID: 25890918 DOI: 10.1016/j.redar.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
Abstract
Lung ultrasound has become part of the diagnostic armamentarium in Resuscitation and Recovery Units with an enormous potential due to its many advantages: capacity to diagnose more precisely than conventional radiology, earlier diagnosis, convenience due to being able to performed at the bedside, possibility of being performed by one person, absence of ionising radiation, and, due to its dynamic character, is capable of transforming into physiological processes that were once static images. However, lung ultrasound also has its limitations and has a learning curve. The aim of this review is to provide sufficient information that may help the specialist starting in this field to approach the technique with good possibilities of success. To do this, the review is structured into two parts. In the first, the normal ultrasound of the chest wall is presented, as well as the pleura, diaphragm, and lung parenchyma, and the most important pathologies of the chest wall (rib fractures and hematomas), the pleura (pleural effusion and its different types, and pneumothorax), and the diaphragm (hypokinesia and paralysis). In the second part, parenchymal diseases will be approached and will include, atelectasis, pneumonia and abscess, lung oedema, respiratory distress, and pulmonary thromboembolism.
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Affiliation(s)
- F B de la Quintana Gordon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Madrid, España.
| | - B Nacarino Alcorta
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Madrid, España
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Ho MC, Ker CR, Hsu JH, Wu JR, Dai ZK, Chen IC. Usefulness of lung ultrasound in the diagnosis of community-acquired pneumonia in children. Pediatr Neonatol 2015; 56:40-5. [PMID: 25034957 DOI: 10.1016/j.pedneo.2014.03.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/19/2014] [Accepted: 03/18/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pneumonia is a life-threatening disease in children. With the current lack of universal diagnostic criteria, the diagnosis is usually made on clinical manifestations and findings from chest radiographs. Ultrasonography has recently been applied to the detection of pulmonary diseases. However, few data have been published showing its effectiveness in detecting pneumonia in children. The objective of this study was to determine the power of lung ultrasonography (LUS) for the diagnosis of pneumonia in children. METHODS This retrospective study was carried out by reviewing medical records. Patients admitted to a pediatric ward with a diagnosis of pneumonia from June 1, 2010 to December 31, 2012 were enrolled in this study. Personal information, laboratory data, characteristics on LUS scan, and the results of chest radiography and LUS were collected. We compared the detection rate of pneumonia by chest radiography and LUS. LUS scans were followed up in 23 patients during the progression of their disease. RESULTS A total of 163 patients was enrolled. Chest radiography was able to detect pneumonia in 152 patients, whereas LUS detected pneumonia in 159 patients. In LUS, the positive rates of the comet-tail sign, air bronchograms, fluid bronchograms, vascular pattern within the consolidation, and pleural effusion were 50.9%, 93.7%, 20.1%, and 28.9%, respectively. During follow up, the average size of the pneumonia patch in 23 patients decreased from 10.9 ± 8.7 cm(2) to 5.5 ± 8.2 cm(2), and finally to 2 ± 1.9 cm(2) on Day 1, Days 3-5 and Days 7-14, respectively. CONCLUSION LUS is a sensitive diagnostic tool with which to identify pneumonia in children. It is also useful in following up the progress of pneumonia. We suggest that LUS is a complementary tool to chest radiography in the diagnosis of pneumonia in children and that the follow up of pneumonia by LUS can reduce the exposure of children to ionizing radiation.
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Affiliation(s)
- Meng-Chieh Ho
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Ru Ker
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Perazzo A, Gatto P, Barlascini C, Ferrari-Bravo M, Nicolini A. Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis? ACTA ACUST UNITED AC 2014; 40:6-12. [PMID: 24626264 PMCID: PMC4075913 DOI: 10.1590/s1806-37132014000100002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/14/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: Thoracentesis is one of the bedside procedures most commonly associated with
iatrogenic complications, particularly pneumothorax. Various risk factors for
complications associated with thoracentesis have recently been identified,
including an inexperienced operator; an inadequate or inexperienced support team;
the lack of a standardized protocol; and the lack of ultrasound guidance. We
sought to determine whether ultrasound-guided thoracentesis can reduce the risk of
pneumothorax and improve outcomes (fewer procedures without fluid removal and
greater volumes of fluid removed during the procedures). In our comparison of
thoracentesis with and without ultrasound guidance, all procedures were performed
by a team of expert pulmonologists, using the same standardized protocol in both
conditions. METHODS: A total of 160 participants were randomly allocated to undergo thoracentesis with
or without ultrasound guidance (n = 80 per group). The primary outcome was
pneumothorax following thoracentesis. Secondary outcomes included the number of
procedures without fluid removal and the volume of fluid drained during the
procedure. RESULTS: Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided
thoracentesis and in 10 of the 80 patients who underwent thoracentesis without
ultrasound guidance, the difference being statistically significant (p = 0.009).
Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance
and in 72 of the 80 procedures performed without it. The mean volume of fluid
drained was larger during the former than during the latter (960 ± 500 mL vs. 770
± 480 mL), the difference being statistically significant (p = 0.03). CONCLUSIONS: Ultrasound guidance increases the yield of thoracentesis and reduces the risk of
post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier:
ChiCTR-TRC-12002174 [http://www.chictr.org/en/])
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Affiliation(s)
- Alessandro Perazzo
- Sestri Levante General Hospital, Department of Respiratory Diseases, Sestri Levante, Italy, Physician. Department of Respiratory Diseases, Sestri Levante General Hospital, Sestri Levante, Italy
| | - Piergiorgio Gatto
- Sestri Levante General Hospital, Department of Respiratory Diseases, Sestri Levante, Italy, Physician. Department of Respiratory Diseases, Sestri Levante General Hospital, Sestri Levante, Italy
| | - Cornelius Barlascini
- ASL4, Department of Forensic Medicine, Chiavarese, Italy, Physician. Department of Forensic Medicine, ASL4, Chiavarese, Italy
| | - Maura Ferrari-Bravo
- ASL4, Department of Public Health, Chiavarese, Italy, Physician. Department of Public Health, ASL4, Chiavarese, Italy
| | - Antonello Nicolini
- Sestri Levante General Hospital, Department of Respiratory Diseases, Sestri Levante, Italy, Physician. Department of Respiratory Diseases, Sestri Levante General Hospital, Sestri Levante, Italy
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Daabis R, Banawan L, Rabea A, Elnakedy A, Sadek A. Relevance of chest sonography in the diagnosis of acute respiratory failure: Comparison with current diagnostic tools in intensive care units. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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13
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Pseudo-hemothorax at computed tomography due to residual contrast media. Clin Imaging 2014; 38:333-5. [DOI: 10.1016/j.clinimag.2014.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/31/2013] [Accepted: 01/08/2014] [Indexed: 01/12/2023]
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14
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Quintana Puerta JE. Applications of perioperative and critical care ultrasound. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Quintana Puerta JE. Aplicaciones de la ecografía perioperatoria y de cuidado crítico. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cavaliere F, Zamparelli R, Soave MP, Gargaruti R, Scapigliati A, De Paulis S. Ultrasound artifacts mimicking pleural sliding after pneumonectomy. J Clin Anesth 2014; 26:131-5. [PMID: 24561105 DOI: 10.1016/j.jclinane.2013.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To determine the presence of pleural sliding on chest ultrasonography (US) in a series of patients admitted to a surgical intensive care unit (SICU). DESIGN Prospective, observational study. SETTING 16-bed SICU of a University hospital. PATIENTS 8 patients (7 men, 1 woman), aged 64 - 73 years (mean 67.5 yrs). Seven patients underwent pneumonectomy for pulmonary neoplasms; one patient underwent an atypical lung resection after having undergone a pneumonectomy one year before. INTERVENTIONS None. MEASUREMENTS Chest ultrasounds were performed during mechanical ventilation and spontaneous ventilation after endotracheal tube removal. In both examinations, pleural sliding was searched bilaterally in brightness mode (B-mode) and motion mode (M-mode) on the anterior thoracic wall in the least gravitationally dependent areas. RESULTS During mechanical ventilation, pleural sliding was always absent on the side of the pneumonectomy and present on the other side. During spontaneous ventilation, some artifacts mimicking pleural sliding were noted on the side of the pneumonectomy both in B-mode and M-mode (presence of the seashore sign) in all patients, except for the one patient who had undergone a pneumonectomy one year earlier. Those artifacts became more pronounced during deep breaths. CONCLUSIONS Ultrasound artifacts mimicking pleural sliding may be observed in the absence of the lung and may originate from the activity of intercostal muscles since they become more evident during deep breathing.
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Affiliation(s)
- Franco Cavaliere
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy.
| | - Roberto Zamparelli
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Maurizio P Soave
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Riccardo Gargaruti
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Stefano De Paulis
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
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17
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Puerta JEQ. Applications of perioperative and critical care ultrasound☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442020-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Sikora K, Perera P, Mailhot T, Mandavia D. Ultrasound for the Detection of Pleural Effusions and Guidance of the Thoracentesis Procedure. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/676524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective. To review the use of ultrasound for the detection of pleural effusions and guidance of the thoracentesis procedure. Methods. Two clinical cases will be presented in which ultrasound proved beneficial in guiding the diagnosis and management of patients with pleural effusions and respiratory distress. The ultrasound techniques for the evaluation of pleural effusions and performance of the thoracentesis procedure are discussed. A review of the most current literature follows to present the known diagnostic and safety benefits of ultrasound guidance for thoracentesis. Conclusions. Ultrasound improves the diagnostic accuracy for the detection of pleural effusions over standard chest radiographs. Ultrasound can also diagnose a complicated pleural effusion that may be at higher risk for an adverse outcome during a thoracentesis. Optimally, thoracentesis should be performed under direct ultrasound guidance to decrease the complication rate and improve patient safety.
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Affiliation(s)
- Kamila Sikora
- Department of Emergency Medicine, USC Medical Center, General Hospital, 1200 State Street, Los Angeles, CA 90033, USA
| | - Phillips Perera
- Division of Emergency Medicine, Stanford University Medical Center, 300 Pasteur Drive, Alway Building, M121, Stanford, CA 94305, USA
| | - Thomas Mailhot
- Department of Emergency Medicine, USC Medical Center, General Hospital, 1200 State Street, Los Angeles, CA 90033, USA
| | - Diku Mandavia
- Department of Emergency Medicine, USC Medical Center, General Hospital, 1200 State Street, Los Angeles, CA 90033, USA
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