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Grapatsas K, Leivaditis V, Ehle B, Papaporfyriou A. Can Chest Ultrasound Replace Chest X-ray in Thoracic Surgery? Tomography 2022; 8:2083-2092. [PMID: 36006073 PMCID: PMC9412512 DOI: 10.3390/tomography8040175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the accuracy of CUS after thoracic surgery. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Six studies with a total of 789 patients were included in this meta-analysis. Performing CXR decreased in up to 61.6% of cases, with the main reasons for performing CXR being massive subcutaneous emphysema or complex hydrothorax. Agreement between CUS and routine-based therapeutic options was, in some studies, up to 97%. Conclusions: The selectively postoperative use of CUS may reduce the number of routinely performed CXR. However, if CUS findings are inconclusive, further radiological examinations are obligatory.
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Affiliation(s)
- Konstantinos Grapatsas
- Department of Thoracic Surgery, Klinikum Bielefeld, 33647 Bielefeld, Germany
- Correspondence:
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, 79098 Freiburg, Germany
| | - Anastasia Papaporfyriou
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
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2
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Heldeweg MLA, Vermue L, Kant M, Brouwer M, Girbes ARJ, Haaksma ME, Heunks LMA, Mousa A, Smit JM, Smits TW, Paulus F, Ket JCF, Schultz MJ, Tuinman PR. The impact of lung ultrasound on clinical-decision making across departments: a systematic review. Ultrasound J 2022; 14:5. [PMID: 35006383 PMCID: PMC8748548 DOI: 10.1186/s13089-021-00253-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background Lung ultrasound has established itself as an accurate diagnostic tool in different clinical settings. However, its effects on clinical-decision making are insufficiently described. This systematic review aims to investigate the impact of lung ultrasound, exclusively or as part of an integrated thoracic ultrasound examination, on clinical-decision making in different departments, especially the emergency department (ED), intensive care unit (ICU), and general ward (GW). Methods This systematic review was registered at PROSPERO (CRD42021242977). PubMed, EMBASE, and Web of Science were searched for original studies reporting changes in clinical-decision making (e.g. diagnosis, management, or therapy) after using lung ultrasound. Inclusion criteria were a recorded change of management (in percentage of cases) and with a clinical presentation to the ED, ICU, or GW. Studies were excluded if examinations were beyond the scope of thoracic ultrasound or to guide procedures. Mean changes with range (%) in clinical-decision making were reported. Methodological data on lung ultrasound were also collected. Study quality was scored using the Newcastle–Ottawa scale. Results A total of 13 studies were included: five studies on the ED (546 patients), five studies on the ICU (504 patients), two studies on the GW (1150 patients), and one study across all three wards (41 patients). Lung ultrasound changed the diagnosis in mean 33% (15–44%) and 44% (34–58%) of patients in the ED and ICU, respectively. Lung ultrasound changed the management in mean 48% (20–80%), 42% (30–68%) and 48% (48–48%) of patients in the ED, in the ICU and in the GW, respectively. Changes in management were non-invasive in 92% and 51% of patients in the ED and ICU, respectively. Lung ultrasound methodology was heterogeneous across studies. Risk of bias was moderate to high in all studies. Conclusions Lung ultrasound, exclusively or as a part of thoracic ultrasound, has substantial impact on clinical-decision making by changing diagnosis and management in the EDs, ICUs, and GWs. The current evidence level and methodological heterogeneity underline the necessity for well-designed trials and standardization of methodology. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00253-3.
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Affiliation(s)
- Micah L A Heldeweg
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands. .,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands.
| | - Lian Vermue
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Max Kant
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Michelle Brouwer
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Mark E Haaksma
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Amne Mousa
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Jasper M Smit
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands
| | - Thomas W Smits
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Johannes C F Ket
- Medical Library, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pieter Roel Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands
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Malík M, Dzian A, Skaličanová M, Hamada Ĺ, Zeleňák K, Grendár M. Chest Ultrasound Can Reduce the Use of Roentgenograms in Postoperative Care After Thoracic Surgery. Ann Thorac Surg 2020; 112:897-904. [PMID: 33186604 DOI: 10.1016/j.athoracsur.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roentgenography remains the standard imaging modality after thoracic surgery. Trials from intensive medicine proved a high accuracy of ultrasound examination in the diagnosis of various conditions. The assumption was that ultrasound examination could reduce the number of roentgenograms after thoracic surgery. METHODS This prospective study compared ultrasound examinations performed by thoracic surgeons with roentgenograms in the diagnosis of pneumothorax and pleural effusion after noncardiac thoracic surgery. Patients received 2 ultrasound scans, the first on the day of surgery and the second before chest tube removal. RESULTS A total of 297 patients underwent 545 examinations; 336 ultrasound scans (61.6%) showed neither pneumothorax nor pleural effusion. Pneumothorax was detected on 69 roentgenograms and 51 ultrasound scans. Both modalities showed positive results in 32 cases and negative results in 395 cases (Cohen's κ, 53.4%). Ultrasound missed 37 clinically irrelevant pneumothoraces. Roentgenograms missed 19 pneumothoraces; 15 of them were clinically irrelevant. Sensitivity and specificity were 59.4% and 95.9% in the first examination and 50.0% and 94.8% in the second examination, respectively. Pleural effusion was detected on 169 roentgenograms and 117 ultrasound scans. Both modalities showed positive results in 88 cases and negative results in 336 cases (Cohen's κ, 49.6%). Ultrasound scans missed 81 pleural effusions; except for 5 cases, the clinical decisions would not have changed. Roentgenograms missed 29 clinically irrelevant pleural effusions. Sensitivity and specificity were 44.4% and 92.6% in the first examination and 60.9% and 91.3% in the second examination, respectively. CONCLUSIONS Given high specificities, a large share of results without pneumothorax and pleural effusion, and mismatch analysis, we could reduce the number of roentgenograms by 61.6% by using ultrasound as a primary imaging modality.
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Affiliation(s)
- Marek Malík
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia.
| | - Michaela Skaličanová
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Ĺuboš Hamada
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Kamil Zeleňák
- Department of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Slovakia, Martin, Slovakia
| | - Marián Grendár
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis. Sci Rep 2020; 10:7347. [PMID: 32355210 PMCID: PMC7192898 DOI: 10.1038/s41598-020-64405-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms. However, there is much debate about the diagnostic accuracy of this instrument. This meta-analysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. Studies concerning adult patients with respiratory symptoms are included. Main outcomes are pooled estimates of sensitivity and specificity with 95% confidence intervals, likelihood ratios (LRs), area under the curve (AUC) of lung auscultation for different pulmonary pathologies and breath sounds. A meta-regression analysis is performed to reduce observed heterogeneity. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR− and specificity are acceptable. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. Results are limited by significant heterogeneity. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. When better diagnostic modalities are available, they should replace lung auscultation. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role.
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Chiappetta M, Congedo MT, Smargiassi A, Nachira D, Margaritora S. Chest ultrasonography and X-ray may be perfectly integrated in patients management after thoracic surgery such as Shaq and Kobe. J Thorac Dis 2019; 11:E115-E116. [PMID: 31559078 DOI: 10.21037/jtd.2019.08.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Chiappetta
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Pulmonary Medicine Department, Fondazione Policlinico Universitario A.Gemelli - IRCCS, Rome, Italy
| | - Maria Teresa Congedo
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Pulmonary Medicine Department, Fondazione Policlinico Universitario A.Gemelli - IRCCS, Rome, Italy
| | - Andrea Smargiassi
- Thoracic Surgery, Pulmonary Medicine Department, Fondazione Policlinico Universitario A.Gemelli - IRCCS, Rome, Italy.,Pulmonary Medicine Department, Fondazione Policlinico Universitario A.Gemelli - IRCCS, Rome, Italy
| | - Dania Nachira
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Pulmonary Medicine Department, Fondazione Policlinico Universitario A.Gemelli - IRCCS, Rome, Italy
| | - Stefano Margaritora
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Pulmonary Medicine Department, Fondazione Policlinico Universitario A.Gemelli - IRCCS, Rome, Italy
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Touw HR, Schuitemaker AE, Daams F, van der Peet DL, Bronkhorst EM, Schober P, Boer C, Tuinman PR. Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study. Ultrasound J 2019; 11:20. [PMID: 31523784 PMCID: PMC6745303 DOI: 10.1186/s13089-019-0135-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/16/2019] [Indexed: 12/28/2022] Open
Abstract
Background Postoperative pulmonary complications after major abdominal surgery are associated with adverse outcome. The diagnostic accuracy of chest X-rays (CXR) to detect pulmonary disorders is limited. Alternatively, lung ultrasound (LUS) is an established evidence-based point-of-care diagnostic modality which outperforms CXR in critical care. However, its feasibility and diagnostic ability for postoperative pulmonary complications following abdominal surgery are unknown. In this prospective observational feasibility study, we included consecutive patients undergoing major abdominal surgery with an intermediate or high risk developing postoperative pulmonary complications according to the Assess Respiratory risk In Surgical patients in CATalonia (ARISCAT) score. LUS was routinely performed on postoperative days 0–3 by a researcher blinded for CXR or other clinical findings. Then, reports were drawn up for LUS concerning feasibility and detection rates of postoperative pulmonary complications. CXRs were performed on demand according to daily clinical practice. Subsequently, we compared LUS and CXR findings. Results A total of 98 consecutive patients with an ARISCAT score of 41 (34–49) were included in the study. LUS was feasible in all patients. In 94 (95%) patients, LUS detected one or more postoperative pulmonary complications during the first four postoperative days. On day 0, LUS detected 31 out of 43 patients (72.1%) with one or more postoperative pulmonary complications, compared to 13 out of 36 patients (36.1%) with 1 or more postoperative pulmonary complications detected with CXR RR 2.0 (95 CI [1.24–3.20]) (p = 0.004). The number of discordant observations between both modalities was high for atelectasis 23 (43%) and pleural effusion 29 (54%), but not for pneumothorax, respiratory infection and pulmonary edema 8 (15%), 3 (5%), and 5 (9%), respectively. Conclusions This study shows that LUS is highly feasible and frequently detects postoperative pulmonary complications after major abdominal surgery. Discordant observations in atelectasis and pleural effusions for LUS and CXR can be explained by a superior diagnostic ability of LUS in detecting these conditions. The effects of LUS as primary imaging modality on patient outcome should be evaluated in future studies.
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Affiliation(s)
- H R Touw
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - A E Schuitemaker
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - F Daams
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D L van der Peet
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - E M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - P Schober
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - C Boer
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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