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Sieber S, Garbe J, Böhm S, Eisenmann S. Pneumothorax detection with thoracic ultrasound as the method of choice in interventional pulmonology - A retrospective single-center analysis and experience. BMC Pulm Med 2023; 23:227. [PMID: 37365532 DOI: 10.1186/s12890-023-02511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Recent studies have shown that thoracic ultrasound (TUS) is not inferior to chest radiography (CR) in detecting pneumothorax (PTX). It is unclear if adopting TUS can reduce the number of CR in the daily clinical routine. This retrospective study investigates the utilization of post-interventional CR and TUS for PTX detection after the introduction of TUS as the method of choice in an interventional pulmonology unit. METHODS All interventions with CR or TUS for ruling out PTX performed in the Pneumology Department of the University Hospital Halle (Germany) 2014 to 2020 were included. The documented TUS and CR performed before (period A) and after the introduction of TUS as the method of choice (period B), as well as the number of diagnosed and missed PTX were recorded. RESULTS The study included 754 interventions (110 in period A and 644 in period B). The proportion of CR decreased from 98.2% (n = 108) to 25.8% (n = 166) (p < 0.001). During period B, a total of 29 (4.5%) PTX were diagnosed. Of these, 28 (96.6%) were detected on initial imaging (14 by CR, 14 by TUS ). One PTX (0.2%) was initially missed by TUS, none by CR. Confirmatory investigations were ordered more frequently after TUS (21 of 478, 4.4%) than after CR (3 of 166, 1.8%). CONCLUSION The use of TUS in interventional pulmonology can effectively reduce the number of CR and thus save resources. However, CR may still be favored in specific circumstances or if pre-existing conditions limit sonographic findings.
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Affiliation(s)
- Sonja Sieber
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany.
| | - Jakob Garbe
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Sebastian Böhm
- Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
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Marzouk M, Nasri O, Hammami R, Ben Messaoud C, Thamlaoui S, Baffoun N, Kaabachi O, Kaddour C. Exclusion des complications des cathéters veineux centraux : Echographie
versus radiographie. LA TUNISIE MEDICALE 2023; 101:351-355. [PMID: 38263923 PMCID: PMC11157238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2024]
Abstract
INTRODUCTION The placement of central venous catheters (CVC) is a frequent procedure in intensive care. It is not devoid of complications, the diagnosis of which relied for a long time on the chest X-ray. Currently, ultrasound appears to be an interesting alternative. AIM To report the impact of the use of ultrasound on the time to exclusion of mechanical complications after CVC placement. METHODS This is a prospective, multicenter, comparative, double-blind study. Were included the patients in whom the placement of a CVC was decided. After placement, a chest X-ray was ordered and an ultrasound was performed to look for signs of misplacement and pneumothorax. The two examinations were interpreted by two different doctors. The primary endpoint between the ultrasound group and the RTX group was the time "T1" represented by the time required to exclude complications. RESULTS 30 patients were included in our study. The mean ultrasound T1time was significantly lower than the mean radiological T1time (p=0.000). Only one case of pneumothorax was observed. It was first detected by ultrasound. For the 29 other patients, exclusion of pneumothorax was confirmed by ultrasound and chest X-ray. No misplacement type complications detected. This was confirmed by ultrasound and radiological exclusions. CONCLUSION Ultrasound is a faster tool than RTX in excluding mechanical complications after CVC placement. It guarantees a non-irradiating examination as efficient as chest X-ray for intensive care patients.
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Affiliation(s)
- Mahmoud Marzouk
- Kassab Institute of Orthopaedics, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Oussama Nasri
- Kassab Institute of Orthopaedics, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Rabeb Hammami
- Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Chadha Ben Messaoud
- Kassab Institute of Orthopaedics, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Saber Thamlaoui
- Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Nader Baffoun
- Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Olfa Kaabachi
- Kassab Institute of Orthopaedics, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Chokri Kaddour
- Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Lung Ultrasound for the Exclusion of Pneumothorax after Interventional Bronchoscopies-A Retrospective Study. J Clin Med 2023; 12:jcm12041474. [PMID: 36836009 PMCID: PMC9967502 DOI: 10.3390/jcm12041474] [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] [Received: 01/20/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
A chest X-ray (CXR) is recommended after bronchoscopies with an increased risk of pneumothorax (PTX). However, concerns regarding radiation exposure, expenses and staff requirements exist. A lung ultrasound (LUS) is a promising alternative for the detection of PTX, though data are scarce. This study aims to investigate the diagnostic yield of LUS compared to CXR, to exclude PTX after bronchoscopies with increased risk. This retrospective single-centre study included transbronchial forceps biopsies, transbronchial lung cryobiopsies and endobronchial valve treatments. Post-interventional PTX screening consisted of immediate LUS and CXR within two hours. In total, 271 patients were included. Early PTX incidence was 3.3%. Sensitivity, specificity, and the positive and negative predictive values of LUS were 67.7% (95% CI 29.93-92.51%), 99.2% (95% CI 97.27-99.91%), 75.0% (95% CI 41.16-92.79%) and 98.9% (95% CI 97.18-99.54%), respectively. PTX detection by LUS enabled the immediate placement of two pleural drains along with the bronchoscopy. With CXR, three false-positives and one false-negative were observed; the latter evolved into a tension-PTX. LUS correctly diagnosed these cases. Despite low sensitivity, LUS enables early diagnosis of PTX, thus preventing treatment delays. We recommend immediate LUS, in addition to LUS or CXR after two to four hours and monitoring for signs and symptoms. Prospective studies with higher sample sizes are needed.
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Eisenmann S, Lambrecht N, Dießel L, Busse C, Nuding S, Vogt A. Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series. BMC Pulm Med 2023; 23:5. [PMID: 36604710 PMCID: PMC9815052 DOI: 10.1186/s12890-022-02296-1] [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] [Received: 04/02/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently challenging. Surgical lung biopsy was previously reported to be of additive value. We describe our institutional experience using transbronchial cryobiopsy (TBCB) for further characterization of severe and unexplained ARDS cases. CASE PRESENTATION We retrospectively collected data of TBCB in patients with unexplained ARDS, whether with or without ECMO-support. Between 2019 and 2020 TBCB was performed in eight patients. Decision for the intervention was decided in multidisciplinary discussion. Five patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. TBCB was performed in one segment, that was prophylactically occluded by Watanabe spigot or swab after the procedure. Histology results and their contribution to further therapeutic decisions were analyzed. Histology revealed five diffuses alveolar damage, one acute fibrinoid organizing pneumonia, one cryptogenic organizing pneumonia and one lung cancer. All results contributed to the decision of further management. While no pneumothorax or severe endobronchial bleeding occurred, two delayed hematothoraces needed surgical treatment. No patients died due to TBCB. CONCLUSION TBCB is feasible in ARDS even during ECMO treatment. Histologic results can play a significant role in therapeutic and ethic discussion to guide the patients' care. Side effects should be considered and monitored.
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Affiliation(s)
- Stephan Eisenmann
- grid.461820.90000 0004 0390 1701Department of Internal Medicine I, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Nina Lambrecht
- grid.461820.90000 0004 0390 1701Department of Internal Medicine I, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Linda Dießel
- grid.461820.90000 0004 0390 1701Department of Pathology, University Hospital Halle, Magdeburger Strasse 2, 06112 Halle, Germany
| | - Christin Busse
- grid.461820.90000 0004 0390 1701Department of Pathology, University Hospital Halle, Magdeburger Strasse 2, 06112 Halle, Germany
| | - Sebastian Nuding
- Department of Internal Medicine, IIIUniversity Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Alexander Vogt
- Department of Internal Medicine, IIIUniversity Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
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Kjelle E, Andersen ER, Krokeide AM, Soril LJJ, van Bodegom-Vos L, Clement FM, Hofmann BM. Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Arne Magnus Krokeide
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Lesley J J Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Leti van Bodegom-Vos
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fiona M Clement
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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Soni NJ, Winsett RE, Velez MI, Singhal P, Proud KC, Abedi A, Restrepo MI, Angel LF. Pleural Ultrasound for Detection of Postbronchoscopy Pneumothorax in Lung Transplant Recipients. J Bronchology Interv Pulmonol 2021; 28:307-309. [PMID: 34374670 PMCID: PMC8460076 DOI: 10.1097/lbr.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Nilam J. Soni
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health—San Antonio
- Section of Pulmonary Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Robert E. Winsett
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health—San Antonio
| | - Maria I. Velez
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health—San Antonio
| | - Preeti Singhal
- Department of Medicine, University of Southern California, Los Angeles, CA
| | - Kevin C. Proud
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health—San Antonio
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, NY
| | - Ali Abedi
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health—San Antonio
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health—San Antonio
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, NY
| | - Luis F. Angel
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, NY
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