1
|
dos Reis NF, Figueiredo FCXS, Biscaro RRM, Lunardelli EB, Maurici R. Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge. Am J Crit Care 2022; 31:65-72. [PMID: 34972844 DOI: 10.4037/ajcc2022732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Barthel Index, originally developed and validated to assess activities of daily living in patients with neuromuscular disorders, is commonly used in research and clinical practice involving critically ill patients. OBJECTIVES To evaluate the internal consistency, reliability, measurement error, and construct validity of the Barthel Index used at intensive care unit discharge. METHODS In this observational study, 2 physiotherapists measured the physical functioning of 122 patients at intensive care unit discharge, using the Barthel Index and other measurement instruments. RESULTS The patients had a median (IQR) age of 56 (47-66) years, and 62 patients (51%) were male. The primary reason for intensive care unit admission was sepsis (28 patients [23%]), and 83 patients (68%) were receiving mechanical ventilation. The Cronbach α value indicating internal consistency was 0.81. For interrater reliability, the intraclass correlation coefficient for the total score was 0.98 (95% CI, 0.97-0.98; P < .001) and the κ statistic for the individual items was 0.54 to 0.94. The standard error of measurement was 7.22, the smallest detectable change was 20.01, and the 95% limits of agreement were -10.3 and 11.8. The Barthel Index showed moderate to high correlations with the other physical functioning measurement instruments (ρ = 0.57 to 0.88; P < .001 for all). CONCLUSION The Barthel Index is a reliable and valid instrument for assessing physical functioning at intensive care unit discharge.
Collapse
Affiliation(s)
- Nair Fritzen dos Reis
- Nair Fritzen dos Reis is a physiotherapist and doctoral student in medical sciences at Santa Catarina Federal University, Florianopolis, Brazil
| | | | - Roberta Rodolfo Mazzali Biscaro
- Roberta Rodolfo Mazzali Biscaro is a physiotherapist and doctoral student in medical sciences at Santa Catarina Federal University
| | - Elizabeth Buss Lunardelli
- Elizabeth Buss Lunardelli is a physician and a doctoral student in medical sciences at Santa Catarina Federal University
| | - Rosemeri Maurici
- Rosemeri Maurici is a physician and professor in the postgraduate program in medical sciences at Santa Catarina Federal University
| |
Collapse
|
2
|
Reis NFD, Biscaro RRM, Figueiredo FCXS, Lunardelli ECB, Silva RMD. Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. Rev Bras Ter Intensiva 2021; 33:353-361. [PMID: 35107546 PMCID: PMC8555403 DOI: 10.5935/0103-507x.20210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Traduzir, adaptar transculturalmente para o português do Brasil o
instrumento Early Rehabilitation Index e validar para uso
na unidade de terapia intensiva o instrumento Early Rehabilitation
Barthel Index, para avaliação do estado
funcional. Métodos Foram executadas as seguintes etapas: preparação,
tradução, reconciliação, tradução
reversa, revisão, harmonização, pré-teste e
avaliação psicométrica. Após esse processo
inicial, a versão em português foi aplicada por dois
avaliadores em pacientes que permaneciam pelo menos 48 horas internados na
unidade de terapia intensiva. Verificou-se a confiabilidade da escala por
meio da consistência interna, da confiabilidade entre avaliadores e
do efeito piso e teto. Para a validade de constructo, correlacionou-se o
Early Rehabilitation Barthel Index com instrumentos que
usualmente são utilizados para avaliação do estado
funcional na unidade de terapia intensiva. Resultados Participaram 122 pacientes com mediana de idade de 56 [46,8 - 66] anos. O
Early Rehabilitation Barthel Index teve confiabilidade
adequada com coeficiente alfa de Cronbach de 0,65. A confiabilidade entre
avaliadores foi excelente, com coeficiente de correlação
intraclasse de 0,94 (IC95% 0,92 - 0,96) e moderado a excelente com
índice de concordância de kappa de 0,54 a 1,0. Os efeitos piso
e teto foram mínimos. Observou-se a validade do Early
Rehabilitation Barthel Index por meio das
correlações com o escore total do Perme Escore (rô =
0,72), da Escala de Estado Funcional em UTI (rô = 0,77), do
Physical Function in Intensive Care Test-score
(rô = 0,69), do Medical Research Council sum score
(rô = 0,58), além das dinamometrias de preensão palmar
(rô = 0,58) e manual de coxa (rô = 0,55), todos com p <
0,001. Conclusão A versão adaptada do Early Rehabilitation Index para
o português brasileiro e na sua totalidade, Early
Rehabilitation Barthel Index é confiável e
válida para avaliação do estado funcional dos pacientes
na alta da unidade de terapia intensiva.
Collapse
Affiliation(s)
- Nair Fritzen Dos Reis
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Roberta Rodolfo Mazzali Biscaro
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Fernanda Cabral Xavier Sarmento Figueiredo
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Elizabeth Cristiane Buss Lunardelli
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Rosemeri Maurici da Silva
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| |
Collapse
|
3
|
Bonorino KC, Biscaro RRM. To: Patient functionality and walking speed after discharge from the intensive care unit. Rev Bras Ter Intensiva 2021; 33:179-180. [PMID: 33886869 PMCID: PMC8075333 DOI: 10.5935/0103-507x.20210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kelly Cattelan Bonorino
- Unidade de Terapia Intensiva Adulto, Hospital Universitário Polydoro de Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Roberta Rodolfo Mazzali Biscaro
- Unidade de Terapia Intensiva Adulto, Hospital Universitário Polydoro de Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| |
Collapse
|
4
|
Fonseca FR, Biscaro RRM, de Rê A, Junkes-Cunha M, dos Reis CM, Bahl MM, Yohannes AM, Maurici R. The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error. J Bras Pneumol 2019; 46:e20180397. [PMID: 31851219 PMCID: PMC7462675 DOI: 10.1590/1806-3713/e20180397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/31/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. METHODS We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. RESULTS The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, -2.24 to 1.96 and -2.65 to 2.69. CONCLUSIONS In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.
Collapse
Affiliation(s)
- Fernanda Rodrigues Fonseca
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | | | - Alexânia de Rê
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Maíra Junkes-Cunha
- . Departamento de Fisioterapia, Centro de Ciências da Saúde, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| | - Cardine Martins dos Reis
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Marina Mônica Bahl
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | | | - Rosemeri Maurici
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
- . Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| |
Collapse
|
5
|
Staub LJ, Biscaro RRM, Maurici R. Emergence of Alveolar Consolidations in Serial Lung Ultrasound and Diagnosis of Ventilator-Associated Pneumonia. J Intensive Care Med 2019; 36:304-312. [PMID: 31818178 DOI: 10.1177/0885066619894279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lung ultrasound (LUS) has been reported as a promising diagnostic tool for ventilator-associated pneumonia (VAP), but patients with previous lung parenchyma commitment have been not studied. PURPOSE To evaluate whether the emergence of sonographic consolidations, rather than their presence, can improve the VAP diagnosis in a sample including patients with previous lung parenchyma diseases. METHODS Patients who completed 48 hours of mechanical ventilation were prospectively studied with daily LUS examinations. We checked the emergence of different consolidation types on the eve and on the day of a clinical suspicion of VAP. We elaborated an algorithm considering, sequentially, the emergence of (1) subpleural consolidations in anterior lung regions on the eve of suspicion; (2) lobar/sublobar consolidation in anterior lung regions on the day of suspicion; (3) lobar/sublobar consolidation with dynamic air bronchograms on the day of suspicion; and (4) any other lobar/sublobar consolidation on the day of suspicion in association with a positive Gram smear of endotracheal aspirate. RESULTS Of the 188 included patients, 60 were suspected and 33 confirmed VAP. The presence of sonographic consolidations at the clinical suspicion had no diagnostic value for VAP. The emergence of subpleural consolidations in anterior lung regions on the eve of suspicion had specificity of 95% (95% confidence interval [CI], 79%-99%). The emergence of lobar/sublobar consolidations in anterior lung regions on the day of suspicion had specificity of 100% (95% CI, 87%-100%). The emergence of lobar/sublobar consolidations with dynamic air bronchograms on the day of suspicion had specificity of 96% (95% CI, 81%-99%). Finally, the proposed algorithm had sensitivity of 63% (95% CI, 46%-77%) and specificity of 85% (95% CI, 67%-94%) for VAP. CONCLUSIONS The presence of sonographic consolidations was not accurate for VAP when patients with previous lung parenchyma commitment were included. However, serial LUS examinations detected the emergence of specific signs of VAP.
Collapse
Affiliation(s)
- Leonardo Jönck Staub
- Department of Clinical Medicine, 28117Federal University of Santa Catarina, Florianópolis, Brazil.,Division of Clinical Medicine, University Hospital of 28117Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Rosemeri Maurici
- Department of Clinical Medicine, 28117Federal University of Santa Catarina, Florianópolis, Brazil.,Graduate Program in Clinical Sciences, 28117Federal University of Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
6
|
Reis CMD, Karloh M, Fonseca FR, Biscaro RRM, Mazo GZ, Mayer AF. Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test. ACTA ACUST UNITED AC 2018; 44:370-377. [PMID: 30020345 PMCID: PMC6467592 DOI: 10.1590/s1806-37562017000000118] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 12/07/2017] [Indexed: 12/03/2022]
Abstract
Objective: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. Methods: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. Results: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (−0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). Conclusions: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.
Collapse
Affiliation(s)
- Cardine Martins Dos Reis
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| | - Manuela Karloh
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| | - Fernanda Rodrigues Fonseca
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| | - Roberta Rodolfo Mazzali Biscaro
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| | - Giovana Zarpellon Mazo
- . Departamento de Educação Física, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| | - Anamaria Fleig Mayer
- . Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis (SC) Brasil
| |
Collapse
|
7
|
Staub LJ, Mazzali Biscaro RR, Velho GV, Reis C, Maurici R. A 59-Year-Old Man With ARDS Receiving “Protective” Ventilation. Chest 2018; 153:e67-e70. [DOI: 10.1016/j.chest.2017.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/11/2017] [Accepted: 10/31/2017] [Indexed: 10/17/2022] Open
|
8
|
Staub LJ, Biscaro RRM, Kaszubowski E, Maurici R. Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax: A systematic review and meta-analysis. Injury 2018; 49:457-466. [PMID: 29433802 DOI: 10.1016/j.injury.2018.01.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the accuracy of the chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax in adults. STUDY DESIGN Systematic review and meta-analysis. METHODS PubMed, EMBASE, Scopus, Web of Science and LILACS (up to 2016) were systematically searched for prospective studies on the diagnostic accuracy of ultrasonography for pneumothorax and haemothorax in adult trauma patients. The references of other systematic reviews and the included studies were checked for further articles. The characteristics and results of the studies were extracted using a standardised form, and their methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Primary analysis was performed considering each hemithorax as an independent unit, while secondary analysis considered each patient. The global diagnostic accuracy of the chest ultrasonography was estimated using the Rutter-Gatsonis hierarchical summary ROC method. Moreover, Reitsma's bivariate model was used to estimate the sensitivity, specificity, positive likelihood ratio (LR + ) and negative likelihood ratio (LR-) of each sonographic sign. This review was previously registered (PROSPERO CRD42016048085). RESULTS Nineteen studies were included in the review, 17 assessing pneumothorax and 5 assessing haemothorax. The reference standard was always chest tomography, alone or in parallel with chest radiography and observation of the chest tube. The overall methodological quality of the studies was low. The diagnostic accuracy of chest ultrasonography had an area under the curve (AUC) of 0.979 for pneumothorax (Fig). The absence of lung sliding and comet-tail artefacts was the most reported sonographic sign of pneumothorax, with a sensitivity of 0.81 (95% confidence interval [95%CI], 0.71-0.88), specificity of 0.98 (95%CI, 0.97-0.99), LR+ of 67.9 (95%CI, 26.3-148) and LR- of 0.18 (95%CI, 0.11-0.29). An echo-poor or anechoic area in the pleural space was the only sonographic sign for haemothorax, with a sensitivity of 0.60 (95%CI, 0.31-0.86), specificity of 0.98 (95%CI, 0.94-0.99), LR+ of 37.5 (95%CI, 5.26-207.5), LR- of 0.40 (95%CI, 0.17-0.72) and AUC of 0.953. CONCLUSION Notwithstanding the limitations of the included studies, this systematic review and meta-analysis suggested that chest ultrasonography is an accurate tool for the diagnostic assessment of traumatic pneumothorax and haemothorax in adults.
Collapse
Affiliation(s)
- Leonardo Jönck Staub
- Emergency Department, University Hospital, Federal University of Santa Catarina, 88036-800, Rua Professora Maria Flora Pausewang, Bairro Trindade, Florianópolis, Santa Catarina, Brazil; Intensive Care Unit, Nereu Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
| | | | - Erikson Kaszubowski
- Department of Psychology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rosemeri Maurici
- Department of Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
9
|
Staub LJ, Biscaro RRM, Maurici R. Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review. J Intensive Care Med 2017; 33:447-455. [PMID: 29084483 DOI: 10.1177/0885066617737756] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). PURPOSE To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. METHODS We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening? MAIN RESULTS Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate-VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP. CONCLUSION Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening.
Collapse
Affiliation(s)
- Leonardo Jönck Staub
- 1 Emergency Department of University Hospital, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,2 Intensive Care Unit of Nereu Ramos Hospital, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Rosemeri Maurici
- 4 Department of Clinical Medicine, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,5 Graduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|