Research Article
Year 2024,
Volume: 63 Issue: 4, 572 - 579, 09.12.2024
Abstract
Introduction: This study aimed to evaluate the effectiveness of lung ultrasonography (US) in detecting the cause of acute respiratory distress in the emergency department.
Methods: This cross-sectional analytical study was carried out on 195 adult patients who were admitted to the Emergency Department of a University Hospital with acute respiratory failure in 6months period. The validity of the US diagnoses was assessed by comparing the decisions made by researchers according to the BLUE protocol classification with the final judgments made by the primary doctors using gold-standard diagnostic techniques suggested by the guidelines.
Results: The diagnostic accuracy of lung US was 89.7%. While Congestive Heart Failure (CHF) (n=91), Chronic Obstructive Pulmonary Disease (COPD) (n=53), pneumonia (n=69), and Pneumothorax (PTX) (n=5) could be diagnosed by ultrasound with high sensitivity and specificity, its specificity in the diagnosis of Pulmonary Thromboembolism (PTE)(n=18) was low (67%). Ultrasonography could also diagnose combined pathologies such as pneumonia associated with CHF, or pneumonia associated with COPD, with high sensitivity and specificity. It has been determined that the diagnostic accuracy of the routine physical examination and lung radiography used in the emergency room to assess bedside respiratory distress is lower than that of ultrasonography.
Discussion: In this study, we found that lung US was effective in the diagnosis of CHF, COPD, pneumonia, PTE, and PTX. Compared to the gold standard tests, it shortened the duration of the diagnosis. Finally, US can also be applied safely in centers where advanced diagnostic facilities are not available.
References
- Marx J, Adams J, Walls R, Rosen P, Hockberger R. Rosen’s Emergency Medicine Concept and clinical practice. Elsevier; 2009. 129 p.
- Zanobetti M, Scorpiniti M, Gigli C, Nazerian P, Vanni S, Innocenti F, et al. Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED. Chest. 2017;151(6):1295–301.
- Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure the BLUE protocol. Chest. 2008;134(1):117–25.
- Cardinale L, Volpicelli G, Binello F, Garofalo G, Priola SM, Veltri A, et al. Clinical application of lung ultrasound in patients with acute dyspnoea: differential diagnosis between cardiogenic and pulmonary causes. Radiol Medica. 2009;114(7):1053–64.
- Copetti R, Soldati G, Copetti P. Chest sonography: A useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;29:6–16.
- Volpicelli G. Lung sonography. J Ultrasound Med. 2013;32(1):165–71.
- Noble VE, Lamhaut L, Capp R, Bosson N, Liteplo A, Marx JS, et al. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Educ. 2009;12(9):3–4.
- Lichtenstein D. Lung ultrasound in acute respiratory failure an introduction to the BLUE-protocol. Minerva Anestesiol. 2009;75(5):313–7.
- Helen E Davies, Robert J O Davies, Christopher W H Davies; BTS Pleural Disease Guideline Group, Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline, Thorax. 2010 Aug:65 Suppl 2:ii41-53. doi: 10.1136/thx.2010.137000.
- Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal. August 2019. doi:10.1093/eurheartj/ehz405
- Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):1810-52. doi: 10.1161/CIR.0b013e31829e8807
- Shireen Mirza, Ryan D Clay, Matthew A Koslow, Paul D Scanlon COPD Guidelines: A Review of the 2018 GOLD Report Mayo Clin Proc. 2018 Oct;93(10):1488-1502. doi: 10.1016/j.mayocp.2018.05.026.
- Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. October 2019:e45-e67. doi:10.1164/rccm.201908-1581st
- Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231–8.
- Lichtenstein D. General ultrasound in the critically ill. 2nd Editio. Heidelberg: Springer-Verlag; 2005. 70-95 p.
- Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care. 2014;4:1–5.
- Stefanidis K, Dimopoulos S, Nanas S. Basic principles and current applications of lung ultrasonography in the intensive care unit. Respirology. 2011;16(2):249–56.
- Joyner CR, Herman RJ, Reid JM. Reflected Ultrasound in the Detection and Localization of Pleural Effusion. JAMA J Am Med Assoc. 1967;200:399–402.
- Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative Diagnostic Performances of Auscultation, Chest Radiography, and Lung Ultrasonography in Acute Respiratory Distress Syndrome. Anesthesiology. 2004;100(1):9–15.
- Radzina, M., & Biederer, J. (2019). Ultrasonography of the Lung. Rofo. 2019 Oct;191(10):909-923. doi: 10.1055/a-0881-3179. Epub 2019 Apr 4.
- Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact: An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640–6.
- Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB. The air bronchogram: Sonographic demonstration. Am J Roentgenol. 1986;147:593–5.
- Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30:276–81.
- Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: Lung sliding. Chest. 1995;108:1345–8.
- Lichtenstein DA. BLUE-Protocol and FALLS-Protocol. Chest. 2015;147(6):1659–70.
- Patel CJ, Bhatt HB, Parikh SN, Jhaveri BN, Puranik JH. dside Lung Ultrasound in Emergency Protocol as a Diagnostic Tool in Patients of Acute Respiratory Distress Presenting to Emergency Department. J Emerg Trauma Shock. 2018;11(2):125–9.
- 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 Mar;49(3):457-466. doi: 10.1016/j.injury.2018.01.033.
- Mathis G, Metzler J, Fussenegger D, Sutterlütti G, Feurstein M, Fritzsche H. Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism. Eur Heart J. 1993;14(6):804–8.
- Mathis G. Ultrasound in thromboembolism. Praxis (Bern 1994). 2015;104(19):1013–8.
- Mathis G, Bitschnau R, Gehmacher O, Scheier M, Kopf A, Schwärzler B, et al. Chest ultrasound in diagnosis of pulmonary embolism in comparison to helical CT. Ultraschall der Medizin. 1999;20(2):54–9.
- Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. 2006;24(6):689–96.
- Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012;122:130–41.
- Pagano A, Numis FG, Visone G et al. Lung ultrasound for diagnosis of pneumonia in emergency department Intern Emerg Med. 2015 Oct;10(7):851-4. doi: 10.1007/s11739-015-1297-2. Epub 2015 Sep 7.
- Biagi C, Pierantoni L, Baldazzi M. et al. Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm Med. 2018 Dec 7;18(1):191. doi: 10.1186/s12890-018-0750-1.
- Murali A, Prakash A, Dixit R. et al. Lung Ultrasound: A Complementary Imaging Tool for Chest X-Ray in the Evaluation of Dyspnea. Indian J Radiol Imaging. 2023 Jan 6;33(2):162-172. doi: 10.1055/s-0042-1759850.
Year 2024,
Volume: 63 Issue: 4, 572 - 579, 09.12.2024
Abstract
Giriş: Bu çalışmada acil serviste akut solunum sıkıntısının nedeninin saptanmasında akciğer ultrasonografisinin (US) etkinliğinin değerlendirilmesi amaçlandı.
Yöntemler: Bu kesitsel analitik çalışma, bir Üniversite Hastanesi Acil Servisi'ne 6 aylık sürede akut solunum yetmezliği nedeniyle başvuran 195 yetişkin hasta üzerinde gerçekleştirildi. US teşhislerinin geçerliliği, araştırmacıların BLUE protokol sınıflandırmasına göre verdiği kararlar ile primer doktorların kılavuzların önerdiği altın standart teşhis tekniklerini kullanarak verdikleri nihai kararların karşılaştırılması yoluyla değerlendirildi.
Bulgular: Akciğer US'un tanısal doğruluğu %89,7 idi. US ile yüksek duyarlık ve özgüllükle; Konjestif Kalp Yetmezliği (KKY) (n=91), Kronik Obstrüktif Akciğer Hastalığı (KOAH) (n=53), pnömoni (n=69) ve Pnömotoraks (PTX) (n=5) tanıları konulabilmektedir. Pulmoner Tromboembolizm (PTE)(n=18) tanısında duyarlılığı ve özgüllüğü düşük (%67) idi. Ultrasonografi aynı zamanda KKY ile ilişkili pnömoni veya KOAH ile ilişkili pnömoni gibi kombine patolojileri de yüksek duyarlılık ve özgüllükle teşhis edebilir. Acil serviste yatak başı solunum sıkıntısını değerlendirmek için kullanılan rutin fizik muayene ve akciğer grafisinin tanısal doğruluğunun ultrasonografiye göre daha düşük olduğu belirlendi.
Tartışma: Bu çalışmada akciğer US'un KKY, KOAH, pnömoni, PTE ve PTX tanısında etkili olduğunu bulduk. Altın standart testlerle karşılaştırıldığında tanı süresini kısalttı. Son olarak US, ileri tanı olanaklarının bulunmadığı merkezlerde de güvenle uygulanabilir.
References
- Marx J, Adams J, Walls R, Rosen P, Hockberger R. Rosen’s Emergency Medicine Concept and clinical practice. Elsevier; 2009. 129 p.
- Zanobetti M, Scorpiniti M, Gigli C, Nazerian P, Vanni S, Innocenti F, et al. Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED. Chest. 2017;151(6):1295–301.
- Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure the BLUE protocol. Chest. 2008;134(1):117–25.
- Cardinale L, Volpicelli G, Binello F, Garofalo G, Priola SM, Veltri A, et al. Clinical application of lung ultrasound in patients with acute dyspnoea: differential diagnosis between cardiogenic and pulmonary causes. Radiol Medica. 2009;114(7):1053–64.
- Copetti R, Soldati G, Copetti P. Chest sonography: A useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;29:6–16.
- Volpicelli G. Lung sonography. J Ultrasound Med. 2013;32(1):165–71.
- Noble VE, Lamhaut L, Capp R, Bosson N, Liteplo A, Marx JS, et al. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Educ. 2009;12(9):3–4.
- Lichtenstein D. Lung ultrasound in acute respiratory failure an introduction to the BLUE-protocol. Minerva Anestesiol. 2009;75(5):313–7.
- Helen E Davies, Robert J O Davies, Christopher W H Davies; BTS Pleural Disease Guideline Group, Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline, Thorax. 2010 Aug:65 Suppl 2:ii41-53. doi: 10.1136/thx.2010.137000.
- Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal. August 2019. doi:10.1093/eurheartj/ehz405
- Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):1810-52. doi: 10.1161/CIR.0b013e31829e8807
- Shireen Mirza, Ryan D Clay, Matthew A Koslow, Paul D Scanlon COPD Guidelines: A Review of the 2018 GOLD Report Mayo Clin Proc. 2018 Oct;93(10):1488-1502. doi: 10.1016/j.mayocp.2018.05.026.
- Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. October 2019:e45-e67. doi:10.1164/rccm.201908-1581st
- Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231–8.
- Lichtenstein D. General ultrasound in the critically ill. 2nd Editio. Heidelberg: Springer-Verlag; 2005. 70-95 p.
- Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care. 2014;4:1–5.
- Stefanidis K, Dimopoulos S, Nanas S. Basic principles and current applications of lung ultrasonography in the intensive care unit. Respirology. 2011;16(2):249–56.
- Joyner CR, Herman RJ, Reid JM. Reflected Ultrasound in the Detection and Localization of Pleural Effusion. JAMA J Am Med Assoc. 1967;200:399–402.
- Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative Diagnostic Performances of Auscultation, Chest Radiography, and Lung Ultrasonography in Acute Respiratory Distress Syndrome. Anesthesiology. 2004;100(1):9–15.
- Radzina, M., & Biederer, J. (2019). Ultrasonography of the Lung. Rofo. 2019 Oct;191(10):909-923. doi: 10.1055/a-0881-3179. Epub 2019 Apr 4.
- Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact: An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640–6.
- Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB. The air bronchogram: Sonographic demonstration. Am J Roentgenol. 1986;147:593–5.
- Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30:276–81.
- Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: Lung sliding. Chest. 1995;108:1345–8.
- Lichtenstein DA. BLUE-Protocol and FALLS-Protocol. Chest. 2015;147(6):1659–70.
- Patel CJ, Bhatt HB, Parikh SN, Jhaveri BN, Puranik JH. dside Lung Ultrasound in Emergency Protocol as a Diagnostic Tool in Patients of Acute Respiratory Distress Presenting to Emergency Department. J Emerg Trauma Shock. 2018;11(2):125–9.
- 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 Mar;49(3):457-466. doi: 10.1016/j.injury.2018.01.033.
- Mathis G, Metzler J, Fussenegger D, Sutterlütti G, Feurstein M, Fritzsche H. Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism. Eur Heart J. 1993;14(6):804–8.
- Mathis G. Ultrasound in thromboembolism. Praxis (Bern 1994). 2015;104(19):1013–8.
- Mathis G, Bitschnau R, Gehmacher O, Scheier M, Kopf A, Schwärzler B, et al. Chest ultrasound in diagnosis of pulmonary embolism in comparison to helical CT. Ultraschall der Medizin. 1999;20(2):54–9.
- Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. 2006;24(6):689–96.
- Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012;122:130–41.
- Pagano A, Numis FG, Visone G et al. Lung ultrasound for diagnosis of pneumonia in emergency department Intern Emerg Med. 2015 Oct;10(7):851-4. doi: 10.1007/s11739-015-1297-2. Epub 2015 Sep 7.
- Biagi C, Pierantoni L, Baldazzi M. et al. Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm Med. 2018 Dec 7;18(1):191. doi: 10.1186/s12890-018-0750-1.
- Murali A, Prakash A, Dixit R. et al. Lung Ultrasound: A Complementary Imaging Tool for Chest X-Ray in the Evaluation of Dyspnea. Indian J Radiol Imaging. 2023 Jan 6;33(2):162-172. doi: 10.1055/s-0042-1759850.
There are 35 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 9, 2024 |
| Submission Date | July 19, 2024 |
| Acceptance Date | August 17, 2024 |
| Published in Issue | Year 2024Volume: 63 Issue: 4 |
