Bedside Lung Ultrasound in Critical Care Units
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- Category: Vol. 78, September 2010
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Bedside Lung Ultrasound in Critical Care Units,MOHAMED T. ELKHOLY, HATEM S. ABDELHAMID, SAMEH S. HANAFI and KHALED H. HUSSEIN
Abstract
The accurate etiological diagnosis of lung opacities on a bedside chest radiograph in critically ill patients is a real challenge. Acute respiratory failure patients is one of the most distressing conditions that are not ideal for immediate diag-nosis, which sometimes compromises the outcome. The aim of this study was evaluation of chest ultrasound as a bedside method to assess lung morphology in hypoxemic patients in critical care practice. This study was conducted in 34 beds in ICU. The study included 130 dyspnic patients with a definite diagnosis. The chest ultrasonography results were compared with the final diagnoses. Those 130 patients represented 34 patients with cardiogenic pulmonary edema, 22 pneumonia patients, COPD were 32 cases, bronchial asthma in exacerba-tion were 26 patients, 9 cases of pulmonary embolism, and 7 patients diagnosed as pneumothorax. The ultrasonography findings were grouped under profiles A, A', B, B', A/B+, C, and PLAPS to avoid repetitive descriptions. 5 Mhz microcon-vex probe was used. The results revealed B profile in pulmo-nary edema with 97% sensitivity and 95% specificity. Normal profile and A' profile without PLAPS in COPD and asthma with sensitivity of 93% and specificity of 97%. Ultrasound in pulmonary embolism when accompanied by deep vein thrombosis showing predominant A lines have 89% sensitivity and 99% specificity. The presence of lung point and absent lung sliding represented 100% sensitivity and specificity in pneumothorax cases. Pneumonia yields numerous signs B', AB, and C profiles that highlighted distinctions between pneumonia and pulmonary edema. Ultrasound in pneumonia cases has sensitivity of 88% and specificity of 94%. The conclusion was that lung ultrasound saves time and decreases the need for CT whose drawbacks include delayed care im-plementation, irradiation, cost, and required supine position. Lung ultrasound may appear complex at first but simply requires a change in thinking. Once the process has been learned, a step-by-step use will make it routine.