Role of thoracic ultrasound in diagnosis of pulmonary and pleural diseases in critically ill patients

Abstract

ObjectiveTo evaluate the diagnostic performance of thoracic ultrasound and compare it with the bedside chest radiography (CXR) and thoracic computed tomography (CT) for the detection of various pathologic abnormalities in unselected critically ill patients. IntroductionLung imaging in critically ill patients is usually performed either by bedside CXR or thoracic CT, but both techniques have limitations which constrain their usefulness. Ultrasound has quite similar performances to CT. Nowadays, bedside thoracic ultrasound is increasingly used in critically ill patients. Patients and methodsThis study was conducted upon 130 mechanically ventilated and non-mechanically ventilated patients; 84 males and 46 females with a mean age of 43.23±12.62years in the medical and surgical ICUs – Menoufia University Hospitals from October 2014 to October 2015. The patients were evaluated for any possible lung pathology according to the modified lung ultrasound protocol and the lung ultrasound results were compared to those of plain CXR and CT chest. ResultsRegarding pneumonia diagnosis, US showed a sensitivity of 93%, specificity of 95%, PPV of 98% and NPV of 87% and when combined with clinical findings, these values became 94%, 93%, 97%, 89% respectively. In diagnosing pleural effusion, US showed a sensitivity of 94%, specificity of 96%, PPV of 97% and NPV of 90% and also when combined with clinical findings, these values became 94%, 96%, 97%, 90% respectively. In diagnosing pulmonary edema, US showed a sensitivity of 93%, specificity of 93%, PPV of 62% and NPV of 99% and when combined with clinical findings these values became 93%, 91%, 54%, 99% respectively. In diagnosing pneumothorax, the US sensitivity was 96%, specificity was 98%, PPV was 93% and NPV was 99% and also when combined with clinical findings these values became 100%, 98%, 93%, 100% respectively. ConclusionThe results and advantages of thoracic US make it a suitable diagnostic modality for evaluating lung and pleural pathologies in the ICU that will have the upper hand over CXR and chest CT in the following decades.