The application of Critical Care Chest Ultrasonic Evaluation-plus Protocol in the etiological diagnosis of dyspnea and/or hemodynamic instability caused by abdominal abnormality

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Objective: To investigate the application of Critical Care Chest Ultrasonic Examination (CCUE)-plus (CCUE-plus) in the etiological diagnosis in patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities. Methods: Patients who suffered from dyspnea and/or hemodynamic instability in the Department of Critical Care Medicine, Xiangya Hospital, Central South University from September 2013 to September 2016 were recruited in this study. A total of 255 consecutive patients completed CCUE within 2hrs of admission. If the diaphragm could not be seen in the routine phrenic points according to Bedside Lung Ultrasound Evaluation (BLUE) protocol, it would be found along midaxillary line and defined m-point. The 59 patients with altered diaphragmatic position (m-point was more than 2 cm higher than phrenic point) received sequential abdominal ultrasonography. The latter ultrasonographic findings were compared with CT results. Results: There were 42(71.19%) cases with positive findings of abdominal ultrasonography, including 18 cases of seroperitoneum, 16 cases of intestinal obstruction and 8 cases combined. Compared with 56 patients who applied with CT exam, the abdominal ultrasonography revealed a sensitivity of 76.7% and a specificity of 100.0% to diagnose seroperitoneum (AUC(ROC) 0.917); whereas the sensitivity was 75.0% and the specificity was 90.9% (AUC(ROC) 0.778) to diagnose intestinal obstruction. Moreover, there were 44(74.58%) patients with normal left ventricular systolic function; more than three quarters (46/59, 77.97%) patients had pulmonary consolidation. Conclusion: In patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities and altered diaphragmatic position in BLUE protocol, CCUE-plus protocol has a high positive predictive value of more than 90% in abdominal abnormality. The findings of abdominal ultrasonography may change therapeutic target from cardio-pulmonary optimization to relief of intestinal obstruction or drainage of seroperitoneum.