The role of ultrasound in the diagnosis of atelectasis and reaeration after recruitment maneuvers compared with chest computed tomography in critically ill, mechanically ventilated patients

Abstract

Introduction In critically ill patients, atelectasis is an extremely common condition, so accurate diagnosis of atelectasis with available diagnostic methods and trials of atelectasis improvement would be very helpful. First, computed tomography (CT) is believed to be the gold standard method for atelectasis or consolidation detection and consequently a gold standard for the evaluation of reaeration after different recruitment maneuvers. Ultrasound (US) has been underestimated for a long period and thought to be of limited value in the field of chest and lung diseases, but US has proved with accurate usage and qualified application techniques to be a very important bedside tool for the diagnosis of chest diseases and may has values over CT techniques in some clinical issues. US is playing an important role in the diagnosis of many diseases, which gives many advantages of US in ICU wards as ultrasonography is of low cost, available, lightweight, gives real-time image, and diagnosis with low radiation exposure,. Portable could be used in the ward without patient transportation and immediate results. Objective The aim of this study was to assess the role of ultrasonography in the diagnosis of lung reaeration after recruitment maneuvers compared with CT chest in critically ill mechanically ventilated patients using chest ultrasonography. Materials and methods The study was carried out on 30 intubated and mechanically ventilated patients, who were admitted to ICUs (postsurgical and general ICUs). Ultrasonography was repeated every 12 h for 2 days together with arterial blood gases sampling to monitor reaeration and resolving of hypoxia. After 48 h, CT chest was done to monitor the efficacy of ultrasonography in detecting signs of reaeration. Results There was no statistically significant difference in the diagnostic ability of US before and after recruitment; diagnostic ability of US before recruitment was 93.3% and after recruitment it decreased to 86.7%, which was not significant. The role of US in the diagnosis of recruitment was very high as its sensitivity 95% confidence interval=86.7 (77.9–99.18) as well as its positive predictive value (95% confidence interval) was 100 (87.66–100). Conclusion Lung US has proved its diagnostic value besides it having advantages as a bedside, real-time image, low-radiation, and of lower cost than CT in recruitment maneuver assessment.