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ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 110-114

Lung ultrasound in intensive care unit: a prospective comparative study with bedside chest radiography using computed tomography of chest as a gold standard


1 Department of Critical Care Medicine, Cairo University, Giza, Egypt
2 Department of Radiology, Cairo University, Giza, Egypt

Correspondence Address:
Ali Mohsen
Department of Critical Care Medicine, Cairo University, Giza, 11742
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_52_17

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Background Bedside chest radiography (CXR) is routinely performed on a daily basis to assess lung status for the critically ill patients. However, the technical difficulties during the procedure have led to the incorrect assessment of most common lung pathologies diagnosed in the ICUs, like pneumothorax (PTX), pleural effusion, lung consolidation, and acute interstitial syndrome (AIS). Recently, lung ultrasound (LUS) has become a new reliable, accurate, and attractive tool for diagnosing most of these lung pathologies. Objective Our study was designed to find out if LUS could be a more reliable, accurate, and sensitive bedside tool in diagnosing most of the common chest diseases encountered in the ICUs, in comparison with bedside CXR, using thoracic computed tomography (CT) as a gold standard. Patients and methods Forty critically ill patients scheduled for CT chest were prospectively studied with a standard LUS protocol. Four pathologic entities were evaluated: consolidation, AIS, PTX, and pleural effusion. Each hemithorax was evaluated for the presence or absence of each abnormality. Eighty hemithoracies were evaluated by the three imaging techniques. Results In comparing bedside CXR with CT chest, bedside CXR detected three cases of PTX of 12 by CT (P=0.02), 11 cases of pulmonary consolidation of 21 by CT (P=0.04), 12 cases of pleural effusion of 19 by CT (P=0.03), and 27 cases of AIS of 36 by CT (P=0.11). On the contrary, comparing LUS with CT chest, LUS detected 11 cases of PTX of 12 by CT (P=0.12), 21 cases of pulmonary consolidation of 21 by CT (P=1.0), 17 cases of pleural effusion of 19 by CT (P=0.32), and 32 cases of AIS of 36 by CT (P=0.02). The sensitivity, specificity, and diagnostic accuracy of CXR were found to be 62, 89, and 73%, respectively, for consolidation; 50, 73.6, and 60%, respectively, for AIS; 25, 100, and 78%, respectively, for PTX; and 46, 90, and 78%, respectively, for pleural effusion. The corresponding values for LUS were 100, 81.4, and 93% for consolidation; 100, 58, and 78% for AIS; 100, 86, and 90% for PTX; and 100, 97, and 98% for pleural effusion. Conclusion In our general ICU population, LUS has shown a considerably better diagnostic performance and is more reliable than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to chest CT.


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