Nektaria Xirouchaki, Eleftherios Magkanas, Katerina Vaporidi, Eumorfia Kondili, Maria Plataki, Alexandros Patrianakos, Evaggelia Akoumianaki, Dimitrios Georgopoulos
PURPOSE: To compare the diagnostic performance of lung ultrasound and bedside chest radiography (CXR) for the detection of various pathologic abnormalities in unselected critically ill patients, using thoracic computed tomography (CT) as a gold standard. METHODS: Forty-two mechanically ventilated patients scheduled for CT were prospectively studied with a modified lung ultrasound protocol. Four pathologic entities were evaluated: consolidation, interstitial syndrome, pneumothorax, and pleural effusion...
September 2011: Intensive Care Medicine
Gregor Prosen, Petra Klemen, Matej Štrnad, Stefek Grmec
INTRODUCTION: We studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet-tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP) and clinical assessment (according to the modified Boston criteria) in differentiating heart failure (HF)-related acute dyspnea from pulmonary (chronic obstructive pulmonary disease (COPD)/asthma)-related acute dyspnea in the prehospital setting. METHODS: Our prospective study was performed at the Center for Emergency Medicine, Maribor, Slovenia, between July 2007 and April 2010...
2011: Critical Care: the Official Journal of the Critical Care Forum
Daniel A Lichtenstein, Gilbert A Mezière, Jean-François Lagoueyte, Philippe Biderman, Ivan Goldstein, Agnès Gepner
BACKGROUND: The risk of pulmonary edema is the main limiting factor in fluid therapy in the critically ill. Interstitial edema is a subclinical step that precedes alveolar edema. This study assesses a bedside tool for detecting interstitial edema, lung ultrasound. The A-line is a horizontal artifact indicating a normal lung surface. The B-line is a kind of comet-tail artifact indicating subpleural interstitial edema. The relationship between anterior interstitial edema detected by lung ultrasound and the pulmonary artery occlusion pressure (PAOP) value was investigated...
October 2009: Chest
Stefano Parlamento, Roberto Copetti, Stefano Di Bartolomeo
OBJECTIVES: The aim of this study is to assess the ability of bedside lung ultrasound (US) to confirm clinical suspicion of pneumonia and the feasibility of its integration in common emergency department (ED) clinical practice. METHODS: In this study we performed lung US in adult patients admitted in our ED with a suspected pneumonia. Subsequently, a chest radiograph (CXR) was carried out for each patient. A thoracic computed tomographic (CT) scan was made in patients with a positive lung US and a negative CXR...
May 2009: American Journal of Emergency Medicine
Camilla L Wong, Jayna Holroyd-Leduc, Sharon E Straus
CONTEXT: Pleural effusion is a common finding among patients presenting with respiratory symptoms. The value of the bedside examination to detect pleural effusion is unclear. OBJECTIVE: To systematically review the evidence regarding the accuracy of the physical examination in assessing the probability of a pleural effusion. DATA SOURCES: We searched MEDLINE (1950-October 2008) and EMBASE (1980-October 2008) using Ovid to identify English-language studies conducted in a clinical setting...
January 21, 2009: JAMA
Michael Blaivas, James W Tsung
OBJECTIVE: Determining the correct position of endotracheal tubes in critically ill patients may be complicated by external factors such as noise, body habitus, and the need for ongoing resuscitation. Multiple detection techniques have been developed to determine the correct endotracheal tube position, recently including the use of sonography to evaluate lung expansion and diaphragmatic excursion. These techniques have also been applied to diagnosis of right endobronchial main stem intubation, which may be confused with a unilateral pneumothorax in some cases...
May 2008: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Daniel A Lichtenstein, Gilbert A Mezière
BACKGROUND: This study assesses the potential of lung ultrasonography to diagnose acute respiratory failure. METHODS: This observational study was conducted in university-affiliated teaching-hospital ICUs. We performed ultrasonography on consecutive patients admitted to the ICU with acute respiratory failure, comparing lung ultrasonography results on initial presentation with the final diagnosis by the ICU team. Uncertain diagnoses and rare causes (frequency<2%) were excluded...
July 2008: Chest
Giovanni Volpicelli, Luciano Cardinale, Giorgio Garofalo, Andrea Veltri
This review discusses the usefulness of bedside lung ultrasound in the diagnostic distinction between different causes of acute dyspnea in the emergency setting, particularly focusing on differential diagnosis of pulmonary edema and exacerbation of chronic obstructive pulmonary disease (COPD). This is possible using a simple unit and easy-to-acquire technique performed by radiologists and clinicians. Major advantages include bedside availability, absence of radiation, high feasibility and reproducibility, and cost efficiency...
May 2008: Emergency Radiology
Giovanni Volpicelli, Alessandro Mussa, Giorgio Garofalo, Luciano Cardinale, Giovanna Casoli, Fabio Perotto, Cesare Fava, Mauro Frascisco
OBJECTIVES: To assess the potential of bedside lung ultrasound to diagnose the radiologic alveolar-interstitial syndrome (AIS) in patients admitted to an emergency medicine unit and to estimate the occurrence of ultrasound pattern of diffuse and multiple comet tail artifacts in diseases involving lung interstitium. METHODS: The ultrasonic feature of multiple and diffuse comet tail artifacts B line was investigated in each of 300 consecutive patients within 48 hours after admission to our emergency medicine unit...
October 2006: American Journal of Emergency Medicine
Daniel A Lichtenstein, Gilbert Mezière, Nathalie Lascols, Philippe Biderman, Jean-Paul Courret, Agnès Gepner, Ivan Goldstein, Marc Tenoudji-Cohen
OBJECTIVES: Pneumothorax can be missed by bedside radiography, and computed tomography is the current alternative. We asked whether lung ultrasound could be of any help in this situation. DESIGN: Retrospective study. SETTING: The medical intensive care unit of a university-affiliated teaching hospital. PATIENTS: All patients admitted to the intensive care unit are routinely scanned with whole-body ultrasound (including screening for pneumothorax) and chest radiography...
June 2005: Critical Care Medicine
D Lichtenstein, G Mezière, P Biderman, A Gepner
OBJECTIVE: We studied an ultrasound sign, the fleeting appearance of a lung pattern (lung sliding or pathologic comet-tail artifacts) replacing a pneumothorax pattern (absent lung sliding plus exclusive horizontal lines) in a particular location of the chest wall. This sign was called the "lung point". DESIGN: Prospective study. SETTING: The medical ICU of a university-affiliated teaching hospital. PATIENTS: The "lung point" was sought in 66 consecutive cases of proven pneumothorax analyzable using ultrasound--including 8 radio-occult cases diagnosed by means of CT and in 233 consecutive hemithoraces studied by CT and free of pneumothorax-- including 17 cases where pneumothorax was suspected...
October 2000: Intensive Care Medicine
D Lichtenstein, G Mezière, P Biderman, A Gepner
OBJECTIVE: Ultrasound artifacts arising from the lung-wall interface are either vertical (comet-tail artifacts) or horizontal. The significance of these artifacts for the diagnosis of pneumothorax was assessed. DESIGN: Prospective clinical study. SETTING: The medical ICU of a university-affiliated teaching hospital. PATIENTS: We compared 41 complete pneumothoraces with 146 hemithoraces in 73 critically ill patients in which computed tomography showed absence of pneumothorax...
April 1999: Intensive Care Medicine
D Lichtenstein, G Mezière
OBJECTIVE: Acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease (COPD) can have a similar clinical presentation, and X-ray examination does not always solve the problem of differential diagnosis. The potential of lung ultrasound to distinguish these two disorders was assessed. DESIGN: Prospective clinical study. SETTING: The medical ICU of a university-affiliated teaching hospital. PATIENTS: We investigated 66 consecutive dyspneic patients: 40 with pulmonary edema and 26 with COPD...
December 1998: Intensive Care Medicine
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