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Comparative Study
. 2024 Nov 15;47(3):e1088.
doi: 10.23938/ASSN.1088.

[Diagnostic comparison of bedside lung ultrasound and chest radiography in the intensive care unit]

[Article in Spanish]
Juan-Ambrosio Martínez-Molina  1 , Miguel Angel Martínez-González  2 , Marc Vives Santacana  3 , Ariel Duilio González Delgado  4 , Karlos Reviejo Jaka  5 , Pablo Monedero  6
Affiliations
Comparative Study

[Diagnostic comparison of bedside lung ultrasound and chest radiography in the intensive care unit]

[Article in Spanish]
Juan-Ambrosio Martínez-Molina et al. An Sist Sanit Navar. .

Abstract
in English, Spanish

Background: Bedside lung ultrasound (POCUS) offers advantages over chest X-ray, including better cost-effectiveness for diagnosing certain pulmonary pathologies. This study compares the diagnostic concordance between portable chest X-rays and bedside lung ultrasounds in the intensive care unit (ICU).

Methods: Adult ICU patients were included. POCUS was performed using the abbreviated BLUE protocol. Diagnostic results from POCUS and chest radiographies were compared using the intensivist clinical diagnosis - based on clinical examinations and lung ultrasounds - as the reference. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasounds were calculated.

Results: A total of 100 patients were included, 71 with pulmonary pathologies. The average time to perform the ultrasound was 308 seconds. Ultrasound identified pathology in 20 patients with a normal chest radiographs. Diagnostic discrepancies occurred in 30 patients, highlighting ultrasound´s superior sensitivity in detecting atelectasis, pleural effusions, and pulmonary edema. Ultrasound demonstrated sensitivity (S) of 85%, specificity (E) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 55%.

Conclusion: Lung point-of-care ultrasound at ICU admission detects more pathologies and does not miss significant abnormalities seen on chest X-rays. It also shows good diagnostic accuracy. These findings suggest that pulmonary POCUS, using an abbreviated protocol, could be a viable alternative to chest radiography for initial evaluation and follow-up of pulmonary pathologies in critically ill patients, potentially improving care quality and management.

Fundamento:: La ecografía pulmonar abreviada a-pie-de-cama (POCUS) ofrece ventajas respecto a la radiografía de tórax. Este estudio compara los hallazgos entre POCUS y radiografía portátil de tórax, así como el desempeño diagnóstico de la POCUS en la unidad de cuidados intensivos (UCI).

Metodología:: Se incluyeron pacientes adultos ingresados en la UCI. La POCUS se realizó utilizando el protocolo abreviado BLUE. Se compararon los hallazgos entre POCUS y radiografía portátil de tórax. El desempeño diagnóstico de la POCUS se analizó utilizando como referencia el diagnóstico clínico del intensivista, basado en la exploración clínica y la ecografía pulmonar, obteniéndose sensibilidad (S), especificidad (E), y valores predictivos positivo (VPP) y negativo (VPN).

Resultados:: Se incluyeron 100 pacientes, 71 con hallazgos de patología pulmonar. El tiempo medio para realizar la ecografía fue 308 segundos. La ecografía detectó patología en 20 pacientes con radiografía de tórax normal. Se observaron discrepancias diagnósticas en 30 pacientes, destacando la superior sensibilidad de la ecografía para detectar atelectasias, derrames pleurales y edema pulmonar. La ecografía mostró S=85%, E=100%, VPP=100% y VPN=55%.

Conclusiones:: La POCUS pulmonar al ingreso en la UCI detectó un mayor número de patologías y no omitió ninguna anomalía importante detectada en la radiografía. Además, mostró una buena exactitud diagnóstica. Estos resultados sugieren que la POCUS pulmonar, realizada con un protocolo abreviado, puede ser una alternativa viable a la radiografía de tórax en la evaluación inicial y el seguimiento de la patología pulmonary en pacientes críticos, impactando en la calidad de su atención y manejo.

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Conflict of interest statement

Conflictos de intereses: Los autores declaran no tener conflictos de intereses.

Figures

Figura 1
Figura 1. Puntos de exploración en la ecografía pulmonar a pie de cama. 1: anterosuperior, 2: anteroinferior, 3: posterolateral superior, 4: posterolateral inferior.
See this image and copyright information in PMC

References

    1. Aliaga M, Forel JM, De Bourmont S, Jung B, Thomas G, Mahul M, et al. Diagnostic yield and safety of CT scans in ICU. Intensive Care Med. 2015;41(3):436–443. doi: 10.1007/s00134-014-3592-1. - DOI - PubMed
    1. Graat ME, Choi G, Wolthuis EK, Korevaar JC, Spronk PE, Stoker J, et al. The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low. Crit Care. 2006;10(1):R11–R11. doi: 10.1186/cc3955. - DOI - PMC - PubMed
    1. Hendrikse KA, Gratama JW, Hove Wt, Rommes JH, Schultz MJ, Spronk PE. Low value of routine chest radiographs in a mixed medical-surgical ICU. Chest. 2007;132(3):823–828. doi: 10.1378/chest.07-1162. - DOI - PubMed
    1. Marini TJ, Rubens DJ, Zhao YT, Weis J, O'Connor TP, Novak WH, et al. Lung ultrasound: the essentials. Radiol Cardiothorac Imaging. 2021;3(2):e200564. doi: 10.1148/ryct.2021200564. - DOI - PMC - PubMed
    1. Vetrugno L, Biasucci DG, Deana C, Spadaro S, Lombardi FA, Longhini F, et al. Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993-2023) Ultrasound J. 2024;16(1):7–7. doi: 10.1186/s13089-023-00351-4. - DOI - PMC - PubMed

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