Extended lung ultrasound protocol effective diagnostic tool in pulmonary consolidation
In the hands of experienced physicians, the extended lung ultrasound protocol can be a powerful diagnostic tool to determine the presence of pneumonia versus atelectasis in the general ICU population, according to a recent study published in the Critical Care Medicine
A study was conducted to determine the diagnostic accuracy of extended lung ultrasonographic assessment, including evaluation of dynamic air bronchograms and colour Doppler imaging to differentiate pneumonia and atelectasis in patients with consolidation on chest radiograph. Compare this approach to the Simplified Clinical Pulmonary Infection Score, Lung Ultrasound Clinical Pulmonary Infection Score, and the Bedside Lung Ultrasound in the Emergency protocol.
Adult patients that underwent a chest radiograph for any indication at any time during admission. Patients with acute respiratory distress syndrome, coronavirus disease 2019, severe thoracic trauma, and infectious isolation measures were excluded.
A lung ultrasound was performed within 24 hours of the chest radiograph. Consolidated tissue was assessed for the presence of dynamic air bronchograms and with colour Doppler imaging for the presence of flow. Clinical data were recorded after ultrasonographic assessment. The primary outcome was diagnostic accuracy of dynamic air bronchogram and colour Doppler imaging alone and within a decision, tree to differentiate pneumonia from atelectasis.
Results:
- Of 120 patients included, 51 were diagnosed with pneumonia.
- The dynamic air bronchogram had a 45% sensitivity and 99% doppler imaging had a 90% sensitivity and 68% specificity.
- The combined decision tree had an 86% sensitivity and 86% specificity.
- The Bedside Lung Ultrasound in Emergency protocol had a 100% sensitivity and 0% specificity, while the Simplified Clinical Pulmonary Infection Score and Lung Ultrasound Clinical Pulmonary Infection Score had a 41% sensitivity, 84% specificity and 68% sensitivity, 81% specificity, respectively.
Thus, in critically ill patients with pulmonary consolidation on chest radiograph, an extended lung ultrasound protocol is an accurate and directly bedside available tool to differentiate pneumonia from atelectasis. It outperforms standard lung ultrasound and clinical scores.
Reference:
Extended Lung Ultrasound to Differentiate Between Pneumonia and Atelectasis in Critically Ill Patients: A Diagnostic Accuracy Study by Haaksma, Mark E. et al. published in the Critical Care Medicine
doi: 10.1097/CCM.0000000000005303
