الفهرس 
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Abstract
Traditionally, lung imaging in critically ill patients is performed
either by bedside chest radiography (CXR) or thoracic computed
tomography (CT), both techniques have limitations which constrain
their usefulness. Although thoracic CT is the gold standard for lung
imaging, it is expensive and cannot be performed on a routine basis. In
addition the transportation of critically ill patients to the radiology
department combined with the radiation exposure carries a measurable
risk [2]. On the other hand, limitations of bedside CXR have been
well described and lead to poor quality X-ray films with low
sensitivity
All intensivists prefer the least invasive tool, all else being
equal. Ultrasound is an answer to the longstanding dilemma:
“Radiography or CT in the ICU?” Radiography is a familiar tool that
lacks sensitivity 60-70%, all fields considered
Nowadays, bedside lung ultrasound is increasingly used in
patients managed in intensive care units (ICUs) ,and so ultrasound
should be considered as reasonable, bedside “gold standard”. For all
assessed disorders; it provides quantitative data. Pleural effusions can
be quantified lung consolidation can be monitored, which is useful for
those who want to increase end expiratory pressure the volume and
progression of a pneumothorax are monitored using the lung point
location .
Patient and methods
The study was comparative prospective randomized single
group observational study was conducted in critical care unit (medical
- surgical ICU) Menoufia university hospitals. The study was approved by institutional review board, and an informed consent was
taken from the patient if aware or forms his 1st degree relatives if not
aware.
This study was conducted upon 130 mechanically ventilated and
non-mechanically ventilated patients 84 male and 46 female who were
admitted critical care unit Menoufia university between October 2014
to October 2015 eligible to our inclusion criteria were included,
whether mechanically ventilated or not mechanically ventilated
patient were sedated and volume controlled at 8 ml/Kg chest
ultrasound and chest
X-ray was done, and their results were compared to the gold standard
CT.
Inclusion criteria: Any patient above 18 years, Patients admitted
with chest problem or newly developed a chest problem in ICU,
Suggestive history (fever, cough, sputum production, dyspnoea and
pleuritic chest pain), clinical examinations: [Vital signs (tachycardia,
tachypnea), local examination (bronchial breathing, rales, diminished
air entry) and Systemic examination (to exclude other causes) and
suggestive lab abnormality including elevated TLC and CRP.
Exclusion criteria: pregnant women, morbid obese and patients
couldn’t be transferred. The patients were evaluated for any possible
lung pathology according to the modified lung ultrasound protocol
and the lung ultrasound results were compared to those of CXR and
CT chest.
All patients will be subjected to the following
Clinical assessment upon recruitment in the study, which included:
Blood pressure;
Temperature;
Pulse rate;
Chest inspection, percussion and auscultation for intensity and
type of breath sounds and for adventitious breath sounds.
Oxygen saturation.
arterial blood gasesABG and other routine laboratory
investigations as needed.
Mode of mechanical ventilation.
chest X-ray.
lung ultrasonography.
Computed tomography (CT)
Chest ultrasound was done by Philips HD-11 Digital Ultrasound
Machine examination methodology: Visualization of the lungs was
performed using a micro convex 5–9 MHz transducer appropriate
for transthoracic examination. Access to standardized images
(seashore sign, stratosphere sign) was possible. Ultrasonography
was evaluated by a single operator, who was unaware of the CT
and CXR findings.
Patients were studied in the supine position. The patients’ lung was
examined anteriorly and laterally only as the accessibility for
posterior surface examination was limited. This, however,
represents a major limitation of regional analysis.
Results
We studied 130 patient varying between mechanically
ventilated (sedated and volume controlled 8 ml/Kg) and not
mechanically ventilated, mean age was (43.23 ± 12.62P), mean
APACHE II (10.72 ± 4.65) and the leading cause of admission in
study group was stroke (15.4%, n=20) followed by chest infection
(13.8%, n=18)
When comparing the results of CXR and chest US versus
results of CT scan being the gold standard we have found that
sensitivity of both diagnostic tools to pneumonia were (70% versus
93%) respectively, while in pleural effusion sensitivity was
(70%versus 94%) respectively, while in pulmonary edema (36%
versus 93% respectively) and results of pneumothorax were (69%
versus 96) respectively.
Regarding pneumonia, the diagnostic performance of LUS is
higher than CXR as shown by their AUC-ROC 0.95(0.89-0.99) Vs
0.82(0.75-90) respectively with significant p value (p<0.05).
Regarding effusion, the diagnostic performance of LUS is
higher than CXR as shown by their AUC-ROC 0.94(0.90-0.99) Vs
0.80(0.72-87) respectively with significant p value (p<0.05).
Regarding edema, the diagnostic performance of LUS is higher
than CXR as shown by their AUC-ROC 0.93(0.84-1.01) Vs
0.62(0.45-79) respectively and signifcat p value (p<0.05).
Regarding pneumothorax, the diagnostic performance of LUS is
higher than CXR as shown by their AUC-ROC 0.93(0.84-1.01) Vs
0.84(0.73-83) respectively and signifcat p value (p<0.05).
After adding clinical examination into chest x ray
Regarding pneumonia, the diagnostic performance of LUS is
higher than CXR+clinical examination as shown by their AUC-ROC
0.95(0.90-0.99) Vs 0.89(0.82-95) respectively.
Regarding effusion, the diagnostic performance of LUS is
higher than CXR+clinical examination as shown by their AUC-ROC
0.94(0.89-0.99) Vs 0.87(0.81-94) respectively.
Regarding oedema, the diagnostic performance of LUS is
higher than CXR+clinical examination as shown by their AUC-ROC
0.93(0.84-0.99) Vs 0.67(0.50-83) respectively and signifcat p value
(p<0.05).
Regarding pneumothorax no significant difference in AUCROC
between LUS and CXR+clinical examination.