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Correspondence |

Ultrasonography for the Detection of PneumothoraxUltrasonography for the Detection of Pneumothorax FREE TO VIEW

Adriano Peris, MD; Francesco Barbani, MD
Author and Funding Information

From the Anaesthesia and Intensive Care Unit of the Emergency Department (Dr Peris), Careggi Teaching Hospital; and the Postgraduate School of Anesthesia and Intensive Care (Dr Barbani), Faculty of Medicine, University of Florence.

Correspondence to: Francesco Barbani, MD, Largo Brambilla 3, 50139, Florence, Italy; e-mail: francescobarbani@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):538. doi:10.1378/chest.12-0604
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To the Editor:

We read with great interest the article published in CHEST by Alrajhi et al1 (March 2012) that strongly emphasizes the usefulness of bedside lung ultrasonography in the diagnosis of pneumothorax, with important implications in the treatment of critically ill patients. However, Alrajhi et al1 cited only pneumothorax resulting from trauma (six of eight analyzed works) and from invasive procedures (transthoracic needle aspiration and biopsy, two of eight reported works). In our opinion, for completeness, it is also necessary to discuss two other important issues not considered in the meta-analysis of Alrajhi et al1: use of lung ultrasonography for diagnosis of iatrogenic pneumothorax deriving from mechanical ventilation, and the effects on ultrasound diagnosis of pneumothorax of the semirecumbent position, indicated for the prevention of ventilator-associated pneumonia.2

Although iatrogenic pneumothorax arising from mechanical ventilation is no longer a frequent outcome, critically ill patients with acute lung injury/ARDS have a substantially elevated risk for the development of iatrogenic pneumothorax,3 with an incidence ranging up to 38% in critically ill patients with acute lung injury from aspiration pneumonia,4 resulting in a very important effect on days of hospitalization, morbidity, and mortality.5 Surveillance for pneumothorax in the critical care setting is very important because of the high-risk population deriving from underlying disease: In this setting, chest radiograph is usually performed in the semirecumbent position. Instead, in the works considered by Alrajhi et al,1 chest radiographs were performed predominantly in the supine position, and only in 34 of the 864 available chest radiograph data in the semirecumbent position. To the best of our knowledge, there are no data available from the literature comparing test characteristics of ultrasonography and chest radiograph both performed in the semirecumbent position. Further studies may be needed for the adoption in the critical care setting, especially in ventilated patients who have to stay in the semirecumbent position for the prevention of pneumonia associated with ventilation.

Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012;141(3):703-708.
 
Antonelli M, Bonten M, Chastre J, et al. Year in review inIntensive Care Medicine2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation. Intensive Care Med. 2012;38(3):345-358.
 
Gammon RB, Shin MS, Groves RH Jr, Hardin JM, Hsu C, Buchalter SE. Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Am J Respir Crit Care Med. 1995;152(4 pt 1):1235-1240.
 
de Latorre FJ, Tomasa A, Klamburg J, Leon C, Soler M, Rius J. Incidence of pneumothorax and pneumomediastinum in patients with aspiration pneumonia requiring ventilatory support. Chest. 1977;72(2):141-144.
 
Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290(14):1868-1874.
 

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References

Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012;141(3):703-708.
 
Antonelli M, Bonten M, Chastre J, et al. Year in review inIntensive Care Medicine2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation. Intensive Care Med. 2012;38(3):345-358.
 
Gammon RB, Shin MS, Groves RH Jr, Hardin JM, Hsu C, Buchalter SE. Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Am J Respir Crit Care Med. 1995;152(4 pt 1):1235-1240.
 
de Latorre FJ, Tomasa A, Klamburg J, Leon C, Soler M, Rius J. Incidence of pneumothorax and pneumomediastinum in patients with aspiration pneumonia requiring ventilatory support. Chest. 1977;72(2):141-144.
 
Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290(14):1868-1874.
 
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