Original Research: Critical Care |

Usefulness of Cardiothoracic Chest Ultrasound in the Management of Acute Respiratory Failure in Critical Care PracticeCardiothoracic Ultrasound in Respiratory Failure

Stein Silva, MD, PhD; Caroline Biendel, MD; Jean Ruiz, MD; Michel Olivier, MD; Benoit Bataille, MD; Thomas Geeraerts, MD, PhD; Arnaud Mari, MD; Beatrice Riu, MD; Olivier Fourcade, MD, PhD; Michele Genestal, MD
Author and Funding Information

From the Réanimation Polyvalente et Médecine Hyperbare (Drs Silva, Ruiz, Olivier, Mari, Riu, and Genestal) and Pôle Anesthésie-Réanimation (Drs Silva, Ruiz, Olivier, Bataille, Geeraerts, Mari, Riu, Fourcade, and Genestal), CHU Purpan; Pôle Cardiovasculaire et Métabolique (Dr Biendel), CHU Rangueil; and Equipe d’Accueil (Drs Silva, Geeraerts, and Fourcade), MATN, IFR 150, Université Paul Sabatier, Toulouse, France.

Correspondence to: Stein Silva, MD, PhD, Critical Care Unit, CHU Purpan, 31059 Toulouse Cedex 3, France; e-mail: silvastein@me.com; silva.s@chu-toulouse.fr

Funding/Support: This research was supported by institutional departmental funds from Centre Hospitalier Universitaire de Toulouse, Toulouse, France.

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

Chest. 2013;144(3):859-865. doi:10.1378/chest.13-0167
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Background:  This study investigated the clinical relevance of early general chest ultrasonography (ie, heart and lung recordings) in patients in the ICU with acute respiratory failure (ARF).

Methods:  We prospectively compared this diagnostic approach (ultrasound) to a routine evaluation established from clinical, radiologic, and biologic data (standard). Subjects were patients consecutively admitted to the ICU of a university teaching hospital during a 1-year period. Inclusion criteria were age ≥ 18 years and the presence of severe ARF criteria to justify ICU admission. We compared the diagnostic approaches and the final diagnosis determined by a panel of experts.

Results:  Seventy-eight patients were included (age, 70 ± 18 years; sex ratio, 1). Three patients given two or more simultaneous diagnoses were subsequently excluded. The ultrasound approach was more accurate than the standard approach (83% vs 63%, respectively; P < .02). Receiver operating characteristic curve analysis showed greater diagnostic performance of ultrasound in cases of pneumonia (standard, 0.74 ± 0.12; ultrasound, 0.87 ± 0.14; P < .02), acute hemodynamic pulmonary edema (standard, 0.79 ± 0.11; ultrasound, 0.93 ± 0.08; P < .007), decompensated COPD (standard, 0.8 ± 0.09; ultrasound, 0.92 ± 0.15; P < .05), and pulmonary embolism (standard, 0.65 ± 0.12; ultrasound, 0.81 ± 0.17; P < .04). Furthermore, we found that the use of ultrasound data could have significantly improved the initial treatment.

Conclusions:  The use of cardiothoracic ultrasound appears to be an attractive complementary diagnostic tool and seems able to contribute to an early therapeutic decision based on reproducible physiopathologic data.

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