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Feasibility and Diagnostic Accuracy of Real-Time Lung Ultrasound in Patients Requiring Medical Emergency Team Evaluation for Respiratory Deterioration FREE TO VIEW

Soumitra Sen, MD; Ghazwan Acash, MD; Akmal Sarwar, MD; Yuxui Lei, PhD; James Dargin, MD
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Lahey Clinic, Somerville, MA

Chest. 2015;148(4_MeetingAbstracts):318A. doi:10.1378/chest.2277494
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SESSION TITLE: Mechanical Ventilation Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Tuesday, October 27, 2015 at 02:45 PM - 04:15 PM

PURPOSE: To determine the feasibility and diagnostic accuracy of real-time ultrasound in patients requiring medical emergency team (MET) activation for respiratory deterioration.

METHODS: We performed a prospective observational study at a tertiary center. Adults who required MET for respiratory deterioration were included. Thoracic and lower extremity ultrasonography were performed according to the “BLUE protocol.” MET clinical diagnosis was recorded. Two blinded investigators independently determined the “ultrasound diagnosis” and two experts determined the final diagnosis of respiratory deterioration. We recorded the proportion of ultrasound exams that were completed and interpretable. To assess diagnostic performance, we compared the ultrasound and MET clinical diagnostic accuracy to the final diagnosis using the Fisher’s exact test, calculated sensitivity and specificity, and constructed an ROC curve. Inter-rater agreement was assessed using a kappa reliability test.

RESULTS: We enrolled 25 subjects. The median age was 66 (IQR 58-69), 52% were male, 56% had a respiratory cause for hospital admission, 64% had chronic lung disease and 16% had a history of CHF. The mean SpO2 was 81%±14, respiratory rate 28±6, and SOFA score 3.5±2.5. During MET activation, 48% required NIPPV, 20% required intubation, and 64% required ICU transfer. The inpatient mortality was 24%. 100% of exams were complete and interpretable. The diagnostic accuracy of the ultrasound protocol and MET evaluation were 76% and 72%, respectively (p=0.64). The sensitivity and specificity of the ultrasound protocol were 77% and 92%, compared to 87% and 95% for the MET clinical diagnosis. The area under the ROC curve for MET clinical diagnosis was 0.77 compared to 0.88 for the ultrasound diagnosis (p=0.11). The kappa values for ultrasound readers and final diagnosis interpretation was 0.92 and 0.87, respectively. The ultrasound protocol could have uncovered an unsuspected diagnosis in 6(24%) cases and improved initial treatment in 4(16%) cases.

CONCLUSIONS: Real-time ultrasound using the BLUE protocol is feasible and accurate to determine the etiology of respiratory deterioration during MET evaluations. Use of bedside ultrasound may help to improve diagnostic accuracy and initial treatment during MET activation for respiratory deterioration.

CLINICAL IMPLICATIONS: Bedside ultrasound is a readily accessible, ancillary tool that can validate suspected diagnoses and improve the accuracy of therapeutic decisions during MET evaluations for respiratory distress.

DISCLOSURE: The following authors have nothing to disclose: Soumitra Sen, Ghazwan Acash, Akmal Sarwar, Yuxui Lei, James Dargin

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