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Hiroshi Sekiguchi, MD; Ognjen Gajic, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: Hiroshi Sekiguchi, MD, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):1109. doi:10.1016/j.chest.2016.01.022
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We appreciate the insightful comments about our article made by Dr Keng. The information on consolidative (C)-pattern in examination point 5 was missing in e-Table 1. The revised e-Table 1 is attached to this response letter. We defined C-pattern as areas of tissue hepatization with or without air bronchogram. C-pattern in zone R5 was seen in 36 patients (61%) in the group with cardiogenic pulmonary edema (CPE), 23 (55%) in the group with ARDS, and 12 (38%) in the miscellaneous group (P = .093). C-pattern in zone L5 was seen in 44 patients (75%) in the group with CPE group, 22 (52%) in the group with ARDS, and 13 (41%) in the miscellaneous group (P = .004). These variables were not selected as statistically significant in a prediction model for CPE in the multivariate analysis.

C-pattern reflects a variety of causes such as atelectasis (eg, resorptive, compressive, and passive), consolidation, contusion, infection, mass, and pulmonary embolism. It is often difficult to identify a cause of C-pattern with critical care ultrasonography alone. We anticipated that C-pattern in the form of compressive atelectasis was associated with pleural effusion in the posterolateral zone. In an effort to differentiate effusion-induced compressive atelectasis from consolidation or other causes of C-pattern, we created a variable, C-pattern without significant pleural effusion (< 20 mm), in zone 5. C-pattern without significant pleural effusion in zone R5 was seen in 14 patients (24%) in the group with CPE, 16 (38%) in the group with ARDS, and 10 (31%) in the miscellaneous group (P = .304). C-pattern without significant pleural effusion in zone L5 was seen in 16 patients (27%) in the group with CPE, 12 (29%) in the group with ARDS, and 10 (31%) in the miscellaneous group (P = .94). These two variables were included in the multivariate analysis; however, they were not statistically significant for differentiating CPE from ARDS.

C-pattern was not an important variable for differentiating CPE from ARDS in patients with acute hypoxemic respiratory failure. Although variables on C-pattern were accidentally missing in the original e-Table 1, they were included in the initial multivariate analysis. Therefore, the study conclusions are the same as demonstrated in our original article: left-sided pleural effusion (> 20 mm), moderately or severely decreased left ventricular function, and a large inferior vena cava minimal diameter (> 23 mm) were predictive of CPE. Our results are consistent with previous reports on CT, which demonstrated that atelectasis and consolidation are seen in both patients with CPE and those with ARDS.,

Supplementary Data

Sekiguchi H. .Schenck L.A. .Horie R. .et al Critical care ultrasonography differentiates ARDS, pulmonary edema, and other causes in the early course of acute hypoxemic respiratory failure. Chest. 2015;148:912-918 [PubMed]journal. [CrossRef] [PubMed]
 
Volpicelli G. .Elbarbary M. .Blaivas M. .et al International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577-591 [PubMed]journal. [CrossRef] [PubMed]
 
Doerschug K.C. .Schmidt G.A. . Intensive care ultrasound: III. Lung and pleural ultrasound for the intensivist. Ann Am Thorac Soc. 2013;10:708-712 [PubMed]journal. [CrossRef] [PubMed]
 
Scillia P. .Bankier A.A. .Gevenois P.A. . Computed tomography assessment of lung structure and function in pulmonary edema. Crit Rev Comput Tomogr. 2004;45:293-307 [PubMed]journal. [CrossRef] [PubMed]
 
Simon M, Braune S, Laqmani A, et al. Value of computed tomography of the chest in subjects with ARDS: a retrospective observational study [Epub ahead of print December 8 2015].Respir Care.pii:respcare.04308.
 

Figures

Tables

References

Sekiguchi H. .Schenck L.A. .Horie R. .et al Critical care ultrasonography differentiates ARDS, pulmonary edema, and other causes in the early course of acute hypoxemic respiratory failure. Chest. 2015;148:912-918 [PubMed]journal. [CrossRef] [PubMed]
 
Volpicelli G. .Elbarbary M. .Blaivas M. .et al International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577-591 [PubMed]journal. [CrossRef] [PubMed]
 
Doerschug K.C. .Schmidt G.A. . Intensive care ultrasound: III. Lung and pleural ultrasound for the intensivist. Ann Am Thorac Soc. 2013;10:708-712 [PubMed]journal. [CrossRef] [PubMed]
 
Scillia P. .Bankier A.A. .Gevenois P.A. . Computed tomography assessment of lung structure and function in pulmonary edema. Crit Rev Comput Tomogr. 2004;45:293-307 [PubMed]journal. [CrossRef] [PubMed]
 
Simon M, Braune S, Laqmani A, et al. Value of computed tomography of the chest in subjects with ARDS: a retrospective observational study [Epub ahead of print December 8 2015].Respir Care.pii:respcare.04308.
 
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