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Kastamonu Medical Journal

Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

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Original Article
Use of ultrasonography in the diagnosis of pneumonia in intensive care patients
Abstract
Aims: A significant portion of respiratory system infections seen in intensive care units is ventilator-associated pneumonia, which has a high mortality rate and diagnosis may be delayed. Bedside lung ultrasonography offers the advantages of standard diagnostic methods as chest radiography or thorax tomography. We aim to evaluate the bedside lung ultrasonography correlation with the chest radiography or thorax tomography
Methods: It was conducted prospectively on 60 patients between the ages of 18-85 who were admitted to intensive care with respiratory failure within an 8-month period. Anterioposterior chest radiographs were taken on the first day of mechanical ventilation for the patients included in the study. Ultrasonographic (USG) examination was performed separately for both hemithoraxes and recorded digitally. Simultaneously with the ultrasonographic examination, PEEP, FiO2, blood gas examination results and the highest body temperatures in the last 24 hours were recorded. The quality and quantity of tracheal secretions were evaluated, and sampling was performed for complete blood examination and tracheal aspirate culture-antibiogram. Lung injury score (LIS) and pulmonary infection score (CPIS) were calculated from the data obtained. In this process, independent of the research, the same day examination results of patients who required thorax tomography (CT) for diagnosis and treatment planning were evaluated together with USG and chest radiography. Tomographic examinations were evaluated by a radiologist.
Results: In the examination of 120 hemithoraxes of 60 patients we included in the study, we were able to detect 74.17% of the pathological images obtained with chest radiography and ultrasonographic examination with bedside ultrasonography and 70.84% with chest radiography. Of the 20 patients who underwent tomographic evaluation, pathology was observed in 40 hemithoraxes in 92.5% by tomography, in 85% by ultrasonography, and in 75% by chest radiography. While isolated consolidation was detected equally on USG and CT imaging, there was a high false-positive rate of 48% on chest radiography. 58.8% of the patients with consolidation detected by CT, we observed that there was growth in the tracheal aspirate of 56.2% of the patients whose ultrasonographic examination revealed consolidation.
Conclusion: Bedside lung ultrasonography is a fast, non-invasive, repeatable and reliable diagnostic method in patients followed in intensive care, and is compatible with traditionally used laboratory and clinical parameters. This reveals that USG, which is known to have other advantages such as cost, applicability, and not using radiopaque, will become an indispensable examination for ICU.

Keywords : Bedside lung ultrasonography, chest radiography, thorax tomography, consolidations, pneumonia, intensive care unit

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1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7):1303-1310.
2. Vincent JL, Abraham E, Annane D, Bernard G, Rivers E, Van den Berghe G. Reducing mortality in sepsis: new directions. Crit Care. 2002;6(Suppl 3): S1-S18.
3. Jean-Louis V. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-2329.
4. Agrafiotis M, Siempos II, Ntaidou TK, Falagas ME. Attributable mortality of ventilator-associated pneumonia: a meta-analysis. Int J Tuberc Lung Dis. 2011;15(9):1154-1163.
5. Wiener MD, Garay SM, Leitman BS, Wiener DN, Ravin CE. Imaging of the intensive care unit patient. Clin Chest Med. 1991;12(1):169-198.
6. Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q, Grenier P. Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS severity score. Intensive Care Med. 2000;26(8):1046-1056. doi:10.1007/s001340051317
7. Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16.
8. Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: bedside lung ultrasound in critical care practice.Crit Care. 2007;11(1):205. doi:10.1186/cc5668
9. Dubs-Kunz B. Sonography of the chest wall. Eur J Ultrasound. 1996;3:103-111.
10. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P: Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian incident monitoring. Intensive Care Med. 2004;30(8):1579-1585.
11. Syrjala H, Broas M, Suramo I, Ojala A, Lahde S. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis. 1998;27(2):358-363.
12. Bouhemad B, Richecoeur J, Lu Q, Malbouisson LM, Cluzel P, Rouby JJ: Effects of contrast material on computed tomographic measurements of lung volumes in patients with acute lung injury. Crit Care. 2003;7(1):63-71.
13. Gazon M, Eboumbou N, Robert MO, Branche P, Duperret S, Viale JP. Agreement between lung ultrasonography and chest radiography in the intensive care unit. Ann Fr Anesth Reanim. 2011;30(1):6-12.
14. Sperandeo M, Carnevale V, Muscarella S, et al. Clinical application of transthoracic ultrasonography in inpatients with pneumonia. Eur J Clin Invest. 2011;41(1):1-7.
15. Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009;27(4): 379-384.
16. Reissig A, Kroegel C. Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration. 2007;74(5):537-547.
17. Tu CY, Hsu WH, Hsia TC, et al. Pleural effusions in febrile medical ICU patients: chest ultrasound study. Chest. 2004;126(4):1274-1280.
18. Nicolaou S, Talsky A, Khashoggi K, Venu V. Ultrasound-guided interventional radiology in critical care. Crit Care Med. 2007;35(5 suppl): S186-S197.
19. Vignon P, Chastagner C, Berkane V, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med. 2005;33(8):1757-1763.
20. Evans AL, Gleeson FV. Radiology in pleural disease: state of the art. Respirology. 2004;9(3):300-312.
21. Xirouchaki N, Magkanas E, Vaporidi K, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488-1493.
22. Zanobetti M, Poggioni C, Pini R. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED?. Chest. 2011;139(5):1140-1147.
23. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9-15.
24. Doelken P, Strange C. Chest ultrasound for “Dummies”. Chest. 2003;123(2): 332-333.
25. Peris A, Tutino L, Zagli G, et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg. 2010;111(3):687-692.
26. Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30(2): 276-281.
27. Gehmacher O, Mathis G, Kopf A, Scheier M. Ultrasound imaging of pneumonia. Ultrasound Med Biol. 1995;21(9):1119-1122.
28. Khilnani GC, Arafath TK, Hadda V, Kapil A, Sood S, Sharma SK. Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia. Indian J Crit Care Med. 2011;15(1):16-23.
29. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
30. Shorr AF, Sherner JH, Jackson WL, Kollef MH. Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2005;33(1):46-53.
31. Greenbaum DM, Marschall KE. The value of routine daily chest X-Rays in intubated patients in the medical intensive care unit. Crit Care Med. 1982;10(1):29-30.
32. Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q, Grenier P. Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS severity score. Intensive Care Med. 2000;26(8):1046-1056.
Article available in :
Volume 4, Issue 4, 2024
Page : 200-205
https://doi.org/10.51271/KMJ-0172
Article Information
Received : 18 Ağu 2024
Accepted : 04 Eki 2024
Published : 01 Ara 2024
Corresponding Author :

Özgür Yılmaz: Department of Anesthesiology and Reanimation, Kastamonu Training and Research Hospital, Kastamonu, Turkiye

[email protected]
Citation : Yılmaz Ö, Ünal N. Use of ultrasonography in the diagnosis of pneumonia in intensive care patients. Kastamonu Med J. 2024; 4(4):200-205.

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