The Most Effective Approach for Diagnosing Acute Respiratory Failure Is Identified

Pulmonary ultrasonography (PU) has the potential to serve as an adjunct or replacement diagnostic tool for chest computed tomography (CT) or portable chest radiography (pCXR) among patients with acute respiratory failure who are on mechanical ventilation, results of a new study suggest.

The determination comes after a 9-point examination protocol strategy for PU and specific-CT yielded agreeable results in regard to lung- and lobe-specific location among patients with acute respiratory failure. According to the researchers, the finding shows that PU significantly outperformed pCXR.

To conduct their study, the researchers evaluated data on 67 intubated adults with acute respiratory failure who had been hospitalized in either the medical, surgical, or neurologic intensive care unit at a single urban teaching hospital. 

Upon intubation, the patients had undergone a 9-point PU examination. Within 24 hours of intubation, the patients had had chest CT, pCXR, and PU scans. 

PU and CT had an overall lobe-specific agreement of 87%, while pCXR and CT had an overall lobe-specific agreement of 62%.

Findings of atelectasis/consolidation yielded the highest lobe-specific agreement for both pCXR (73%) and PU (96%) with CT. The lowest lobe-specific agreement was interstitial process for pCXR (29%) and normal lung for PU (79%). Interstitial findings were the biggest difference in lobe-specific agreement between PU (86%) and pCXR (29%).

Lung-specific agreement of PU and pCXR with CT was higher. PU matched CT 92.5% in the right lung and 83.6% in the left lung. Meanwhile, pCXR matched CT 65.7% in the right lung and 71.6% in the left lung.

According to the researchers, pleural effusion agreement differed between PU and pCXR. 

“In the hands of well-trained providers with an appreciation for its limitations, PU can be an invaluable, cost-saving, risk-reducing imaging modality as an adjunct or replacement for pCXR and CT in patients with [acute respiratory failure],” the researchers concluded.

—Colleen Murphy

Reference:

Tierney DM, Huelster JS, Overgaard JD, et al. Comparative performance of pulmonary ultrasound, chest radiograph, and CT among patients with acute respiratory failure. Crit Care Med. 2020;48(2):151-157. doi:10.1097/CCM.0000000000004124.