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Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill

BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of...

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Autores principales: Cox, Eline G. M., Koster, Geert, Baron, Aidan, Kaufmann, Thomas, Eck, Ruben J., Veenstra, T. Corien, Hiemstra, Bart, Wong, Adrian, Kwee, Thomas C., Tulleken, Jaap E., Keus, Frederik, Wiersema, Renske, van der Horst, Iwan C. C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958607/
https://www.ncbi.nlm.nih.gov/pubmed/31931844
http://dx.doi.org/10.1186/s13054-019-2719-8
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author Cox, Eline G. M.
Koster, Geert
Baron, Aidan
Kaufmann, Thomas
Eck, Ruben J.
Veenstra, T. Corien
Hiemstra, Bart
Wong, Adrian
Kwee, Thomas C.
Tulleken, Jaap E.
Keus, Frederik
Wiersema, Renske
van der Horst, Iwan C. C.
author_facet Cox, Eline G. M.
Koster, Geert
Baron, Aidan
Kaufmann, Thomas
Eck, Ruben J.
Veenstra, T. Corien
Hiemstra, Bart
Wong, Adrian
Kwee, Thomas C.
Tulleken, Jaap E.
Keus, Frederik
Wiersema, Renske
van der Horst, Iwan C. C.
author_sort Cox, Eline G. M.
collection PubMed
description BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. METHODS: This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. RESULTS: The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. CONCLUSION: The agreement between lung ultrasound and auscultation is poor. TRIAL REGISTRATION: NCT02912624. Registered on September 23, 2016.
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spelling pubmed-69586072020-01-17 Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill Cox, Eline G. M. Koster, Geert Baron, Aidan Kaufmann, Thomas Eck, Ruben J. Veenstra, T. Corien Hiemstra, Bart Wong, Adrian Kwee, Thomas C. Tulleken, Jaap E. Keus, Frederik Wiersema, Renske van der Horst, Iwan C. C. Crit Care Research BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. METHODS: This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. RESULTS: The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. CONCLUSION: The agreement between lung ultrasound and auscultation is poor. TRIAL REGISTRATION: NCT02912624. Registered on September 23, 2016. BioMed Central 2020-01-13 /pmc/articles/PMC6958607/ /pubmed/31931844 http://dx.doi.org/10.1186/s13054-019-2719-8 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Cox, Eline G. M.
Koster, Geert
Baron, Aidan
Kaufmann, Thomas
Eck, Ruben J.
Veenstra, T. Corien
Hiemstra, Bart
Wong, Adrian
Kwee, Thomas C.
Tulleken, Jaap E.
Keus, Frederik
Wiersema, Renske
van der Horst, Iwan C. C.
Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
title Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
title_full Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
title_fullStr Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
title_full_unstemmed Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
title_short Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
title_sort should the ultrasound probe replace your stethoscope? a sics-i sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958607/
https://www.ncbi.nlm.nih.gov/pubmed/31931844
http://dx.doi.org/10.1186/s13054-019-2719-8
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