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Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure

INTRODUCTION: Lung ultrasound when used in isolation, usually misses out metabolic causes of dyspnoea and differentiating acute exacerbation of COPD from pneumonia and pulmonary embolism is difficult, hence we thought of combining critical care ultrasonography (CCUS) with arterial blood gas analysis...

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Autores principales: Panda, Rajesh, Saigal, Saurabh, Joshi, Rajnish, Pakhare, Abhijit, Joshi, Ankur, Sharma, Jai Prakash, Tandon, Sahil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sciendo 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987272/
https://www.ncbi.nlm.nih.gov/pubmed/36890971
http://dx.doi.org/10.2478/jccm-2023-0006
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author Panda, Rajesh
Saigal, Saurabh
Joshi, Rajnish
Pakhare, Abhijit
Joshi, Ankur
Sharma, Jai Prakash
Tandon, Sahil
author_facet Panda, Rajesh
Saigal, Saurabh
Joshi, Rajnish
Pakhare, Abhijit
Joshi, Ankur
Sharma, Jai Prakash
Tandon, Sahil
author_sort Panda, Rajesh
collection PubMed
description INTRODUCTION: Lung ultrasound when used in isolation, usually misses out metabolic causes of dyspnoea and differentiating acute exacerbation of COPD from pneumonia and pulmonary embolism is difficult, hence we thought of combining critical care ultrasonography (CCUS) with arterial blood gas analysis (ABG). AIM OF THE STUDY: The objective of this study was to estimate accuracy of Critical Care Ultrasonography (CCUS) plus Arterial blood gas (ABG) based algorithm in diagnosing aetiology of dyspnoea. Accuracy of traditional Chest X-ray (CxR) based algorithm was also validated in the following setting. METHODS: It was a facility based comparative study, where 174 dyspneic patients were subjected to CCUS plus ABG and CxR based algorithms on admission to ICU. The patients were classified into one of five pathophysiological diagnosis 1) Alveolar( Lung-pneumonia)disorder ; 2) Alveolar (Cardiac-pulmonary edema) disorder; 3) Ventilation with Alveolar defect (COPD) disorder ;4) Perfusion disorder; and 5) Metabolic disorder. We calculated diagnostic test properties of CCUS plus ABG and CXR based algorithm in relation to composite diagnosis and correlated these algorithms for each of the defined pathophysiological diagnosis. RESULTS: The sensitivity of CCUS and ABG based algorithm was 0.85 (95% CI-75.03-92.03) for alveolar (lung) ; 0.94 (95% CI-85.15-98.13) for alveolar (cardiac); 0.83 (95% CI-60.78-94.16) for ventilation with alveolar defect; 0.66 (95% CI-30-90.32) for perfusion defect; 0.63 (95% CI-45.25-77.07) for metabolic disorders.Cohn’s kappa correlation coefficient of CCUS plus ABG based algorithm in relation to composite diagnosis was 0.7 for alveolar (lung), 0.85 for alveolar (cardiac), 0.78 for ventilation with alveolar defect, 0.79 for perfusion defect and 0.69 for metabolic disorders. CONCLUSION: CCUS plus ABG algorithm is highly sensitive and it’s agreement with composite diagnosis is far superior. It is a first of it’s kind study, where authors have attempted combining two point of care tests and creating an algorithmic approach for timely diagnosis and intervention.
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spelling pubmed-99872722023-03-07 Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure Panda, Rajesh Saigal, Saurabh Joshi, Rajnish Pakhare, Abhijit Joshi, Ankur Sharma, Jai Prakash Tandon, Sahil J Crit Care Med (Targu Mures) Research Article INTRODUCTION: Lung ultrasound when used in isolation, usually misses out metabolic causes of dyspnoea and differentiating acute exacerbation of COPD from pneumonia and pulmonary embolism is difficult, hence we thought of combining critical care ultrasonography (CCUS) with arterial blood gas analysis (ABG). AIM OF THE STUDY: The objective of this study was to estimate accuracy of Critical Care Ultrasonography (CCUS) plus Arterial blood gas (ABG) based algorithm in diagnosing aetiology of dyspnoea. Accuracy of traditional Chest X-ray (CxR) based algorithm was also validated in the following setting. METHODS: It was a facility based comparative study, where 174 dyspneic patients were subjected to CCUS plus ABG and CxR based algorithms on admission to ICU. The patients were classified into one of five pathophysiological diagnosis 1) Alveolar( Lung-pneumonia)disorder ; 2) Alveolar (Cardiac-pulmonary edema) disorder; 3) Ventilation with Alveolar defect (COPD) disorder ;4) Perfusion disorder; and 5) Metabolic disorder. We calculated diagnostic test properties of CCUS plus ABG and CXR based algorithm in relation to composite diagnosis and correlated these algorithms for each of the defined pathophysiological diagnosis. RESULTS: The sensitivity of CCUS and ABG based algorithm was 0.85 (95% CI-75.03-92.03) for alveolar (lung) ; 0.94 (95% CI-85.15-98.13) for alveolar (cardiac); 0.83 (95% CI-60.78-94.16) for ventilation with alveolar defect; 0.66 (95% CI-30-90.32) for perfusion defect; 0.63 (95% CI-45.25-77.07) for metabolic disorders.Cohn’s kappa correlation coefficient of CCUS plus ABG based algorithm in relation to composite diagnosis was 0.7 for alveolar (lung), 0.85 for alveolar (cardiac), 0.78 for ventilation with alveolar defect, 0.79 for perfusion defect and 0.69 for metabolic disorders. CONCLUSION: CCUS plus ABG algorithm is highly sensitive and it’s agreement with composite diagnosis is far superior. It is a first of it’s kind study, where authors have attempted combining two point of care tests and creating an algorithmic approach for timely diagnosis and intervention. Sciendo 2023-02-08 /pmc/articles/PMC9987272/ /pubmed/36890971 http://dx.doi.org/10.2478/jccm-2023-0006 Text en © 2023 Rajesh Panda, Saurabh Saigal, Rajnish Joshi, Abhijit Pakhare, Ankur Joshi, Jai Prakash Sharma, Sahil Tandon, published by Sciendo https://creativecommons.org/licenses/by/4.0/This work is licensed under the Creative Commons Attribution 4.0 International License.
spellingShingle Research Article
Panda, Rajesh
Saigal, Saurabh
Joshi, Rajnish
Pakhare, Abhijit
Joshi, Ankur
Sharma, Jai Prakash
Tandon, Sahil
Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
title Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
title_full Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
title_fullStr Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
title_full_unstemmed Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
title_short Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
title_sort accuracy of critical care ultrasonography plus arterial blood gas analysis based algorithm in diagnosing aetiology of acute respiratory failure
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987272/
https://www.ncbi.nlm.nih.gov/pubmed/36890971
http://dx.doi.org/10.2478/jccm-2023-0006
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