Fast differential diagnostics of acute respiratory insufficiency using ultrasound

Česká verzia

Authors: V. Zoľák ¹; S. Nosáľ ¹; B. Zoľáková ²; M. Minárik ³; H. Poláček ⁴
Authors place of work: Klinika detskej anestéziológie a intenzívnej medicíny JLF UK a UNM, Martin, Slovenská republika ¹; Neonatologická klinika JLF UK a UNM, Martin, Slovenská republika ²; Klinika anestéziológie a intenzívnej medicíny JLF UK a UNM, Martin, Slovenská republika ³; Rádiologická klinika JLF UK a UNM, Martin, Slovenská republika ⁴
Published in the journal: Anest. intenziv. Med., 26, 2015, č. 6, s. 333-341
Category: Intenzivní medicína - Původní práce

Summary

Objective:
Lung ultrasound (LUS) is a modern alternative method for imaging the lungs that can be used in intensive care units not only for fast differential diagnosis of acute respiratory insufficiency but also for dynamic monitoring of the lungs. Our aims were: To validate the usability of LUS in healthy and critically ill children, to find out if there is a difference in the LUS image between non-ventilated and ventilated patients; to analyze time to diagnosis by lung auscultation, chest X-ray and lung ultrasound; to perform inter-observer analysis of these methods and to calculate the sensitivity and specificity of LUS for selected diseases.

Design:
Prospective clinical study.

Setting:
Paediatric intensive care unit of a university hospital.

Materials and methods:
Total 135 children were included in this study. Group I consisted of 45 critically ill children with respiratory insufficiency, Group II included 90 children without respiratory pathology. Times to disease diagnosis by auscultation, chest X-ray and LUS were recorded.

Results:
“Physiological” variants of the B-lines were detected in about 30% of children in Group II. We did not find any significant difference between artifact occurrence in ventilated and non-ventilated children (concordance 95%, κ coefficient 0.9). We determined a statistically significant difference in time to diagnosis by the different diagnostic methods (p < 0.001). Time to diagnosis by auscultation and LUS positively correlated with present lung pathology and negatively correlated with the age of the child. In inter-observer analysis of the three methods we stated inferior concordance of both auscultation and X-ray compared with LUS. We also calculated the sensitivity and specifity in selected diagnoses – i.e. pneumonia (94.7% and 98%, respectively) with the best values achieved using LUS.

Conclusion:
Lung ultrasound is a reliable method for differential diagnostics of acute respiratory insufficiency.

Keywords:
lung ultrasound – acute respiratory insuficiency – bedside diagnostics – critically ill children – pneumonia – ARDS – bronchiolitis – lung contusions – lung atelectasis

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