Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Woodhead, M.; Blasi, F.; Ewig, S.; Garau, J.; Huchon, G.; Ieven, M.; Ortqvist, A.; Schaberg, T.; Torres, A.; van der Heijden, G.; et al. JointTaskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidel. Manag. Adult Low. Respir. Tract Infect.—Full Version. Clin. Microbiol. Infect. 2011, 17 (Suppl. 6), E1–E59. [Google Scholar]
- Self, W.H.; Courtney, D.M.; McNaughton, C.D.; Wunderink, R.G.; Kline, J.A. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: Implications for diagnosing pneumonia. Am. J. Emerg. Med. 2013, 31, 401–405. [Google Scholar] [CrossRef] [Green Version]
- Upchurch, C.P.; Grijalva, C.G.; Wunderink, R.G.; Williams, D.J.; Waterer, G.W.; Anderson, E.J.; Zhu, Y.; Hart, E.M.; Carroll, F.; Bramley, A.M.; et al. Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes. Chest 2018, 153, 601–610. [Google Scholar] [CrossRef] [PubMed]
- Pagano, A.; Numis, F.G.; Visone, G.; Pirozzi, C.; Masarone, M.; Olibet, M.; Nasti, R.; Schiraldi, F.; Paladino, F. Lung ultrasound for diagnosis of pneumonia in emergency department. Intern. Emerg. Med. 2015, 10, 851–854. [Google Scholar] [CrossRef] [PubMed]
- Soldati, G.; Prediletto, R.; Demi, M.; Salvadori, S.; Pistolesi, M. Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study. Diagnostics 2022, 12, 952. [Google Scholar] [CrossRef] [PubMed]
- Gargani, L. Lung ultrasound: A new tool for the cardiologist. Cardiovasc. Ultrasound 2011, 9, 6. [Google Scholar] [CrossRef] [Green Version]
- Olson, G.; Davis, A.M. Diagnosis and Treatment of Adults with Community-Acquired Pneumonia. JAMA 2020, 323, 885–886. [Google Scholar] [CrossRef]
- Le Bel, J.; Hausfater, P.; Chenevier-Gobeaux, C.; Blanc, F.X.; Benjoar, M.; Ficko, C.; Ray, P.; Choquet, C.; Duval, X.; Claessens, Y.E.; et al. Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan. Crit. Care 2015, 19, 366. [Google Scholar] [CrossRef] [Green Version]
- Bertolone, D.T.; De Colle, C.; Rozza, F.; Fucile, I.; Santoro, C.; Conte, M.; De Luca, N.; Mancusi, C. Lung ultrasound: A narrative review and proposed protocol for patients admitted to Cardiac Rehabilitation Unit. Monaldi Arch. Chest Dis. 2021, 92. [Google Scholar] [CrossRef]
- Kameda, T.; Mizuma, Y.; Taniguchi, H.; Fujita, M.; Taniguchi, N. Point-of-care lung ultrasound for the assessment of pneumonia: A narrative review in the COVID-19 era. J. Med. Ultrason. 2021, 48, 31–43. [Google Scholar] [CrossRef]
- Sforza, A.; Carlino, M.V.; Guarino, M.; Romano, G.; Paladino, F.; de Simone, G.; Mancusi, C. Anterior vs lateral symmetric interstitial syndrome in the diagnosis of acute heart failure. Int. J. Cardiol. 2019, 280, 130–132. [Google Scholar] [CrossRef] [PubMed]
- Sforza, A.; Carlino, M.V.; Guarino, M.; Russo, S.; Albano, G.; Paladino, F.; Mancusi, C. A case of pulmonary edema: The critical role of lung-heart integrated ultrasound examination. Monaldi Arch. Chest Dis. 2018, 88, 982. [Google Scholar] [CrossRef]
- Breitkopf, R.; Treml, B.; Rajsic, S. Lung Sonography in Critical Care Medicine. Diagnostics 2022, 12, 1405. [Google Scholar] [CrossRef]
- Al Deeb, M.; Barbic, S.; Featherstone, R.; Dankoff, J.; Barbic, D. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: A systematic review and meta-analysis. Acad. Emerg. Med. 2014, 21, 843–852. [Google Scholar] [CrossRef]
- Pivetta, E.; Goffi, A.; Lupia, E.; Tizzani, M.; Porrino, G.; Ferreri, E.; Volpicelli, G.; Balzaretti, P.; Banderali, A.; Iacobucci, A.; et al. Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study. Chest 2015, 148, 202–210. [Google Scholar] [CrossRef] [Green Version]
- Liteplo, A.S.; Marill, K.A.; Villen, T.; Miller, R.M.; Murray, A.F.; Croft, P.E.; Capp, R.; Noble, V.E. Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): Sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad. Emerg. Med. 2009, 16, 201–210. [Google Scholar] [CrossRef] [PubMed]
- Gargani, L.; Frassi, F.; Soldati, G.; Tesorio, P.; Gheorghiade, M.; Picano, E. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: A comparison with natriuretic peptides. Eur. J. Heart Fail. 2008, 10, 70–77. [Google Scholar] [CrossRef] [PubMed]
- Liu, X.L.; Lian, R.; Tao, Y.K.; Gu, C.D.; Zhang, G.Q. Lung ultrasonography: An effective way to diagnose community-acquired pneumonia. Emerg. Med. J. 2015, 32, 433–438. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chavez, M.A.; Shams, N.; Ellington, L.E.; Naithani, N.; Gilman, R.H.; Steinhoff, M.C.; Santosham, M.; Black, R.E.; Price, C.; Gross, M.; et al. Lung ultrasound for the diagnosis of pneumonia in adults: A systematic review and meta-analysis. Respir Res. 2014, 15, 50. [Google Scholar] [CrossRef] [Green Version]
- Ticinesi, A.; Lauretani, F.; Nouvenne, A.; Mori, G.; Chiussi, G.; Maggio, M.; Meschi, T. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward. Medicine 2016, 95, e4153. [Google Scholar] [CrossRef] [PubMed]
- Nazerian, P.; Volpicelli, G.; Vanni, S.; Gigli, C.; Betti, L.; Bartolucci, M.; Zanobetti, M.; Ermini, F.R.; Iannello, C.; Grifoni, S. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am. J. Emerg. Med. 2015, 33, 620–625. [Google Scholar] [CrossRef] [PubMed]
- Araiza-Garaygordobil, D.; Baeza-Herrera, L.A.; Gopar-Nieto, R.; Solis-Jimenez, F.; Cabello-López, A.; Martinez-Amezcua, P.; Sarabia-Chao, V.; González-Pacheco, H.; Sierra-Lara Martinez, D.; Briseño-De la Cruz, J.L.; et al. Pulmonary Congestion Assessed by Lung Ultrasound and Cardiovascular Outcomes in Patients With ST-Elevation Myocardial Infarction. Front. Physiol. 2022, 13, 881626. [Google Scholar] [CrossRef]
- Araujo, G.N.; Silveira, A.D.; Scolari, F.L.; Custodio, J.L.; Marques, F.P.; Beltrame, R.; Menegazzo, W.; Machado, G.P.; Fuchs, F.C.; Goncalves, S.C.; et al. Admission Bedside Lung Ultrasound Reclassifies Mortality Prediction in Patients With ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc. Imaging 2020, 13, e010269. [Google Scholar] [CrossRef] [PubMed]
- Kang, Y.; Fang, X.Y.; Wang, D.; Wang, X.J. Factors associated with acute myocardial infarction in older patients after hospitalization with community-acquired pneumonia: A cross-sectional study. BMC Geriatr. 2021, 21, 113. [Google Scholar] [CrossRef] [PubMed]
- Chaitra, S.; Hattiholi, V.V. Diagnostic Accuracy of Bedside Lung Ultrasound in Emergency Protocol for the Diagnosis of Acute Respiratory Failure. J. Med. Ultrasound 2021, 30, 94–100. [Google Scholar]
- Bouhemad, B.; Dransart-Rayé, O.; Mojoli, F.; Mongodi, S. Lung ultrasound for diagnosis and monitoring of ventilator-associated pneumonia. Ann. Transl. Med. 2018, 6, 418. [Google Scholar] [CrossRef] [PubMed]
- Javaudin, F.; Marjanovic, N.; de Carvalho, H.; Gaborit, B.; Le Bastard, Q.; Boucher, E.; Haroche, D.; Montassier, E.; Le Conte, P. Contribution of lung ultrasound in diagnosis of community-acquired pneumonia in the emergency department: A prospective multicentre study. BMJ Open 2021, 11, e046849. [Google Scholar] [CrossRef]
- Volpicelli, G.; Elbarbary, M.; Blaivas, M.; Lichtenstein, D.A.; Mathis, G.; Kirkpatrick, A.W.; Melniker, L.; Gargani, L.; Noble, V.E.; Via, G.; et al. International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012, 38, 577–591. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nazerian, P.; Cerini, G.; Vanni, S.; Gigli, C.; Zanobetti, M.; Bartolucci, M.; Grifoni, S.; Volpicelli, G. Diagnostic accuracy of lung ultrasonography combined with procalcitonin for the diagnosis of pneumonia: A pilot study. Crit. Ultrasound J. 2016, 8, 17. [Google Scholar] [CrossRef] [Green Version]
- Zhou, J.; Song, J.; Gong, S.; Hu, W.; Wang, M.; Xiao, A.; Zhang, C.; Dong, Z. Lung Ultrasound Combined With Procalcitonin for a Diagnosis of Ventilator-Associated Pneumonia. Respir. Care 2019, 64, 519–527. [Google Scholar] [CrossRef]
- Linsalata, G.; Okoye, C.; Antognoli, R.; Guarino, D.; Ravenna, V.; Orsitto, E.; Calsolaro, V.; Monzani, F. Pneumonia Lung Ultrasound Score (PLUS): A New Tool for Detecting Pneumonia in the Oldest Patients. J. Am. Geriatr. Soc. 2020, 68, 2855–2862. [Google Scholar] [CrossRef] [PubMed]
Total Study Population n = 110 | With Pneumonia n = 26 | Without Pneumonia n = 84 | p Value | |
---|---|---|---|---|
Age (years) | 70 ± 11 | 72 ± 12 | 69.6 ± 11 | 0.383 |
Women (%) | 31.8 | 20 | 80 | 0.54 |
White blood cell count(×103/µL) | 10.6 ± 5.4 | 13 ± 8 | 9.8 ± 4 | 0.12 |
Hemoglobin (g/dL) | 12.4 ± 2.2 | 11.8 ± 2.2 | 12.6 ± 2.2 | 0.142 |
Hs C reactive protein (mg/dL) | 44.3 ± 57.9 | 102 ± 68 | 24.26 ± 38 | 0.0001 |
BNP (pg/mL) | 1793 ± 3186 | 2099 ± 4215 | 1770 ± 2661 | 0.799 |
pH | 7.45 ± 0.06 | 7.46 ± 0.07 | 7.43 ± 0.05 | 0.094 |
PaO2/FiO2 | 256 ± 105 | 220 ± 96 | 277 ± 106 | 0.048 |
Lactate level (mmol/L) | 1.4 ± 0.9 | 1.3 ± 0.6 | 1.4 ± 1.05 | 0.575 |
Pleural effusion (%) | 54.8 | 84.6 | 39.3 | 0.0001 |
Interstitial syndrome (%) | 66.7 | 73.1 | 65.5 | 0.470 |
Concomitant heart failure (%) | 49 | 46.2 | 50 | 0.732 |
Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | PPV (%) (95% CI) | NPV (%) (95% CI) | Positive Likelihood Ratio | Negative Likelihood Ratio | |
---|---|---|---|---|---|---|
Lung ultrasound | 92.6% (75.7–99.1) | 80.95% (70.92–88.70) | 61% (48.77–70.27) | 97.14% (89.94–99.23) | 4.85 | 0.1 |
Chest X ray | 42.86% (21.82–65.98) | 95.12% (87.98–98.66) | 69.23% (43.42 86.84) | 86.67 (81.73–90.43) | 3.95 | 0.37 |
Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | PPV (%) (95% CI) | NPV (%) (95% CI) | Accuracy (%) | |
---|---|---|---|---|---|
Panel a No pleural effusion (n = 55) | |||||
Lung ultrasound | 100% (40–100) | 96.1% (86.5–99.5) | 67% (34–89) | 100% (--) | 96.4% |
Chest X ray | 50% (7–93) | 96.1% (86- 99.5) | 50% (15.6–84.2) | 96.1 (90.1–98.4) | 92.7% |
Panel b pleural effusion (n = 55) | |||||
Lung ultrasound | 90.1% (71–98.8) | 57.6% (39.2–74.5) | 58.5 (48.4–68.5) | 98.5 (71–97.3) | 72% |
Chest X ray | 91.8% (14–55) | 92.4% (79–98.6) | 76% (44.1–92) | 66% (58–70%) | 64% |
Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | PPV (%) (95% CI) | NPV (%) (95% CI) | Positive Likelihood Ratio | Negative Likelihood Ratio | |
---|---|---|---|---|---|---|
Lung ultrasound | 100% (71.5–100) | 73.9% (51.6–90) | 64.7% (47.8–78.5) | 100% (--) | 3.83 | - |
Chest X ray | 18.2% (2.3–51.8) | 91.3% (71.2–98.9) | 50% (13.9–86.1) | 70 (63.2–76.0) | 2.09 | 0.9 |
Chest CT scan | 90.9% (58.72–99.77) | 95.6% (78.05–99.89) | 90.91 (59.30–98.56) | 95.65 (77.21–99.30) | 20.9 | 0.1 |
Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | PPV (%) (95% CI) | NPV (%) (95% CI) | Accuracy (%) | |
---|---|---|---|---|---|
Panel a (n = 110) | |||||
Lung ultrasound | 100% (74–100) | 74% (52–89.70) | 66.7% (50.1–79.9) | 100% (--) | 83% |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Mancusi, C.; Fucile, I.; Gargiulo, P.; Mosca, M.; Migliaccio, B.; Basile, C.; Gargiulo, G.; Santoro, C.; Morisco, C.; De Luca, N.; et al. Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia. Diagnostics 2022, 12, 3082. https://doi.org/10.3390/diagnostics12123082
Mancusi C, Fucile I, Gargiulo P, Mosca M, Migliaccio B, Basile C, Gargiulo G, Santoro C, Morisco C, De Luca N, et al. Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia. Diagnostics. 2022; 12(12):3082. https://doi.org/10.3390/diagnostics12123082
Chicago/Turabian StyleMancusi, Costantino, Ilaria Fucile, Paola Gargiulo, Mariangela Mosca, Biagio Migliaccio, Christian Basile, Giuseppe Gargiulo, Ciro Santoro, Carmine Morisco, Nicola De Luca, and et al. 2022. "Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia" Diagnostics 12, no. 12: 3082. https://doi.org/10.3390/diagnostics12123082