Clinical review: Bedside lung ultrasound in critical care practice.
Ontology highlight
ABSTRACT:
SUBMITTER: Bouhemad B
PROVIDER: S-EPMC2151891 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Lung ultrasound is an effective tool for the evaluation of undifferentiated dyspnea in the emergency department. Impact of lung ultrasound on clinical decisions for the evaluation of patients with dyspnea in resource-limited settings is not well-known. The objective of this study was to evaluate the impact of lung ultrasound on clinical decision-making for patients presenting with dyspnea to an emergency department in the resource-limited setting of Nepal. METHODS:A prospective, cross-sectional study of clinicians working in the Patan Hospital Emergency Department was performed. Clinicians performed lung ultrasounds on patients presenting with dyspnea and submitted ultrasounds with their pre-test diagnosis, lung ultrasound interpretation, post-test diagnosis, and any change in management. RESULTS:Twenty-two clinicians participated in the study, completing 280 lung ultrasounds. Diagnosis changed in 124 (44.3%) of patients with dyspnea. Clinicians reported a change in management based on the lung ultrasound in 150 cases (53.6%). Of the changes in management, the majority involved treatment (83.3%) followed by disposition (13.3%) and new consults (2.7%). CONCLUSIONS:In an emergency department in Nepal, bedside lung ultrasound had a significant impact on physician clinical decision-making, especially on patient diagnosis and treatment.
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Project description:ObjectiveTo describe the recommended procedure and common ultrasonographic findings and present a framework for labelling, recording and reporting of images obtained during a focused lung ultrasound study.BackgroundLung ultrasound is a widely utilised point-of-care investigation in acute care, providing valuable diagnostic information in patients with dyspnoea or haemodynamic instability. It has a number of recognised advantages and has been incorporated into a variety of clinical algorithms. Recommendations for performing lung ultrasound and description of common artefacts are readily available; however, there is a lack of a recognised framework for labelling and reporting a lung ultrasound study. Standardised recording, labelling and reporting are important clinically, while promoting consistency, quality assurance, teaching and research opportunities. Documenting lung ultrasound also has potential medico-legal implications.ResultsFor focused lung ultrasound, an extended bilateral four-quadrant approach is recommended. Acquired images and loops should be clearly labelled identifying left or right, anterior or lateral and inferior, superior or posterior locations. 2D loops should be of sufficient length to clearly demonstrate pleural sliding, complemented by M-mode stills if required. Reports should provide information regarding the presence or absence of an intact pleural interface, the presence or absence and the size and nature of pleural collections as well as any parenchymal artefacts or consolidation, in all examined locations. It is important to use internationally accepted terminology to describe findings, and it is also recommended to conclude the report with a clear summary that can be interpreted by healthcare providers without specific training in lung ultrasound.
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Project description:A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.
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