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Chapter 7 - Point-of-Care Lung Ultrasound

Published online by Cambridge University Press:  28 April 2020

By
Zachary Kuschner  and
John M. Oropello
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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Summary

Lung ultrasound is a point-of-care test particularly well suited to diagnose pneumothorax, pleural effusion, pulmonary edema, and consolidation. In the operating room setting imaging can establish a baseline for comparison to maximize confidence in later examinations displaying new pathology. In conjunction with cardiac and IVC ultrasound, the etiology of hypotension can be ascertained as hypovolemic, distributive, and cardiac. In addition, even more basic assessment regarding volume status and fluid responsiveness is improved. Ultrasound can be used to guide, confirm, and localize tracheal tube placement. In the postoperative setting pulmonary ultrasound can facilitate clinical decisions regarding weaning patients from mechanical ventilation and the need for ICU admission.

Keywords

Lung ultrasoundpoint-of-carepneumothoraxpulmonary edemapleural effusionconsolidationatelectasisartifactstracheal intubation
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 67 - 79
Publisher: Cambridge University Press
Print publication year: 2020

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References

Joyner, CR, Jr., Herman, RJ, Reid, JM. Reflected ultrasound in the detection and localization of pleural effusion. JAMA 1967;200(5):399–402.Google Scholar
Pell, R. Ultrasound for routine clinical investigations. Ultrasonics 1964;2(2):87–9.Google Scholar
Rantanen, NW. Diseases of the thorax. Vet Clin North Am Equine Pract 1986;2(1):49–66.Google Scholar
Wernecke, K, Galanski, M, Peters, PE, Hansen, J. Pneumothorax: evaluation by ultrasound–preliminary results. J Thorac Imaging 1987;2(2):76–8.CrossRefGoogle ScholarPubMed
Lichtenstein, DA, Meziere, GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134(1):117–25.Google Scholar
Mittal, AK, Gupta, N. Intraoperative lung ultrasound: a clinicodynamic perspective. J Anaesthesiol Clin Pharmacol 2016;32(3):288–97.CrossRefGoogle ScholarPubMed
Shander, A, Fleisher, LA, Barie, PS, et al. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 2011;39(9):2163–72.Google Scholar
Abstracts of the 30th International Symposium on Intensive Care and Emergency Medicine. Brussels, Belgium. March 9–12, 2010. Crit Care 2010;14 Suppl 1:P1–602.Google Scholar
Restrepo, RD, Braverman, J. Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis. Expert Rev Respir Med 2015;9(1):97–107.Google Scholar
Zieleskiewicz, L, Fresco, R, Duclos, G, et al. Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: Impact on the management of 756 patients. Injury 2018;49(10):1774–80.Google Scholar
Blaivas, M, Lyon, M, Duggal, S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med 2005;12(9):844–9.Google Scholar
Lichtenstein, DA, Meziere, G, Lascols, N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005;33(6):1231–8.CrossRefGoogle ScholarPubMed
Lichtenstein, D, van Hooland, S, Elbers, P, Malbrain, ML. Ten good reasons to practice ultrasound in critical care. Anaesthesiol Intensive Ther 2014;46(5):323–5.Google Scholar
Koh, DM, Burke, S, Davies, N, Padley, SP. Transthoracic US of the chest: clinical uses and applications. Radiographics 2002;22(1):e1.Google Scholar
Lichtenstein, DA, Menu, Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest 1995;108(5):1345–8.Google Scholar
Husain, LF, Hagopian, L, Wayman, D, Baker, WE, Carmody, KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock 2012;5(1):76–81.Google Scholar
Targhetta, R, Bourgeois, JM, Chavagneux, R, et al. Ultrasonic signs of pneumothorax: preliminary work. J Clin Ultrasound 1993;21(4):245–50.Google Scholar
Slater, A, Goodwin, M, Anderson, KE, Gleeson, FV. COPD can mimic the appearance of pneumothorax on thoracic ultrasound. Chest 2006;129(3):545–50.Google Scholar
De Luca, C, Valentino, M, Rimondi, MR, et al. Use of chest sonography in acute-care radiology. J Ultrasound 2008;11(4):125–34.Google Scholar
Lichtenstein, D, Meziere, G, Biderman, P, Gepner, A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 2000;26(10):1434–40.Google Scholar
Sato, I, Kanda, H, Kanao-Kanda, M, Kurosawa, A, Kunisawa, T. A case of iatrogenic pneumothorax in which chest tube placement could be avoided by intraoperative evaluation with transthoracic ultrasonography. Ther Clin Risk Manag 2017;13:843–5.Google Scholar
Aspler, A, Pivetta, E, Stone, MB. Double-lung point sign in traumatic pneumothorax. Am J Emerg Med 2014;32(7):819e81–2.Google Scholar
Gelabert, C, Nelson, M. Bleb point: mimicker of pneumothorax in bullous lung disease. West J Emerg Med 2015;16(3):447–9.Google Scholar
Stone, MB, Chilstrom, M, Chase, K, Lichtenstein, D. The heart point sign: description of a new ultrasound finding suggesting pneumothorax. Acad Emerg Med 2010;17(11):e149–150.Google Scholar
Lichtenstein, DA, Lascols, N, Prin, S, Meziere, G. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med 2003;29(12):2187–92.CrossRefGoogle ScholarPubMed
Lichtenstein, D, Meziere, G, Biderman, P, Gepner, A, Barre, O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 1997;156(5):1640–6.Google Scholar
Kerley, P. Radiology in Heart Disease. Br Med J 1933;2(3795):594–612.3.Google Scholar
Jambrik, Z, Monti, S, Coppola, V, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 2004;93(10):1265–70.CrossRefGoogle ScholarPubMed
Baldi, G, Gargani, L, Abramo, A, et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med 2013;39(1):74–84.Google Scholar
Platz, E, Lewis, EF, Uno, H, et al. Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. Eur Heart J 2016;37(15):1244–51.Google Scholar
Theerawit, P, Touman, N, Sutherasan, Y, Kiatboonsri, S. Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation. Indian J Crit Care Med 2014;18(4):195–99.Google Scholar
Aras, MA, Teerlink, JR. Lung ultrasound: a “B-line” to the prediction of decompensated heart failure. Eur Heart J 2016;37(15):1252–4.Google Scholar
Dietrich, CF, Mathis, G, Blaivas, M, et al. Lung B-line artefacts and their use. J Thorac Dis 2016;8(6):1356–65.Google Scholar
Lichtenstein, D, Meziere, G, Biderman, P, Gepner, A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 1999;25(4):383–8.Google Scholar
Joyner, CR Jr, Miller, LD, Dudrick, SJ, Eskin, DJ, Bloom, P. Reflected ultrasound in the study of diseases of the chest. Trans Am Clin Climatol Assoc 1967;78:28–37.Google Scholar
Kataoka, H, Takada, S. The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll Cardiol 2000;35(6):1638–46.Google Scholar
Kalokairinou-Motogna, M, Maratou, K, Paianid, I, et al. Application of color Doppler ultrasound in the study of small pleural effusion. Med Ultrason 2010;12(1):12–16.Google Scholar
Rothlin, MA, Naf, R, Amgwerd, M, Candinas, D, Frick, T, Trentz, O. Ultrasound in blunt abdominal and thoracic trauma. J Trauma 1993;34(4):488–95.Google Scholar
Hasan, AA, Makhlouf, HA, Mohamed, ARM. Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography. Egyptian Chest Diseases Tuberculosis 2013;62:429–33.Google Scholar
Atkinson, P, Milne, J, Loubani, O, Verheul, G. The V-line: a sonographic aid for the confirmation of pleural fluid. Crit Ultrasound J 2012;4(1):19.CrossRefGoogle ScholarPubMed
Acosta, CM, Maidana, GA, Jacovitti, D, et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology 2014;120(6):1370–9.Google Scholar
Weinberg, B, Diakoumakis, EE, Kass, EG, Seife, B, Zvi, ZB. The air bronchogram: sonographic demonstration. AJR Am J Roentgenol 1986;147(3):593–5.CrossRefGoogle ScholarPubMed
Lichtenstein, DA, Lascols, N, Mezière, G, Gepner, A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 2004;30(2):276–81.Google Scholar
Cassanelli, N, Caroli, G, Dolci, G, et al. Accuracy of transthoracic ultrasound for the detection of pleural adhesions. Eur J Cardiothorac Surg 2012;42(5):813–18; discussion 818.Google Scholar
Wei, B, Wang, T, Jiang, F, Wang, H. Use of transthoracic ultrasound to predict pleural adhesions: a prospective blinded study. Thorac Cardiovasc Surg 2012;60(2):101–4.Google Scholar
Grmec, S. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med 2002;28(6):701–4.Google Scholar
Neumar, RW, Otto, CW, Link, MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122(18 Suppl 3):S729–767.Google Scholar
Weaver, B, Lyon, M, Blaivas, M. Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign. Acad Emerg Med 2006;13(3):239–44.Google Scholar
Rajan, S, Surendran, J, Paul, J, Kumar, L. Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming endotracheal intubation in overweight and obese patients. Indian J Anaesth 2017;61(3):230–4.CrossRefGoogle ScholarPubMed
Sim, SS, Lien, WC, Chou, HC, et al. Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation. Resuscitation 2012;83(3):307–12.CrossRefGoogle ScholarPubMed
Sustic, A, Protic, A, Cicvaric, T, Zupan, Z. The addition of a brief ultrasound examination to clinical assessment increases the ability to confirm placement of double-lumen endotracheal tubes. J Clin Anesth 2010;22(4):246–9.Google Scholar
Ma, G, Davis, DP, Schmitt, J, Vilke, GM, Chan, TC, Hayden, SR. The sensitivity and specificity of transcricothyroid ultrasonography to confirm endotracheal tube placement in a cadaver model. J Emerg Med 2007;32(4):405–7.Google Scholar
Chou, HC, Chong, KM, Sim, SS, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation 2013;84(12):1708–12.Google Scholar
Ma, Gene, Hayden, SR, Chan, Theodore C, et al., Using ultrasound to visualize and confirm endotracheal intubation. Academic Emergency Medicine 1999;6(5):515.Google Scholar
Werner, SL, Smith, CE, Goldstein, JR, Jones, RA, Cydulka, RK. Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Ann Emerg Med 2007;49(1):75–80.CrossRefGoogle ScholarPubMed
Ball, CG, Ranson, K, Dente, CJ, et al. Clinical predictors of occult pneumothoraces in severely injured blunt polytrauma patients: a prospective observational study. Injury 2009;40(1):44–7.Google Scholar
Du, J, Tan, J, Yu, K, Wang, R. Lung recruitment maneuvers using direct ultrasound guidance: a case study. Respir Care 2015;60(5):e93–96.Google Scholar
Lichtenstein, D. FALLS-protocol: lung ultrasound in hemodynamic assessment of shock. Heart Lung Vessel 2013;5(3):142–7.Google ScholarPubMed
Kajimoto, K, Madeen, K, Nakayama, T, et al. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012;10(1):49.Google Scholar
Smetana, GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med 2009;76 Suppl 4:S60–65.Google Scholar
Lichtenstein, D, Goldstein, I, Mourgeon, E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100(1):9–15.CrossRefGoogle ScholarPubMed
Copetti, R, Soldati, G, Copetti, P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 2008;6:16.Google Scholar

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