Chest
Original ResearchInterventional PulmonologyPleural Ultrasound Compared With Chest Radiographic Detection of Pneumothorax Resolution After Drainage
Section snippets
Design
Between November 2007 and May 2009, we conducted a prospective observational study in a four-bed intermediate care unit that houses all patients with pneumothorax requiring drainage in our tertiary teaching hospital. This unit is part of a 14-bed medical ICU that has 1,080 admissions a year. In this ICU, ultrasonography is a routine part of patient care. All patients with pneumothorax requiring drainage were eligible for the study, and informed consent was required before inclusion. Exclusion
Patients
Fifty-one patients admitted between November 2007 and May 2009 had pneumothorax requiring drainage. Five patients were excluded because they were on mechanical ventilation, and two were excluded because of important subcutaneous emphysema that impaired pleural line visualization on PU. The final analysis included 44 patients with unilateral pneumothorax (mean age, 37.5 ± 15.0 years; men, n = 31 [70.5%]). Pneumothorax cause was as follows: primary spontaneous (n = 31, 70.5%), traumatic (n = 7,
Discussion
This is the first study to our knowledge to show that PU is better than CXR for detecting residual pneumothoraces after drainage and that 39% of them were not identified by CXR. We confirmed that results of PU are obtained more rapidly than results of CXR.14, 29 Finally, the learning curve showed that naïve residents were able to perform reliable PU after 2 h of training.
The lung point is an inconstant sign, but has a specificity of 100% for pneumothorax diagnosis.24 The fact that the PPV of PU
Conclusions
This study showed that PU diagnostic performance was excellent for pneumothorax follow-up after drainage. PU offered several advantages over CXR: PU diagnosed all residual pneumothoraces, many of which were not identified by CXR; PU led to extra therapeutic interventions; PU gave faster results than CXR; and PU was performed competently by naïve physicians after a brief (2-h) training session.
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Guidelines for management of patients with primary spontaneous pneumothorax
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2018, Respiratory MedicineCitation Excerpt :In the intensive care unit (ICU) and trauma setting (Table 1), ultrasound is sensitive and specific for the diagnosis of pneumothorax [19–22], and is clearly superior to chest X-Ray (CXR). There are also data showing accuracy of ultrasound for the diagnosis [23–25] and monitoring [26] of post-procedure pneumothoraces, although specific ARF data are lacking. In contrast to traumatic and iatrogenic pneumothorax, sonographic detection of spontaneous pneumothorax in ARF may be less reliable, due to lower prevalence (3–4% vs 13–30%) [27].
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