Korean J Crit Care Med.  2017 Nov;32(4):323-332. 10.4266/kjccm.2017.00318.

The Use of Lung Ultrasound in a Surgical Intensive Care Unit

• Kang HK
• So HJ
• Kim DH
• Koo HK
• Park HK
• Lee SS
• Jung H

• KMID: 2405118
• DOI: http://doi.org/10.4266/kjccm.2017.00318

Abstract

BACKGROUND
Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU).
METHODS
This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016.
RESULTS
The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively.
CONCLUSIONS
LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.

Keyword

complication; lung; surgical intensive care; ultrasonography

MeSH Terms

Anoxia
Critical Care*
Critical Illness
Diagnosis
Diaphragm
Fever
Humans
Lung*
Medical Records
Pneumonia
Pneumothorax
Pulmonary Atelectasis
Pulmonary Edema
Radiography, Thoracic
Retrospective Studies
Ultrasonography*
Weaning

Figure

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  Figure 1. Flow chart for study enrollment. LUS: lung ultrasound; BLUE: bedside LUS in emergency; ICU: intensive care unit.

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  Figure 2. Overall flow diagram outlining the diagnoses of pulmonary complications. LUS: lung ultrasound; ARDS: acute respiratory distress syndrome.

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  Figure 3. Comparison of a chest radiograph and lung ultrasound image in a representative case. (A) Chest anteroposterior view. Active lesions were not visible. (B) Lung ultrasound of the posterior chest wall. Hypoechoic consolidation with an air bronchogram (arrow) was noted.

Reference

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