Chest ultrasonography compared to chest x-ray in pneumothorax patients before intercostal tube removal

ABSTRACT Pneumothorax is the most common serious pleural complication in the Intensive Care Unit (ICU). Traditionally lung imaging in critically ill patients is performed either by bedside chest radiography (CXR) or thoracic computed tomography (CT Chest). Nowadays bedside lung ultrasound is increasingly used for the evaluation of critically ill patients with different lung and pleural pathologies. Our study was designed to determine the role of chest ultrasonography in comparison to CXR for detection of residual pneumothorax in pneumothorax patients before Intercostal tube(ICT) removal using thoracic CT as a gold standard. The study was conducted on Fifty Three adult critically ill patients of both genders who were admitted to the Department of Critical Care Medicine in Alexandria Main University Hospital during six months duration "from April 2016 to September 2016". Lung ultrasound, a bedside CXR and CT scan were performed 24 hours after bubbling in the aspiration device had stopped and after clamping of the intercostal tube for 6 hours before removal to exclude residual pneumothorax. Simple bedside lung ultrasound provided diagnosis of residual pneumothorax after intercostal tube clamp in seventeen out of fifty three included patients. The sensitivity, specificity, and diagnostic accuracy of CXR were 57.89%, 88.24%, and77.36 % respectively. The corresponding values for lung ultrasound were 84.21%, 97.06%, 92.45% respectively. Lung ultrasound has a better diagnostic performance than CXR for the diagnosis of residual pneumothorax before intercostal tube removal and may be used as an alternative to thoracic CT. Keywords: Chest ultrasonography, Intercostal Tube, Lung point, Pneumothorax. REFERENCES Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England.Thorax 2000; 55: 666–671. Strange C. Pleural complications in the intensive care unit.Clin Chest Med 1999; 20:317–327. Gammon RB, Shin MS, Groves RH Jr, Hardin JM, Hsu C, Buchalter SE,et al. Clinical risk factors for pulmonary barotrauma: a multivariate analysis. Am J Respir Crit Care Med 1995; 152:1235–1240. de Latorre FJ, Tomasa A, Klamburg J, Leon C, Soler M, Rius J, et al. Incidence of pneumothorax and pneumomediastinum in patients with aspiration pneumonia requiring ventilatory support. Chest 1977; 72:141–144. Rubinowitz AN, Siegel MD, Tocino I. Thoracic imaging in the ICU. Crit Care Clin 2007; 23:539–573. Brenner DJ, Hall EJ. Computed tomography an increasing source of radiation exposure. N Engl J Med 2007; 357:2277-84. Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: bedside lung ultrasound in critical care practice. Crit Care 2007; 11:205. Graat M, Wolthius E, Choi G, Stoker J, Vroom M. The clinical value of daily routine chest radiographs in mixed medical surgical Intensive Care is low. Critical Care 2006; 10: R11. Beckh S, Bolcskei PL, Lessnau KD. Real time chest ultrasonography: a comprehensive review for the pulmonologist. Chest 2002; 122:1759-73. Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care 2014;20(3):315-22. Sateesh Pujari, & Estari Mamidala. (2015). Anti-diabetic activity of Physagulin-F isolated from Physalis angulata fruits. The American Journal of Science and Medical Research, 1(2), 53–60. https://doi.org/10.5281/zenodo.7352308 Elnaem W , Tammam H, Zidan M, Mahmoud M. The relative efficacy of chest ultrasonography in comparison to other diagnostic modalities in the evaluation of dyspneic patient. Egyptian Journal of Chest Diseases and Tuberculosis 2017;66(1):165–8 Ball CG, Kirkpatrick AW, Laupland KB, Fox DL, Litvinchuk S, Dyer DM, et al. Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces. Am J Surg 2005;189:541–6. Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: A meta-analysis. Chest 2011;140:859–66. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care 2006;10:R112. Yarmus L, Feller-Kopman D. Pneumothorax in the critically Ill patient. Chest 2012; 141(4):1098-105. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG,et al. Occult traumatic pneumothorax: Diagnostic accuracy of lung ultrasonography in the emergency department. Chest 2008;133:204–11. Helland G, Gaspari R, Licciardo S, Sanseverino A, Torres U, Emhoff T,et al. Comparison of Four Views to Single-view Ultrasound Protocols to Identify Clinically Significant Pneumothorax. Acad Emerg Med 2016;23(10):1170-1175 [19].Lichtenstein D, Mezière G, Biderman P, Gepner A. The "lung point": an ultrasound sign specific to pneumothorax. Intensive Care Med 2000;26(10):1434-40