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Erschienen in: European Surgery 4/2015

01.08.2015 | Original Article

High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous pneumothorax: can we omit X-rays for tube management?

verfasst von: V. Constantin, MD, PhD, A. C. Carap, MD, L. Zaharia, MD, S. Bobic, A. Ciudin, E. Brătilă, V. Vlădăreanu, B. Socea

Erschienen in: European Surgery | Ausgabe 4/2015

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Summary

Background

Primary spontaneous pneumothorax (PSP) is a common medical condition in the emergency department. Clinically stable patients with large pneumothoraces usually undergo chest tube drainage. During the course of hospital stay, several chest X-rays are ordered at various time points. Because the number of chest X-rays during diagnosis and management of PSP can be quite high and lung ultrasound has a proven efficacy for the assessment of lung re-expansion, we decided to investigate the use of lung ultrasound for the management and decision-making regarding chest drains for PSP.

Material and methods

A total of 25 patients with PSP were evaluated. A comparison between chest X-rays and lung ultrasound was made at four different time points during patient hospitalization (T1—immediately after drainage, T2–third or fourth post-drainage day, T3—before chest tube removal, T4—after chest tube removal). The rate of agreement between the two investigations was analyzed, as their result impacts decision-making regarding chest tube management and removal.

Results

Overall, positive and negative agreements were high in all time points, except time point 3. Calculated p values using Fisher’s and Barnard’s test were also good for time points 1, 2, and 4 (< 0.05).

Conclusions

For all time points except the third, we can safely reject the null hypothesis, thereby arriving at the conclusion that lung ultrasound can substitute chest X-rays after tube drainage of PSP.
Literatur
1.
Zurück zum Zitat Melton LJ 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. 1979;120:1379–82.PubMed Melton LJ 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. 1979;120:1379–82.PubMed
2.
Zurück zum Zitat Baumann MH, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach? Chest. 1997;112:789–804.PubMedCrossRef Baumann MH, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach? Chest. 1997;112:789–804.PubMedCrossRef
3.
Zurück zum Zitat Baumann MH, Strange C. The clinician’s perspective on pneumothorax management. Chest. 1997;112:822–8.PubMedCrossRef Baumann MH, Strange C. The clinician’s perspective on pneumothorax management. Chest. 1997;112:822–8.PubMedCrossRef
4.
Zurück zum Zitat Baumann MH, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119:590–602.PubMedCrossRef Baumann MH, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119:590–602.PubMedCrossRef
5.
Zurück zum Zitat Koenig SJ, Narasimhan M, Mayo PH. Thoracic ultrasonography for the pulmonary specialist. Chest. 2011;140(5):1332–41.PubMedCrossRef Koenig SJ, Narasimhan M, Mayo PH. Thoracic ultrasonography for the pulmonary specialist. Chest. 2011;140(5):1332–41.PubMedCrossRef
7.
Zurück zum Zitat Volpicelli G, Elbarbary M, Blaivas M, et al., International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 38:577–91.PubMedCrossRef Volpicelli G, Elbarbary M, Blaivas M, et al., International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 38:577–91.PubMedCrossRef
8.
Zurück zum Zitat Berlet T, Fehr T, Merz TM. Current practice of lung ultrasonography (LUS) in the diagnosis of pneumothorax: a survey of physician sonographers in Germany. Crit Ultrasound J. 2014;6(1):16.PubMedCentralPubMedCrossRef Berlet T, Fehr T, Merz TM. Current practice of lung ultrasonography (LUS) in the diagnosis of pneumothorax: a survey of physician sonographers in Germany. Crit Ultrasound J. 2014;6(1):16.PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling-out pneumothorax in the critically ill. Lung sliding. Chest. 1995;108:1345–8.PubMedCrossRef Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling-out pneumothorax in the critically ill. Lung sliding. Chest. 1995;108:1345–8.PubMedCrossRef
10.
Zurück zum Zitat Marusteri M, Bacarea V. Comparing groups for statistical differences: how to choose the right statistical test? Biochem Med. 2010;20(1):15–32.CrossRef Marusteri M, Bacarea V. Comparing groups for statistical differences: how to choose the right statistical test? Biochem Med. 2010;20(1):15–32.CrossRef
11.
Zurück zum Zitat Bipasa B Assessing agreement for diagnostic devices. FDA/Industry Statistics Workshop. 2006. Bipasa B Assessing agreement for diagnostic devices. FDA/Industry Statistics Workshop. 2006.
12.
Zurück zum Zitat Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.PubMedCrossRef Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.PubMedCrossRef
13.
Zurück zum Zitat Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. McGraw Hill, New York. 2008. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. McGraw Hill, New York. 2008.
14.
Zurück zum Zitat Jakobson DJ, Iftach S. Merging ultrasound in the intensive care routine. Isr Med Assoc J. 2013;15:688–92.PubMed Jakobson DJ, Iftach S. Merging ultrasound in the intensive care routine. Isr Med Assoc J. 2013;15:688–92.PubMed
15.
Zurück zum Zitat Chira R, Chira A, Săplăcan R, et al. Pleural ultrasonography. Pictorial essay. Med Ultrason. 2014;16(4):364–71.PubMed Chira R, Chira A, Săplăcan R, et al. Pleural ultrasonography. Pictorial essay. Med Ultrason. 2014;16(4):364–71.PubMed
16.
Zurück zum Zitat Lichtenstein DA, Meziere G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33:1231–8.PubMedCrossRef Lichtenstein DA, Meziere G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33:1231–8.PubMedCrossRef
17.
Zurück zum Zitat Lichtenstein DA, Lascols N, Prin S, et al. The lung pulse: an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29:2187–92.PubMedCrossRef Lichtenstein DA, Lascols N, Prin S, et al. The lung pulse: an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29:2187–92.PubMedCrossRef
18.
Zurück zum Zitat Agricola E, Bove T, Oppizzi M, et al. Ultrasound comet-tail images: a marker of pulmonary edema. A comparative study with wedge pressure and extravascular lung water. Chest. 2005;127:1690–5.PubMedCrossRef Agricola E, Bove T, Oppizzi M, et al. Ultrasound comet-tail images: a marker of pulmonary edema. A comparative study with wedge pressure and extravascular lung water. Chest. 2005;127:1690–5.PubMedCrossRef
19.
Zurück zum Zitat Lichtenstein D, Meziere G, Biderman P, et al. The comet-tail artifact, an ultrasound sign ruling out pneumothorax. Intensive Care Med. 1999;25:383–8.PubMedCrossRef Lichtenstein D, Meziere G, Biderman P, et al. The comet-tail artifact, an ultrasound sign ruling out pneumothorax. Intensive Care Med. 1999;25:383–8.PubMedCrossRef
20.
Zurück zum Zitat Lichtenstein DA, Meziere G, Biderman P, et al. The lung point: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26:1434–40.PubMedCrossRef Lichtenstein DA, Meziere G, Biderman P, et al. The lung point: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26:1434–40.PubMedCrossRef
21.
Zurück zum Zitat Monti JD, Younggren B, Blankenship R. Ultrasound detection of pneumothorax with minimally trained sonographers: a preliminary study. J Spec Oper Med. 2009;9:43–6.PubMed Monti JD, Younggren B, Blankenship R. Ultrasound detection of pneumothorax with minimally trained sonographers: a preliminary study. J Spec Oper Med. 2009;9:43–6.PubMed
22.
Zurück zum Zitat Lavingia KS, Soult MC, Collins JN, et al. Basic ultrasound training can replace chest radiography for safe tube thoracostomy removal. Am Surg. 2014;80(8):783–6.PubMed Lavingia KS, Soult MC, Collins JN, et al. Basic ultrasound training can replace chest radiography for safe tube thoracostomy removal. Am Surg. 2014;80(8):783–6.PubMed
Metadaten
Titel
High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous pneumothorax: can we omit X-rays for tube management?
verfasst von
V. Constantin, MD, PhD
A. C. Carap, MD
L. Zaharia, MD
S. Bobic
A. Ciudin
E. Brătilă
V. Vlădăreanu
B. Socea
Publikationsdatum
01.08.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0333-9

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