Could chest ultrasonography replace routine chest X-rays in mechanically ventilated patients?

Abstract

Background: Although conventional chest radiography remains the first routine radiologic examination in mechanically ventilated patients, chest ultrasound provides more accurate information, with less ionizing radiation and less time delay. Objective: To compare between sensitivity of chest ultrasound and routine daily chest X-ray in diagnosis and follow up of diseases in mechanically ventilated patients admitted at Respiratory ICU of the Ain Shams University Hospital. Design: The study was carried out as a prospective analytical study. Patients and methods: The study was conducted upon twenty-five mechanically ventilated patients (16 male patients and 9 female patients), with a mean age of 58.8 years (SD ± 15.64) who were admitted at the Respiratory Intensive Care Unit of the Ain Shams University Hospital during the period from October 2012 to May 2013. Chest ultrasound examination was done for patients on mechanical ventilation on the first day of enrollment prior to seeing their chest X-ray, then follow up daily chest ultrasound examination was done over the entire period of mechanical ventilation with comparison of examination results with that of chest X-ray. Results: Initial chest ultrasound was more sensitive in the detection of pleural effusion (40% of cases) than chest X-ray (8% of cases). This superiority of chest ultrasound over chest X-ray persisted in follow up studies (44%, 8% respectively). As regards consolidation, there was no statistically significant difference between chest ultrasound (consolidation was detected in 16 out of 25 cases) and chest X-ray (consolidation was detected in 15 out of 25 cases) in the initial studies, and also along the follow up period, chest ultrasound detected consolidation in 17/25 patients, while CXR detected consolidation in 18/25 patients. In the follow up of five mechanically ventilated patients with no obvious radiologic abnormalities on chest X-ray, initial and follow-up ultrasound was also free and detected no localized abnormality. There was a statistically significant relationship between chest ultrasound findings in cases with pleural effusion and in cases with consolidation and clinical progress. Conclusion: Chest ultrasound is a reliable tool for evaluation of mechanically ventilated patients.

Keywords

• Chest ultrasound
• Mechanical ventilation
• Respiratory intensive care unit
• Chest X-ray