In a prospective, single-blind study of 192 critically ill patients, each patient received a LUS examination, a bedside chest radiograph, followed by a thoracic CT scan searching for pneumothorax, CT of the chest confirmed the diagnosis of pneumothorax in 36 (18.75%) patients of which 31 were diagnosed by thoracic US and chest radiograph detected only 19 cases. Overall, LUS showed a considerably higher sensitivity than bedside chest radiograph (86.1% versus 52.7%). LUS also showed higher negative predictive values and diagnostic accuracy compared with chest radiograph (96.8% versus 90.1% and 95.3% versus 90.6%, respectively). Chest radiographs had a slightly higher specificity than LUS (99.4% versus 97.4%) as well as higher positive predictive values (95.0% versus 88.6%) [16]. Intensive Care Unit Patients A meta-analysis showed that the diagnostic accuracy of chest US was higher than supine chest radiographs for detection of pneumothorax. It seems that chest US is superior to chest radiographs in detection of pneumothorax, even after adjusting for possible sources of heterogeneity [5,12,16,17]. LUS is also a valid tool in excluding pneumothoraces after lung biopsy in postlung transplant patients [18]. In a multicenter prospective study of 99 patients with suspected ventilator-associated pneumonia, the diagnostic performance of LUS findings of infection with direct microbiologic examination of endotracheal aspirates showed that LUS had a positive predictive value of 86% to 94% [19,20]. LUS showed better sensitivity and specificity than chest radiography for the diagnosis of pleural effusion and also helped distinguish between different forms of effusions, guide thoracentesis, and insertion of chest tubes [21]. LUS could also monitor the volume of effusion drained to help decide removal of the drainage [21].
Intensive Care Unit Patients. In a prospective, single-blind study of 192 critically ill patients, each patient received a LUS examination, a bedside chest radiograph, followed by a thoracic CT scan searching for pneumothorax, CT of the chest confirmed the diagnosis of pneumothorax in 36 (18.75%) patients of which 31 were diagnosed by thoracic US and chest radiograph detected only 19 cases. Overall, LUS showed a considerably higher sensitivity than bedside chest radiograph (86.1% versus 52.7%). LUS also showed higher negative predictive values and diagnostic accuracy compared with chest radiograph (96.8% versus 90.1% and 95.3% versus 90.6%, respectively). Chest radiographs had a slightly higher specificity than LUS (99.4% versus 97.4%) as well as higher positive predictive values (95.0% versus 88.6%) [16]. Intensive Care Unit Patients A meta-analysis showed that the diagnostic accuracy of chest US was higher than supine chest radiographs for detection of pneumothorax. It seems that chest US is superior to chest radiographs in detection of pneumothorax, even after adjusting for possible sources of heterogeneity [5,12,16,17]. LUS is also a valid tool in excluding pneumothoraces after lung biopsy in postlung transplant patients [18]. In a multicenter prospective study of 99 patients with suspected ventilator-associated pneumonia, the diagnostic performance of LUS findings of infection with direct microbiologic examination of endotracheal aspirates showed that LUS had a positive predictive value of 86% to 94% [19,20]. LUS showed better sensitivity and specificity than chest radiography for the diagnosis of pleural effusion and also helped distinguish between different forms of effusions, guide thoracentesis, and insertion of chest tubes [21]. LUS could also monitor the volume of effusion drained to help decide removal of the drainage [21].