They concluded that defining clear indications for selective chest radiographs after cardiac surgery is effective and seems to be safe. This approach can significantly reduce the total number of chest radiographs performed and increase their efficacy. Current evidence shows that chest radiographs could be forgone after lung resection because on-demand chest radiographs based on clinical monitoring have a better impact on management and have not proved to negatively affect patient outcomes [11]. The authors, however, noted that their results question the current use of chest radiograph as the first-line diagnostic modality for critically ill patients with respiratory symptoms as LUS seems to be a good alternative. Larger trials that compare chest radiograph with LUS not only for accuracy but also for effects on outcome, clinical utility, and ease of implementation are needed [5,12]. In another study of 253 LUS examinations, patient management was changed directly as a result of information provided by the LUS in 119 out of 253 cases (47%) [3]. In 81 cases, the change in patient management involved invasive interventions (chest tube, bronchoscopy, diagnostic thoracentesis/fluid drainage, continuous venous- venous hemofiltration, abdominal decompression, tracheotomy), and in 38 cases, noninvasive interventions (PEEP in bed position, antibiotics change/titration, recruitment maneuver, diuretics, physiotherapy, change initiation/change). In 21%, the LUS revealed findings not suspected by the primary physician (7 cases of pneumothorax, 9 cases of significant pleural effusion, 9 cases of pneumonia, 16 cases of unilateral atelectasis, and 12 cases of diffuse interstitial syndrome). It was concluded that, thoracic US has similar diagnostic accuracy to CT in pleural effusion, consolidation, and pneumothorax [3]. Variant 2: Stable intensive care unit patient. No change in clinical status. Initial imaging.
Intensive Care Unit Patients. They concluded that defining clear indications for selective chest radiographs after cardiac surgery is effective and seems to be safe. This approach can significantly reduce the total number of chest radiographs performed and increase their efficacy. Current evidence shows that chest radiographs could be forgone after lung resection because on-demand chest radiographs based on clinical monitoring have a better impact on management and have not proved to negatively affect patient outcomes [11]. The authors, however, noted that their results question the current use of chest radiograph as the first-line diagnostic modality for critically ill patients with respiratory symptoms as LUS seems to be a good alternative. Larger trials that compare chest radiograph with LUS not only for accuracy but also for effects on outcome, clinical utility, and ease of implementation are needed [5,12]. In another study of 253 LUS examinations, patient management was changed directly as a result of information provided by the LUS in 119 out of 253 cases (47%) [3]. In 81 cases, the change in patient management involved invasive interventions (chest tube, bronchoscopy, diagnostic thoracentesis/fluid drainage, continuous venous- venous hemofiltration, abdominal decompression, tracheotomy), and in 38 cases, noninvasive interventions (PEEP in bed position, antibiotics change/titration, recruitment maneuver, diuretics, physiotherapy, change initiation/change). In 21%, the LUS revealed findings not suspected by the primary physician (7 cases of pneumothorax, 9 cases of significant pleural effusion, 9 cases of pneumonia, 16 cases of unilateral atelectasis, and 12 cases of diffuse interstitial syndrome). It was concluded that, thoracic US has similar diagnostic accuracy to CT in pleural effusion, consolidation, and pneumothorax [3]. Variant 2: Stable intensive care unit patient. No change in clinical status. Initial imaging.