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Published in: Cardiovascular Ultrasound 1/2017

Open Access 01-12-2017 | Research

Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?

Authors: Etrusca Brogi, Elena Bignami, Anna Sidoti, Mohammed Shawar, Luna Gargani, Luigi Vetrugno, Giovanni Volpicelli, Francesco Forfori

Published in: Cardiovascular Ultrasound | Issue 1/2017

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Abstract

Background

Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure.

Methods

Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU.

Results

A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed.

Conclusions

Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome.
Literature
2.
go back to reference Tecce PM, Fishman EK, Kuhlman JE. CT evaluation of the anterior mediastinum: spectrum of disease. Radiographics. 1994;14(5):973–90.CrossRefPubMed Tecce PM, Fishman EK, Kuhlman JE. CT evaluation of the anterior mediastinum: spectrum of disease. Radiographics. 1994;14(5):973–90.CrossRefPubMed
3.
go back to reference Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.CrossRefPubMed Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.CrossRefPubMed
4.
go back to reference Tapson VF. Advances in the diagnosis and treatment of acute pulmonary embolism. F1000 Med Rep. 2012;4:9. doi:10.3410/M4-9. Tapson VF. Advances in the diagnosis and treatment of acute pulmonary embolism. F1000 Med Rep. 2012;4:9. doi:10.​3410/​M4-9.
5.
go back to reference Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9–15.CrossRefPubMed Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9–15.CrossRefPubMed
6.
7.
go back to reference Agricola E, Arbelot C, Blaivas M, Bouhemad B, Copetti R, Dean A, Dulchavsky S, Elbarbary M, Gargani L, Hoppmann R, et al. Ultrasound performs better than radiographs. Thorax. 2011;66(9):828–9. author reply 829CrossRefPubMed Agricola E, Arbelot C, Blaivas M, Bouhemad B, Copetti R, Dean A, Dulchavsky S, Elbarbary M, Gargani L, Hoppmann R, et al. Ultrasound performs better than radiographs. Thorax. 2011;66(9):828–9. author reply 829CrossRefPubMed
8.
go back to reference Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488–93.CrossRefPubMed Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488–93.CrossRefPubMed
9.
go back to reference Mongodi S, Via G, Girard M, Rouquette I, Misset B, Braschi A, Mojoli F, Bouhemad B. Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. Chest. 2016;149(4):969–80.CrossRefPubMed Mongodi S, Via G, Girard M, Rouquette I, Misset B, Braschi A, Mojoli F, Bouhemad B. Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. Chest. 2016;149(4):969–80.CrossRefPubMed
10.
go back to reference Biasucci DG, Cutuli SL, Pizza A, Cavaliere F. Clinically integrated ultrasound for decreasing the number of chest x-rays in the intensive care unit: It is high time to move forward a "global" use of ultrasound. J Crit Care. 2015;30(5):1137–8.CrossRefPubMed Biasucci DG, Cutuli SL, Pizza A, Cavaliere F. Clinically integrated ultrasound for decreasing the number of chest x-rays in the intensive care unit: It is high time to move forward a "global" use of ultrasound. J Crit Care. 2015;30(5):1137–8.CrossRefPubMed
11.
go back to reference Zieleskiewicz L, Cornesse A, Hammad E, Haddam M, Brun C, Vigne C, Meyssignac B, Remacle A, Chaumoitre K, Antonini F, et al. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost. Anaesth Crit Care Pain Med. 2015;34(1):41–4.CrossRefPubMed Zieleskiewicz L, Cornesse A, Hammad E, Haddam M, Brun C, Vigne C, Meyssignac B, Remacle A, Chaumoitre K, Antonini F, et al. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost. Anaesth Crit Care Pain Med. 2015;34(1):41–4.CrossRefPubMed
12.
go back to reference Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, et al. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–60.CrossRefPubMed Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, et al. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–60.CrossRefPubMed
13.
go back to reference Salamonsen M, McGrath D, Steiler G, Ware R, Colt H, Fielding D. A new instrument to assess physician skill at thoracic ultrasound, including pleural effusion markup. Chest. 2013;144(3):930–4.CrossRefPubMed Salamonsen M, McGrath D, Steiler G, Ware R, Colt H, Fielding D. A new instrument to assess physician skill at thoracic ultrasound, including pleural effusion markup. Chest. 2013;144(3):930–4.CrossRefPubMed
14.
go back to reference Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, Fava C, Frascisco M. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. 2006;24(6):689–96.CrossRefPubMed Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F, Fava C, Frascisco M. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. 2006;24(6):689–96.CrossRefPubMed
15.
go back to reference Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiov Ultrasound. 2014;12:25.CrossRef Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiov Ultrasound. 2014;12:25.CrossRef
16.
go back to reference Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–91.CrossRefPubMed Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–91.CrossRefPubMed
17.
go back to reference Allyn J, Ferdynus C, Bohrer M, Dalban C, Valance D, Allou N. Simplified Acute Physiology Score II as Predictor of Mortality in Intensive Care Units: A Decision Curve Analysis. PLoS ONE. 2016;11(10). Allyn J, Ferdynus C, Bohrer M, Dalban C, Valance D, Allou N. Simplified Acute Physiology Score II as Predictor of Mortality in Intensive Care Units: A Decision Curve Analysis. PLoS ONE. 2016;11(10).
19.
go back to reference Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes. Am J Med. 2004;117(5):305–11.CrossRefPubMed Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes. Am J Med. 2004;117(5):305–11.CrossRefPubMed
20.
go back to reference Lee J, Geyer B, Naraghi L, Kaafarani HM, Eikermann M, Yeh DD, Bajwa EK, Cobb JP, Raja AS. Advanced imaging use in intensive care units has decreased, resulting in lower charges without negative effects on patient outcomes. J Crit Care. 2015;30(3):460–4.CrossRefPubMed Lee J, Geyer B, Naraghi L, Kaafarani HM, Eikermann M, Yeh DD, Bajwa EK, Cobb JP, Raja AS. Advanced imaging use in intensive care units has decreased, resulting in lower charges without negative effects on patient outcomes. J Crit Care. 2015;30(3):460–4.CrossRefPubMed
21.
go back to reference Peris A, Tutino L, Zagli G, Batacchi S, Cianchi G, Spina R, Bonizzoli M, Migliaccio L, Perretta L, Bartolini M, et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg. 2010;111(3):687–92.CrossRefPubMed Peris A, Tutino L, Zagli G, Batacchi S, Cianchi G, Spina R, Bonizzoli M, Migliaccio L, Perretta L, Bartolini M, et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg. 2010;111(3):687–92.CrossRefPubMed
22.
go back to reference Pinto A, Pinto F, Faggian A, Rubini G, Caranci F, Macarini L, Genovese EA, Brunese L. Sources of error in emergency ultrasonography. Crit Ultrasound J. 2013;5 Suppl 1:S1.PubMed Pinto A, Pinto F, Faggian A, Rubini G, Caranci F, Macarini L, Genovese EA, Brunese L. Sources of error in emergency ultrasonography. Crit Ultrasound J. 2013;5 Suppl 1:S1.PubMed
Metadata
Title
Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?
Authors
Etrusca Brogi
Elena Bignami
Anna Sidoti
Mohammed Shawar
Luna Gargani
Luigi Vetrugno
Giovanni Volpicelli
Francesco Forfori
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2017
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-017-0113-8

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