RESUMO
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation. The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases. In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis. With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward. In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising. In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness. In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. In neuromuscular patients, ultrasound is a good predictor of impaired lung function. Currently, in Neuromuscular Disease Units, TU is an indispensable tool. Ultrasound study of the intercostal musculature is also effective in the study of respiratory function, and is widely used in Respiratory Rehabilitation. In Intermediate Care Units, thoracic ultrasound is indispensable for patient management. In these units there are ultrasound protocols for the management of patients with acute dyspnoea that have proven to be very effective.
Assuntos
Doenças Pleurais , Derrame Pleural Maligno , Doenças Torácicas , Humanos , Derrame Pleural Maligno/etiologia , Pleurodese/métodos , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Doenças Pleurais/complicações , Doenças Torácicas/diagnóstico por imagem , PleuraRESUMO
Introduction: Lung ultrasound (LUS) has proven to be a more sensitive tool than radiography (X-ray) to detect alveolar-interstitial involvement in COVID-19 pneumonia. However, its usefulness in the detection of possible pulmonary alterations after overcoming the acute phase of COVID-19 is unknown. In this study we proposed studying the utility of LUS in the medium- and long-term follow-up of a cohort of patients hospitalized with COVID-19 pneumonia. Materials and methods: This was a prospective, multicentre study that included patients, aged over 18 years, at 3 ± 1 and 12 ± 1 months after discharge after treatment for COVID-19 pneumonia. Demographic variables, the disease severity, and analytical, radiographic, and functional clinical details were collected. LUS was performed at each visit and 14 areas were evaluated and classified with a scoring system whose global sum was referred to as the "lung score." Two-dimensional shear wave elastography (2D-SWE) was performed in 2 anterior areas and in 2 posterior areas in a subgroup of patients. The results were compared with high-resolution computed tomography (CT) images reported by an expert radiologist. Results: A total of 233 patients were included, of whom 76 (32.6%) required Intensive Care Unit (ICU) admission; 58 (24.9%) of them were intubated and non-invasive respiratory support was also necessary in 58 cases (24.9%). Compared with the results from CT images, when performed in the medium term, LUS showed a sensitivity (S) of 89.7%, specificity (E) 50%, and an area under the curve (AUC) of 78.8%, while the diagnostic usefulness of X-ray showed an S of 78% and E of 47%. Most of the patients improved in the long-term evaluation, with LUS showing an efficacy with an S of 76% and E of 74%, while the X-ray presented an S of 71% and E of 50%. 2D-SWE data were available in 108 (61.7%) patients, in whom we found a non-significant tendency toward the presentation of a higher shear wave velocity among those who developed interstitial alterations, with a median kPa of 22.76 ± 15.49) versus 19.45 ± 11.39; p = 0.1). Conclusion: Lung ultrasound could be implemented as a first-line procedure in the evaluation of interstitial lung sequelae after COVID-19 pneumonia.
RESUMO
OBJECTIVE: Assessing patients with chronic obstructive pulmonary disease (COPD) accounts for 30% of all pneumology outpatient evaluations. COPD is a heterogeneous disease and generates a massive public health problem. Overall morbidity, particularly cardiovascular disease, challenges patient management. This is an observational, multicentre study, performed at four hospitals in the Canary Islands (Spain), aimed at characterising patients with COPD referred to pneumology outpatient services. Demographic variables, lung function, and morbidity were assessed. RESULTS: Of the 877 included patients, 44.9% were active smokers with a mean (± SD) age of 68.2 ± 10.3 years. The median (IQR) score for the Charlson comorbidity index was 2 (2), and 70.6% of the patients were assigned high risk according to the Spanish Guidelines for COPD (GesEPOC) 2021. The degree of airflow obstruction defined by the GOLD 2021 stages 1, 2, 3, and 4 corresponded to 13.6%, 49%, 31%, and 6.3% of patients, respectively. The most frequently associated morbidities were arterial hypertension (59.5%), dyslipidaemia (54.3%), and type 2 diabetes mellitus (31.2%); 32% of the patients suffered heart disease. There is a high prevalence of active smoking, type 2 diabetes mellitus, and heart disease in patients referred for COPD to Canary Island pneumology outpatient services.
Assuntos
Diabetes Mellitus Tipo 2 , Doença Pulmonar Obstrutiva Crônica , Pneumologia , Idoso , Assistência Ambulatorial , Comorbidade , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Índice de Gravidade de Doença , Espanha/epidemiologiaRESUMO
Pulmonary ultrasound is becoming very important for the diagnosis and monitoring of respiratory diseases in different areas, such as emergency departments, outpatient clinics, inpatient areas, etc. This review attempts to encompass most of the applications and utilities of thoracic ultrasound in daily clinical practice. For this, the review focuses on how the ultrasound image would be visualized in each of the pleuro-pulmonary pathologies to which it has access and its use in interventional pulmonology. In addition, a schematic illustration with the most frequent pathologies and their ultrasound representation is presented, in order to better understand what we are seeing with this complementary test of great diagnostic value.
Assuntos
Pneumopatias , Pneumologia , Serviço Hospitalar de Emergência , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVE: The dramatic spread of SARS-CoV-2 infections calls for reliable, inexpensive tools to quickly identify patients with a poor prognosis. In this study, acute respiratory distress syndrome (ARDS) was assessed within 72 h after admission of each of 153 consecutive, SARS-CoV-2 infected, adult patients to either of two hospitals in Tenerife, Spain, using suitable routine laboratory tests for lymphocyte counts, as well as ferritin, lactate dehydrogenase (LDH), and C-reactive protein levels. Results were correlated with the patients' respiratory function, defined through their pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) ratio. RESULTS: Within 72 h from admission, criteria matched ARDS (SpO2/FiO2 < 235) in 13.1% of cases. We found a significant, negative correlation between SpO2/FiO2 ratios and D-dimer, ferritin, and LDH levels (- 0.31, - 0.32, and - 0.41; p = 0.004, 0.004, and < 0.0001, respectively). In patients with ARDS, the mean LDH was 373 U/L (CI95%: 300.6-445.3), but only 298 U/L (CI95%: 274.7-323.1) when they did not develop the syndrome (p = 0.015). None of the additionally evaluated biomarkers correlated with the SpO2/FiO2 ratios. Serum LDH levels in patients hospitalised for COVID-19 correlate with ARDS, as defined by their SpO2/FiO2 ratio, and might help to predict said complication.
Assuntos
Biomarcadores/sangue , COVID-19/complicações , Síndrome do Desconforto Respiratório/diagnóstico , Idoso , COVID-19/sangue , COVID-19/diagnóstico , Estudos de Coortes , Feminino , Hospitalização , Humanos , L-Lactato Desidrogenase/sangue , Pessoa de Meia-Idade , Oximetria , Oxigênio/metabolismo , Gravidade do Paciente , Síndrome do Desconforto Respiratório/sangue , Síndrome do Desconforto Respiratório/virologia , Estudos Retrospectivos , EspanhaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Pneumonia Lipoide/diagnóstico por imagem , Pneumonia Lipoide/tratamento farmacológico , Vaselina/efeitos adversos , Ex-FumantesRESUMO
No disponible
Assuntos
Humanos , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pandemias , Ultrassonografia , Sensibilidade e EspecificidadeRESUMO
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation.The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases.In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis.With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward.In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising.In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness.In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. (AU)
Assuntos
Humanos , Doenças Pleurais/complicações , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Derrame Pleural Maligno/etiologia , Pleurodese/métodos , Doenças Torácicas/diagnóstico por imagemRESUMO
No disponible
Assuntos
Humanos , Pneumologia/tendências , Doenças Respiratórias/diagnóstico por imagem , Ultrassonografia/tendências , Tórax/diagnóstico por imagem , Derrame Pleural , Pneumotórax , Tecido Parenquimatoso/diagnóstico por imagem , Neoplasias Pulmonares , Doenças Pulmonares Intersticiais , Infarto Pulmonar , Embolia Pulmonar , Hérnia DiafragmáticaAssuntos
Hipnóticos e Sedativos/uso terapêutico , Biópsia Guiada por Imagem , Pulmão/patologia , Midazolam/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/psicologia , Masculino , Pessoa de Meia-Idade , Dor Processual/etiologia , Dor Processual/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários , Ultrassonografia de IntervençãoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Sedação Consciente/métodos , Midazolam/administração & dosagem , Ultrassonografia/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Estudos de Casos e Controles , Estudos Retrospectivos , Inquéritos e Questionários , Frequência CardíacaRESUMO
No disponible