title: Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice.
abstract: BACKGROUND
  This study investigated the clinical relevance of early general chest ultrasonography (ie, heart and lung recordings) in patients in the ICU with acute respiratory failure (ARF).
  
  
  METHODS
  We prospectively compared this diagnostic approach (ultrasound) to a routine evaluation established from clinical, radiologic, and biologic data (standard). Subjects were patients consecutively admitted to the ICU of a university teaching hospital during a 1-year period. Inclusion criteria were age ≥ 18 years and the presence of severe ARF criteria to justify ICU admission. We compared the diagnostic approaches and the final diagnosis determined by a panel of experts.
  
  
  RESULTS
  Seventy-eight patients were included (age, 70 ± 18 years; sex ratio, 1). Three patients given two or more simultaneous diagnoses were subsequently excluded. The ultrasound approach was more accurate than the standard approach (83% vs 63%, respectively; P &lt; .02). Receiver operating characteristic curve analysis showed greater diagnostic performance of ultrasound in cases of pneumonia (standard, 0.74 ± 0.12; ultrasound, 0.87 ± 0.14; P &lt; .02), acute hemodynamic pulmonary edema (standard, 0.79 ± 0.11; ultrasound, 0.93 ± 0.08; P &lt; .007), decompensated COPD (standard, 0.8 ± 0.09; ultrasound, 0.92 ± 0.15; P &lt; .05), and pulmonary embolism (standard, 0.65 ± 0.12; ultrasound, 0.81 ± 0.17; P &lt; .04). Furthermore, we found that the use of ultrasound data could have significantly improved the initial treatment.
  
  
  CONCLUSIONS
  The use of cardiothoracic ultrasound appears to be an attractive complementary diagnostic tool and seems able to contribute to an early therapeutic decision based on reproducible physiopathologic data.
authors.affiliation: Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan; Equipe d'Accueil, MATN, IFR 150, Université Paul Sabatier, Toulouse, France. Electronic address: silvastein@me.com.
authors.forename: Stein
authors.initials: S
authors.lastname: Silva
authors.affiliation: Pôle Cardiovasculaire et Métabolique, CHU Rangueil.
authors.forename: Caroline
authors.initials: C
authors.lastname: Biendel
authors.affiliation: Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan.
authors.forename: Jean
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan.
authors.forename: Michel
authors.initials: M
authors.lastname: Olivier
authors.affiliation: Pôle Anesthésie-Réanimation, CHU Purpan.
authors.forename: Benoit
authors.initials: B
authors.lastname: Bataille
authors.affiliation: Pôle Anesthésie-Réanimation, CHU Purpan; Equipe d'Accueil, MATN, IFR 150, Université Paul Sabatier, Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
authors.affiliation: Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mari
authors.affiliation: Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Riu
authors.affiliation: Pôle Anesthésie-Réanimation, CHU Purpan; Equipe d'Accueil, MATN, IFR 150, Université Paul Sabatier, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Réanimation Polyvalente et Médecine Hyperbare, CHU Purpan; Pôle Anesthésie-Réanimation, CHU Purpan.
authors.forename: Michele
authors.initials: M
authors.lastname: Genestal
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging* / Q000628:therapy; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data*