Skip to main content Accesibility Help
×
×
Home

A lung ultrasound score for early triage of elderly patients with acute dyspnea

  • Thibaut Markarian (a1), Laurent Zieleskiewicz (a2), Gilles Perrin (a1), Pierre-Géraud Claret (a3), Anderson Loundou (a4), Pierre Michelet (a1) and Xavier Bobbia (a1) (a3)...
Abstract
CLINICIAN'S CAPSULE

What is known about the topic?

A lung ultrasound has good accuracy in finding the cause of acute dyspnea.

What did this study ask?

Can a simple lung ultrasound score, done early, detect dyspneic patients who will require intensive care?

What did this study find?

A modified lung ultrasound (MLUS) has very good accuracy in predicting intensive care unit admission and/or death.

Why does this study matter to clinicians?

Dyspneic patients with a high MLUS should be monitored and treated early.

Objectif

L’échographie pulmonaire (EP) a une valeur diagnostique dans la dyspnée. L’étude avait pour objectif principal d’évaluer l'exactitude du score d’échographie pulmonaire modifiée (EPM) aux fins de prévision du degré de gravité de la dyspnée aiguë chez les personnes âgées.

Méthode

Il s'agit d'une étude d'observation monocentrique, menée chez des patients âgés de plus de 64 ans et admis au service des urgences pour de la dyspnée aiguë, accompagnée d'hypoxie. Les participants ont été soumis à une EP précoce, effectuée par un urgentologue spécialisé en la matière, puis ont reçu les soins usuels donnés par des professionnels tenus dans l'ignorance des résultats de l'EP. Les patients ont été classés, selon les suites à donner, dans le groupe de soins intensifs (SI) (patients admis au service de soins intensifs [SSI] ou morts au cours des 48 h suivant leur arrivée) ou dans le groupe de soins usuels (SU).

Résultats

Les dossiers de 137 patients ont été analysés (âge moyen : 79 ± 13 ans; femmes : 74 [54%]) et, sur ce nombre, 43 (31%) ont été classés dans le groupe de SI. Le temps d'attente des résultats de l'EPM s'est établi à 30 ± 22 min. La valeur prévisionnelle de la surface sous la courbe de l'EPM pour le classement des patients dans le groupe de SI était de 0,97 (0,92–0,99; p < 0,01), et la valeur-seuil a été établie rigoureusement au-dessus de 17, d'où une sensibilité de 93% (81–99); une spécificité de 99% (94–100); une valeur prévisionnelle positive de 98% (87–100); une valeur prévisionnelle négative de 97% (91–99); un rapport de vraisemblance positif de 86; un rapport de vraisemblance négatif de 0,07 et une exactitude diagnostique de 97% (93–99). D'après l'analyse plurifactorielle, le score d'EPM était le seul facteur indépendant associé au groupe de SI.

Conclusion

Le score d'EP précoce offre une valeur prévisionnelle quant à la nécessité d'admettre des personnes âgées dyspnéiques au SSI ou à la mort dans les 48 h suivant leur arrivée.

Copyright
Corresponding author
Correspondence to: Dr. Xavier Bobbia, Pôle ARDU CHU Nîmes, Place du Pr Robert Debré 30029, Nîmes, France; Email: xavier.bobbia@gmail.com
References
Hide All
1.Malas, O, Cağlayan, B, Fidan, A, et al. Cardiac or pulmonary dyspnea in patients admitted to the emergency department. Respir Med 2003;97(12):1277–81.
2.Mueller, C, Scholer, A, Laule-Kilian, K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004;350(7):647–54.
3.Ray, P, Birolleau, S, Lefort, Y, et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care Lond Engl 2006;10(3):R82.
4.Vinson, JM, Rich, MW, Sperry, JC, et al. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc 1990;38(12):1290–5.
5.Marrie, TJ. Community-acquired pneumonia in the elderly. Clin Infect Dis 2000;31(4):1066–78.
6.Abidov, A, Rozanski, A, Hachamovitch, R, et al. Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med 2005;353(18):1889–98.
7.Celli, BR, Cote, CG, Marin, JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350(10):1005–12.
8.Le Gall, JR, Loirat, P, Alperovitch, A. Simplified acute physiological score for intensive care patients. Lancet Lond Engl 1983;2(8352):741.
9.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–29.
10.Lemeshow, S, Klar, J, Teres, D. Outcome prediction for individual intensive care patients: useful, misused, or abused? Intensive Care Med 1995;21(9):770–6.
11.Glance, LG, Osler, T, Shinozaki, T. Intensive care unit prognostic scoring systems to predict death: a cost-effectiveness analysis. Crit Care Med 1998;26(11):1842–9.
12.Lien, CTC, Gillespie, ND, Struthers, AD, McMurdo, MET. Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 2002;4(1):91–8.
13.Lichtenstein, D, Mezière, G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med 1998;24(12):1331–4.
14.Lichtenstein, DA, Mezière, GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134(1):117–25.
15.Liu, Z-P, Zhang, Y, Bian, H, et al. Clinical application of rapid B-line score with lung ultrasonography in differentiating between pulmonary infection and pulmonary infection with acute left ventricular heart failure. Am J Emerg Med 2016;34(2):278–81.
16.Xirouchaki, N, Kondili, E, Prinianakis, G, et al. Impact of lung ultrasound on clinical decision making in critically ill patients. Intensive Care Med 2014;40(1):5765.
17.Volpicelli, G, Mussa, A, Garofalo, G, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med 2006;24(6):689–96.
18.Zanobetti, M, Scorpiniti, M, Gigli, C, et al. Point-of-care ultrasonography for evaluation of acute dyspnea in the ED. Chest 2017;151(6):1295–301.
19.Bouhemad, B, Zhang, M, Lu, Q, Rouby, J-J. Clinical review: bedside lung ultrasound in critical care practice. Crit Care Lond Engl 2007;11(1):205.
20.Bouhemad, B, Liu, Z-H, Arbelot, C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 2010;38(1):8492.
21.Soummer, A, Perbet, S, Brisson, H, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med 2012;40(7):2064–72.
22.Li, L, Yang, Q, Li, L, et al. [The value of lung ultrasound score on evaluating clinical severity and prognosis in patients with acute respiratory distress syndrome]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015;27(7):579–84.
23.Zhao, Z, Jiang, L, Xi, X, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med 2015;15:98.
24.Mongodi, S, Via, G, Girard, M, et al. Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest 2016;149(4):969–80.
25.Hurst, JW, Morris, DC, Alexander, RW. The use of the New York Heart Association's classification of cardiovascular disease as part of the patient's complete problem list. Clin Cardiol 1999;22(6):385–90.
26.Bouhemad, B, Mongodi, S, Via, G, Rouquette, I. Ultrasound for “lung monitoring” of ventilated patients. Anesthesiology 2015;122(2):437–47.
27.Volpicelli, G, Elbarbary, M, Blaivas, M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38(4):577–91.
28.Pivetta, E, Goffi, A, Lupia, E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest 2015;148(1):202–10.
29.Silva, S, Biendel, C, Ruiz, J, et al. Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice. Chest 2013;144(3):859–65.
30.Bataille, B, Riu, B, Ferre, F, et al. Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest 2014;146(6):1586–93.
31.Laursen, CB, Sloth, E, Lassen, AT, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med 2014;2(8):638–46.
32.Xirouchaki, N, Magkanas, E, Vaporidi, K, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 2011;37(9):1488–93.
33.Inglis, AJ, Nalos, M, Sue, K-H, et al. Bedside lung ultrasound, mobile radiography and physical examination: a comparative analysis of diagnostic tools in the critically ill. Crit Care Resusc J Australas Acad Crit Care Med 2016;18(2):124.
34.Blaivas, M, Lyon, M, Duggal, S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med Off J Soc Acad Emerg Med 2005;12(9):844–9.
35.Lichtenstein, D, Goldstein, I, Mourgeon, E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100(1):915.
36.Frassi, F, Gargani, L, Tesorio, P, et al. Prognostic value of extravascular lung water assessed with ultrasound lung comets by chest sonography in patients with dyspnea and/or chest pain. J Card Fail 2007;13(10):830–5.
37.Leblanc, D, Bouvet, C, Degiovanni, F, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med 2014;40(10):1468–74.
38.Bobbia, X, Clément, A, Claret, PG, et al. Diaphragmatic excursion measurement in emergency patients with acute dyspnea: toward a new diagnostic tool? Am J Emerg Med 2016;34(8):1653–7.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed