Clinical Research Of Bedside Ultrasound Techniques In The Thoracic Emergency

Objective : to evaluate the diagnostic value of bedside ultrasonography in ventilator-associated pneumonia (VAP)、tension pneumothorax.Methods: (1)Eighty-two patients who were hospitalized in our intensive care unit(ICU) from January 2013 to February 2015 were enrolled in this study. All patients were suspected VAP after tracheal intubation for more than 48 hours. Portable ultrasound device was used for evaluating parietal pleura, thoracic cavity and visceral pleura at bedside. Ultrasound imaging features were analyzed and its findings were compared with CT and final clinical outcomes. (2) Twenty patients(23 side) who were hospitalized from January 2013 to December 2015 were retrospectively enrolled in this study. Portable ultrasound device was used for evaluating tension pneumothorax.Ultrasound imaging features were analyzed and its findings were compared with CT and final clinical outcomes.Results: (1) Final clinical outcomes showed that 75 of 82 patients with suspected VAP were defined as VAP. CT diagnosed 74 cases with VAP, 3 cases with atelectasis, 2 cases with pulmonary infarction. In comparison with clinical final outcomes, ultrasound diagnosed VAP accurately in 72 cases, 3 cases with atelectasis and 4 cases with heart failure. 3 cases were misdiagnosed by ultrasound. Bedside ultrasound in the diagnosis of VAP sensitivity was 96% (72/75), specificity of 100%.Ultrasound and CT in the diagnosis of ventilator -associated pneumonia (VAP) had consistently results (κ=0.875) .There was no significant difference between the findings of CT and ultrasound(p>0.05). (2 ) Two-dimensional gray-scale sonography in the diagnosis of acute tension pneumothorax sensitivity was 91.3% (21/23), specificity of 100%, mainly for "slide lung", "comet tail sign" and "A line" sign (deep parallel linear high echo) all disappeared;Power doppler by identifying "slide lung" in the diagnosis of the sensitivity of the tension pneumothorax was 91.3% (21/23), specificity 100%;Normal chest wall and lung ultrasonic M type characterized by "coast", not in 23 side pneumothorax, Not seen "intermittent coast" sign in bilateral pneumothorax 23, "intermittent coast" in the diagnosis of the sensitivity of the tension pneumothorax was 0%.Conclusion: Bedside ultrasound diagnosis of ventilator-associated pneumonia and tension pneumothorax is of high accuracy, convenient bedside ultrasound, noninvasive,economy, and can be repeatedly check, can be used as ventilator-associated pneumonia and tension pneumothorax diagnosis and follow-up of one of the main imaging diagnostic methods, deserves further research and application.Gray-scale ultrasound and power doppler in the diagnosis of tension pneumothorax is larger, M type ultrasound in the diagnosis of tension pneumothorax limited value.