Colour Doppler ultrasound after major cardiac surgery improves diagnostic accuracy of the pulmonary infection score in acute respiratory failure: A prospective observational study.
Aged
Cardiac Surgical Procedures
/ adverse effects
Female
Humans
Lung
/ diagnostic imaging
Male
Middle Aged
Pneumonia
/ diagnosis
Postoperative Complications
/ diagnosis
Postoperative Period
Prospective Studies
Radiography, Thoracic
Respiratory Distress Syndrome
/ diagnosis
Sensitivity and Specificity
Ultrasonography, Doppler, Color
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
pubmed:
21
5
2019
medline:
17
6
2020
entrez:
21
5
2019
Statut:
ppublish
Résumé
Postoperative pneumonia is a frequent complication after cardiac surgery, and its diagnosis is difficult. Little is known about the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia in cardiac surgical patients. The substitution of chest radiography by colour Doppler LUS (LUS-sCPIS) in the simplified clinical pulmonary infection score (sCPIS) could improve the diagnosis of pneumonia following cardiac surgery. The aim of this study was to compare the diagnostic accuracy of LUS-sCPIS and of sCPIS alone in the detection of postoperative pneumonia after cardiac surgery. A prospective study of diagnostic accuracy. A Surgical Intensive Care Unit of a French University Hospital. Fifty-one patients with acute respiratory failure within 72 h after cardiac surgery were enrolled between January and May 2015. The two index tests, LUS-sCPIS and sCPIS, were calculated for all patients at the onset of acute respiratory failure. The reference standard for the diagnosis of pneumonia was based on the consensus of three physicians, blind to the sCPIS and LUS-sCPIS data, based on a posthoc review of all the clinical, radiological and microbiological evidence. The diagnostic accuracy of LUS-sCPIS was compared with that of sCPIS in the detection of postoperative pneumonia. Pneumonia was diagnosed in 26 out of 51 patients. The LUS-sCPIS detected the presence of pneumonia with a sensitivity of 92% (95% CI 0.85 to 0.99) and a specificity of 68% (95% CI 0.55 to 0.81). The sCPIS detected the presence of pneumonia with a sensitivity of 35% (95% CI 0.22 to 0.48) and a specificity of 84% (95% CI 0.74 to 0.94). The area under the curve (AUC) of LUS-sCPIS at 0.80 (95% CI 0.69 to 0.91) was higher than the AUC of sCPIS at 0.59 (95% CI 0.47 to 0.71; P = 0.0008). Compared with sCPIS, LUS-sCPIS improved diagnostic accuracy in the detection of postoperative pneumonia in patients with acute respiratory failure after cardiac surgery. It could be a useful bedside tool to guide pneumonia management. Clinicaltrials.gov identifier: NCT03279887.
Sections du résumé
BACKGROUND
BACKGROUND
Postoperative pneumonia is a frequent complication after cardiac surgery, and its diagnosis is difficult. Little is known about the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia in cardiac surgical patients. The substitution of chest radiography by colour Doppler LUS (LUS-sCPIS) in the simplified clinical pulmonary infection score (sCPIS) could improve the diagnosis of pneumonia following cardiac surgery.
OBJECTIVE
OBJECTIVE
The aim of this study was to compare the diagnostic accuracy of LUS-sCPIS and of sCPIS alone in the detection of postoperative pneumonia after cardiac surgery.
DESIGN
METHODS
A prospective study of diagnostic accuracy.
SETTING
METHODS
A Surgical Intensive Care Unit of a French University Hospital.
PATIENTS
METHODS
Fifty-one patients with acute respiratory failure within 72 h after cardiac surgery were enrolled between January and May 2015.
MAIN OUTCOME MEASURE
METHODS
The two index tests, LUS-sCPIS and sCPIS, were calculated for all patients at the onset of acute respiratory failure. The reference standard for the diagnosis of pneumonia was based on the consensus of three physicians, blind to the sCPIS and LUS-sCPIS data, based on a posthoc review of all the clinical, radiological and microbiological evidence. The diagnostic accuracy of LUS-sCPIS was compared with that of sCPIS in the detection of postoperative pneumonia.
RESULTS
RESULTS
Pneumonia was diagnosed in 26 out of 51 patients. The LUS-sCPIS detected the presence of pneumonia with a sensitivity of 92% (95% CI 0.85 to 0.99) and a specificity of 68% (95% CI 0.55 to 0.81). The sCPIS detected the presence of pneumonia with a sensitivity of 35% (95% CI 0.22 to 0.48) and a specificity of 84% (95% CI 0.74 to 0.94). The area under the curve (AUC) of LUS-sCPIS at 0.80 (95% CI 0.69 to 0.91) was higher than the AUC of sCPIS at 0.59 (95% CI 0.47 to 0.71; P = 0.0008).
CONCLUSION
CONCLUSIONS
Compared with sCPIS, LUS-sCPIS improved diagnostic accuracy in the detection of postoperative pneumonia in patients with acute respiratory failure after cardiac surgery. It could be a useful bedside tool to guide pneumonia management.
TRIAL REGISTRATION
BACKGROUND
Clinicaltrials.gov identifier: NCT03279887.
Identifiants
pubmed: 31107351
doi: 10.1097/EJA.0000000000001022
doi:
Banques de données
ClinicalTrials.gov
['NCT03279887']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM