Ultrasound diagnosis of alveolar consolidation in the critically ill

Byline: Daniel A. Lichtenstein (1,2,3), Nathalie Lascols (2), Gilbert Meziere (1,2,3), Agnes Gepner (3) Keywords: Chest ultrasonography; Ultrasound diagnosis; Lungs; Respiratory failure; Alveolar consolidation; Intensive care unit Abstract: Objective Alveolar consolidation is a basic concern in critically ill patients. Radiography is not a precise tool, and referral to CT raises problems (transport, irradiation). The aim of this study was to assess the utility of ultrasound in the diagnosis of alveolar consolidation. Design Prospective clinical study. Setting The medical ICU of a university-affiliated teaching hospital. Patients A total of 65 cases of alveolar consolidation proven on CT were compared to 53 CT controls. Measurements Alveolar consolidation was defined as a tissue-like pattern visible at the chest wall, arising from the pleural line and devoid of centrifugal inspiratory dynamics. Results Feasibility was 99%. In 65 cases of alveolar consolidation, ultrasound was positive in 59 and negative in 6. In 52 analyzable controls, ultrasound was negative in 51 and positive in 1. Sensitivity of ultrasound was 90% and specificity 98%. A concordance test showed a Kappa coefficient of 0.89. Among 62 posterior locations on CT, ultrasound showed posterior consolidation patterns in 56 cases and was negative in 6. Ultrasound showed anterior involvement in all 3 cases of whole lung consolidation. Conclusions Ultrasound provides a reliable non-invasive, bedside method for accurate detection and location of alveolar consolidation in critically ill patients. Author Affiliation: (1) Service de Reanimation Medicale, Hopital Ambroise-Pare, 9 avenue du General Charles-de-Gaulle, 92100 , Boulogne (Paris-Ouest), France (2) Cercle des Echographistes d'Urgence et de Reanimation Francophones, 14 rue Alfred Couturier, 78160 , Marly, France (3) Service de Reanimation Polyvalente, Centre Hospitalier General, 92210 , Saint-Cloud (Paris), France Article History: Registration Date: 23/10/2003 Received Date: 20/06/2003 Accepted Date: 20/10/2003 Online Date: 13/01/2004 Article note: An editorial regarding this article can be found in the same issue ( http://dx.doi.org/10.1007/s00134-003-2083-6)