[POCUS : diagnosis of pneumonia by lung ultrasonography]. / POCUS : diagnostiquer la pneumonie par l'échographie pleuropulmonaire.

Point-Of-Care Ultrasonography (POCUS) has emerged to support the diagnosis process and management strategies. Its use for the diagnosis of pneumonia has been shown to be reliable and effective over the past decade. Various ultrasonography patterns exist, none of which are pathognomonic for pneumonia. Therefore, POCUS findings must be interpreted in association with the clinical setting. POCUS enables early identification of complications such as parapneumonic effusion and pulmonary abscess. It also provides guidance for invasive procedure such as thoracocentesis and pleural drainage. The forthcoming results of the Swiss OCTOPLUS study will provide data on the clinical and economic impact of a diagnostic strategy based on targeted lung ultrasonography.

L'échographie ciblée, aussi connue sous le terme de Point-Of-Care Ultrasonography (POCUS), a émergé comme outil essentiel dans la démarche diagnostique et la stratégie de prise en charge des patients. Son utilisation pour le diagnostic de la pneumonie a été démontrée comme fiable et performante depuis plus d'une décennie. Plusieurs profils échographiques existent mais aucun n'est pathognomonique de la pneumonie. L'examen échographique est ainsi indissociable du contexte clinique. Le POCUS permet en outre la recherche précoce de complications (épanchement parapneumonique et abcès pulmonaire) et le guidage des gestes invasifs (thoracocentèse et drainage thoracique). Les résultats à venir de l'étude suisse OCTOPLUS permettront d'en savoir plus sur l'impact clinique et économique d'une stratégie diagnostique basée sur l'échographie pleuropulmonaire.

Eight versus 28-point lung ultrasonography in moderate acute heart failure: a prospective comparative study.

Lung ultrasonography (LUS) is an accurate method of estimating lung congestion but there is ongoing debate on the optimal number of scanning points. The aim of the present study was to compare the reproducibility (i.e. interobserver agreement) and the feasibility (i.e. time consumption) of the two most practiced protocols in patients hospitalized for acute heart failure (AHF). This prospective trial compared 8- and 28-point LUS protocols. Both were performed by an expert-novice pair of sonographers at admission and after 4 to 6 days on patients admitted for AHF. A structured bio-clinical evaluation was simultaneously carried out by the treating physician. The primary outcome was expert-novice interobserver agreement estimated by kappa statistics. Secondary outcomes included time spent on image acquisition and interpretation. During the study period, 43 patients underwent a total of 319 LUS exams. Expert-novice interobserver agreement was moderate at admission and substantial at follow-up for 8-point protocol (weighted kappa of 0.54 and 0.62, respectively) with no significant difference for 28-point protocol (weighted kappa of 0.51 and 0.41; P value for comparison 0.74 at admission and 0.13 at follow-up). The 8-point protocol required significantly less time for image acquisition at admission (mean time difference - 3.6 min for experts, - 5.1 min for novices) and interpretation (- 6.0 min for experts and - 6.3 min for novices; P value < 0.001 for all time comparisons). Similar differences were observed at follow-up. In conclusion, an 8-point LUS protocol was shown to be timesaving with similar reproducibility when compared with a 28-point protocol. It should be preferred for evaluating lung congestion in AHF inpatients.

Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey.

Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors' ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians' confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with > 15 years of experience and POCUS-naïve doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%, p < 0.001) and pleural effusion (80% vs 34%, p < 0.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.

[Use of point-of-care ultrasonography (POCUS) in patients with suspected bacterial infection]. / Intérêt de l'échographie ciblée dans la suspicion d'infection bactérienne.

Severe bacterial infection requires prompt diagnosis and treatment. Point-of-care ultrasonography (POCUS) can significantly reduce time to diagnosis. In this article we discuss the diagnostic performance of POCUS through the illustration of four common infectious clinical situations: pneumonia, complicated pleural effusion, cholecystitis and obstructive pyelonephritis.

L'infection bactérienne sévère nécessite un diagnostic et un traitement rapides. L'échographie ciblée, aussi appelée Point-of-care ultrasonography (POCUS), permet de réduire sensiblement les délais jusqu'au diagnostic. Dans cet article, nous discutons des performances diagnostiques de l'échographie ciblée à travers l'illustration de quatre situations cliniques fréquentes de problématiques infectieuses : la pneumonie, l'épanchement parapneumonique compliqué, la cholécystite et la pyélonéphrite obstructive.