Identification of persistent and resolving subphenotypes of acute hypoxemic respiratory failure in two independent cohorts.

BACKGROUND: Acute hypoxemic respiratory failure (HRF) is associated with high morbidity and mortality, but its heterogeneity challenges the identification of effective therapies. Defining subphenotypes with distinct prognoses or biologic features can improve therapeutic trials, but prior work has focused on ARDS, which excludes many acute HRF patients. We aimed to characterize persistent and resolving subphenotypes in the broader HRF population. METHODS: In this secondary analysis of 2 independent prospective ICU cohorts, we included adults with acute HRF, defined by invasive mechanical ventilation and PaO2-to-FIO2 ratio ≤ 300 on cohort enrollment (n = 768 in the discovery cohort and n = 1715 in the validation cohort). We classified patients as persistent HRF if still requiring mechanical ventilation with PaO2-to-FIO2 ratio ≤ 300 on day 3 following ICU admission, or resolving HRF if otherwise. We estimated relative risk of 28-day hospital mortality associated with persistent HRF, compared to resolving HRF, using generalized linear models. We also estimated fold difference in circulating biomarkers of inflammation and endothelial activation on cohort enrollment among persistent HRF compared to resolving HRF. Finally, we stratified our analyses by ARDS to understand whether this was driving differences between persistent and resolving HRF. RESULTS: Over 50% developed persistent HRF in both the discovery (n = 386) and validation (n = 1032) cohorts. Persistent HRF was associated with higher risk of death relative to resolving HRF in both the discovery (1.68-fold, 95% CI 1.11, 2.54) and validation cohorts (1.93-fold, 95% CI 1.50, 2.47), after adjustment for age, sex, chronic respiratory illness, and acute illness severity on enrollment (APACHE-III in discovery, APACHE-II in validation). Patients with persistent HRF displayed higher biomarkers of inflammation (interleukin-6, interleukin-8) and endothelial dysfunction (angiopoietin-2) than resolving HRF after adjustment. Only half of persistent HRF patients had ARDS, yet exhibited higher mortality and biomarkers than resolving HRF regardless of whether they qualified for ARDS. CONCLUSION: Patients with persistent HRF are common and have higher mortality and elevated circulating markers of lung injury compared to resolving HRF, and yet only a subset are captured by ARDS definitions. Persistent HRF may represent a clinically important, inclusive target for future therapeutic trials in HRF.

How to Stage Airflow Limitation in Stable Chronic Obstructive Pulmonary Disease Male Patients?

No study has evaluated the utility of different classifications of chronic obstructive pulmonary disease (COPD) airflow limitation (AFL) in terms of the refined "ABCD" classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) or in terms of the impacts on quality of life. This study aimed to compare some relevant health outcomes (i.e., GOLD classification and quality-of-life scores) between COPD patients having "light" and "severe" AFL according to five COPD AFL classifications. It was a cross-sectional prospective study including 55 stable COPD male patients. The COPD assessment test (CAT), the VQ11 quality-of-life questionnaire, a spirometry, and a bronchodilator test were performed. The patients were divided into GOLD "A/B" and "C/D." The following five classifications of AFL severity, based on different post-bronchodilator forced expiratory volume in 1 s (FEV1) expressions, were applied: FEV1%pred: "light" (≥50), "severe" (<50); FEV1z-score: "light" (≥-3), "severe" (<-3); FEV1/height2: "light" (≥0.40), "severe" (<0.40); FEV1/height3: "light" (≥0.29), "severe" (<0.29); and FEV1Quotient: "light" (≥2.50), "severe" (<2.50). The percentages of the patients with "severe" AFL were significantly influenced by the applied classification of the AFL severity (89.1 [FEV1z-score], 63.6 [FEV1%pred], 41.8 [FEV1/height3], 40.0 [FEV1Quotient], and 25.4 [FEV1/height2]; Cochrane test = 91.49, df = 4). The CAT and VQ11 scores were significantly different between the patients having "light" and "severe" AFL. In GOLD "C/D" patients, only the FEV1Quotient was able to distinguish between the two AFL severities. To conclude, the five classifications of COPD AFL were not similar when compared with regard to some relevant health outcomes.

Management of hypoxaemia in the critically ill patient.

Hypoxaemia is a common presentation in critically ill patients, with the potential for severe harm if not addressed appropriately. This review provides a framework to guide the management of any hypoxaemic patient, regardless of the clinical setting. Key steps in managing such patients include ascertaining the severity of hypoxaemia, the underlying diagnosis and implementing the most appropriate treatment. Oxygen therapy can be delivered by variable or fixed rate devices, and non-invasive ventilation; if patients deteriorate they may require tracheal intubation and mechanical ventilation. Early critical care team involvement is a key part of this pathway. Specialist treatments for severe hypoxaemia can only be undertaken on an intensive care unit and this field is developing rapidly as trial results become available. It is important that each new scenario is approached in a structured manner with an open diagnostic mind and a clear escalation plan.

Persistent type 2 respiratory failure on background of advanced thymoma with lung metastases.

We report a patient in her 60s with history of end-stage thymoma with bilateral lung metastases on palliative chemotherapy presented to the hospital with sudden shortness of breath initially treated for probable pulmonary embolism (PE) pending CT of the pulmonary arteries which was subsequently negative for PE. During this admission, she developed transient right-sided facial droop and slurred speech which resolved spontaneously; however, the patient became unresponsive and desaturated with severe decompensated type 2 respiratory failure. Patient was supported with non-invasive ventilation (biphasic positive airway pressure) for few days. Myasthenia gravis was suspected due to clinical features and confirmed by the high titre of acetylcholine receptor antibody titre.

Williams-Campbell syndrome complicated with pulmonary hypertension and Type 2 respiratory failure: An adult case report.

Williams-Campbell syndrome, is a rare disorder characterized by a deficiency of cartilage in subsegmental bronchi, leading to distal airway collapse and bronchiectasis, which typically affects the fourth- to sixth-order bronchi. This article reported a 31-year-old female patient who was diagnosed with Williams-Campbell syndrome with pulmonary hypertension and Type 2 respiratory failure due to extensive cystic bronchiectasis. CT of the thorax showed the affected bronchi had characteristic ballooning on inspiration and collapse on expiration.

High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure. METHODS: We performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods. RESULTS: We included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use. CONCLUSION: In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.

Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern.

OBJECTIVE: To identify in the literature the defining characteristics and related factors of the nursing diagnosis "ineffective breathing pattern". METHOD: Integrative review with the steps: problem identification, literature search, evaluation and analysis of data and presentation of results. RESULTS: Twenty articles and two dissertations were included. In children, the most prevalent related factor was bronchial secretion, followed by hyperventilation. The main defining characteristics were dyspnea, tachypnea, cough, use of accessory muscles to breathe, orthopnea and adventitious breath sounds. Bronchial secretion, cough and adventitious breath sounds are not included in the NANDA-International (NANDA-I). For adults and older adults, the related factors were fatigue, pain and obesity and the defining characteristics were dyspnea, orthopnea and tachypnea. CONCLUSION: This diagnosis manifests differently according to the patients' age group. It was observed that some defining characteristics and related factors are not included in the NANDA-I. Their inclusion can improve this nursing diagnosis.

Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern / Características definitorias y factores relacionados del diagnóstico de enfermería estándar respiratorio ineficaz / Características definidoras e fatores relacionados do diagnóstico de enfermagem padrão respiratório ineficaz

ABSTRACT Objective: To identify in the literature the defining characteristics and related factors of the nursing diagnosis "ineffective breathing pattern". Method: Integrative review with the steps: problem identification, literature search, evaluation and analysis of data and presentation of results. Results: Twenty articles and two dissertations were included. In children, the most prevalent related factor was bronchial secretion, followed by hyperventilation. The main defining characteristics were dyspnea, tachypnea, cough, use of accessory muscles to breathe, orthopnea and adventitious breath sounds. Bronchial secretion, cough and adventitious breath sounds are not included in the NANDA-International (NANDA-I). For adults and older adults, the related factors were fatigue, pain and obesity and the defining characteristics were dyspnea, orthopnea and tachypnea. Conclusion: This diagnosis manifests differently according to the patients' age group. It was observed that some defining characteristics and related factors are not included in the NANDA-I. Their inclusion can improve this nursing diagnosis.

RESUMEN Objetivo: Identificar en la literatura las características definitorias y los factores relacionados del diagnóstico de enfermería estándar respiratorio ineficaz. Método: Se trata de una revisión integradora conteniendo las etapas de formulación del problema, revisión da literatura, evaluación y análisis de los datos y presentación de los resultados. Resultados: Se incluyeron 20 artículos y 02 disertaciones. En los niños, el factor relacionado que prevaleció fue la secreción en los bronquios seguido de hiperventilación. Las características definitorias principales fueron la disnea, la taquipnea, la tos, el uso de la musculatura accesoria para respirar, la ortopnea y los ruidos adventicios, siendo que la secreción en los bronquios, la tos y los ruidos adventicios no constan en la NANDA-Internacional (NANDA-I). Para los adultos y personas mayores, los factores relacionados fueron la fatiga, el dolor y la obesidad, y las características definitorias, la disnea, la ortopnea y la taquipnea. Conclusión: Este diagnóstico difiere según la edad de los pacientes; cabe destacar que ciertas características definitorias y factores relacionados no constan en la NANDA-I, cuya inclusión podría mejorar este diagnóstico de enfermería.

RESUMO Objetivo: Identificar na literatura as características definidoras e os fatores relacionados do diagnóstico de enfermagem Padrão respiratório ineficaz. Método: Revisão integrativa com as etapas formulação do problema, revisão da literatura, avaliação e análise dos dados e apresentação de resultados. Resultados: Foram incluídos 20 artigos e 02 dissertações. Em crianças, o fator relacionado mais prevalente nos estudos foi a secreção nos brônquios, seguido da hiperventilação. As principais características definidoras foram dispneia, taquipneia, tosse, uso da musculatura acessória para respirar, ortopneia e ruídos adventícios, sendo que a secreção nos brônquios, a tosse e os ruídos adventícios não constam na NANDA-Internacional (NANDA-I). Para adultos e idosos, os fatores relacionados foram fadiga, dor e obesidade. As características definidoras foram dispneia, ortopneia e taquipneia. Conclusão: Esse diagnóstico manifesta-se diferententemente de acordo com a faixa etária dos pacientes. Observou-se que algumas características definidoras e fator relacionado não constam na NANDA-I, cuja inclusão pode aprimorar esse diagnóstico de enfermagem.

National survey: current prevalence and characteristics of home mechanical ventilation in Hungary.

BACKGROUND: Home mechanical ventilation is an established treatment for chronic respiratory failure resulting in improved survival and quality of life. Technological advancement, evolving health care reimbursement systems and newly implemented national guidelines result in increased utilization worldwide. Prevalence shows great geographical variations and data on East-Central European practice has been scarce to date. The aim of the current study was to evaluate prevalence and characteristics of home mechanical ventilation in Hungary. METHODS: We conducted a nationwide study using an online survey focusing on patients receiving ventilatory support at home. The survey focused on characterization of the site (affiliation, type), experience with home mechanical ventilation, number of patients treated, indication for home mechanical ventilation (disease type), description of home mechanical ventilation (invasive/noninvasive, ventilation hours, duration of ventilation) and description of the care provided (type of follow up visits, hospitalization need, reimbursement). RESULTS: Our survey uncovered a total of 384 patients amounting to a prevalence of 3.9/100,000 in Hungary. 10.4% of patients received invasive, while 89.6% received noninvasive ventilation. The most frequent diagnosis was central hypopnea syndromes (60%), while pulmonary (20%), neuromuscular (11%) and chest wall disorders (7%) were less frequent indications. Daily ventilation need was less than 8 h in 74.2%, between 8 and 16 h in 15.4% and more than 16 h in 10.4% of patients reported. When comparing sites with a limited (< 50 patients) versus substantial (> 50 patients) case number, we found the former had significantly higher ratio of neuromuscular conditions, were more likely to ventilate invasively, with more than 16 h/day ventilation need and were more likely to provide home visits and readmit patients (p < 0,001). CONCLUSIONS: Our results show a reasonable current estimate and characterization of home mechanical ventilation practice in Hungary. Although a growing practice can be assumed, current prevalence is still markedly reduced compared to international data reported, the duality of current data hinting to a possible gap in diagnosis and care for more dependent patients. This points to the importance of establishing home mechanical ventilation centers, where increased experience will enable state of the art care to more dependent patients as well, increasing overall prevalence.

Accuracy of Administrative Codes for Distinguishing Positive Pressure Ventilation From High-Flow Nasal Cannula.

OBJECTIVES: Noninvasive positive pressure ventilation (NIPPV) is increasingly used in critically ill pediatric patients, despite limited data on safety and efficacy. Administrative data may be a good resource for observational studies. Therefore, we sought to assess the performance of the International Classification of Diseases, Ninth Revision procedure code for NIPPV. METHODS: Patients admitted to the PICU requiring NIPPV or heated high-flow nasal cannula (HHFNC) over the 11-month study period were identified from the Virtual PICU System database. The gold standard was manual review of the electronic health record to verify the use of NIPPV or HHFNC among the cohort. The presence or absence of a NIPPV procedure code was determined by using administrative data. Test characteristics with 95% confidence intervals (CIs) were generated, comparing administrative data with the gold standard. RESULTS: Among the cohort (n = 562), the majority were younger than 5 years, and the most common primary diagnosis was bronchiolitis. Most (82%) required NIPPV, whereas 18% required only HHFNC. The NIPPV code had a sensitivity of 91.1% (95% CI: 88.2%-93.6%) and a specificity of 57.6% (95% CI: 47.2%-67.5%), with a positive likelihood ratio of 2.15 (95% CI: 1.70-2.71) and negative likelihood ratio of 0.15 (95% CI: 0.11-0.22). CONCLUSIONS: Among our critically ill pediatric cohort, NIPPV procedure codes had high sensitivity but only moderate specificity. On the basis of our study results, there is a risk of misclassification, specifically failure to identify children who require NIPPV, when using administrative data to study the use of NIPPV in this population.

Mortality in Code Blue; can APACHE II and PRISM scores be used as markers for prognostication?

BACKGROUND: Code blue (CB) is an emergency call system developed to respond to cardiac and respiratory arrest in hospitals. However, in literature, no scoring system has been reported that can predict mortality in CB procedures. In this study, we aimed to investigate the effectiveness of estimated APACHE II and PRISM scores in the prediction of mortality in patients assessed using CB to retrospectively analyze CB calls. METHODS: We retrospectively examined 1195 patients who were evaluated by the CB team at our hospital between 2009 and 2013. The demographic data of the patients, diagnosis and relevant de-partments, reasons for CB, cardiopulmonary resuscitation duration, mortality calculated from the APACHE II and PRISM scores, and the actual mortality rates were retrospectively record-ed from CB notification forms and the hospital database. RESULTS: In all age groups, there was a significant difference between actual mortality rate and the expected mortality rate as estimated using APACHE II and PRISM scores in CB calls (p<0.05). The actual mortality rate was significantly lower than the expected mortality. CONCLUSION: APACHE and PRISM scores with the available parameters will not help predict mortality in CB procedures. Therefore, novels scoring systems using different parameters are needed.

Pathophysiology and Classification of Respiratory Failure.

Respiratory failure is a condition in which the respiratory system fails in one or both of its gas exchange functions. It is a major cause of morbidity and mortality in patients admitted to intensive care units. It is a result of either lung failure, resulting in hypoxemia, or pump failure, resulting in alveolar hypoventilation and hypercapnia. This article covers the basic lung anatomy, pathophysiology, and classification of respiratory failure.

A case of severe and rigid congenital thoracolumbar lordoscoliosis with diastematomyelia presenting with type 2 respiratory failure: managed by staged correction with controlled axial traction.

INTRODUCTION: Congenital lordoscoliosis is an uncommon pathology and its management poses formidable challenge especially in the presence of type 2 respiratory failure and intraspinal anomalies. In such patients standard management protocols are not applicable and may require multistage procedure to minimize risk and optimize results. CASE DESCRIPTION: A 15-year-old girl presented in our hospital emergency services with severe breathing difficulty. She had a severe and rapidly progressing deformity in her back, noted since 6 years of age, associated with severe respiratory distress requiring oxygen and BiPAP support. She was diagnosed to have a severe and rigid congenital right thoracolumbar lordoscoliosis (coronal Cobb's angle: 105° and thoracic lordosis -10°) with type 1 split cord malformation with bony septum extending from T11 to L3. This leads to presentation of restrictive lung disease with type 2 respiratory failure. As her lung condition did not allow for any major procedure, we did a staged procedure rather than executing in a single stage. Controlled axial traction by halogravity was applied initially followed by halo-femoral traction. Four weeks later, this was replaced by halo-pelvic distraction device after a posterior release procedure with asymmetric pedicle substraction osteotomies at T7 and T10. Halo-pelvic distraction continued for 4 more weeks to optimize and correct the deformity. Subsequently definitive posterior stabilization and fusion was done. The detrimental effect of diastematomyelia resection in such cases is clearly evident from literature, so it was left unresected. A good scoliotic correction with improved respiratory function was achieved. Three years follow-up showed no loss of deformity correction, no evidence of pseudarthrosis and a good clinical outcome with reasonably balanced spine. CONCLUSION: The management of severe and rigid congenital lordoscoliotic deformities with intraspinal anomalies is challenging. Progressive reduction in respiratory volume in untreated cases can lead to acute respiratory failure. Such patients have a high rate of intraoperative and postoperative morbidity and mortality. Hence a staged procedure is recommended. Initially a less invasive procedure like halo traction helps to improve their respiratory function with simultaneous correction of the deformity, while allowing for monitoring of neurological deficit. Subsequently spinal osteotomies and combined halo traction helps further improve the correction, following which definitive instrumented fusion can be done.

New Respiratory Failure Coding Affects Payments.

Differences between ICD-9 and ICD-10 don't appear significant until healthcare organizations drill down to the specifics.

Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients.

OBJECTIVE: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. METHODS: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). RESULTS: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. CONCLUSIONS: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.

OBJETIVO: O ultrassom pulmonar (USP) à beira do leito é uma técnica de imagem não invasiva e prontamente disponível que pode complementar a avaliação clínica. O protocolo Bedside Lung Ultrasound in Emergency (BLUE, ultrassom pulmonar à beira do leito em situações de emergência) demonstrou elevado rendimento diagnóstico em pacientes com insuficiência respiratória aguda (IRpA). Recentemente, um programa de treinamento em USP à beira do leito foi implementado na nossa UTI. O objetivo deste estudo foi avaliar a acurácia do USP baseado no protocolo BLUE, quando realizado por médicos com habilidades básicas em ultrassonografia, para orientar o diagnóstico de IRpA. MÉTODOS: Ao longo de um ano, todos os pacientes adultos consecutivos respirando espontaneamente admitidos na UTI por IRpA foram prospectivamente inclusos. Após treinamento, 4 operadores com habilidades básicas em ultrassonografia realizaram o USP em até 20 minutos após a admissão na UTI, cegados para a história do paciente. Os diagnósticos do USP foram comparados aos diagnósticos da equipe assistente ao final da internação na UTI (padrão-ouro). RESULTADOS: Foram inclusos na análise 37 pacientes (média etária: 73,2 ± 14,7 anos; APACHE II: 19,2 ± 7,3). O diagnóstico do USP demonstrou concordância com o diagnóstico final em 84% dos casos (kappa total: 0,81). As causas mais comuns de IRpA foram pneumonia (n = 17) e edema pulmonar cardiogênico (n = 15). A sensibilidade e a especificidade do USP comparado ao diagnóstico final foram de 88% e 90% para pneumonia e de 86% e 87% para edema pulmonar cardiogênico, respectivamente. CONCLUSÕES: O USP baseado no protocolo BLUE foi reproduzível por médicos com habilidades básicas em ultrassonografia e acurado para o diagnóstico de pneumonia e de edema pulmonar cardiogênico.

Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients, / Acurácia diagnóstica do protocolo de ultrassom pulmonar à beira do leito em situações de emergência para diagnóstico de insuficiência respiratória aguda em pacientes com ventilação espontânea

Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema. .

Objetivo: O ultrassom pulmonar (USP) à beira do leito é uma técnica de imagem não invasiva e prontamente disponível que pode complementar a avaliação clínica. O protocolo Bedside Lung Ultrasound in Emergency (BLUE, ultrassom pulmonar à beira do leito em situações de emergência) demonstrou elevado rendimento diagnóstico em pacientes com insuficiência respiratória aguda (IRpA). Recentemente, um programa de treinamento em USP à beira do leito foi implementado na nossa UTI. O objetivo deste estudo foi avaliar a acurácia do USP baseado no protocolo BLUE, quando realizado por médicos com habilidades básicas em ultrassonografia, para orientar o diagnóstico de IRpA. Métodos: Ao longo de um ano, todos os pacientes adultos consecutivos respirando espontaneamente admitidos na UTI por IRpA foram prospectivamente inclusos. Após treinamento, 4 operadores com habilidades básicas em ultrassonografia realizaram o USP em até 20 minutos após a admissão na UTI, cegados para a história do paciente. Os diagnósticos do USP foram comparados aos diagnósticos da equipe assistente ao final da internação na UTI (padrão-ouro). Resultados: Foram inclusos na análise 37 pacientes (média etária: 73,2 ± 14,7 anos; APACHE II: 19,2 ± 7,3). O diagnóstico do USP demonstrou concordância com o diagnóstico final em 84% dos casos (kappa total: 0,81). As causas mais comuns de IRpA foram pneumonia (n = 17) e edema pulmonar cardiogênico (n = 15). A sensibilidade e a especificidade do USP comparado ao diagnóstico final foram de 88% e 90% para pneumonia e de 86% e 87% para edema pulmonar cardiogênico, respectivamente. Conclusões: O USP baseado no protocolo BLUE foi reproduzível por médicos com habilidades básicas em ultrassonografia e acurado para o diagnóstico de pneumonia e de edema pulmonar cardiogênico. .