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Focused ultrasound of the pleural cavities and the pericardium by nurses after cardiac surgery.

Graven T, Wahba A, Hammer AM, Sagen O, Olsen Ø, Skjetne K, Kleinau JO, Dalen H - Scand. Cardiovasc. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust , Levanger , Norway.

ABSTRACT

Objectives: We aimed to study the feasibility and reliability of focused ultrasound (US) examinations to quantify pericardial (PE)- and pleural effusion (PLE) by a pocket-size imaging device (PSID) performed by nurses in patients early after cardiac surgery.

Design: After a 3-month training period, with cardiologists as supervisors, two nurses examined 59 patients (20 women) with US using a PSID at a median of 5 days after cardiac surgery. The amount of PE and PLE was classified in four categories by US (both) and chest x-ray (PLE only). Echocardiography, including US of the pleural cavities, by experienced cardiologists was used as reference.

Results: Focused US by the nurses was more sensitive than x-ray to detect PLE. The correlations of the quantification of PE and PLE by the nurses and reference was r (95% confidence interval) 0.76 (0.46-0.89) and 0.81 (0.73-0.89), both p < 0.001. PE and PLE were drained in one and six (eight cavities) patients, all classified as large amount by the nurses.

Conclusions: Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.

No MeSH data available.


Related in: MedlinePlus

Chest ultrasound with examples of pleural effusion. A: absent, B: small (only in the costophrenic angle), C: moderate, D: large. Double arrows show the measurement of pleural effusion. Thick arrows indicate the diaphragm. X: lung (in B air-filled, in C and D consolidated). ∗pleural effusion.
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Figure 2: Chest ultrasound with examples of pleural effusion. A: absent, B: small (only in the costophrenic angle), C: moderate, D: large. Double arrows show the measurement of pleural effusion. Thick arrows indicate the diaphragm. X: lung (in B air-filled, in C and D consolidated). ∗pleural effusion.

Mentions: After completing the focused echocardiography, thoracic ultrasonography was performed with the same device with the patient in sitting position. With the transducer placed in the intercostal space, the liver and spleen were used as landmarks to identify the diaphragm of the right and left hemithoraces, respectively. During quiet breathing, US scanning of the posterior chest was performed along the paravertebral, scapular, posterior and medial axillary lines, continuously focusing on the diaphragm as a landmark. The air-filled lung surface results in a bright line and distal shadows, indicating the absence of PLE (Figure 2A). The presence of PLE was diagnosed by the appearance of a hypoechoic space between the diaphragm and the air-filled or consolidated lung surface (Figure 2B). If the PLE was located in the costodiaphragmatic angle only, this was assessed semi quantitatively and classified as insignificant (Figure 2C). By larger effusions the dimension between the diaphragm and the lung surface was measured in the middle, between the transducer and the mediastinum. If a consolidated lung, yielding a tissue pattern, bulged into the effusion, the extent of the effusion was measured just medially to the protruding edge of the lower lung lobe (Figure 2D). Dimensions were measured in real time on the PSID. For each pleural cavity, the amount of PLE was classified as: 1) not present, 2) insignificant (costodiaphragmatic angle only), 3) moderate if the PLE separated the diaphragm and the lung with a maximum distance between these two organs < 30 mm and 4) large if this maximum distance was ≥ 30 mm.


Focused ultrasound of the pleural cavities and the pericardium by nurses after cardiac surgery.

Graven T, Wahba A, Hammer AM, Sagen O, Olsen Ø, Skjetne K, Kleinau JO, Dalen H - Scand. Cardiovasc. J. (2015)

Chest ultrasound with examples of pleural effusion. A: absent, B: small (only in the costophrenic angle), C: moderate, D: large. Double arrows show the measurement of pleural effusion. Thick arrows indicate the diaphragm. X: lung (in B air-filled, in C and D consolidated). ∗pleural effusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389761&req=5

Figure 2: Chest ultrasound with examples of pleural effusion. A: absent, B: small (only in the costophrenic angle), C: moderate, D: large. Double arrows show the measurement of pleural effusion. Thick arrows indicate the diaphragm. X: lung (in B air-filled, in C and D consolidated). ∗pleural effusion.
Mentions: After completing the focused echocardiography, thoracic ultrasonography was performed with the same device with the patient in sitting position. With the transducer placed in the intercostal space, the liver and spleen were used as landmarks to identify the diaphragm of the right and left hemithoraces, respectively. During quiet breathing, US scanning of the posterior chest was performed along the paravertebral, scapular, posterior and medial axillary lines, continuously focusing on the diaphragm as a landmark. The air-filled lung surface results in a bright line and distal shadows, indicating the absence of PLE (Figure 2A). The presence of PLE was diagnosed by the appearance of a hypoechoic space between the diaphragm and the air-filled or consolidated lung surface (Figure 2B). If the PLE was located in the costodiaphragmatic angle only, this was assessed semi quantitatively and classified as insignificant (Figure 2C). By larger effusions the dimension between the diaphragm and the lung surface was measured in the middle, between the transducer and the mediastinum. If a consolidated lung, yielding a tissue pattern, bulged into the effusion, the extent of the effusion was measured just medially to the protruding edge of the lower lung lobe (Figure 2D). Dimensions were measured in real time on the PSID. For each pleural cavity, the amount of PLE was classified as: 1) not present, 2) insignificant (costodiaphragmatic angle only), 3) moderate if the PLE separated the diaphragm and the lung with a maximum distance between these two organs < 30 mm and 4) large if this maximum distance was ≥ 30 mm.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust , Levanger , Norway.

ABSTRACT

Objectives: We aimed to study the feasibility and reliability of focused ultrasound (US) examinations to quantify pericardial (PE)- and pleural effusion (PLE) by a pocket-size imaging device (PSID) performed by nurses in patients early after cardiac surgery.

Design: After a 3-month training period, with cardiologists as supervisors, two nurses examined 59 patients (20 women) with US using a PSID at a median of 5 days after cardiac surgery. The amount of PE and PLE was classified in four categories by US (both) and chest x-ray (PLE only). Echocardiography, including US of the pleural cavities, by experienced cardiologists was used as reference.

Results: Focused US by the nurses was more sensitive than x-ray to detect PLE. The correlations of the quantification of PE and PLE by the nurses and reference was r (95% confidence interval) 0.76 (0.46-0.89) and 0.81 (0.73-0.89), both p < 0.001. PE and PLE were drained in one and six (eight cavities) patients, all classified as large amount by the nurses.

Conclusions: Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.

No MeSH data available.


Related in: MedlinePlus