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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

Receiver operating characteristics curve of pocket-size ultrasound by nurses and chest x-ray with respect to detect at least moderate pleural effusion. Reference is high-end examination by cardiologist. AUC, area under curve; CI, confidence interval.
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Figure 4: Receiver operating characteristics curve of pocket-size ultrasound by nurses and chest x-ray with respect to detect at least moderate pleural effusion. Reference is high-end examination by cardiologist. AUC, area under curve; CI, confidence interval.

Mentions: The correlation of the quantification of PE and PLE performed by the nurses and the reference method was high with r (95% CI) 0.76 (0.46–0.89) and 0.81 (0.73–0.89), both p < 0.001, respectively (Table III). There was no significant difference between the two nurses compared to reference regarding the measurements of PE and PLE, both p ≥ 0.29. The corresponding correlation of chest x-ray with reference was low with r (95% CI) 0.21 (0.04–0.37), p = 0.03. The sensitivity and specificity to detect at least moderate PE by US performed by the nurses was 91% and 56%, respectively. In 11 cases, nurses classified the amount of PE as moderate while the cardiologist classified the amount as less (< 5 mm). For PLE, the corresponding sensitivity and specificity was 98% and 70% for focused ultrasound by the nurses and 40% and 78% by chest x-ray, respectively (Table IV). The low sensitivity of chest x-ray to detect PLE was illustrated in further analyses. Detection of PLE exceeding the costodiaphragmatic angle by chest x-ray had only a sensitivity of 53% to detect large amount of pleural effusion classified by reference. In two (3%) patients PE was quantified as large, and both were correctly identified by the nurses. The Bland–Altman plots illustrate no significant reduction in the accuracy of the measurements of PE and PLE performed by nurses with larger amount of PE or PLE (Figure 3). In Figure 4, the superiority of focused US compared with chest x-ray for the assessment of PLE, using high-end echocardiography by the cardiologists as the reference, is shown. Whether the chest x-ray was performed by standard beam directions or anteroposterior beam direction only did not alter the results. The area under the ROC curve for chest x-ray performed with standard versus anteroposterior beam direction was 0.56 (0.26–0.84) versus 0.55 (0.42–0.67), respectively.


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)

Receiver operating characteristics curve of pocket-size ultrasound by nurses and chest x-ray with respect to detect at least moderate pleural effusion. Reference is high-end examination by cardiologist. AUC, area under curve; CI, confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Receiver operating characteristics curve of pocket-size ultrasound by nurses and chest x-ray with respect to detect at least moderate pleural effusion. Reference is high-end examination by cardiologist. AUC, area under curve; CI, confidence interval.
Mentions: The correlation of the quantification of PE and PLE performed by the nurses and the reference method was high with r (95% CI) 0.76 (0.46–0.89) and 0.81 (0.73–0.89), both p < 0.001, respectively (Table III). There was no significant difference between the two nurses compared to reference regarding the measurements of PE and PLE, both p ≥ 0.29. The corresponding correlation of chest x-ray with reference was low with r (95% CI) 0.21 (0.04–0.37), p = 0.03. The sensitivity and specificity to detect at least moderate PE by US performed by the nurses was 91% and 56%, respectively. In 11 cases, nurses classified the amount of PE as moderate while the cardiologist classified the amount as less (< 5 mm). For PLE, the corresponding sensitivity and specificity was 98% and 70% for focused ultrasound by the nurses and 40% and 78% by chest x-ray, respectively (Table IV). The low sensitivity of chest x-ray to detect PLE was illustrated in further analyses. Detection of PLE exceeding the costodiaphragmatic angle by chest x-ray had only a sensitivity of 53% to detect large amount of pleural effusion classified by reference. In two (3%) patients PE was quantified as large, and both were correctly identified by the nurses. The Bland–Altman plots illustrate no significant reduction in the accuracy of the measurements of PE and PLE performed by nurses with larger amount of PE or PLE (Figure 3). In Figure 4, the superiority of focused US compared with chest x-ray for the assessment of PLE, using high-end echocardiography by the cardiologists as the reference, is shown. Whether the chest x-ray was performed by standard beam directions or anteroposterior beam direction only did not alter the results. The area under the ROC curve for chest x-ray performed with standard versus anteroposterior beam direction was 0.56 (0.26–0.84) versus 0.55 (0.42–0.67), respectively.

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