Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure
, , , , , and | Feb 08, 2023
About this article
Article Category: Research Article
Published Online: Feb 08, 2023
Page range: 20 - 29
Received: Feb 16, 2022
Accepted: Jan 20, 2023
DOI: https://doi.org/10.2478/jccm-2023-0006
Keywords
© 2023 Rajesh Panda, Saurabh Saigal, Rajnish Joshi, Abhijit Pakhare, Ankur Joshi, Jai Prakash Sharma, Sahil Tandon, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fig. 1
Fig. 2
Distribution of participants by their demographic and other characteristics
| Age (mean+SD, years) |
53.0 (37.0-64.0) |
| Gender n (%) | |
| F -n (%) | 67 (38.5%) |
| M -n (%) |
107 (61.5%) |
| Source n(%) | |
| CCU (Coronary care unit) | 4 (2.3%) |
| CTVS surgery) (Cardiothoracic ward vascular | 2 (1.1%) |
| ED (Emergency department) | 105 (60.3%) |
| ENT (Ear nose throat) ward | 1 (0.6%) |
| EW (Eye ward) | 1 (0.6%) |
| MW (Medicine ward) | 51 (29.3%) |
| PW (Pulmonary ward) |
10 (5.7%) |
| Mode of ventilation n (%) | |
| Facemask/NRBM/HFNO | 11 (6.3%) |
| NIV | 74 (42.5%) |
| INVASIVE |
89 (51.1%) |
| SOFA on DOA to ICU Median (IQR) |
6.0 (4.0-9.8) |
| CCUS based DX n (%) | |
| Alveolar (lung) defect | 69 (39.7%) |
| Alveolar (cardiac) defect | 60 (34.5%) |
| Ventilation plus alveolar defect | 19 (10.9%) |
| Perfusion defect | 4 (2.3%) |
| Metabolic defect |
22 (12.6%) |
| CXR based DX n (%) | |
| Alveolar (lung) defect | 71 (40.8%) |
| Alveolar(cardiac) defect | 69 (39.7%) |
| Ventilation plus alveolar defect | 5 (2.9%) |
| Perfusion defect | 24 (13.8%) |
| Metabolic defect | 5 (2.9%) |
| Need of vasopressors on day 1 n (%) | 137 (78.7%) |
| LOS in ICU days Median (IQR) |
6.0 (4.0, 11.0) |
| Composite diagnosis n (%) | |
| Alveolar (lung) defect | 63 (36.2%) |
| Alveolar(cardiac) defect | 55 (31.6%) |
| Ventilation plus alveolar defect | 18 (10.3%) |
| Perfusion defect | 6 (3.4%) |
| Metabolic defect |
32 (18.4%) |
| Outcome n (%) | |
| Discharged | 115 (66.1%) |
| Death | 59 (33.9%) |
Correlation of CCUS based algorithm/ Chest X ray based algorithm vs Composite diagnosis
| 1 | CCUS vs Composite diagnosis (Alveolar- Pneumonia) | 85.71% (75.03-92.3) | 86.49% (78.9-91.64) | 78.26 (67.18-86.36) | 0.7074 (0.5593-0.8566) |
| 2 | CxR vs Composite diagnosis (Alveolar- Pneumonia) | 84.13% (73.91-91.14) | 83.78% (75.82-89.94) | 74.65 (63.45-83.30) | 0.661 (0.5131-0.8088) |
| 3 | CCUS vs CxR (Alveolar- Pneumonia) | 0.59 (0.44-0.74) | |||
| 4 | CCUS vs Composite diagnosis (Alveolar- Cardiogenic Pulmonary Edema) | 94.55% (85.15-98.13) | 93.28% (87.28-98.55) | 86.67 (75.83-93.08) | 0.8573 (0.709-1.006) |
| 5 | CxR vs Composite diagnosis (Alveolar- Cardiogenic Pulmonary Edema) | 90.91% (80.42-96.05) | 84.03% (76.4-89.53) | 72.46 (60.95-81.61) | 0.7014 (0.551-0.8477) |
| 6 | CCUS vs CxR (Alveolar- Cardiogenic Pulmonary Edema) | 0.6438 (0.49-0.75) | |||
| 7 | CCUS (Ventilation vs Composite with Alveolar diagnosis defect) | (60.7883.33-94.16% ) | (93.5997.44-% 99) | (56.6778.95 -91.49) | (0.13980.7883 -0.9368) |
| 8 | CxR vs Composite diagnosis (Ventilation with Alveolar defect) | 22.22% (9.001-45.22) | 99.36% (96.46-99.89) | 80 (37.55-96.38) | 0.3171 (0.1973-0.4369) |
| 9 | CCUS vs CxR (Ventilation with Alveolar defect) | 0.3016 (0.18-0.41) | |||
| 10 | CCUS vs Composite diagnosis ( Perfusion defect) | 66.67% (30-90.32) | 100% (97.76-100) | 100 (51.01-100) | 0.7943 (0.6489-0.9397) |
| 11 | CxR vs Composite diagnosis ( Perfusion defect) | 50% (18.78-81.24) | 87.5% (81.65-91.68) | 12.5 (4.344-31) | 0.1553 (0.0385-0.2681) |
| 12 | CCUS vs CxR (Perfusion defect) | 0.10 (0.08-0.207) | |||
| 13 | CCUS vs Composite diagnosis (Metabolic defect) | 62.65% (45.25-77.07) | 98.59% (95.01-99.69) | 90.91 (72.98-97.47) | 0.695 (0.55-0.840) |
| 14 | CxR vs Composite diagnosis (Metabolic defect) | 15.63% (6.864-31.75) | 100 (97.37-100) | 100 (96.55-100) | 0.2321 (0.1369-0.3273) |
| 15 | CCUS vs CxR (Metabolic defect) | 0.28 (0.15-0.37) |
Agreement of CCUS with CXR
| Alveolar (lung) defect | 53 (76.8%) | 8 (13.3%) | 8 (42.1%) | 0 (0.0%) | 2 (9.1%) |
| Alveolar(cardiac) defect | 12 (17.4%) | 50 (83.3%) | 5 (26.3%) | 2 (50.0%) | 0 (0.0%) |
| Ventilation plus alveolar defect | 1 (1.4%) | 0 (0.0%) | 4 (21.1%) | 0 (0.0%) | 0 (0.0%) |
| Perfusion defect | 2 (2.9%) | 2 (3.3%) | 2 (10.5%) | 2 (50.0%) | 16 (72.7%) |
| Metabolic defect | 1 (1.4%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 4 (18.2%) |
Agreement of CCUS and CXR with Composite Diagnosis
| Alveolar (lung) defect | 54 (85.7%) | 3 (5.5%) | 3 (16.7%) | 0 (0.0%) | 9 (28.1%) |
| Alveolar(cardiac) defect | 5 (7.9%) | 52 (94.5%) | 0 (0.0%) | 0 (0.0%) | 3 (9.4%) |
| Ventilation plus alveolar defect | 2 (3.2%) | 0 (0.0%) | 15 (83.3%) | 2 (33.3%) | 0 (0.0%) |
| Perfusion defect | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 4 (66.7%) | 0 (0.0%) |
| Metabolic defect |
2 (3.2%) |
0 (0.0%) |
0 (0.0%) |
0 (0.0%) |
20 (62.5%) |
| Alveolar (lung) defect | 53 (84.1%) | 5 (9.1%) | 10 (55.6%) | 0 (0.0%) | 3 (9.4%) |
| Alveolar(cardiac) defect | 8 (12.7%) | 50 (90.9%) | 3 (16.7%) | 3 (50.0%) | 5 (15.6%) |
| Ventilation plus alveolar defect | 1 (1.6%) | 0 (0.0%) | 4 (22.2%) | 0 (0.0%) | 0 (0.0%) |
| Perfusion defect | 1 (1.6%) | 0 (0.0%) | 1 (5.6%) | 3 (50.0%) | 19 (59.4%) |
| Metabolic defect | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 5 (15.6%) |