Can we use bedside Ultrasound to differentiate between COPD and Pulmonary edema?
Date First Published:
October 18, 2004
Last Updated:
June 11, 2011
Report by:
Muhammad Azam Majeed, ST6 (The Alexandra Hospital, Redditch)
Three-Part Question:
Is [bedside USG] in ED [highly sensitive and specific] to [diagnose pulmonary edema]?
Clinical Scenario:
65 yrs old gentleman comes with SOB for last 12 hrs, has got previous history of COPD and IHD, would Ultrasound be helpful to differentiate between Pulmonary edema and COPD?
Search Strategy:
Embase, 1980- june 2011
Medline, 1950- june 2011
Cinhal, 1981- june 2011
Google
Medline, 1950- june 2011
Cinhal, 1981- june 2011
Search Details:
(ultrasound AND pulmonary AND edema).ti,ab
Outcome:
We had 281 hits and 5 papers were found to be relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Ultrasound Comet-Tail Images”: A Marker Of PulmonaryEdema E Agricola et al May-05 Italy | 20 pts , post cardiac surgery | Prospective, observational, single center study. | The presence and the number of comet-tail images provide reliable information on interstitial pulmonary edema. | A significant positive linear correlation was found between echo comet score and radiologic score (r = 0.60, p < 0.0001), and no significant difference in the mean difference between these two scores was observed (bias, 4.7; 95% limits of agreement, − 9.9 to 19.3). | Single center, Small number, Selection bias, Training issues. |
| , A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD D Lichtenstein et al 1997 France | 250 pts at Intensive care unit | Prospective, Observational study | Analysis of the comet-tail artifact allowed us to detect alveolar-interstitial syndromes, at the bedside | USG has 92.5% sensitivity and 65.1% specificity in diagnosing alveolar-interstitial syndrome | Single center, Small number, Selection bias. |
| Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome R Coppeti et al 2008 Italy | 58 consecutive pts admitted to ICU with ARDS, Pulmonary Edema | Prospective, Observational | In the critically ill the ultrasound demonstration of a dyshomogeneous AIS with spared areas, pleural line modifications and lung consolidations is strongly predictive, in an early phase, of non-cardiogenic pulmonary edema. | AIS was found in 100% of patients with ALI/ARDS and in 100% of patients with APE ). A pleural effusion was present in 66.6% of patients with ALI/ARDS and in 95% of patients with APE (p < 0.004). 'Lung pulse' was observed in 50% of patients with ALI/ARDS and in 0% of patients with APE (p < 0.0001). | Single center, Small number, Selection bias, No training details. No power calculation |
| Bedside Ultrasound of the lung for the monitoring of acute decompensated heart failure G Volpicelli et al 2008 Italy | Usefulness of bedside US in diagnostic distinction between different causes of dyspnea. | Review article | Bedside USS is a non ionizing, immediately implemented, highly feasible and time saving technique for differentiating between COPD and pulmonary edema. | >3 comet tail artefacts/ screen are diagnostic of Pulmonary edema. | No statistical significance, no clear objectives, no power calculation. |
| Prehospital lung ultrasound in the distinction between pulmonary edema and exacerbation of COPD P M Zechner et al 2009 Austria | 2 pts with COPD and IHD. | Case report | Pre hospital USG helped differentiating between Pulmonary edema and COPD. | Bedside USG is a useful technique for differentiating between Pulmonary edema and COPD and can lead us to right treatment. | Case report, no statistical significance. |
Author Commentary:
The level of evidence available is 3 and 4 but it still signifies the role of US to to differentiate between Pulmonary edema and COPD.We do need a multicenter, randomised trial to make a stronger case.
Bottom Line:
The available evidence does show that bedside ED USG is highly valuable to diagnose pulmonary edema in acutely unwell patients.
References:
- E Agricola et al. Ultrasound Comet-Tail Images”: A Marker Of PulmonaryEdema
- D Lichtenstein et al. , A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD
- R Coppeti et al. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome
- G Volpicelli et al. Bedside Ultrasound of the lung for the monitoring of acute decompensated heart failure
- P M Zechner et al. Prehospital lung ultrasound in the distinction between pulmonary edema and exacerbation of COPD