Lung ultrasonographic findings among adult patients with respiratory symptoms admitted in ICU at Muhimbili National Hospital

Abstract

ABSTRACT Background: Lung ultrasound is a bedside, noninvasive investigation tool used by radiologists, radiographers, pulmonary physicians, in Emergency and ICU departments for aiding diagnosis and treatment of pulmonary parenchyma, pleural and thoracic cage disease conditions. The study aimed at determining lung ultrasonographic findings in patients admitted to ICU with respiratory symptoms. Methodology: We conducted a descriptive cross-sectional study on patients presenting with respiratory symptoms at the ICU of a tertiary hospital. The Principal Investigator performed lung ultrasound according to lung ultrasound protocol. The findings were discussed with the radiologist to reach consensus. The clinical diagnosis was subsequently compared to ultrasonographic findings. A structured questionnaire was used for demographic, clinical and ultrasonographic data recording. Statistical package for social sciences (SPSS) version 23 was used for data analysis and a p-value of 0.05 was considered statistically significant. Results: The study enrolled a total of 52 patients, most of them were males (67.3%), and Females accounted for (32.7%). The majority of the patients were below 60years of age (75.0%), while those above were(25.0%).Most of the patients with respiratory symptoms in the ICU had a working clinical diagnosis of pulmonary edema(57.7%), followed by Pneumonia(51.9%).While on lung ultrasound, most of the patients in the ICU had pneumonia(55.8%)which wasfollowed by pulmonary edema(46.2%). The most occurring lung ultrasound pattern observed was lung sliding (90.4%), followed by significant B-lines(3 or more lines) (82, 7%).The predominant findings ofpulmonary edema on lung ultrasound were: Significant B-line (55.8%, vs. 44.2% P value =0.002), Coalesced B-line (80.0%, vs. 20.0%, P-value =0.00), Bilateral B-line (57.1%, vs.42.9% P-value 0.001), The predominant findings of pneumonia on lung ultrasound were: Tissue like sign with air bronchogram and shredding (100.0%, vs. 0.00%, P-value=0.00), Unilateral B-line appears with higher significance in diagnosing pneumonia (100.0% vs. 0.00 P-value=0.00).

Conclusion: This study has shown that, lung ultrasound is a useful imaging modality in diagnosing instant and of bed side pathological conditions of (pleural and pulmonary parenchyma) which cause respiratory symptoms in patients admitted in ICU. Majority of patients admitted in ICU were males (67.3%). And large number of them were below 60years of age (75.0%), The most occurring lung ultrasound diagnosis was pneumonia (55.8%), followed by pulmonary edema (46.2%), Significant B-line has relation with pulmonary edema on lung ultrasound diagnosis. Tissue like sign with airbronchogram and shredding has relation with Pneumonia on lung ultrasound diagnosis.

Recommendation • Emphasis on further studies with large sample size regarding lung ultrasound is highly recommended. • Lung ultrasound is safe and efficient imaging tool recommended for diagnosis of lung conditions. • The study can be used as the baseline for further researches and implementation of the modality at tertiary hospital and the country.