Ultrasonido para el diagnóstico diferencial de la patología pulmonar en el paciente crítico

María Camila Arango-Granados, Virginia Zarama Córdoba

Resumen


Durante los últimos años, la ecografía se ha convertido en una herramienta diagnóstica de primera línea para el enfoque y el manejo del paciente críticamente enfermo y es considerada hoy día uno de los pilares en la evaluación integral de todos los pacientes. Se ha demostrado que el ultrasonido mejora el rendimiento diagnóstico de la patología pulmonar y de la falla respiratoria aguda. Su utilidad radica en la capacidad de realizar el estudio a la cabecera del paciente, sin irradiación, de manera inmediata por el mismo médico tratante, sumado a la capacidad diagnóstica para identificar condiciones tales como el edema pulmonar cardiogénico y no cardiogénico, describir los patrones de ocupación alveolar y consolidación pulmonar, caracterizar y cuantificar el derrame pleural y diagnosticar la presencia de neumotórax. Adicionalmente, de la mano de una ecografía cardíaca enfocada, aumenta el rendimiento diagnóstico tempranamente en el tromboembolismo pulmonar con compromiso de ventrículo derecho (VD) o la falla cardíaca descompensada. En esta revisión se ilustran los hallazgos ultrasonográficos más importantes en el diagnóstico diferencial de la patología pulmonar y se revisa la evidencia disponible sobre su rendimiento diagnóstico. Es indiscutible la utilidad de esta herramienta para el abordaje del paciente crítico en las unidades de cuidados intensivos (UCI) o en los servicios de emergencias. Su prontitud, el buen rendimiento diagnóstico y la oportunidad de inicio temprano de terapias específicas obligan a los clínicos que manejan pacientes críticos a incorporar el ultrasonido en la práctica diaria.

Palabras clave


ultrasonografía; enfermedades pulmonares; insuficiencia respiratoria; cuidados críticos

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Referencias


Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795-815.

Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016;44(6):1206-27.

Frankel HL, Kirkpatrick AW, Elbarbary M, Blavias M, Desai H, Evans D, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part I: General Ultrasonography. Crit Care Med. 2015;43(11):2479-502.

Neskovic AN, Hagendorff A, Lancellotti P, Guarracino F, Vargas A, Cosyns B, et al. Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging. 2013;14(1):1-11.

Silva S, Biendel C, Ruiz J, Olivier M, Bataille B, Geeraerts T, et al. Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice. Chest. 2013;144(3):859-65.

Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995;108(5):1345-8.

Miller A. Practical approach to lung ultrasound. BJA Education. 2016;16(2):39-45.

Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156(5):1640-6.

Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344(1):17-22.

McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787-847.

Boussuges A, Blanc P, Molenat F, Burnet H, Habib G, Sainty JM. Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit. Crit Care Med. 2002;30(2):362-7.

Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol. 1998;32(4):865-75.

Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30(6):1527-33.

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321-60.

Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J. 2016;37(27):2097-104.

Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jörres A, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care. 2015;19:36.

Liteplo AS, Marill KA, Villen T, Miller RM, Murray AF, Croft PE, et al. Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med. 2009;16(3):201-10.

Miglioranza MH, Gargani L, Sant’Anna RT, Rover MM, Martins VM, Mantovani A, et al. Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. JACC Cardiovasc Imaging. 2013;6(11):1141-51.

Volpicelli G, Skurzak S, Boero E, Carpinteri G, Tengattini M, Stefanone V, et al. Lung ultrasound predicts well extravascular lung water but is of limited usefulness in the prediction of wedge pressure. Anesthesiology. 2014;121(2):320-7.

Pivetta E, Goffi A, Lupia E, Tizzani M, Porrino G, Ferreri E, et al. Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study. Chest. 2015;148(1):202-10.

Bataille B, Riu B, Ferre F, Moussot PE, Mari A, Brunel E, et al. Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest. 2014;146(6):1586-93.

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33.

Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016;315(8):788-800.

Guérin C, Beuret P, Constantin JM, Bellani G, Garcia-Olivares P, Roca O, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018;44(1):22-37.

Bouferrache K, Amiel JB, Chimot L, Caille V, Charron C, Vignon P, et al. Initial resuscitation guided by the Surviving Sepsis Campaign recommendations and early echocardiographic assessment of hemodynamics in intensive care unit septic patients: a pilot study. Crit Care Med. 2012;40(10):2821-7.

Zapol WM, Kobayashi K, Snider MT, Greene R, Laver MB. Vascular obstruction causes pulmonary hypertension in severe acute respiratory failure. Chest. 1977;71(2 suppl):306-7.

Price LC, McAuley DF, Marino PS, Finney SJ, Griffiths MJ, Wort SJ. Pathophysiology of pulmonary hypertension in acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2012;302(9):L803-15.

Mekontso Dessap A, Boissier F, Charron C, Bégot E, Repessé X, Legras A, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Med. 2016;42(5):862-70.

Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med. 2002;166(10):1310-9.

Mahjoub Y, Pila C, Friggeri A, Zogheib E, Lobjoie E, Tinturier F, et al. Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med. 2009;37(9):2570-5.

Vieillard-Baron A, Chergui K, Augarde R, Prin S, Page B, Beauchet A, et al. Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am J Respir Crit Care Med. 2003;168(6):671-6.

Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, et al. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med. 2001;29(8):1551-5.

Vignon P, Repessé X, Vieillard-Baron A, Maury E. Critical care ultrasonography in acute respiratory failure. Crit Care. 2016;20(1):228.

Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183(3):341-7.

Mekontso Dessap A, Boissier F, Leon R, Carreira S, Campo FR, Lemaire F, et al. Prevalence and prognosis of shunting across patent foramen ovale during acute respiratory distress syndrome. Crit Care Med. 2010;38(9):1786-92.

Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16.

Singh AK, Mayo PH, Koenig S, Talwar A, Narasimhan M. The Use of M-Mode Ultrasonography to Differentiate the Causes of B Lines. Chest. 2018;153(3):689-96.

Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30(2):276-81.

Lichtenstein DA, Malbrain MLNG. Lung ultrasound in the critically ill (LUCI): A translational discipline. Anaesthesiol Intensive Ther. 2017;49(5):430-6.

Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis. Chest. 2017;151(2):374-82.

Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. Chest. 2009;135(6):1421-5.

Lichtenstein DA, Lascols N, Prin S, Mezière G. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29(12):2187-92.

Lichtenstein D. Lung ultrasound in acute respiratory failure an introduction to the BLUE-protocol. Minerva Anestesiol. 2009;75(5):313-7.

Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA. Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest. 1997;111(4):1018-23.

Razazi K, Thille AW, Carteaux G, Beji O, Brun-Buisson C, Brochard L, et al. Effects of pleural effusion drainage on oxygenation, respiratory mechanics, and hemodynamics in mechanically ventilated patients. Ann Am Thorac Soc. 2014;11(7):1018-24.

Umbrello M, Mistraletti G, Galimberti A, Piva IR, Cozzi O, Formenti P. Drainage of pleural effusion improves diaphragmatic function in mechanically ventilated patients. Crit Care Resusc. 2017;19(1):64-70.

Lichtenstein D, Hulot JS, Rabiller A, Tostivint I, Mezière G. Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med. 1999;25(9):955-8.

Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9-15.

Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest. 2013;143(2):532-8.

Dancel R, Schnobrich D, Puri N, Franco-Sadud R, Cho J, Grikis L, et al. Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine. J Hosp Med. 2018;13(2):126-35.

Vieillard-Baron A, Qanadli SD, Antakly Y, Fourme T, Loubières Y, Jardin F, et al. Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: a comparison with radiological procedures. Intensive Care Med. 1998;24(5):429-33.

Sevestre MA, Labarère J, Casez P, Bressollette L, Taiar M, Pernod G, et al. Accuracy of complete compression ultrasound in ruling out suspected deep venous thrombosis in the ambulatory setting. A prospective cohort study. Thromb Haemost. 2009;102(1):166-72.

Johnson SA, Stevens SM, Woller SC, Lake E, Donadini M, Cheng J, et al. Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis. JAMA. 2010;303(5):438-45.

Mathis G, Blank W, Reissig A, Lechleitner P, Reuss J, Schuler A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest. 2005;128(3):1531-8.

Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004;57(2):288-95.

Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest. 2008;133(1):204-11.

Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231-8.

Lichtenstein D, Mezière G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26(10):1434-40.

Lichtenstein D, Mezière G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med. 1999;25(4):383-8.

Oveland NP, Lossius HM, Wemmelund K, Stokkeland PJ, Knudsen L, Sloth E. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with CT scanning. Chest. 2013;143(2):415-22.




DOI: http://dx.doi.org/10.30789/rcneumologia.v30.n1.2018.299

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