الفهرس 
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Abstract
Lung ultrasonography has significantly improved the efficiency of diagnostic procedures performed by intensivists and emergency physicians at the patient’s bedside. It is particularly useful for diagnosing pneumothorax, pleural effusions, and other thoracic diseases. Furthermore, the potential application of this technique in diagnosing pneumonia has been explored, taking into account the significant constraints of chest X-ray imaging.
In recent years, the utilization of chest CT for diagnosing pneumonia has increased significantly. While CT scans are often regarded as the most reliable method for diagnosing pneumonia, they cannot be utilized as the initial radiologic test for all patients with suspected pneumonia.
In this study, we assess the efficacy of lung ultrasonography in diagnosing pneumonia in critically ill patients.
The current investigation comprised 60 patients who were referred to the critical care units of Minia university hospitals due to suspected pneumonia based on clinical assessment and radiological findings. Written consent was obtained from the patients between October 2022 and September 2023. Each patient underwent a thorough assessment of their medical history, a full examination of the chest area, and a laboratory inquiry that encompassed various tests. CBC, CRP, PCT, RFTs, CURB-65 score assessment, plain chest radiography, CT chest imaging, and LUS were performed on all patients. CT chest imaging was conducted as the definitive diagnostic testing for all 60 individuals.
The results of the study showed that:
As regard demographic data, the mean age of the studied patients in our study was 57.6 ± 14.7 and males represented 46.7% of and 53.3% of them were females. Most of our patients (66.6%) were non-smoker, 16.7% were X smoker and 16.7% were current smoker.
As regard comorbidities, in the present study, 10 of the studied patients had no comorbidities, 41.7% patients had diabetes mellitus, 55% had hypertension, 25 % had liver cirrhosis, 23.3% had chronic kidney disease (CKD), 11.7 % had stroke, 8.3% had COPD, 8.3 had ischemic heart disease and 3.3 % had malignancy and 3.3 % had autoimmune disease.
As regard Clinical Presentation, the present study showed that dyspnea, fever and cough were the most common clinical symptoms in patients with pneumonia
As regard laboratory data, our study showed that, there were statistically significant difference between cases positive for pneumonia by CT chest and cases negative for pneumonia regarding TLC, lymphocyte, neutrophil, CRP and procalcitonin (p value <0.05).
As mean TLC, neutrophil, CRP and procalcitonin was significantly higher in pneumonia positive cases (15.5, 78, 140.8 and 5591 respectively) than in pneumonia negative cases (10.5, 73, 62 and 3683 respectively), however mean lymphocyte was significantly lower in pneumonia positive cases (10.3) than in pneumonia negative cases (16.3)
The mean PaO2 was 66.1±21 mmHg and SaO2 was 84.9±9.8 %. The mean CURB-A score was 3.1 ±0.7
As regard sputum culture of the studied cases, about 13.3% of cases had no growth on sputum culture and the remaining 86.7% had positive sputum culture. the majority of cases (38%) had positive Klebsiella pneumoniae on sputum culture, 11.7% had Pseudomonas, 10% had Strept. Pneumoniae and only two cases had acinobacter and enterococci infection.
In the present study that include 60 patients admitted as pneumonia by symptoms and signs suggestive of pneumonia, pneumonia was proved by chest CT (which was standard imaging in our study) in 50 patients (83.33 %).
As regard lung ultrasound, LUS had the ability to diagnose 40 cases of them (80 %) and fail to diagnose 10 cases (20) that are considered as false negative cases. Chest ultrasound diagnosed 6 cases as pneumonia out of 10 confirmed negative cases by chest CT and considered as false positive cases. There was no statistically significant difference between LUS and CT chest, as regarding the ability to detect pneumonia (p = 0.11). The present study demonstrated that LUS has low but accepted sensitivity (80 %), but low specificity (40 %) for the detection of pneumonia.
As regard Chest X ray, CXR detect 40 cases (76.67 %) as pneumonia out of 60 patients admitted to ICU by symptoms and signs of pneumonia. Chest X-ray was able to detect 35 positive cases (70.0%) out of 50 CT chest confirmed pneumonia cases by chest CT while it failed to detect 15 cases confirmed pneumonia by CT chest). CXR diagnosed 5 cases as pneumonia (out of 10 confirmed negative cases by chest CT that is considered as false positive cases). There was no statistically significant difference between CXR and CT chest, as regarding the ability to detect pneumonia (p = 0.22). Sensitivity and specificity of CXR for diagnosis of pneumonia was estimated to be 70% and 50% respectively
The present study revealed that LUS is superior over CXR in the diagnosis of pneumonia in critically ill patients where LUS detected pneumonia in 80 % (40 out the 50 cases diagnosed by chest CT), while plain CXR detected 70 % only (35/50). Also, LUS has higher sensitivity than CXR in detecting pneumonia (87% versus 70 % respectively).
In conclusion, it cannot be expected that LUS will replace CT as the gold standard for the diagnosis of pneumonia because it does not provide a precise estimate of the size of consolidation and a whole assessment of both lungs. However, LUS has the potential to serve as an appropriate technique for verifying the clinical diagnosis and for monitoring patients with pneumonia at the bedside.
When compared to chest X-ray (CXR), lung ultrasound (LUS) appears to be a more effective, sensitive, and viable imaging tool for the diagnosis of pneumonia in critically ill patients, according to the present study. When a CT scan is too challenging to complete, LUS seems to be a good substitute.
Conclusion
Based on currently available evidence, LUS is an additional imaging method that can be used to confirm the diagnosis in patients who have pneumonia suspicions
In comparison with CT scan, bedside LUS seems to be a valuable substitute in cases where performing CT is problematic
In comparison with bedside CXR, LUS was found to be a more reliable, accurate, and sensitive bedside tool in diagnosing of pneumonia in critically ill patients.
This is a beginning of a new trend and a convenient bedside tool for diagnosis of a common health problem
Recommendations
Based on the current study,
1- We recommend using LUS as an effective, sensitive, and practical imaging method for diagnosing pneumonia. It enables quicker and easier assessment of pneumonia patients in intensive care units.
2- Further studies probably are required on larger sample size to confirm our results. We may need an additional study to assess the time delay between using lung ultrasound and other techniques like a chest x-ray or CT scan.