Lung slide in ARDS

[slycaper]

Can anyone comment on the appearance of lung slide via ultrasound in a ARDS patient in which you suspect a pneumo?

I have a patient that I suspected had a pneumo and I didn't see much lung slide on US and didn't know if that's from the stiff lungs or a true pneumo that isn't detectable on xray (yes US has higher sensitivity).

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[ProwlerturnGas]

Lung slide rules out PTX only. If any doubt you see slide, you have to obtain another test, be it CXR or preferably CT. ARDS has the ability of showing no slide in a lung that is otherwise up. You have to confirm another way

 

[jdh71]

Here's the thing I've never understood about U/S in this situation. Any pneumo big enough to matter will be seen on a CXR. I've seen one (maybe there are more) study where the U/S was better than CXR in hands of someone who is really good (not just trainees or an a average U/S). Ok. If the pneumo is big enough to actually matter you'll see it on an X-ray.

 

[Bostonredsox]

I would add the caveat that the pt in this stem has ards and is probably on the vent. In my short career I have been taught any ptx in a pt on ppv is significant and needs a chest tube. So even if it at the moment is not big enough to show on a chest film, if it's there, it needs intervention so finding it via lack of slide on us would be important. I'm not sure if this answers the question but it's just a thought I had

 

[QofQuimica]

Can anyone comment on the appearance of lung slide via ultrasound in a ARDS patient in which you suspect a pneumo?

I have a patient that I suspected had a pneumo and I didn't see much lung slide on US and didn't know if that's from the stiff lungs or a true pneumo that isn't detectable on xray (yes US has higher sensitivity).

I don't know the official U/S guru answer to this, but just curious: did you ultrasound the unaffected side as well and compare them? Unless the patient was unlucky enough to have b/L PTX along w/ their ARDS, presumably the two sides would be different. Also, did you use M mode as well, or B mode only?

 

[ThoracicGuy]

I would add the caveat that the pt in this stem has ards and is probably on the vent. In my short career I have been taught any ptx in a pt on ppv is significant and needs a chest tube. So even if it at the moment is not big enough to show on a chest film, if it's there, it needs intervention so finding it via lack of slide on us would be important. I'm not sure if this answers the question but it's just a thought I had

If someone is on a vent and has ARDS with a small PTX, it will eventually show up on the CXR. Looking on ultrasound in the absence of CXR evidence of a PTX seems a bit excessive.

 

[jdh71]

If someone is on a vent and has ARDS with a small PTX, it will eventually show up on the CXR. Looking on ultrasound in the absence of CXR evidence of a PTX seems a bit excessive.

thank you

 

[europeman]

I have an lady with essentially tidal vol of 30cc on vv ecmo with horrible ards who I tried some recruitment maneuvers after bronching her and she crashed. I grabbed ultrasound to look for sliding to rule out tension pneumo but then I realized.... She's not going to have sliding if she has no air movement! That is to say.... She didn't have lung sliding before this happened!

 

[jdh71]

I have an lady with essentially tidal vol of 30cc on vv ecmo with horrible ards who I tried some recruitment maneuvers after bronching her and she crashed. I grabbed ultrasound to look for sliding to rule out tension pneumo but then I realized.... She's not going to have sliding if she has no air movement! That is to say.... She didn't have lung sliding before this happened!

Why recruit someone on ecmo?

 

[europeman]

Trying to get her off ecmo. Eventually you have to get their lungs working again. Usually they come back after ARDSd after a couple weeks. We often will still prone them on ecmo too.