Ultrazvuk pluća u dijagnostici akutnih respiratornih stanja

master's thesis

• Title (english): Lung ultrasound in diagnostics of acute respiratory conditions
• Author: Andrija Agejev
• Mentor: Radovan Radonić (mentor)
• Committee member: Ivan Gornik (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Radovan Radonić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Akutna respiratorna stanja su stanja koja naglo nastaju i uzrokuju narušenje funkcije disanja, odnosno dispneju. Glavni dijagnostički izazov je odrediti etiologiju dispneje. Standardne metode uključuju klinički pregled, odnosno auskultaciju te radiološke metode, u prvom redu radiografiju pluća. Kompjuterizirana tomografija je najpreciznija metoda, međutim zbog brojnih razloga kao što su velike doze zračenja i nemogućnost primjene pretrage uz krevet bolesnika teško može postati metoda prvog izbora u akutnoj respiracijskoj insuficijenciji. Ultrazvuk pluća pokazao je veliku osjetljivost i specifičnost u diferencijalnoj dijagnozi najčešćih akutnih respiratornih stanja. Ova metoda primjenjiva je uz krevet bolesnika, može se koristiti i izvan bolnice, njome se lako prati razvoj bolesti te ne izlaže bolesnika ionizirajućem zračenju. Donedavno se mislilo da ultrazvuk pluća nema nikakvu kliničku važnost zbog gotovo potpunog odbijanja ultrazvučnih valova od površine pluća što onemogućuju pregled pluća ultrazvukom za razliku od pregleda solidnih organa. Međutim, Lichtenstein je otkrio da promatranjem pleure i njoj pridruženih artefakata može doći do ključnih informacija za postavljanje ispravne dijagnoze. Na temelju svojih otkrića razvio je dijagnostički algoritam „BLUE protocol“ koji se pokazao ispravnim u pronalaženju točnog uzroka akutne respiracijske insuficijencije u značajnom broju slučajeva. Ultrazvuk pluća u mnogim je istraživanjima pokazao bolju osjetljivost i specifičnost od radiografije pluća te je stoga moćna dijagnostička metoda u rukama iskusnog kliničara. Potrebna su daljnja istraživanja kako bi se u potpunosti iskoristili njezini potencijali.

Abstract (english)

Acute respiratory conditions are conditions which cause sudden deterioration of respiratory function, also known as dyspnea. Main diagnostic challenge is to determine the etiology of dyspnea. Standard methods include clinical examination, most importantly auscultation and radiologic procedures. Most commonly used is chest radiography. Computerized tomography is a method of highest accuracy, however due to numerous reasons like high radiation dosage or incapability of performing the procedure bedside it can hardly become the method of choice in acute respiratory failure. Lung ultrasound has shown to be highly sensitive and specific in differential diagnosis of the most frequent acute respiratory conditions. This method can be applied bedside, it can be used even outside of hospitals, the follow-up is easy and it does not expose patients to ionizing radiation. It had been considered until recently that lung ultrasound is of no clinical importance due to almost complete reflection of ultrasound waves against lung surface, which makes lung ultrasound examination impossible. However, Lichtenstein revealed that by examining pleura and joined artefacts key information for making a right diagnosis can be obtained. Based on his discoveries, he developed a diagnostic algorithm „BLUE protocol“ which showed great accuracy in detecting the correct cause of acute respiratory insufficiency in a significant number of cases. Many studies show that lung ultrasound is more sensitive and more specific in comparison to chest radiography what makes him a powerful tool in hands of an experienced clinician. Further research needs to be undertaken in order to fully use its potential.

• Keywords: ultrazvuk pluća; dispneja; B linije; klizanje pleure
• Keywords (english): lung ultrasound; dyspnea; B lines; lung sliding
• Language: croatian
• URN:NBN: urn:nbn:hr:105:410698
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-13 10:23:09