<< Emergency Ultrasound In Patients With Respiratory Distress


TOC Will Appear Here



Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study, will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.

  1. American College of Emergency Physicians, News Media Resources. Available at www.acep.org/webportal/Newsroom/NewsMediaResources/StatisticsData/default.htm. Accessed October 21, 2011. (American College of Emergency Physicians reference database)
  2. Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA. 1989:261(6):884-888. (Prospective; 50 patients)
  3. Ray P, Birolleau S, Lefort Y, et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Critical Care. 2006;10(3):R82. (Prospective observational study; 514 patients)
  4. Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294(13):1664–1670. (Meta-analysis; 5051 patients)
  5. American College of Emergency Physicians; Emergency Ultrasound Guidelines 2001. www.acep.org (Practice management guideline)
  6. American College of Emergency Physicians; Emergency Ultrasound Guidelines 2008. www.acep.org (Practice management guideline)
  7. Rose JS, Bair AE. Fundamentals of Ultrasound. In: Cosby KS, Kendall JL. Practical Guide to Emergency Ultrasound. Philadelphia: Lippincott Williams & Wilkins; 2006: 27-41. (Textbook chapter)
  8. Noble VE, Nelson BP. Manual of Emergency and Critical Care Ultrasound. New York: Cambridge University Press; 2011; 1-21. (Textbook)
  9. Collins SP, Lindsell CJ, Storrow AB, Abraham WT; ADHERE Scientific Advisory Committee Investigators and Study Group (2006). Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann Emerg Med. 47(1):13-18. (Retrospective study; 85,376 subjects)
  10. Maisel AS, Krishnaswamv P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-167. (Prospective; 1586 patients)
  11. * Lichtenstein DA, Meziere G, Biderman P, et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156(5):1640-1646. (Prospective study; 121 patients)
  12. * Agricola E, Bove T, Oppizzi M, et al. “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study of wedge pressure and extravascular lung water. Chest. 2005;127(5):1690-1695. (Observational; 20 patients)
  13. * Volpicelli G, Mussa A, Garofalo G, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med. 2006;24(6):689-696. (Prospective, observational study; 300 patients)
  14. Liteplo AS, Marill KA, Villen T, 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):201-210. (Prospective observational study; 100 patients)
  15. * Lichtenstein DA. Ultrasound in the management of thoracic disease. Crit Care Med. 2007;35(5 Suppl):S250-S261. (Review)
  16. Chakko S, Woska D, Martinez H, et al. Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med. 1991;90(3):353-359. (Observational study; 52 patients)
  17. Badgett RG, Lucey CR, Mulrow CD. Can the clinical examination diagnose left-sided heart failure in adults? JAMA. 1997;277(21):1712-1719. (Literature review)
  18. * Lichtenstein DA, Meziere G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med.11998;24(12):1331-1334. (Prospective study; 66 patients)
  19. Jambrik A, Monti S, Coppola V, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol. 2004;93(10):1265-1270. (Observational study; 121 patients)
  20. Picano E, Frassi F, Agricola E, et al. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr. 2006;19(3):356-363. (Review)
  21. Zanobetti M, Poggioni C, Pini R. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest. 2011;139(5):1140-1147. (Prospective, blinded study; 404 patients)
  22. Volpicelli G, Caramello V, Cardinale L, et al. Detection of sonographic B lines in patients with normal lungs or radiographic alveolar consolidation. Med Sci Monit. 2008;14(3):CR122-128. (Observational; 217 patients)
  23. Lichtenstein DA, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9-15. (Prospective; 32 patients)
  24. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117-125. (Observational study; 260 patients)
  25. Reissig A, Kroegel C. Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. J Ultrasound Med. 2003;22(2):173-180. (Observational; 53 patients)
  26. Dao Q, Krishnaswamy P, Kazanegra R, et al. Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent care setting. J Am Coll Cardiol. 2001;37(2):379-385. (Retrospective; 250 subjects)
  27. Collins SP, Ronan-Bentle S, Storrow AB. Diagnostic and prognostic usefulness of natriuretic peptides in emergency department patients with dyspnea. Ann Emerg Med. 2003;41(4): 532-545. (Review)
  28. Morrison LK, Harrison A, Krishnaswamy P, et al. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol. 2002;39(2):202-209. (Retrospective; 321 patients)
  29. Collins JD, Burwell D, Furmanski S, et al. Minimal detectable pleural effusions. Radiology. 1972;105(1):51-53. (Observational cadaver study)
  30. Lichtenstein, DA, Hulot J, Rabiller A, et al. Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med. 1999;25(9):955-958. (Prospective study; 40 patients in the ICU setting)
  31. Sabia P, Abbott RD, Afrookteh A, et al. Importance of two-dimensional echocardiographic assessment of left ventricular systolic function in patients presenting to the emergency room with cardiac-related symptoms. Circulation. 1991;84(4):1615-1624. (Prospective study; 171 patients)
  32. * Moore CL, Rose GA, Tayal VS, et al. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med. 2002;9(3):186-193. (Prospective observational study; 51 patients)
  33. Melamed R, Sprenkle MD, Ulstad VK, et al. Assessment of left ventricular function by intensivist using hand-held echocardiography. Chest. 2009;135(6):1416-1420. (Observational study; 44 patients)
  34. Randazzo MR, Snoey ER, Levitt A, et al. Accuracy of emergency physician assessment of left ventricular function and central venous pressure using echocardiography. Acad Emerg Med. 2003;10(9):973-977. (Cross-sectional observational study; 115 patients)
  35. Kataoka H, Takada S. The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll of Cardiol. 2000;35(6):1638-1646. (Observa tional study; 60 patients)
  36. Yang PC, Luh KT, Chang DB, et al. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. Am J Roentgenol. 1992;159(1):29-33. (Prospective study; 320 patients)
  37. Lichtenstein DA, Hulot JS, Rabiller A, et al. Feasibility and safety of ultrasound-guided thoracentesis in mechanically ventilated patients. Intensive Care Med. 1999;25(9):955-958. (Observational study; 40 patients)
  38. * Mandavia DP, Hoffner RJ, Mahaney K, et al. Bedside echocardiography for emergency physicians. Ann Emerg Med. 2001;38(4):377-382. (Prospective study; 515 patients)
  39. Guberman B, Fowler N, Engel P, et al. Cardiac tamponade in medical patients. Circulation. 1981;64(3):633-640.
  40. Eisenberg MJ, de Romeral LM, Heidenreich PA et al. The diagnosis of pericardial effusion and cardiac tamponade by 12- lead ECG. A technology assessment. Chest. 1996;110(2):318-324. (Blinded cross-sectional study; 155 patients)
  41. Roy CL, Minor MA, Brookhart MA et al. Does this patient with a pericardial effusion have cardiac tamponade? JAMA. 2007;297(16):1810. (Systematic review; 8 studies)
  42. Jacob S, Sebastian JC, Cherian PK, et al. Pericardial effusion impending tamponade: a look beyond Beck’s triad. Am J Emerg Med. 2009;27(2):216-219. (Case report, literature review)
  43. Rozycki GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multi-center study. J Trauma. 1999;46(4):543-551. (Prospective study; 261 patients)
  44. Rozycki GS, Ballard RB, Feliciano DV, et al. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg. 1998;228(4):557-567. (Prospective study; 1540 patients)
  45. Jones AE, Tayal VS, Kline JA. Focused training of emergency medicine residents in goal-directed echocardiography: a prospective study. Acad Emerg Med. 2003;10(10):1054-1058. (Prospective study; 21 subjects)
  46. Blaivas M. Incidence of pericardial effusion in patients presenting to the emergency department with unexplained dyspnea. Acad Emerg Med. 2001;8(12):1143-1146. (Prospective observational study; 103 patients)
  47. Tayal VS, Kline JA. Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation. 2003;59(3):315-318. (Prospective observational study; 20 patients)
  48. Nagdev A, Stone MB. Point-of-care ultrasound evaluation of pericardial effusions: does this patient have cardiac tamponade? Resuscitation. 2011;82(6):671-673. (Review)
  49. Himelman RB, Kircher B, Rockey DC, et al. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of tamponade. J Am Coll Cardiol. 1988;12(6):1470- 1477. (Retrospective study; 115 patients)
  50. Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684-690. (Review)
  51. Armstrong WF, Schilt BF, Helper DJ, et al. Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation. 1982;65(7):1491-1496. (Retrospective study; 91 patients)
  52. Seferovic PM, Ristic AD, Imazio M, et al. Management strategies in pericardial emergencies. Herz. 2006;31(9):891-900. (Review)
  53. Tsung T, Enriquez-sarnao M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002;77(5):429-436. (Retrospective chart review and survey study; 1127 patients)
  54. Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30(5):1165-1171.
  55. Torbicki A, Pruszczyk P. The role of echocardiography in suspected and established PE. Semin Vasc Med. 2001;1(2):165-174. (Review)
  56. Nazeyrollas P, Metz D, Mailier B, et al. Transthoracic echocardiography and diagnosis of acute pulmonary embolism; change in the diagnostic value with respect to thresholds of classification. Arch Mal Coeur Vaiss. 1997;90(4):463-469. (Prospective study; 70 patients)
  57. Jackson RE, Rudoni RR, Hauser AM, et al. Prospective evaluation of two-dimensional transthoracic echocardiography in emergency department patients with suspected pulmonary embolism. Acad Emerg Med. 2000;7(9):994-998. (Prospective study; 225 patients)
  58. Bova C, Greco F, Misuraca G, et al. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism. Am J Emerg Med. 2003;21(3):180-183. (Prospective study; 162 patients)
  59. Miniati M, Monti S, Pratali L, et al. Diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med. 2001;110(7):528-535. (Prospective study; 110 patients)
  60. Cannon CP, Goldhaber SZ. Cardiovascular risk stratification of pulmonary embolism. Am J Cardiol. 1996;78(10):1149-1151. (Review)
  61. Worster A, Smith CO, Silver S, et al. Thrombolytic therapy for submassive pulmonary embolism. Ann Emerg Med. 2007;50(1):78- 84. (Review)
  62. Mansencal N, Joseph T, Vieillard-Baron A, et al. Comparison of different echocardiographic indices secondary to right ventricular obstruction in acute pulmonary embolism. Am J Cardiol. 2003;92(1):116-119. (Retrospective study)
  63. McConnell MV, Solomon SD, Rayan ME, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am. J. Cardiol. 1996;78(4):469–473.
  64. Lang RM, Bierig M, Devereux RB, et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification. J Am Soc Echocardiogr. 2005;18(12):1440-1463. (Practice management guideline)
  65. Burnside PR, Brown MD, Kline JA. Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis. Acad Emerg Med 2008;15(6):493-498. (Review)
  66. Crisp JG, Lovato LM, Jang TB. Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect venous thrombosis in the emergency department. Ann Emerg Med. 2010;56(6):601-610. (Prospective study; 199 patients)
  67. Ball CG, Wyrzykowski AD, Kirkpatrick AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184-188.
  68. * Lichtenstein DA, Meziere G, Lascold N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231- 1238. (Prospective trial; 200 patients)
  69. Dulchavsky SA, Schwarz KL, Kirkpatrick AW, et al. Prospective evaluation of thoracic ultrasound in the detection of pneumothoraceses. J Trauma. 2001;50(2):201-205. (Prospective trial; 382 patients)
  70. Knudtson JL, Dort JM, Helmer SD, et al. Surgeon-performed ultrasound for pneumothorax in the trauma suite. J Trauma. 2004;56(3):527-530. (Prospective trial; 328 patients)
  71. * Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest. 1995;108(5):1345-1348. (Prospective trial; 111 patients)
  72. * Lichtenstein DA, Meziere G, Biderman P, et al. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med. 1999;25(4):383-388. (Prospective trial; 114 patients)
  73. Lichtenstein DA, Meziere G, Biderman P, et al. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26(10):1434-1440. (Prospective trial; 299 patients)
  74. Kirkpatrick AW, Ng AKT, Dulchavsky SA, et al. Sonographic diagnosis of a pneumothorax inapparent on plain radiography: Confirmation by computed tomography. J Trauma. 2001;50(4):750-752. (Prospective trial; 36 patients)
  75. Rowan KR, Kirkpatrick AW, Liu D, et al. Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT – initial experience. Radiology. 2002;225(1):210-214. (Prospective trial; 27 patients)
  76. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849. (Prospective study; 176 patients)
  77. Kirkpatrick AW, Sirois M, Laupland KB, 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):288-295.
  78. * Dulchavsky SA, Hamilton DR, Diebel LN, et al. Thoracic ultrasound diagnosis of pneumothorax. J Trauma. 1999;47:970-971. (Review)
  79. Chan SS. Emergency bedside ultrasound to detect pneumothorax. Acad Emerg Med. 2003;10:91-94. (Review)
  80. Ma OJ, Gaddis G, Norvell JG, et al. How fast is the focused assessment with sonography for trauma examination learning curve? Emerg Med Australas. 2008;20(1):32-37. (Prospective study; 9 patients)
  81. Olsen WR, Hildreth DH. Abdominal paracentesis and peritoneal lavage in blunt abdominal trauma. J Trauma. 1971;11(10):824-829. (Prospective; 90 patients)
  82. Fagenholz PJ, Gutman JA, Murray AF et al. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest. 2007;131(4):1013-1018. (Case series; 11 patients)
  83. Mayron R, Gaidop PE, Plummer D, et al. Echocardiography performed by emergency physicians: impact on diagnosis and therapy. Ann Emerg Med. 1988;17(2):150-151. (Review)
  84. Jones AE, Tayal VS, Sullivan DM, et al. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of non-traumatic hypotension in emergency department patients. Crit Care Med. 2004;32(8):1703-1708. (Prospective randomized controlled trial; 184 patients)
  85. Atkinson PR, McAuley DJ, Kendall RJ, et al. Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J. 2009;26(2):87-91. (Practice management guideline)
  86. Perera P, Mailhot T, Riley D et al. The RUSH exam: Rapid Ultrasound in Shock in the evaluation of the critically ill. Emerge Med Clin North Am. 2010;28(1):29-56. (Review article)
  87. Moore CL, Gregg S, Lambert M. Performance, training, quality assurance and reimbursement of emergency physician performed ultrasonography at academic medical centers. J Ultrasound Med. 2004;23(4):459-466. (Survey; 102 respondents)
Publication Information

Christine B. Irish; Liisa O. Carden

Publication Date

February 4, 2012

Get Permission

Related Articles

An Evidence-Based Approach To Emergency Ultrasound

Get A Sample Issue Of Emergency Medicine Practice
Enter your email to get your copy today! Plus receive updates on EB Medicine every month.
Please provide a valid email address.