PurposeTo evaluate the presence of pulmonary infiltrates on admission among patients with intracranial hemorrhages, further refining on etiology and the agreement between ultrasonography and chest radiography.Materials and MethodsProspective analysis of patients with aneurysmal subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), during a 3-month period in a single center, utilizing a standardized protocol of lung ultrasonography. Clinical and ancillary testing data were also collected.Results44 patients were studied, 30 (68.18%) with ICH, and 14 (31.81%) with SAH. Among patients with ICH, 73.3% had B-lines detected in the assessment, and in the SAH group, 57.14% had presence of lung B-lines. Etiologically, 43% of patients with ICH and 7.1% with SAH had findings suggestive of neurogenic pulmonary edema. 13% of ICH patients and 28.5% in the SAH group had assessments consistent with cardiogenic pulmonary edema. Findings between chest radiography and lung ultrasonography showed poor agreement.ConclusionSonographic lung infiltrates in patients with severe brain injuries are common, reaching up to two-thirds of ICH admissions and the majority of SAH cases. The etiology varied, with presumed neurogenic pulmonary edema leading the incidence in the ICH cohort, and with cardiogenic pulmonary edema being the most common culprit within SAH patients.

The Extended Focused Assessment with Sonography for Trauma (eFAST) plays a crucial role in the emergency department (ED) by providing rapid and non-invasive diagnostic information in trauma patients. It is a diagnostic-free fluid detection technique that uses sonography to assess trauma in different anatomical windows of the chest and abdomen and has been accepted in multiple studies as the initial diagnostic tool for torso injuries in blunt abdominal trauma. By promptly identifying potentially life-threatening injuries, such as haemoperitoneum, haemothorax, and cardiac tamponade, eFAST facilitates timely intervention and improves patient outcomes in the ED. The eFAST exam is reliable, with high sensitivity and specificity, even when performed by non-radiological personnel, saving time and resources in the chaotic emergency environment. This review aims to assess the diagnostic reliability and limitations of eFAST in different trauma conditions and to outline its goals in trauma critical care and in "ABCDE" resuscitation.

Lung ultrasound (LUS) has emerged as a valuable bedside decision-making tool, particularly since the COVID-19 pandemic, with applications in diagnosing pneumonia, managing fluid, and monitoring interstitial lung diseases (ILDs) and acute respiratory distress syndrome (ARDS), ultimately improving patient outcomes. Its repeatability, environmental safety, and reduced radiation exposure make it ideal for vulnerable populations and resource-limited settings. However, challenges such as inadequate documentation and a lack of standardized reporting formats limit its widespread adoption. The evolution of technology offers different possibilities, and improvements in software open up a range of possibilities, but this contrasts with the lack of postgraduate and undergraduate training and formal accreditation. This review addresses the impact of lung ultrasound through the course of air-liquid ratio impairment, crossing different clinical scenarios and exploring the challenges and opportunities for the implementation of lung ultrasound in the post-COVID era.

Lung ultrasound is increasingly used in neonatal intensive care units. We summarized the ultrasonographic patterns, features of most neonatal respiratory morbidities, and clinical application in neonates. Lung ultrasound is a non-invasive, radiation-free, and reproducible adjunct tool that can guide the clinical management of neonates presenting with respiratory distress.

Lung ultrasound, the most precise diagnostic tool for pleural effusions, is underutilized due to healthcare providers' limited proficiency. To address this, deep learning models can be trained to recognize pleural effusions. However, current models lack the ability to diagnose effusions in diverse clinical contexts, which presents significant challenges.

To develop and validate a deep learning model for detecting pleural effusions in lung ultrasound images, with adaptable performance characteristics tailored to specific clinical scenarios.

A retrospective study was conducted at two Canadian tertiary hospitals to evaluate the detection of pleural effusions of varying sizes and complexities using lung ultrasound. A deep learning model incorporating a frame-level convolutional neural network and a clip-level prediction algorithm was developed and validated against expert annotations.

The model was evaluated using a holdout dataset of 103 lung ultrasound clips from 46 patients with pleural effusion and 136 clips from 83 patients without effusion. The general model achieved a sensitivity of 0.90 for small-to-large effusions, with a specificity of 0.89. The large effusion model demonstrated a sensitivity of 0.97 for large effusions while maintaining a specificity of 0.90. The trauma model showed high sensitivity to all effusions, including trace (0.91) and small (0.97) effusions.

Our research highlights the development of a deep learning model that effectively detects pleural effusions of varying sizes and complexities on lung ultrasound in different clinical settings. This tool has the potential to enhance emergency physicians' ability to quickly and accurately diagnose effusions, particularly in time-sensitive situations.

Sudden cardiac arrest (CA) is one of the leading causes of death in Europe, with over 70,000 cases annually in Germany. This study aims to evaluate diagnostic and therapeutic approaches for pulmonary edema in the post-resuscitation phase among intensive care physicians in Germany. Methods: The Working Group on Cardiopulmonary Resuscitation (AG42) of the German Cardiac Society conducted a web-based survey among its members. The survey assessed diagnostic methods, therapeutic strategies, and risk factors related to pulmonary edema after resuscitation. Results: A total of 77 participants, with a mean age of 43.9 years (±9.6), took part in the survey. Among them, 54.5% had more than 10 years of clinical experience in acute and intensive care medicine. Most clinics have access to radiological and sonographic procedures as well as advanced hemodynamic monitoring. Diagnostic measures are predominantly performed immediately upon admission (49.4%) or within one hour (36.4%) and are typically monitored every eight hours (77.9%). The oxygenation index (paO2/FiO2) is used by 64.9% to assess the severity of pulmonary edema, followed by qualitative evaluation of chest X-rays (46.8%) and B-line scoring via lung ultrasound (33.8%). Therapeutic approaches focus on optimizing ventilation parameters, hemodynamic management, and the use of loop diuretics. To prevent pulmonary edema, participants favor a differentiated therapy involving volume and vasoactive agents, guided by invasive hemodynamic measurements. Conclusion: Pulmonary edema, alongside cardiac and cerebral dysfunctions, represents a significant challenge in managing post-resuscitation syndromes. The survey results reveal substantial variability in diagnostic and therapeutic approaches. Prospective studies are needed to better understand the complex pathological mechanisms and develop standardized protocols.

Point-of-care ultrasound (POCUS) is an increasingly valuable tool in maternal medicine, offering rapid, bedside evaluation of critically ill pregnant patients. This study explores the expanding role of POCUS in obstetric care, particularly its application in assessing different organ systems. POCUS enables timely, accurate diagnoses and interventions, crucial for preventing maternal morbidity and mortality. While POCUS is widely used in emergency and intensive care, its potential in obstetric settings remains underexplored. Maternal and Fetal Medicine specialists, who already possess substantial ultrasound expertise, can easily integrate POCUS in daily practice.

Lung ultrasound (LUS) has become a crucial part of the investigative tools available in the management of critically ill patients, both within the intensive care unit setting and in prehospital medicine. The increase in its application, in part driven by the COVID-19 pandemic, along with the easy access and use of mobile and handheld devices, allows for immediate access to information, reducing the need for other radiological investigations. LUS allows for the rapid and accurate diagnosis and grading of respiratory pathology, optimisation of ventilation, assessment of weaning, and monitoring of the efficacy of surfactant therapies. This, however, must occur within the framework of accreditation to ensure patient safety and prevent misinterpretation and misdiagnosis. This narrative review aims to outline the current uses of LUS within the context of published protocols, associated pathologies, LUS scoring systems, and their applications, whilst exploring more novel uses.

The incorporation of artificial intelligence (AI) into point-of-care ultrasound (POCUS) platforms has rapidly increased. The number of B-lines present on lung ultrasound (LUS) serve as a useful tool for the assessment of pulmonary congestion. Interpretation, however, requires experience and therefore AI automation has been pursued. This study aimed to test the agreement between the AI software embedded in a major vendor POCUS system and visual expert assessment.

This single-center prospective study included 55 patients hospitalized for various respiratory symptoms, predominantly acutely decompensated heart failure. A 12-zone protocol was used. Two experts in LUS independently categorized B-lines into 0, 1-2, 3-4, and ≥ 5. The intraclass correlation coefficient (ICC) was used to determine agreement.

A total of 672 LUS zones were obtained, with 584 (87%) eligible for analysis. Compared with expert reviewers, the AI significantly overcounted number of B-lines per patient (23.5 vs. 2.8, p < 0.001). A greater proportion of zones with > 5 B-lines was found by the AI than by the reviewers (38% vs. 4%, p < 0.001). The ICC between the AI and reviewers was 0.28 for the total sum of B-lines and 0.37 for the zone-by-zone method. The interreviewer agreement was excellent, with ICCs of 0.92 and 0.91, respectively.

This study demonstrated excellent interrater reliability of B-line counts from experts but poor agreement with the AI software embedded in a major vendor system, primarily due to overcounting. Our findings indicate that further development is needed to increase the accuracy of AI tools in LUS.

Due to its diagnostic accuracy, point-of-care ultrasound (POCUS) is becoming more frequently used in the emergency department (ED), but the feasibility of its use by in-training residents and the potential clinical impact have not been assessed.

This study aimed to assess the feasibility of implementing a structured POCUS training program for in-training ED residents, as well as the clinical impact of their use of POCUS in the management of patients in the ED.

IMPULSE (Impact of a Point-of Care Ultrasound Examination) is a before-and-after implementation study evaluating the impact of a structured POCUS training program for ED residents on the management of patients admitted with acute respiratory failure (ARF) and/or circulatory failure (ACF) in a Swiss regional hospital. The training curriculum was organized into 3 steps and consisted of a web-based training course; an 8-hour, practical, hands-on session; and 10 supervised POCUS examinations. ED residents who successfully completed the curriculum participated in the postimplementation phase of the study. Outcomes were time to ED diagnosis, rate and time to correct diagnosis in the ED, time to prescribe appropriate treatment, and in-hospital mortality. Standard statistical analyses were performed using chi-square and Mann-Whitney U tests as appropriate, supplemented by Bayesian analysis, with a Bayes factor (BF)>3 considered significant.

A total of 69 and 54 patients were included before and after implementation of the training program, respectively. The median time to ED diagnosis was 25 (IQR 15-60) minutes after implementation versus 30 (IQR 10-66) minutes before implementation, a difference that was significant in the Bayesian analysis (BF=9.6). The rate of correct diagnosis was higher after implementation (51/54, 94% vs 36/69, 52%; P<.001), with a significantly shorter time to correct diagnosis after implementation (25, IQR 15-60 min vs 43, IQR 11-70 min; BF=5.0). The median time to prescribe the appropriate therapy was shorter after implementation (47, IQR 25-101 min vs 70, IQR 20-120 min; BF=2.0). Finally, there was a significant difference in hospital mortality (9/69, 13% vs 3/54, 6%; BF=15.7).

The IMPULSE study shows that the implementation of a short, structured POCUS training program for ED residents is not only feasible but also has a significant impact on their initial evaluation of patients with ARF and/or ACF, improving diagnostic accuracy, time to correct diagnosis, and rate of prescribing the appropriate therapy and possibly decreasing hospital mortality. These results should be replicated in other settings to provide further evidence that implementation of a short, structured POCUS training curriculum could significantly impact ED management of patients with ARF and/or ACF.

Positioning is an important physiotherapy treatment modality for the management of aeration loss associated with acute lobar atelectasis (ALA). Physiotherapists typically rely on lung auscultation and interpretation of chest x-ray (CXR) to inform treatment selection. These tools lack diagnostic accuracy, which could limit the ability of a physiotherapist to locate ALA and select an appropriate treatment position.

The objectives of this study were to determine the number of clinical physiotherapist treatment positions found to be in agreement with lung ultrasound (LUS)-identified aeration loss and to determine the diagnostic accuracy of CXR and lung auscultation against LUS as the reference standard for locating aeration loss in mechanically ventilated patients with ALA.

A prospective cohort study was conducted in a tertiary teaching hospital in Sydney. Mechanically ventilated adult patients in critical care with ALA were included. Physiotherapist-selected positions were compared against location of aeration loss based on LUS results to determine appropriateness. Location of aeration loss as identified by CXR results and lung auscultation was compared against LUS as the reference standard to determine diagnostic accuracy.

Forty-three participants were included in this study. Four out of 43 patients (9.3%) were positioned appropriately. The rate of true positives for CXR and auscultation in locating aeration loss were highest in the lower lobes. Lung auscultation had higher sensitivities (16.7%-97.4%) than CXR (0%-59.5%) in a majority of lobes when detecting location of aeration loss. CXR had higher specificities (16.7%-100%) than lung auscultation (0%-64.9%) in a majority of lobes when detecting location of aeration loss.

Physiotherapists did not deliver appropriate positioning in a majority of cases. Overall, the diagnostic accuracy of lung auscultation and CXR in detecting location of ALA was low. Correctly locating lung aeration loss is imperative to ensure appropriate respiratory physiotherapy positions are selected. Physiotherapists should consider additional assessment tools such as LUS to increase their diagnostic ability.

Lung ultrasound (LUS) aids in the diagnosis of patients with dyspnea, including those with cardiogenic pulmonary edema, but requires technical proficiency for image acquisition. Previous research has demonstrated the effectiveness of artificial intelligence (AI) in guiding novice users to acquire high-quality cardiac ultrasound images, suggesting its potential for broader use in LUS.

To evaluate the ability of AI to guide acquisition of diagnostic-quality LUS images by trained health care professionals (THCPs).

In this multicenter diagnostic validation study conducted between July 2023 and December 2023, participants aged 21 years or older with shortness of breath recruited from 4 clinical sites underwent 2 ultrasound examinations: 1 examination by a THCP operator using Lung Guidance AI and the other by a trained LUS expert without AI. The THCPs (including medical assistants, respiratory therapists, and nurses) underwent standardized AI training for LUS acquisition before participation.

Lung Guidance AI software uses deep learning algorithms guiding LUS image acquisition and B-line annotation. Using an 8-zone LUS protocol, the AI software automatically captures images of diagnostic quality.

The primary end point was the proportion of THCP-acquired examinations of diagnostic quality according to a panel of 5 masked expert LUS readers, who provided remote review and ground truth validation.

The intention-to-treat analysis included 176 participants (81 female participants [46.0%]; mean [SD] age, 63 [14] years; mean [SD] body mass index, 31 [8]). Overall, 98.3% (95% CI, 95.1%-99.4%) of THCP-acquired studies were of diagnostic quality, with no statistically significant difference in quality compared to LUS expert-acquired studies (difference, 1.7%; 95% CI, -1.6% to 5.0%).

In this multicenter validation study, THCPs with AI assistance achieved LUS images meeting diagnostic standards compared with LUS experts without AI. This technology could extend access to LUS to underserved areas lacking expert personnel.

ClinicalTrials.gov Identifier: NCT05992324.

Acute respiratory distress syndrome (ARDS) is a severe complication of critical illness, characterized by bilateral lung infiltrates and hypoxemia. Its clinical and pathophysiological heterogeneity poses challenges for both diagnosis and treatment. This review outlines the evolution of ARDS definitions, discusses the underlying pathophysiology of ARDS, and examines the clinical implications of its heterogeneity. Traditional ARDS definitions required invasive mechanical ventilation and relied on arterial blood gas measurements to calculate the PaO2/FiO2 ratio. Recent updates have expanded these criteria to include patients receiving noninvasive respiratory support, such as high-flow nasal oxygen, and the adoption of the SpO2/FiO2 ratio as an alternative to the PaO2/FiO2 ratio. While these changes broaden the diagnostic criteria, they also introduce additional complexity. ARDS heterogeneity-driven by varying etiologies, clinical subphenotypes, and underlying biological mechanisms-highlights the limitations of a uniform management approach. Emerging evidence highlights the presence of distinct ARDS subphenotypes, each defined by unique molecular and clinical characteristics, offering a pathway to more precise therapeutic targeting. Advances in omics technologies-encompassing genomics, proteomics, and metabolomics-are paving the way for precision-medicine approaches with the potential to revolutionize ARDS management by tailoring interventions to individual patient profiles. This paradigm shift from broad diagnostic categories to precise, subphenotype-driven care holds promise for redefining the landscape of treatment for ARDS and, ultimately, improving outcomes in this complex, multifaceted syndrome.

Accumulating evidence has challenged the traditional model of the liver-kidney connection in hepatorenal syndrome. Cirrhosis can significantly impact cardiac function, leading to cirrhotic cardiomyopathy. Recent understanding reveals how cardiac dysfunction plays a pivotal role in the development of renal dysfunction in this setting, suggesting that disturbances traditionally categorized under hepatorenal syndrome may actually represent a hepatic form of cardiorenal syndrome - hepatocardiorenal syndrome - where the liver affects the kidney through cardiorenal pathways.

Effective management of hepatocardiorenal syndrome and acute kidney injury in cirrhosis relies on accurately assessing a patient's hemodynamic and volume status. Point-of-care ultrasound, including lung and focused cardiac ultrasound, is a valuable diagnostic tool that provides crucial data on fluid tolerance, subclinical pulmonary congestion, and left ventricular filling pressures. This objective, bedside approach offers a comprehensive assessment that directly influences patient management and therapeutic decisions.

Point-of-care ultrasound plays an essential role in evaluating and managing hepatocardiorenal syndrome, providing insights into the underlying pathophysiology. By assessing hemodynamic parameters, it helps guide therapy and monitor patient responses, ensuring more accurate and effective treatment of patients with cirrhosis and acute kidney injury.

Point-of-care ultrasound (POCUS) bridges diagnostic gaps across the continuum of care worldwide and is a particularly potent tool in resource-limited settings (RLS). To capture the scope of its current impact in RLS, this narrative review of POCUS use in public health, primary care, outpatient specialty, pre-hospital, and palliative care settings discusses its use in reducing diagnostic health care inequities. Disease-specific protocols, longitudinal training, quality assurance, and task shifting are key to robust expansion of POCUS in RLS.

robust data on the utility of chest ultrasound scans (CUS) for triage and diagnosis of pediatric tuberculosis (TB) are lacking. Therefore, we aimed to compare CUS features to chest radiography (CXR), which is the recommended imaging modality in children with presumptive pulmonary tuberculosis (PTB).

eighty children ≤14 years of age with presumptive TB underwent CUS and CXR performed by two separate radiologists for each modality, who looked for the presence of consolidation, lymphadenopathy, and pleural effusion in both modalities. These were compared using Fisher's exact test for independence to determine whether there was a significant difference in the findings between the two modalities. Cohen's kappa coefficient was used to calculate the agreement between CXR and CUS. STATA version 15 was used for analysis.

the proportions of children with abnormal findings (consolidation, lymphadenopathy, and pleural effusions) on CUS were 65% (52/80) and 81.3% (65/80) on CXR. Sixty-two-point-five percent (62.5% (33/52)) of those with abnormal findings on CUS and 51.3% (33/65) on CXR were likely to have TB. The overall agreement for these characteristics was moderate (κ-0.42). The differences in the findings of consolidation and pleural effusion were not statistically significant on either CXR or CUS, whereas that of lymphadenopathy was statistically significant (P<0.001).

chest ultrasound scans detected more abnormalities in children with presumptive TB. Overall, the findings were comparable to those of CXR, except for lymphadenopathy. Ultrasound is a promising triage and diagnostic tool for pediatric TB.

Pleural effusions develop frequently after cardiac surgery in humans. Lung ultrasound is an essential non-invasive tool in the diagnosis and treatment of these effusions. Pleural effusions also develop regularly after preclinical cardiac xenotransplantation experiments. Unlike in the human setting, modern ultrasound devices lack pre-installed tools for calculating the volume of pleural effusions in baboons. The aim of this study was to analyze ultrasound examinations of pleural effusions after orthotopic pig-to-baboon cardiac xenotransplantation experiments in order to develop a formula for calculating the effusion volume based on ultrasound measurements.

Hearts from seven genetically modified (GGTA1-KO, hCD46/hTBM transgenic) juvenile pigs were orthotopically transplanted into male baboons. Postoperatively, the baboons were tested regularly for the development of pleural effusions using ultrasound. When thoracocentesis was required, the drained effusion volume (EV) was compared to ultrasound-derived calculations using various formulas. These calculations were based on measuring the distance between lung and diaphragm at the effusions' maximum height (Hmax). Subsequently, the most promising formula was used to describe the interobserver variability between trained and untrained staff members to predict effusion volumes based on ultrasound measurements.

Ultrasound measurement correlated very strongly with the absolute EV (r = 0.9156, p < 0.0001), with EV indexed to total body weight (r = 0.9344, p < 0.0001) and with EV indexed to body surface area (BSA) (r = 0.9394, p < 0.0001). The ratio between Hmax and EV increased with total body weight and BSA and also depended on the baboon species. The sonographic measurements taken by an experienced and an inexperienced observer showed only low interobserver variability. A Bland-Altman plot of both observers' measurements showed an overall bias of -2.39%.

Ultrasound imaging provides a simple and non-invasive tool for measuring pleural effusion quantity in baboons. This facilitates simple and efficient monitoring even in the hands of untrained personnel and may guide the decision-making to perform thoracocentesis.

The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the third Respiratory Failure and Mechanical Ventilation Conference in February 2024. The conference covered key points of acute and chronic respiratory failure in adults. During the 3-day conference ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. In this article, lectures delivered during the event have been summarised by early career members of the Assembly and take-home messages highlighted.

Lung imaging techniques are crucial for managing ventilated patients in pediatric intensive care units (PICUs). Bedside chest x-ray has limitations such as low sensitivity and radiation exposure risks. Recently, lung ultrasound has emerged as a promising technology offering advantages such as real-time monitoring and radiation-free imaging. However, the integration of lung ultrasound into clinical practice raises questions about its impact on chest x-ray prescriptions. This study aims to assess whether implementing lung ultrasound reduces reliance on chest x-rays for ventilated pediatric patients in the PICU. This before-and-after uncontrolled quality improvement project was conducted from January 2022 to December 2023 in a referral PICU. The study included three phases: retrospective evaluation, learning phase, and prospective evaluation. Patients aged under 14 years, intubated, and ventilated for ≤ 30 days were included. Lung ultrasound was performed using a standardized protocol, and chest x-rays were conducted as per clinical indications. During the study period, 430 patients were admitted to the PICU, with 142 requiring mechanical ventilation. Implementation of routine bedside lung ultrasound led to a 39% reduction in chest x-ray requests (p < 0.001). Additionally, there was a significant decrease in irradiation exposure and a 27% reduction in costs associated with chest x-rays.Conclusion: Routine bedside lung ultrasound is a valuable tool in the modern PICU, it reduces the number of chest x-rays, with reduced radiation exposure and a potential cost savings. What is known: • Bedside chest x-ray is the main imaging study in ventilated pediatric patients • Chest x-ray is a valuable tool in pediatric critical care but it is associated with irradiation exposure What is new: • Implementation of bedside lung ultrasound in pediatric critical care unites reduces the chest x-rays requests and therefore patient-irradiation.

Although point of care ultrasound (POCUS) use has become prevalent in medicine, clinicians may not be familiar with the evidence supporting its utility in patient care. The objective of this study is to identify the top five most influential papers published on the use of cardiac POCUS and lung POCUS in adult patients.

A 14-member expert panel from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative used a modified Delphi process. Panel members are ultrasound fellowship trained or equivalent, are engaged in POCUS scholarship, and are leaders in POCUS locally and nationally in Canada. The modified Delphi process consisted of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers on cardiac POCUS and lung POCUS.

A total of 66 relevant papers on cardiac POCUS and 68 relevant papers on lung POCUS were nominated by the panel. There was 100% participation by the panel members in all three rounds of the modified Delphi process. At the end of this process, we identified the top five most influential papers on cardiac POCUS and lung POCUS. Papers include studies supporting the use of POCUS for accurately assessing left ventricular systolic function, diagnosing pericardial effusion, clarifying its test characteristics for pulmonary embolism, identifying pulmonary edema and pneumonia, as well as consensus statements on the use of cardiac and lung POCUS in clinical practice.

We have created a list of the top five influential papers on cardiac POCUS and lung POCUS as an evidence-based resource for trainees, clinicians, and researchers. This will help trainees and clinicians better understand how to use POCUS when scanning the heart and lungs, and it will also help researchers better understand where to direct their scholarly efforts with future research.

Background: During the COVID-19 pandemic, several studies demonstrated the effectiveness of lung ultrasound (LUS) as a frontline tool in diagnosing and managing acute SARS-CoV-2 pneumonia. However, its role in detecting post-COVID-19 lung sequelae remains to be fully determined. This study aims to evaluate the diagnostic accuracy of LUS in identifying lung parenchymal damage, particularly fibrotic-like changes, following COVID-19 pneumonia, comparing its performance to that of CT. Methods: Relevant studies published before July 2024 were identified through a comprehensive search of PubMed, Embase, and Cochrane library. The search terms were combinations of the relevant medical subject heading (MeSH) terms, key words and word variants for "lung", "post-COVID", "long-COVID", and "ultrasound". The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve were used to examine the accuracy of CEUS. The selected works used different thresholds for the detection and counting of B-lines by ultrasound. This led to dividing our analysis into two models, the first based on the lower thresholds for detection of B-lines found in the works, and the second on data obtained using a higher detection threshold. Results: In terms of the diagnostic accuracy of LUS in detecting residual fibrotic-like changes in patients post-COVID-19 infection, a low-threshold model displayed a pooled sensitivity of 0.98 [95% confidence interval (CI): 0.95-0.99] and a pooled specificity of 0.54 (95% CI: 0.49-0.59). The DOR was 44.9 (95% CI: 10.8-187.1). The area under the curve (AUC) of SROC was 0.90. In the second analysis, the model with the higher threshold to detect B-lines showed a pooled sensitivity of 0.90 (95% CI: 0.85-0.94) and a pooled specificity of 0.88 (95% CI: 0.84-0.91). The DOR was 50.4 (95% CI: 15.9-159.3). The AUC of SROC was 0.93. Conclusions: In both analyses (even using the high threshold for the detection of B-lines), excellent sensitivity (98% in model 1 and 90% in model 2) is maintained. The specificity has a significant variation between the two models from 54 (model 1) to 87% (model 2). The model with the highest threshold for the detection of B-lines displayed the best diagnostic accuracy, as confirmed by the AUC values of the SROC (0.93).

Speckle tracking technology quantifies lung sliding and detects lung sliding abolition in case of pneumothorax on selected ultrasound loops through the analysis of acoustic markers.

We aimed to test the ability of speckle tracking technology to quantify lung sliding using a pleural strain value (PS).

We performed a prospective study in 30 healthy volunteers in whom we assessed the pleural speckle tracking using ultrasound loops. Seven breathing conditions with and without non-invasive ventilation were tested. Two observers analyzed the ultrasound loops in four lung areas (anterior and posterior, left and right) and compared the obtained PS values. The first endpoint was to determine the feasibility of the PS measurement in different breathing conditions. The secondary endpoints were to assess the intra- and inter-observer's reliability of the measurement to compare PS values between anterior and posterior lung areas and to explore their correlations with the measured tidal volume.

We analyzed 1624 ultrasound loops from 29 patients after one volunteer's exclusion. Feasibility of this method was rated at 90.8 [95%CI: 89.6 - 92.4]%. The intra-observer reliability measured through Intraclass Correlation Coefficients was 0.96 [95%CI: 0.91-0.98] and 0.93 [95%CI: 0.86-0.97] depending on the operator. The inter-observer reliability was 0.89 [95%CI: 0.78-0.95]. The PS values were significantly lower in the anterior lung areas compared with the posterior areas in all breathing conditions. A weak positive correlation was found in all the lung areas when a positive end expiratory pressure was applied with r = 0.26 [95%CI: 0.12;0.39]; p < 0.01.

Speckle tracking lung sliding quantification with PS was applicable in most conditions with an excellent intra- and inter-observer reliability. More studies in patients under invasive mechanical ventilation are needed to explore the correlation between PS values of pleural sliding and tidal volumes.

NCT05415605.

Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.

Digital health is an opportune way of facilitating the implementation of point-of-care ultrasound (POCUS) in intensive care units (ICUs) of the Brazilian Unified Health System (SUS) through remote tele-mentored ultrasound (RTMUS). Therefore, this pilot diagnostic accuracy study aims to evaluate the sensitivity and specificity of RTMUS, using POCUS as the gold standard for the diagnosis of pulmonary oedema. As a secondary objective, these metrics will be assessed for pneumonia, chronic obstructive pulmonary disease (COPD), pneumothorax, pulmonary embolism, and cardiac tamponade.

The study was conducted in three adult ICUs, monitored by the TeleUTI project, and included 23 patients who underwent POCUS carried out by an ICU medical professional and RTMUS carried out by a tele-intensivist from the institution that proposed the project.

The accuracy in diagnosing pulmonary oedema was 71.43%, COPD 89.96%, and for pneumonia, the results showed an accuracy of 65.22%. Analyses demonstrated that RTMUS has the same capability as POCUS for detecting true positive cases of pulmonary oedema, the same results of true negative cases for COPD, and a limitation in performance for pneumonia.

For COPD and pulmonary oedema, remote examination can support healthcare teams, suggesting that RTMUS has the potential to be a substitute for POCUS. We emphasise that the results should be interpreted within the context of the study, which is considered small and should be validated on a larger scale to consolidate the conclusions.

Lung ultrasound (LUS) is a non-invasive point of care diagnostic tool used to assess the presence and severity of various lung disorders for more than two decades. Within the healthcare professionals are the respiratory therapists (RTs) who play a vital role in managing ventilated and other patients requiring respiratory support, but the incorporation of LUS into their scope of practice has not been well highlighted. This international cross-sectional survey was specifically designed to evaluate the knowledge, attitude, and practice of RTs with respect to LUS.

This observational cross-sectional study was conducted among RTs from different parts of the world using a questionnaire-based study tool. 514 RTs responded to all the questions and were considered for statistical analysis. Descriptive statistics, Analysis of variance, Fisher's exact, Chi-square, Bonferroni post-hoc analysis, and Binomial logistic regression analyses were performed to identify the significance of the data.

From 22 countries, 514 RTs responded to the survey, with the major share from the middle eastern countries. Out of the 514 responders, 44.9% of the responders were in the age group of 23-30 years; 67.1% were bachelor's degree holders; and 40.9% of participants had more than 10 years of experience. The knowledge-based questions revealed that RTs with higher experience and academic qualification provided more positive responses. While in the attitude-related domain it is observed that standardized training in LUS helps them to enhance the current practice and to add LUS to the academic curriculum of respiratory therapy schools; however there remains barriers to practice LUS based on their responses. The practice-based questions revealed that RTs expect some additional seminars/workshops/webinars to be done on LUS frequently. More than half of the participants are found to be knowledgeable with a positive attitude and working towards the inclusion of LUS in respiratory therapy profession.

It is concluded that respiratory therapists have a positive attribute towards the inclusion of lung ultrasound in their clinical practice. Providing more structured training for professional respiratory therapists and including lung ultrasound modules in the respiratory therapy school curriculum may facilitate mastering their diagnostic skills, thereby expanding the scope of practice.

Point-of-care ultrasound (POCUS) allows for rapid bedside assessment and guidance of patient care. Recently, POCUS was included as a mandatory component of Canadian anesthesiology training; however, there is no national consensus regarding the competencies to guide curriculum development. We therefore aimed to define national residency competencies for basic perioperative POCUS proficiency.

We adopted a Delphi process to delineate relevant POCUS competencies whereby we circulated an online survey to academic anesthesiologists identified as POCUS leads/experts (n = 25) at all 17 Canadian anesthesiology residency programs. After reviewing a list of competencies derived from the Royal College of Physicians and Surgeons of Canada's National Curriculum, we asked participants to accept, refine, delete, or add competencies. Three rounds were completed between 2022 and 2023. We discarded items with < 50% agreement, revised those with 50-79% agreement based upon feedback provided, and maintained unrevised those items with ≥ 80% agreement.

We initially identified and circulated (Round 1) 74 competencies across 19 clinical domains (e.g., basics of ultrasound [equipment, nomenclature, clinical governance, physics]; cardiac [left ventricle, right ventricle, valve assessment, pericardial effusion, intravascular volume status] and lung ultrasound anatomy, image acquisition, and image interpretation; and clinical applications [monitoring and serial assessments, persistent hypotension, respiratory distress, cardiac arrest]). After three Delphi rounds (and 100% response rate maintained), panellists ultimately agreed upon 75 competencies.

Through national expert consensus, this study identified POCUS competencies suitable for curriculum development and assessment in perioperative anesthesiology. Next steps include designing and piloting a POCUS curriculum and assessment tool(s) based upon these nationally defined competencies.

The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

Acute hypoxaemic respiratory failure (AHRF) is associated with high mortality in sub-Saharan Africa. This is at least in part due to critical care-related resource constraints including limited access to invasive mechanical ventilation and/or highly skilled acute care workers. Continuous positive airway pressure (CPAP) and high-flow oxygen by nasal cannula (HFNC) may prove useful to reduce intubation, and therefore, improve survival outcomes among critically ill patients, particularly in resource-limited settings, but data in such settings are lacking. The aim of this study is to determine whether CPAP or HFNC as compared with standard oxygen therapy, could reduce mortality among adults presenting with AHRF in a resource-limited setting.

This is a prospective, multicentre, randomised, controlled, stepped wedge trial, in which patients presenting with AHRF in Uganda will be randomly assigned to standard oxygen therapy delivered through a face mask, HFNC oxygen or CPAP. The primary outcome is all-cause mortality at 28 days. Secondary outcomes include the number of patients with criteria for intubation at day 7, the number of patients intubated at day 28, ventilator-free days at day 28 and tolerance of each respiratory support.

The study has obtained ethical approval from the Research and Ethics Committee, School of Biomedical Sciences, College of Health Sciences, Makerere University as well as the Uganda National Council for Science and Technology. Patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.

NCT04693403.

8 September 2023; version 5.

Implementing a structured COVID-19 lung ultrasound system, using COVID-RADS standardization. This case series exams revealed correlations between ultrasonographic and tomographic findings. Ventilatory assessments showed that higher categories required second-line oxygen. This replicable tool will aid in screening and predicting disease severity beyond the pandemic.

We aimed to share our experience in implementing a structured system for COVID-19 lung findings, elucidating key aspects of the lung ultrasound score to facilitate its standardized clinical use beyond the pandemic scenario.

Using a scoring system to classify the extent of lung involvement, we retrospectively analyzed the ultrasound reports performed in our institution according to COVID-RADS standardization.

The study included 69 thoracic ultrasound exams, with 27 following the protocol. The majority of patients were female (52%), with ages ranging from 1 to 96 years and an average of 56 years. Classification according to COVID-RADS was as follows: 11.1% in category 0, 37% in category 1, 44.4% in category 2, and 7.4% in category 3. Ground-glass opacities on tomography correlated with higher COVID-RADS scores (categories 2 and 3) in 82% of cases. Ventilatory assessment revealed that 50% of cases in higher COVID-RADS categories (2 and 3) required second-line oxygen supplementation, while none of the cases in lower categories (0 and 1) utilized this support.

Lung ultrasound has been widely utilized as a diagnostic tool owing to its availability and simplicity of application. In the context of the pandemic emergency, a pressing need for a focused and easily applicable assessment arose. The structured reporting system, incorporating ultrasound findings for stratification, demonstrated ease of replicability. This system stands as a crucial tool for screening, predicting severity, and aiding in medical decisions, even in a non-pandemic context. Lung ultrasound enables precise diagnosis and ongoing monitoring of the disease. Ultrasound is an effective tool for assessing pulmonary findings in COVID-19. Structured reports enhance communication and are easily reproducible.

Pneumonia is a ubiquitous health condition with severe outcomes. The advancement of ultrasonography techniques allows its application in evaluating pulmonary diseases, providing safer and accessible bedside therapeutic decisions compared to chest X-ray and chest computed tomography (CT) scan. Because of its aforementioned benefits, we aimed to confirm the diagnostic accuracy of lung ultrasound (LUS) for pneumonia in adults.

A systematic literature search was performed of Medline, Cochrane and Crossref, independently by two authors. The selection of studies proceeded based on specific inclusion and exclusion criteria without restrictions to particular study designs, language or publication dates and was followed by data extraction. The gold standard reference in the included studies was chest X-ray/CT scan or both.

Twenty-nine (29) studies containing 6702 participants were included in our meta-analysis. Pooled sensitivity, specificity and PPV were 92% (95% CI: 91-93%), 94% (95% CI: 94 to 95%) and 93% (95% CI: 89 to 96%), respectively. Pooled positive and negative likelihood ratios were 16 (95% CI: 14 to 19) and 0.08 (95% CI: 0.07 to 0.09). The area under the ROC curve of LUS was 0. 9712.

LUS has high diagnostic accuracy in adult pneumonia. Its contribution could form an optimistic clue in future updates considering this condition.

This study aimed to elucidate the effectiveness of bedside thoracic ultrasound according to BLUE protocol and to investigate its superiority over other imaging methods in the emergency service.

A total of 120 patients admitted to our institution's emergency care department due to respiratory distress have been enrolled in this prospective research. Thorax USG has been performed in the right and left hemithorax at the points specified in the BLUE protocol for each patient. Pleural sliding motion, A-lines, B-lines, consolidation, effusion, and the presence of barcode signs were evaluated individually. Age, sex, comorbid diseases, other radiological examination findings, laboratory findings, final clinical diagnosis, and hospitalization-discharge status of the patients were recorded.

When a correct diagnosis of pneumonia has been analyzed for imaging techniques, the diagnostic rate of chest radiography was 83.3%, CT was 100.0%, and USG was 66.6%. The correct diagnostic rate of chest radiography was 94.5%; CT and USG were 100.0%. The correct diagnosis of pulmonary edema on chest radiography was 94.5%; CT and USG were 100.0%. While the correct diagnosis of pleural effusion on chest radiography and CT was 100.0%, it was 92.3% in USG imaging. Finally, CT and USG imaging performed better than chest radiography in patients with pneumothorax (chest radiography 80.0%, CT and USG 100%).

USG imaging could be preferred in the diagnosis of pneumonia, pulmonary edema, pleural effusion, pneumothorax, pulmonary embolism, and differential diagnosis at the emergency service.

Several studies have shown that bedside lung ultrasound findings in postanaesthesia care units (PACUs) and intensive care units (ICUs) correlate with postoperative pulmonary complications(PPCs) after noncardiac major surgery. However, it remains unclear whether lung ultrasound findings can be used as early predictors of PPCs in patients undergoing cardiac surgery. The main aim of our study was to evaluate the relationship between early postoperative point-of-care lung ultrasound findings and PPCs after cardiac surgery.

Two board-certified physicians performed a point-of-care pulmonary ultrasound on cardiac surgery patients approximately 2 h after the patient was admitted to the ICU. Pulmonary complications occurring within 30 days postoperatively were recorded. Logistic regression modeling was used to analyze the relationship between lung ultrasound findings and PPCs.

PPCs occurred in 61 (30.9 %) of the 197 patients. Lung ultrasound scores(LUS), number of lung consolidation(NLC), and depth of pleural effusion(DPE) were more significant in patients who developed PPCs (P < 0.001). According to the multivariate analysis, NLC≥3(aOR 2.71,95%CI 1.14-6.44; p = 0.024)and DPE >0.95(aOR 3.79,95%CI 1.60-8.99; p = 0.002) were found to be independently associated with PPCs during this study.

Our study demonstrated that DPE >0.95 and NLC ≥3 were associated with PPCs after cardiac surgery based on bedside lung ultrasound findings in the ICU. When these signs manifest perioperatively, the surgeon should be alerted and the necessary steps should be taken, especially if they present simultaneously.

Thoracentesis is one of the most important invasive procedures in the clinical setting. Particularly, thoracentesis can be relevant in the evaluation of a new diagnosed pleural effusion, thus allowing for the collection of pleural fluid so that laboratory tests essential to establish a diagnosis can be performed. Furthermore, thoracentesis is a maneuver that can have therapeutic and palliative purposes. Historically, the procedure was performed based on a physical examination. In recent years, the role of ultrasound has been established as a valuable tool for assistance and guidance in the thoracentesis procedure. The use of ultrasound increases success rates and significantly reduces complications. The aim of this educational review is to provide a detailed and sequential examination of the procedure, focusing on the two main modalities, the ultrasound-assisted and ultrasound-guided form.

Acute respiratory distress syndrome (ARDS), first described in 1967, is characterized by acute respiratory failure causing profound hypoxemia, decreased pulmonary compliance, and bilateral CXR infiltrates. After several descriptions, the Berlin definition was adopted in 2012, which established three categories of severity according to hypoxemia (mild, moderate and severe), specified temporal aspects for diagnosis, and incorporated the use of non-invasive ventilation. The COVID-19 pandemic led to changes in ARDS management, focusing on continuous monitoring of oxygenation and on utilization of high-flow oxygen therapy and lung ultrasound. In 2021, a New Global Definition based on the Berlin definition of ARDS was proposed, which included a category for non-intubated patients, considered the use of SpO2, and established no particular requirement for oxygenation support in regions with limited resources. Although debates persist, the continuous evolution seeks to adapt to clinical and epidemiological needs, and to the search of personalized treatments.

Lung diseases are commonly diagnosed based on clinical pathological indications criteria and radiological imaging tools (e.g., X-rays and CT). During a pandemic like COVID-19, the use of ultrasound imaging devices has broadened for emergency examinations by taking their unique advantages such as portability, real-time detection, easy operation and no radiation. This provides a rapid, safe, and cost-effective imaging modality for screening lung diseases. However, the current pulmonary ultrasound diagnosis mainly relies on the subjective assessments of sonographers, which has high requirements for the operator's professional ability and clinical experience. In this study, we proposed an objective and quantifiable algorithm for the diagnosis of lung diseases that utilizes two-dimensional (2D) spectral features of ultrasound radiofrequency (RF) signals. The ultrasound data samples consisted of a set of RF signal frames, which were collected by professional sonographers. In each case, a region of interest of uniform size was delineated along the pleural line. The standard deviation curve of the 2D spatial spectrum was calculated and smoothed. A linear fit was applied to the high-frequency segment of the processed data curve, and the slope of the fitted line was defined as the frequency spectrum standard deviation slope (FSSDS). Based on the current data, the method exhibited a superior diagnostic sensitivity of 98% and an accuracy of 91% for the identification of lung diseases. The area under the curve obtained by the current method exceeded the results obtained that interpreted by professional sonographers, which indicated that the current method could provide strong support for the clinical ultrasound diagnosis of lung diseases.

Background/Objectives: Ultrasound (US) has been progressively spreading as the most useful technique for guiding biopsies and fine-needle aspirations that are performed percutaneously. Malignant pleural mesothelioma (MPM) represents the most common malignant pleural tumour. Thoracoscopy represents the gold standard for diagnosis, although conditions hampering such diagnostic approach often coexist. The Objective was to determine whether ultrasound-guided percutaneous needle biopsy (US-PPNB) has a high diagnostic accuracy and represents a safe option for diagnosis of MPM. Methods: US-PPNB of pleural lesions suspected for MPM in patients admitted from January 2021 to June 2023 have been retrospectively analyzed. An 18-gauge semi-automatic spring-loaded biopsy system (Medax Velox 2®) was used by experienced pneumologists. The obtained specimens were histologically evaluated and defined as adequate or non-adequate for diagnosis according to whether the material was considered appropriate or not for immunohistochemistry (IHC) analysis. The primary objective of the study was the diagnostic yield for a tissue diagnosis. Results: US-PPNB was diagnostic of MPM in 15 out of 18 patients (sensitivity: 83.39%; specificity: 100%; PPV: 100%). Three patients with non-adequate US-PPNB underwent thoracoscopy for diagnosis. We found significant differences in terms of mean pleural lesion thickness between patients with adequate and not-adequate biopsy (15.4 mm (SD: 9.19 mm) and 3.77 mm (SD: 0.60 mm), p < 0.0010. In addition, a significant positive correlation has been observed between diagnostic accuracy and FDG-PET avidity value. Conclusions: US-PPNB performed by a pneumologist represents a valid procedure with a high diagnostic yield and accuracy for the diagnosis of MPM, and may be considered as an alternative option in patients who are not suitable for thoracoscopy.

Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed-anatomical and artifactual-pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.

Determining dry weight is crucial for optimizing hemodialysis, influencing efficacy, cardiovascular outcomes, and overall survival. Traditional clinical assessment methods for dry weight, relying on factors such as blood pressure and edema, frequently lack reliability. Lung ultrasound stands out as a promising tool for assessing volume status, given its non-invasiveness and reproducibility. This study aims to explore the role of Lung ultrasound in evaluating the impact of hemodialysis and ultrafiltration on extravascular lung water, with a specific focus on changes in B-lines post-hemodialysis compared to pre-hemodialysis.

The research encompassed searches across PubMed, WOS, and Scopus databases for studies related to lung ultrasound and hemodialysis. A meta-analysis was then performed to determine the mean differences in various parameters before compared to after, hemodialysis, including the number of B-lines, indexed end-inspiratory and end-expiratory inferior vena cava diameters, inferior vena cava collapsibility index, weight, blood pressure, and serum levels of NT-pro-BNP.

Our meta-analysis, included 33 studies with 2301 hemodialysis patients, revealed a significant decrease in the number of B-lines post-hemodialysis (mean difference = 8.30, 95% CI [3.55 to 13.05]). Furthermore, there was a noteworthy reduction in inspiratory and expiratory inferior vena cava diameters post-hemodialysis (mean difference = 2.32, 95% CI [0.31 to 4.33]; mean difference = 4.05, 95% CI [2.44 to 5.65], respectively). Additionally, a significant positive correlation was observed between B-lines and the maximum inferior vena cava diameter both pre- and post-hemodialysis (correlation coefficient = 0.39; correlation coefficient = 0.32, respectively).

These findings indicate the effectiveness of lung ultrasound in detection of volume overload and assessment of response to ultrafiltration in hemodialysis patients.