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Skinner E, Patel A, Ahmad F, Garg R, Da Silva I. Analyses of Lung Parenchyma Infiltrates Using Ultrasonography in Neurocritically ill Patients. J Intensive Care Med 2025:8850666251343005. [PMID: 40492284 DOI: 10.1177/08850666251343005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2025]
Abstract
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.
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Affiliation(s)
- Evan Skinner
- Department of Neurological Sciences, Division of Critical Care Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Alok Patel
- Department of Critical Care, Northwestern University McHenry Hospital, McHenry, Illinois, USA
| | - Fawaz Ahmad
- Department of Critical Care, Swedish Medical Center, Seattle, Washington, USA
| | - Rajeev Garg
- Department of Neurological Sciences, Division of Critical Care Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ivan Da Silva
- Department of Neurology, Division of Neurocritical Care, University of Florida, Gainesville, FL, USA
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2
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Bella FM, Bonfichi A, Esposito C, Zanza C, Bellou A, Sfondrini D, Voza A, Piccioni A, Di Sabatino A, Savioli G. Extended Focused Assessment with Sonography for Trauma in the Emergency Department: A Comprehensive Review. J Clin Med 2025; 14:3457. [PMID: 40429451 PMCID: PMC12112529 DOI: 10.3390/jcm14103457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 04/06/2025] [Accepted: 04/26/2025] [Indexed: 05/29/2025] Open
Abstract
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.
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Affiliation(s)
- Federico M. Bella
- Department of Internal Medicina, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (F.M.B.); (A.B.); (A.D.S.)
| | - Alessandra Bonfichi
- Department of Internal Medicina, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (F.M.B.); (A.B.); (A.D.S.)
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Abdelouahab Bellou
- Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China;
| | - Domenico Sfondrini
- Maxillofacial Unit, Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Antonio Di Sabatino
- Department of Internal Medicina, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (F.M.B.); (A.B.); (A.D.S.)
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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3
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D’Ardes D, Deana C, Boccatonda A, Biasucci DG, Cipollone F, Castro-Sayat M, Colaianni-Alfonso N, Gallardo A, Vetrugno L. Lung Ultrasound After COVID-19: A Pivotal Moment for Clinical Integration-Navigating Challenges and Seizing Opportunities. Healthcare (Basel) 2025; 13:1148. [PMID: 40427984 PMCID: PMC12110943 DOI: 10.3390/healthcare13101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 04/20/2025] [Accepted: 05/13/2025] [Indexed: 05/29/2025] Open
Abstract
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.
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Affiliation(s)
- Damiano D’Ardes
- Institute of “Clinica Medica”, Department of Medicine and Aging Science, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.D.); (F.C.)
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, 33100 Udine, Italy;
| | - Andrea Boccatonda
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, “Tor Vergata” University of Rome, 00133 Rome, Italy;
| | - Francesco Cipollone
- Institute of “Clinica Medica”, Department of Medicine and Aging Science, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.D.); (F.C.)
| | - Mauro Castro-Sayat
- Intermediate Respiratory Care Unit, Juan A. Fernandez Hospital, Buenos Aires C1425, Argentina;
| | | | - Adrián Gallardo
- Department of Kinesiology and Respiratory Care, “Sanatorio Clínica Modelo de Morón”, Morón C1015, Argentina;
- Department of Health Sciences, Kinesiology and Physiatry, National University of La Matanza, San Justo B1754, Argentina
| | - Luigi Vetrugno
- Department of Emergency, Health Integrated Agency of Friuli Centrale, 33100 Udine, Italy;
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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4
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Surak A, Shaireen H, Elsayed Y. Applications of lung ultrasound as an emerging tool in neonates. J Neonatal Perinatal Med 2025; 18:187-196. [PMID: 40340483 DOI: 10.1177/19345798251325492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
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.
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Affiliation(s)
- Aimann Surak
- Section of Neonatology, Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Huma Shaireen
- Section of Neonatology, Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Yasser Elsayed
- Section of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, MB, Canada
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5
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Chaudhary R, Ho J, Smith D, Hossain S, Hargun J, VanBerlo B, Murphy N, Prager R, Rikhraj K, Tschirhart J, Arntfield R. Diagnostic accuracy of an automated classifier for the detection of pleural effusions in patients undergoing lung ultrasound. Am J Emerg Med 2025; 90:142-150. [PMID: 39874677 DOI: 10.1016/j.ajem.2025.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 01/13/2025] [Accepted: 01/15/2025] [Indexed: 01/30/2025] Open
Abstract
RATIONALE 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. OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Rushil Chaudhary
- Department of Medicine, Western University, London, ON N6A 5C1, Canada.
| | - Jordan Ho
- Department of Family Medicine, Western University, London, ON N6A 5C1, Canada
| | - Delaney Smith
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Saad Hossain
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Jaswin Hargun
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Blake VanBerlo
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Niall Murphy
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Ross Prager
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada
| | - Kiran Rikhraj
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jared Tschirhart
- Department of Family Medicine, Western University, London, ON N6A 5C1, Canada
| | - Robert Arntfield
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada
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6
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Voigt I, Graf T, Wengenmayer T, Staudacher DL, Preusch M, Jung C, Michels G. [Cardiac resuscitation-associated lung edema (CRALE): evaluation of diagnostic and therapeutic approaches by an expert group of the German Cardiac Society]. Med Klin Intensivmed Notfmed 2025:10.1007/s00063-025-01268-7. [PMID: 40126642 DOI: 10.1007/s00063-025-01268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 01/31/2025] [Accepted: 03/02/2025] [Indexed: 03/26/2025]
Abstract
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.
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Affiliation(s)
- Ingo Voigt
- Klinik für Akut- und Notfallmedizin, Elisabeth-Krankenhaus Essen, Essen, Deutschland.
| | - Tobias Graf
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Tobias Wengenmayer
- Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Dawid L Staudacher
- Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Michael Preusch
- Sektion Internistische Intensivmedizin, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christan Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland
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7
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van der Zande JA, Rijs K, Shamshirsaz AA, Soliman H, Franx A, Kauling RM, Roos-Hesselink JW, van der Marel CD, Verdonk K, Cornette JMJ. The role of point-of-care ultrasound (POCUS) in maternal medicine. Best Pract Res Clin Obstet Gynaecol 2025; 100:102599. [PMID: 40132463 DOI: 10.1016/j.bpobgyn.2025.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 02/24/2025] [Indexed: 03/27/2025]
Abstract
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.
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Affiliation(s)
- J A van der Zande
- Department of Obstetrics and Fetal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Rijs
- Department of Anesthesia, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A A Shamshirsaz
- Department of Obstetric and Gynecology/Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States
| | - H Soliman
- Department of Cardiothoracic Intensive Care, Royal Brompton and Harefield Hospitals, King's College London, London, United Kingdom
| | - A Franx
- Department of Obstetrics and Fetal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R M Kauling
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C D van der Marel
- Department of Anesthesia, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Verdonk
- Department of Internal and Obstetric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J M J Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Berry L, Rehnberg L, Groves P, Knight M, Stewart M, Dushianthan A. Lung Ultrasound in Critical Care: A Narrative Review. Diagnostics (Basel) 2025; 15:755. [PMID: 40150097 PMCID: PMC11941729 DOI: 10.3390/diagnostics15060755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 03/04/2025] [Accepted: 03/13/2025] [Indexed: 03/29/2025] Open
Abstract
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.
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Affiliation(s)
- Lee Berry
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- School of Health Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Lucas Rehnberg
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
| | - Paul Groves
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Shackleton Department of Anaesthetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Martin Knight
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Shackleton Department of Anaesthetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Michael Stewart
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Shackleton Department of Anaesthetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Perioperative and Critical Care Theme, NIHR Biomedical Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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9
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Labaf A, Åhman-Persson L, Husu LS, Smith JG, Ingvarsson A, Evaldsson AW. Performance of a point-of-care ultrasound platform for artificial intelligence-enabled assessment of pulmonary B-lines. Cardiovasc Ultrasound 2025; 23:3. [PMID: 40025516 PMCID: PMC11874383 DOI: 10.1186/s12947-025-00338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 01/12/2025] [Indexed: 03/04/2025] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ashkan Labaf
- Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Lund University, Skåne University Hospital, Klinikgatan 15, Lund, 221 85, Sweden.
| | - Linda Åhman-Persson
- Department of Internal and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Leo Silvén Husu
- Department of Internal and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - J Gustav Smith
- Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Lund University, Skåne University Hospital, Klinikgatan 15, Lund, 221 85, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Annika Ingvarsson
- Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Lund University, Skåne University Hospital, Klinikgatan 15, Lund, 221 85, Sweden
| | - Anna Werther Evaldsson
- Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Lund University, Skåne University Hospital, Klinikgatan 15, Lund, 221 85, Sweden
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10
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Bieler S, von Düring S, Tagan D, Grosgurin O, Fumeaux T. Impact of a Point-of-Care Ultrasound Training Program on the Management of Patients With Acute Respiratory or Circulatory Failure by In-Training Emergency Department Residents (IMPULSE): Before-and-After Implementation Study. JMIRX MED 2025; 6:e53276. [PMID: 40029894 DOI: 10.2196/53276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/06/2025] [Accepted: 01/30/2025] [Indexed: 03/12/2025]
Abstract
Background 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. Objective 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. Methods 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. Results 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). Conclusions 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.
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Affiliation(s)
- Sandra Bieler
- Médecin cheffe, Service des Urgences, Hôpital de Sion, Sion, 1950, Switzerland
| | - Stephan von Düring
- Faculté de Médecine de l'Université de Genève, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Damien Tagan
- Service des Soins critiques, Hôpital Riviera Chablais, Rennaz, Switzerland
| | - Olivier Grosgurin
- Service de médecine interne générale et Service des Urgences, Hôpitaux Universitaires de Genève, Genève, Switzerland
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Hansell L, Milross M, Ntoumenopoulos G. Appropriateness of respiratory physiotherapy positioning for acute lobar collapse. Aust Crit Care 2025; 38:101114. [PMID: 39304404 DOI: 10.1016/j.aucc.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND 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. OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Louise Hansell
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, Australia.
| | - Maree Milross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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12
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Baloescu C, Bailitz J, Cheema B, Agarwala R, Jankowski M, Eke O, Liu R, Nomura J, Stolz L, Gargani L, Alkan E, Wellman T, Parajuli N, Marra A, Thomas Y, Patel D, Schraft E, O’Brien J, Moore CL, Gottlieb M. Artificial Intelligence-Guided Lung Ultrasound by Nonexperts. JAMA Cardiol 2025; 10:245-253. [PMID: 39813064 PMCID: PMC11904735 DOI: 10.1001/jamacardio.2024.4991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 10/30/2024] [Indexed: 01/16/2025]
Abstract
Importance 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. Objective To evaluate the ability of AI to guide acquisition of diagnostic-quality LUS images by trained health care professionals (THCPs). Design, Setting, and Participants 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. Interventions 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. Main Outcomes and Measures 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. Results 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%). Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT05992324.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Baljash Cheema
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ravi Agarwala
- LeBauer Pulmonary and Critical Care, Cone Health, Greensboro, North Carolina
- University of North Carolina at Chapel Hill
| | - Madeline Jankowski
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Onyinyechi Eke
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Rachel Liu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jason Nomura
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- ChristianaCare Health System, Newark, Delaware
| | - Lori Stolz
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Eren Alkan
- Caption Health/GE HealthCare, Chicago, Illinois
| | | | | | | | | | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Evelyn Schraft
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - James O’Brien
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Christopher L. Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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13
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Al-Husinat L, Azzam S, Al Sharie S, Araydah M, Battaglini D, Abushehab S, Cortes-Puentes GA, Schultz MJ, Rocco PRM. A narrative review on the future of ARDS: evolving definitions, pathophysiology, and tailored management. Crit Care 2025; 29:88. [PMID: 39994815 PMCID: PMC11852867 DOI: 10.1186/s13054-025-05291-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 01/21/2025] [Indexed: 02/26/2025] Open
Abstract
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.
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Affiliation(s)
- Lou'i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Saif Azzam
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Sarah Al Sharie
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Araydah
- Department of Internal Medicine, Istishari Hospital, Amman, Jordan
| | - Denise Battaglini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Suhib Abushehab
- Department of Medicine, University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), Bristol, UK
| | | | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
- Department of Anesthesia, General Intensive Care and Pain Management, Medical University Wien, Vienna, Austria
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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14
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Koratala A, Ronco C, Kazory A. Hepatocardiorenal Syndrome: Integrating Pathophysiology with Clinical Decision-Making via Point-Of-Care Ultrasound. Cardiorenal Med 2025; 15:184-197. [PMID: 39933496 DOI: 10.1159/000543681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 01/16/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND 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. SUMMARY 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. KEY MESSAGES 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.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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15
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Beam M, Abdull Wahab SF, Ramos M. Point-of-Care Ultrasound in Resource-Limited Settings. Med Clin North Am 2025; 109:313-324. [PMID: 39567101 DOI: 10.1016/j.mcna.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
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.
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Affiliation(s)
- Michelle Beam
- Department of General Internal Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | - Shaik Farid Abdull Wahab
- Department of Emergency Medicine, University Science Malaysia, Trauma Center, Hospital University Science Malaysia, 4th Floor, Kubang Kerian, Kelantan 16150, Malaysia
| | - Mena Ramos
- Department of Family and Community Medicine, Global Ultrasound Institute, University of California San Francisco, 1569 Sloat Boulevard, Suite 333, San Francisco, CA 94132, USA; Global Ultrasound Institute, Oakland, CA 94607, USA
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16
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Erem G, Otike C, Okuja M, Ameda F, Nalyweyiso DI, Bugeza S, Mubuuke AG, Kakinda M. Comparison of chest ultrasound features to chest radiography in the diagnosis for pediatric tuberculosis: a cross-sectional study. Pan Afr Med J 2024; 49:95. [PMID: 40060286 PMCID: PMC11889438 DOI: 10.11604/pamj.2024.49.95.45265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 10/13/2024] [Indexed: 05/13/2025] Open
Abstract
Introduction 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). Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Geoffrey Erem
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
- Department of Radiology, St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Caroline Otike
- Department of Data Joint Clinical Research Center, Kampala, Uganda
| | - Maxwell Okuja
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Faith Ameda
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | | | - Samuel Bugeza
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | | | - Michael Kakinda
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
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17
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Bender M, Radan J, Reichart B, Leuschen M, Wall F, Mokelke M, Neumann E, Buttgereit I, Ayares D, Wolf E, Brenner P, Abicht JM, Längin M. Ultrasound Assessment of Pleural Effusions After Orthotopic Pig-to-Baboon Cardiac Xenotransplantation. Xenotransplantation 2024; 31:e70006. [PMID: 39552137 DOI: 10.1111/xen.70006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/19/2024] [Accepted: 10/18/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- Martin Bender
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Radan
- Transregional Collaborative Research Center 127, Walter Brendel Centre of Experimental Medicine, LMU Munich, Munich, Germany
| | - Bruno Reichart
- Transregional Collaborative Research Center 127, Walter Brendel Centre of Experimental Medicine, LMU Munich, Munich, Germany
| | - Maria Leuschen
- Transregional Collaborative Research Center 127, Walter Brendel Centre of Experimental Medicine, LMU Munich, Munich, Germany
| | - Felicia Wall
- Transregional Collaborative Research Center 127, Walter Brendel Centre of Experimental Medicine, LMU Munich, Munich, Germany
| | - Maren Mokelke
- Transregional Collaborative Research Center 127, Walter Brendel Centre of Experimental Medicine, LMU Munich, Munich, Germany
| | - Elisabeth Neumann
- Transregional Collaborative Research Center 127, Walter Brendel Centre of Experimental Medicine, LMU Munich, Munich, Germany
| | - Ines Buttgereit
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Munich, Germany
- Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Munich, Germany
| | - Paolo Brenner
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Jan-Michael Abicht
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Längin
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
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Bianquis C, De Leo G, Morana G, Duarte-Silva M, Nolasco S, Vilde R, Tripipitsiriwat A, Viegas P, Purenkovs M, Duiverman M, Karagiannids C, Fisser C. Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2024. Breathe (Sheff) 2024; 20:240105. [PMID: 39534488 PMCID: PMC11555592 DOI: 10.1183/20734735.0105-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/19/2024] [Indexed: 11/16/2024] Open
Abstract
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.
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Affiliation(s)
- Clara Bianquis
- Sorbonne Université-APHP, URMS 1158, Department R3S, Hôpital Pitié-Salpétriêre, Paris, France
| | - Giancarlo De Leo
- Pulmonology Department, Regional General Hospital ‘F. Miulli’, Acquaviva delle Fonti, Italy
| | - Giorgio Morana
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marta Duarte-Silva
- Pulmonology Department, Hospital Santa Marta, Unidade Local de Saúde São José, Lisboa, Portugal
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico ‘G. Rodolico-San Marco’ University Hospital, Catania, Italy
| | - Rūdolfs Vilde
- Centre of Lung disease and Thoracic surgery, Pauls Stradins clinical university hospital, Riga, Latvia
- Department of internal medicine, Riga Stradins University, Riga, Latvia
| | - Athiwat Tripipitsiriwat
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Pedro Viegas
- Departamento de Pneumonologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Martins Purenkovs
- Centre of Pulmonology and Thoracic surgery, Pauls Stradiņš Clinical university hospital, Riga, Latvia
- Riga Stradiņš University, Riga, Latvia
| | - Marieke Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Christian Karagiannids
- Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Christoph Fisser
- Department of Internal Medicine II University Medical Center Regensburg, Regensburg, Germany
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Thabet F, Zayani S, Daya A, Ben Nasrallah C, Chouchane C, Chouchane S. Impact of routine bedside lung ultrasound implementation on chest x-ray requests for mechanically ventilated children: a before-after uncontrolled quality improvement project. Eur J Pediatr 2024; 183:4379-4384. [PMID: 39096386 DOI: 10.1007/s00431-024-05710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/05/2024]
Abstract
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.
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Affiliation(s)
- Farah Thabet
- Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
| | - Seyfeddine Zayani
- Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Abir Daya
- Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Cyrine Ben Nasrallah
- Department of Preventive and Epidemiology Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Chokri Chouchane
- Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Kim DJ, Sheppard G, Lewis D, Buchanan IM, Jelic T, Thavanathan R, Myslik F, Lalande E, Bell CR, Chenkin J, Heslop CL, Olszynski P, Atkinson P, Burwash-Brennan T. POCUS literature primer: key papers on cardiac and lung POCUS. CAN J EMERG MED 2024; 26:713-720. [PMID: 39183217 DOI: 10.1007/s43678-024-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Ian M Buchanan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Rajiv Thavanathan
- Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire L Heslop
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Talia Burwash-Brennan
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
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21
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Boccatonda A, D’Ardes D, Tallarico V, Guagnano MT, Cipollone F, Schiavone C, Piscaglia F, Serra C. Role of Lung Ultrasound in the Detection of Lung Sequelae in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5607. [PMID: 39337096 PMCID: PMC11432428 DOI: 10.3390/jcm13185607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
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).
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Affiliation(s)
- Andrea Boccatonda
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (D.D.); (M.T.G.); (F.C.)
| | - Viola Tallarico
- Internal Medicine, Bentivoglio Hospital, Azienda Unità Sanitaria Locale (AUSL) Bologna, 40010 Bentivoglio, Italy;
| | - Maria Teresa Guagnano
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (D.D.); (M.T.G.); (F.C.)
| | - Francesco Cipollone
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (D.D.); (M.T.G.); (F.C.)
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy;
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Carla Serra
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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22
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Duclos G, Marecal L, Resseguier N, Postzich M, Taguet C, Hraiech S, Leone M, Müller L, Zieleskiewicz L. Pleural lung sliding quantification using a speckle tracking technology: A feasibility study on 30 healthy volunteers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 254:108316. [PMID: 38968827 DOI: 10.1016/j.cmpb.2024.108316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION 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. OBJECTIVES We aimed to test the ability of speckle tracking technology to quantify lung sliding using a pleural strain value (PS). METHODS 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. RESULTS 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. CONCLUSION 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. CLINICAL REGISTRATION NCT05415605.
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Affiliation(s)
- Gary Duclos
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université.
| | - Ludivine Marecal
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université
| | - Noemie Resseguier
- Service d'Épidémiologie et d'Économie de la Santé, AP-HM, Marseille, France, Aix-Marseille Université; CEReSS-Health Services and Quality of Research, Aix-Marseille University, Marseille, France
| | - Martin Postzich
- Service d'Épidémiologie et d'Économie de la Santé, AP-HM, Marseille, France, Aix-Marseille Université
| | - Chloe Taguet
- Service d'assistance Médicale d'urgence (SAMU), AP-HM, Hôpital de la Timone, Marseille, France, Aix-Marseille Université
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Marc Leone
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université
| | - Laurent Müller
- Service de Réanimation et Surveillance Continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France
| | - Laurent Zieleskiewicz
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université
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Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, Weblin J, Gao-Smith F, Ahmed Z, Duggal NA, Veenith T. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 2024; 15:6447. [PMID: 39085269 PMCID: PMC11291905 DOI: 10.1038/s41467-024-50805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
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.
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Affiliation(s)
- Fiona Howroyd
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK.
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Cyril Chacko
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Andrew MacDuff
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Nandan Gautam
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Brian Pouchet
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Bill Tunnicliffe
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Jonathan Weblin
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Fang Gao-Smith
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Niharika A Duggal
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK.
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König Klever E, Silva GDOL, da Silva MMD, da Rocha JC, da Silva MGS, Chagas MEV, de Amorim JDR, Pires ADA, Cunha Birriel D, Constant HMRM, Moreira TDC, Cabral FC. Telemedicine ultrasound in intensive care unit: A pilot diagnostic accuracy study. ULTRASOUND (LEEDS, ENGLAND) 2024:1742271X241264178. [PMID: 39555156 PMCID: PMC11565499 DOI: 10.1177/1742271x241264178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/03/2024] [Indexed: 11/19/2024]
Abstract
Introduction 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. Methods 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. Results 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. Conclusions 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.
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25
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Mathew CS, Dias E, Sreedharan JK, Al Ahmari M, Trujillo L, West A, Karthika M. Lung ultrasound in respiratory therapy: a global reflective survey. Multidiscip Respir Med 2024; 19:980. [PMID: 38953856 PMCID: PMC11229826 DOI: 10.5826/mrm.2024.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Chris Sara Mathew
- Srinivas Institute of Medical Sciences and Research Center, Srinivas University, Mangalore, India
- Faculty of Medical and Health Sciences, Liwa College, Abu Dhabi, UAE
| | - Edwin Dias
- Srinivas Institute of Medical Sciences and Research Center, Srinivas University, Mangalore, India
| | | | | | - Lisa Trujillo
- Department of Respiratory Care and Diagnostic Science, University of Kansas Medical Center, Kansas, USA
| | - Andrew West
- Canadian Society of Respiratory Therapists, Canada
| | - Manjush Karthika
- Faculty of Medical and Health Sciences, Liwa College, Abu Dhabi, UAE
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Mizubuti GB, Maxwell S, Shatenko S, Braund H, Phelan R, Ho AMH, Dalgarno N, Hobbs H, Szulewski A, Haji F, Arellano R. Competencies for proficiency in basic point-of-care ultrasound in anesthesiology: national expert recommendations using Delphi methodology. Can J Anaesth 2024; 71:967-977. [PMID: 38632162 DOI: 10.1007/s12630-024-02746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston General Hospital Site, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Sarah Maxwell
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Sergiy Shatenko
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Faculty of Health Sciences, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Faculty of Health Sciences, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Hailey Hobbs
- Department of Critical Care Medicine, POCUS Fellowship Program Director, Queen's University, Kingston, ON, Canada
| | - Adam Szulewski
- Departments of Emergency Medicine and Psychology, Educational Scholarship Lead & Resuscitation and Reanimation Medicine Fellowship Program Director, Queen's University, Kingston, ON, Canada
| | - Faizal Haji
- Division of Neurosurgery, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
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Ocrospoma S, Restrepo MI. Severe aspiration pneumonia in the elderly. JOURNAL OF INTENSIVE MEDICINE 2024; 4:307-317. [PMID: 39035624 PMCID: PMC11258512 DOI: 10.1016/j.jointm.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 07/23/2024]
Abstract
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.
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Affiliation(s)
- Sebastian Ocrospoma
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
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Kwizera A, Kabatoro D, Owachi D, Kansiime J, Kateregga G, Nanyunja D, Sendagire C, Nyakato D, Olaro C, Audureau E, Mekontso Dessap A. Respiratory support with standard low-flow oxygen therapy, high-flow oxygen therapy or continuous positive airway pressure in adults with acute hypoxaemic respiratory failure in a resource-limited setting: protocol for a randomised, open-label, clinical trial - the Acute Respiratory Intervention StudiEs in Africa (ARISE-AFRICA) study. BMJ Open 2024; 14:e082223. [PMID: 38951007 PMCID: PMC11218023 DOI: 10.1136/bmjopen-2023-082223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/19/2024] [Indexed: 07/03/2024] Open
Abstract
RATIONALE 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. METHODS 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. ETHICS AND DISSEMINATION 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. TRIAL REGISTRATION NUMBER NCT04693403. PROTOCOL VERSION 8 September 2023; version 5.
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Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daphne Kabatoro
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- Department of Emergency Medicine, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Jackson Kansiime
- Department of Internal Medicine, St Mary's Hospital, Gulu, Uganda
| | - George Kateregga
- Department of Anaesthesia and Intensive Care, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Doreen Nanyunja
- Department of Internal Medicine, China-Uganda Friendship Hospital Naguru, Kampala, Uganda
| | | | | | | | - Etienne Audureau
- CEPIA EA7376, Universite Paris-Est Creteil Val de Marne, Creteil, France
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Romano VC, Lima NTDMB, Jabour VA, Del Guerra GC, Silvério PRB, Garcia RG, Sameshima YT, Francisco Neto MJ, de Queiroz MRG. Lessons from the pandemic and the value of a structured system of ultrasonographic findings in the diagnosis of COVID-19 pulmonary manifestations. EINSTEIN-SAO PAULO 2024; 22:eAE0780. [PMID: 38865568 PMCID: PMC11155724 DOI: 10.31744/einstein_journal/2024ae0780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/05/2023] [Indexed: 06/14/2024] Open
Abstract
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. OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Vítor Carminatti Romano
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Victor Arantes Jabour
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Rodrigo Gobbo Garcia
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Yoshino Tamaki Sameshima
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Miguel José Francisco Neto
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Desai D, Shah AB, Dela JRC, Mugibel TA, Sumaily KM, Sabi EM, Mujamammi AH, Malafi ME, Alkaff SA, Alwahbi TA, Bahabara JO, Dahman LSB. Lung Ultrasonography Accuracy for Diagnosis of Adult Pneumonia: Systematic Review and Meta-Analysis. Adv Respir Med 2024; 92:241-253. [PMID: 38921063 PMCID: PMC11200838 DOI: 10.3390/arm92030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS LUS has high diagnostic accuracy in adult pneumonia. Its contribution could form an optimistic clue in future updates considering this condition.
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Affiliation(s)
- Dev Desai
- Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Gujarat University, Ahmedabad 380006, India; (D.D.); (A.B.S.)
| | - Abhijay B. Shah
- Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Gujarat University, Ahmedabad 380006, India; (D.D.); (A.B.S.)
| | - Joseph Rem C. Dela
- College of Medicine, University of the Philippines, Manila 1000, Philippines;
| | - Tayba A. Mugibel
- College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen; (S.A.A.); (T.A.A.)
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Khalid M. Sumaily
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (K.M.S.); (E.M.S.); (A.H.M.)
| | - Essa M. Sabi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (K.M.S.); (E.M.S.); (A.H.M.)
| | - Ahmed H. Mujamammi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (K.M.S.); (E.M.S.); (A.H.M.)
| | - Maria E. Malafi
- Medical School, Democritus University, 68100 Alexandroupolis, Greece;
| | - Sara A. Alkaff
- College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen; (S.A.A.); (T.A.A.)
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Thurya A. Alwahbi
- College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen; (S.A.A.); (T.A.A.)
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Jamal O. Bahabara
- Radiology Unit, Department of Specialized Surgery, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
| | - Lotfi S. Bin Dahman
- Clinical Biochemistry Unit, Laboratory Medicine Department, College of Medicine and Health Sciences, Hadhramout University, Mukalla, Yemen;
- Hadhramout Foundation—Human Development, Mukalla, Yemen
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Ocel S, Kekec Z, Taskin O, Belli F, Tugcan MO. Diagnostic role of thoracic ultrasound in patients with acute respiratory failure at emergency service. Ir J Med Sci 2024; 193:1573-1579. [PMID: 38308140 DOI: 10.1007/s11845-024-03618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND AIM 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. METHODS 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. RESULTS 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%). CONCLUSION USG imaging could be preferred in the diagnosis of pneumonia, pulmonary edema, pleural effusion, pneumothorax, pulmonary embolism, and differential diagnosis at the emergency service.
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Affiliation(s)
- Samet Ocel
- Department of Emergency Medicine, Adana City Research and Training Hospital, Health Science University, 01060, Adana, Turkey.
| | - Zeynep Kekec
- Department of Emergency Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Omer Taskin
- Emergency Medicine Clinic, Yuregir State Hospital, Adana, Turkey
| | - Fuat Belli
- 5 Ocak State Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Mustafa Oguz Tugcan
- Department of Emergency Medicine, Adana City Research and Training Hospital, Health Science University, 01060, Adana, Turkey
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Fan G, Zhang F, Shan T, Jiang Y, Zheng M, Zang B, Zhao W. Association of point-of-care lung ultrasound findings with 30-day pulmonary complications after cardiac surgery: A prospective cohort study. Heliyon 2024; 10:e31293. [PMID: 38813155 PMCID: PMC11133817 DOI: 10.1016/j.heliyon.2024.e31293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Guanglei Fan
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fengran Zhang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tianchi Shan
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yaning Jiang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mingzhu Zheng
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Baohe Zang
- Department of Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenjing Zhao
- Department of Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Boccatonda A, Baldini C, Rampoldi D, Romani G, Corvino A, Cocco G, D’Ardes D, Catalano O, Vetrugno L, Schiavone C, Piscaglia F, Serra C. Ultrasound-Assisted and Ultrasound-Guided Thoracentesis: An Educational Review. Diagnostics (Basel) 2024; 14:1124. [PMID: 38893651 PMCID: PMC11172328 DOI: 10.3390/diagnostics14111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
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.
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Affiliation(s)
- Andrea Boccatonda
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi Hospital, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy;
| | - Chiara Baldini
- Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (C.B.); (D.R.); (G.R.)
| | - Davide Rampoldi
- Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (C.B.); (D.R.); (G.R.)
| | - Giacomo Romani
- Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant’Orsola, 40138 Bologna, Italy; (C.B.); (D.R.); (G.R.)
| | - Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples Parthenope, 80133 Napoli, Italy;
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, Gabriele d’Annunzio University of Chieti and Pescara, 66100 Chieti, Italy; (G.C.); (C.S.)
| | - Damiano D’Ardes
- Institute of “Clinica Medica”, Department of Medicine and Aging Science, Gabriele d’Annunzio University of Chieti and Pescara, 66100 Chieti, Italy;
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, 80126 Naples, Italy;
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, Gabriele d’Annunzio University of Chieti and Pescara, 66100 Chieti, Italy; (G.C.); (C.S.)
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy;
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi Hospital, 40138 Bologna, Italy;
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Estenssoro E, González I, Plotnikow GA. Post-pandemic acute respiratory distress syndrome: A New Global Definition with extension to lower-resource regions. Med Intensiva 2024; 48:272-281. [PMID: 38644108 DOI: 10.1016/j.medine.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 04/23/2024]
Abstract
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.
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Affiliation(s)
- Elisa Estenssoro
- Escuela de Gobierno en Salud, Ministerio de Salud, Buenos Aires, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina.
| | - Iván González
- Servicio de Rehabilitación, Área de Kinesiología Crítica, Hospital Británico de Buenos Aires, CABA, Argentina
| | - Gustavo A Plotnikow
- Servicio de Rehabilitación, Área de Kinesiología Crítica, Hospital Británico de Buenos Aires, CABA, Argentina; Facultad de Medicina y Ciencias de la Salud, Universidad Abierta Interamericana, Argentina
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Zhang Q, Song R, Hang J, Wei S, Zhu Y, Zhang G, Ding B, Ye X, Guo X, Zhang D, Wu P, Lin H, Tu J. A lung disease diagnosis algorithm based on 2D spectral features of ultrasound RF signals. ULTRASONICS 2024; 140:107315. [PMID: 38603903 DOI: 10.1016/j.ultras.2024.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
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.
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Affiliation(s)
- Qi Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Jing Hang
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Siqi Wei
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yifei Zhu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Guofeng Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Bo Ding
- Zhuhai Ecare Electronics Science & Technology Co., Ltd., Zhuhai 519041, China
| | - Xinhua Ye
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiasheng Guo
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Pingping Wu
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China
| | - Han Lin
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China.
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China.
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Iadevaia C, D’Agnano V, Pagliaro R, Nappi F, Lucci R, Massa S, Bianco A, Perrotta F. Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma. J Clin Med 2024; 13:2600. [PMID: 38731129 PMCID: PMC11084858 DOI: 10.3390/jcm13092600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
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.
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Affiliation(s)
- Carlo Iadevaia
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
| | - Vito D’Agnano
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
| | - Raffaella Pagliaro
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
| | - Felice Nappi
- Department of Respiratory Medicine, Boscotrecase COVID Hospital, 80042 Boscotrecase, Italy;
| | - Raffaella Lucci
- Unit of Pathology, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (R.L.); (S.M.)
| | - Simona Massa
- Unit of Pathology, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (R.L.); (S.M.)
| | - Andrea Bianco
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
| | - Fabio Perrotta
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
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Inchingolo R, Zanforlin A, Buonsenso D, Perrone T, Torri E, Limoli G, Mossolani EE, Tursi F, Soldati G, Marchetti G, Carlucci P, Radovanovic D, Lohmeyer FM, Smargiassi A. Lung Ultrasound Signs: The Beginning. Part 3-An Accademia di Ecografia Toracica Comprehensive Review on Ultrasonographic Signs and Real Needs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:629-641. [PMID: 38168739 DOI: 10.1002/jum.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
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.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Service of Pulmonology, Health District of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziano Perrone
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Elena Torri
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | | | - Paolo Carlucci
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | | | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Elgenidy A, Amin MA, Awad AK, Emad A, Nassar A, Alomari O, Ibrahim R, Husain-Syed F, Aly MG. The use of lung ultrasound in evaluation of extravascular lung water in hemodialysis patients: Systematic review and meta-analysis. Hemodial Int 2024; 28:148-161. [PMID: 38413047 DOI: 10.1111/hdi.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
RATIONALE AND OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION These findings indicate the effectiveness of lung ultrasound in detection of volume overload and assessment of response to ultrafiltration in hemodialysis patients.
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Affiliation(s)
| | | | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | | | | - Omar Alomari
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Radwa Ibrahim
- Nephrology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt
| | - Faeq Husain-Syed
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Mostafa G Aly
- Nephrology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt
- Transplantation Immunology, Institute of Immunology, University Hospital, Heidelberg, Germany
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
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Alonso-Ojembarrena A, Gregorio-Hernández R, Raimondi F. Neonatal point-of-care lung ultrasound: what should be known and done out of the NICU? Eur J Pediatr 2024; 183:1555-1565. [PMID: 38315204 DOI: 10.1007/s00431-023-05375-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/07/2024]
Abstract
Lung ultrasound is rapidly becoming a useful tool in the care of neonates: its ease of use, reproducibility, low cost, and negligible side effects make it a very suitable tool for the respiratory care of all neonates. This technique has been extensively studied by different approaches in neonatal intensive care unit (NICU), both for diagnostic and prognostic aims and to guide respiratory treatments. However, many neonates are being born in level I/II hospitals without NICU facilities so all pediatricians, not just neonatal intensivists, should be aware of its potential. This is made possible by the increasing access to ultrasound machines in a modern hospital setting. In this review, we describe the ultrasonographic characteristics of the normal neonatal lung. We also discuss the ultrasound features of main neonatal respiratory diseases: transient tachypnea of the neonate (TTN), respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), pneumothorax (PNX), pleural effusion (PE), or pneumonia. Finally, we mention two functional approaches to lung ultrasound: 1. The use of lung ultrasound in level I delivery centers as a mean to assess the severity of neonatal respiratory distress and request a transport to a higher degree structure in a timely fashion. 2. The prognostic accuracy of lung ultrasound for early and targeted surfactant replacement. CONCLUSION LU is still a useful tool in level I/II neonatal units, both for diagnostic and functional issues. WHAT IS KNOWN • Neonatal lung ultrasound has been recently introduced in the usual care in many Neonatal Intensive Care Units. WHAT IS NEW • It also has many advantages in level I/II neonatal units, both for neonatologist or even pediatricians that treat neonates in those sites.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Avenida Ana de Viya, 11, 11009, Cádiz, Spain.
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
| | | | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II Di Napoli, Naples, Italy
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Coelho TB, Mariz JA. Dynamic Air Bronchogram Ultrasound Sign in a Noninvasive Ventilated Patient. J Med Ultrasound 2024; 32:173-174. [PMID: 38882618 PMCID: PMC11175364 DOI: 10.4103/jmu.jmu_114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2024] Open
Abstract
Acute dyspnea is one of the most common complaints in any emergency department. Physical examination and chest radiography have been insufficient to diagnose these patients accurately and quickly. We present a clinical case of a dyspneic patient presenting to the emergency department, who was promptly diagnosed with lobar pneumonia by point-of-care pulmonary ultrasonography. This permitted the rapid onset of adequate treatment. Furthermore, we describe a dynamic air bronchogram sign in a noninvasive ventilated patient. Chest computed tomography scan was performed confirming consolidation of the middle lobe. The advent of handheld point-of-care ultrasonography is revolutionizing practical care enabling physicians with a high-accuracy, low-cost, fast, safe, and repeatable diagnostic tool.
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Affiliation(s)
- Telmo Borges Coelho
- Department of Internal Medicine, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
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Boussier J, Lemasle A, Hantala N, Scatton O, Vaillant JC, Paye F, Langeron O, Lescot T, Quesnel C, Verdonk F, Eyraud D, Sitbon A, Delorme L, Monsel A. Lung Ultrasound Score on Postoperative Day 1 Is Predictive of the Occurrence of Pulmonary Complications after Major Abdominal Surgery: A Multicenter Prospective Observational Study. Anesthesiology 2024; 140:417-429. [PMID: 38064713 DOI: 10.1097/aln.0000000000004855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Postoperative pulmonary complications after major abdominal surgery are frequent and carry high morbidity and mortality. Early identification of patients at risk of pulmonary complications by lung ultrasound may allow the implementation of preemptive strategies. The authors hypothesized that lung ultrasound score would be associated with pulmonary postoperative complications. The main objective of the study was to evaluate the performance of lung ultrasound score on postoperative day 1 in predicting pulmonary complications after major abdominal surgery. Secondary objectives included the evaluation of other related measures for their potential prediction accuracy. METHODS A total of 149 patients scheduled for major abdominal surgery were enrolled in a bicenter observational study. Lung ultrasound score was performed before the surgery and on days 1, 4, and 7 after surgery. Pulmonary complications occurring before postoperative day 10 were recorded. RESULTS Lung ultrasound score on postoperative day 1 was higher in patients developing pulmonary complications before day 10 (median, 13; interquartile range, 8.25 to 18; vs. median, 10; interquartile range, 6.5 to 12; Mann-Whitney P = 0.002). The area under the curve for predicting postoperative pulmonary complications before day 10 was 0.65 (95% CI, 0.55 to 0.75; P = 0.003). Lung ultrasound score greater than 12 had a sensitivity of 0.54 (95% CI, 0.40 to 0.67), specificity of 0.77 (95% CI, 0.67 to 0.85), and negative predictive value of 0.74 (95% CI, 0.65 to 0.83). Lung ultrasound score greater than 17 had sensitivity of 0.33 (95% CI, 0.21 to 0.47), specificity of 0.95 (95% CI, 0.88 to 0.98), and positive predictive value of 0.78 (95% CI, 0.56 to 0.93). Anterolateral lung ultrasound score and composite scores using lung ultrasound score and other patient characteristics showed similar predictive accuracies. CONCLUSIONS An elevated lung ultrasound score on postoperative day 1 is associated with the occurrence of pulmonary complications within the first 10 days after major abdominal surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jeremy Boussier
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Aymeric Lemasle
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Nicolas Hantala
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Jean-Christophe Vaillant
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - François Paye
- Department of Surgery, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Greater Paris University Hospitals, University Paris-Est-Créteil, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Daniel Eyraud
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Alexandre Sitbon
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Louis Delorme
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France; Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy, Paris, France; Biotherapy (CIC-BTi), La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Paris, France
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Mongodi S, Arioli R, Quaini A, Grugnetti G, Grugnetti AM, Mojoli F. Lung ultrasound training: how short is too short? observational study on the effects of a focused theoretical training for novice learners. BMC MEDICAL EDUCATION 2024; 24:166. [PMID: 38383377 PMCID: PMC10882777 DOI: 10.1186/s12909-024-05148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Lung ultrasound has been increasingly used in the last years for the assessment of patients with respiratory diseases; it is considered a simple technique, now spreading from physicians to other healthcare professionals as nurses and physiotherapists, as well as to medical students. These providers may require a different training to acquire lung ultrasound skills, since they are expected to have no previous experience with ultrasound. The aim of the study was to assess the impact of a short theoretical training focused on lung ultrasound pattern recognition in a population of novice nurse learners with no previous experience with ultrasound. METHODS We included the nurses attending a critical care advanced course for nurses performed at the University of Pavia. Images' interpretation skills were tested on two slide sets (a 25-clip set focused on B-pattern recognition and a 25-clip set focused on identification of pleural movement as lung sliding, lung pulse, lung point, no movement) before and after three 30-minute teaching modules dedicated to general ultrasound principles, B-lines assessment and lung sliding assessment. A cut off of 80% was considered acceptable for correctly interpreted images after this basic course. RESULTS 22 nurses were enrolled (age 26.0 [24.0-28.0] years; men 4 (18%)); one nurse had previous experience with other ultrasound techniques, none of them had previous experience with lung ultrasound. After the training, the number of correctly interpreted clips improved from 3.5 [0.0-13.0] to 22.0 [19.0-23.0] (p < 0.0001) for B-pattern and from 0.5 [0.0-2.0] to 8.5 [6.0-12.0] (p < 0.0001) for lung sliding assessment. The number of correct answers for B-pattern recognition was significantly higher than for lung sliding assessment, both before (3.5 [0.0-13.0] vs. 0.5 [0.0-2.0]; p = 0.0036) and after (22.0 [19.0-23.0] vs. 8.5 [6.0-12.0]; p < 0.0001) the training. After the training, nurses were able to correctly recognize the presence or the absence of a B-pattern in 84.2 ± 10.3% of cases; lung sliding was correctly assessed in 37.1 ± 15.3% of cases. CONCLUSIONS Lung ultrasound is considered a simple technique; while a short, focused training significantly improves B-pattern recognition, lung sliding assessment may require a longer training for novice learners. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy.
| | - Raffaella Arioli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy
| | - Attilio Quaini
- Department of Health Professions, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giuseppina Grugnetti
- Department of Health Professions, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Anna Maria Grugnetti
- Department of Health Professions, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care , University of Pavia, Pavia, Italy
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Xirouchaki N, Bolaki M, Psarologakis C, Pediaditis E, Proklou A, Papadakis E, Kondili E, Georgopoulos D. Thoracic ultrasound use in hospitalized and ambulatory adult patients: a quantitative picture. Ultrasound J 2024; 16:11. [PMID: 38383809 PMCID: PMC10881936 DOI: 10.1186/s13089-024-00359-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Thoracic ultrasound (TUS) has been established as a powerful diagnostic and monitoring tool in the Intensive Care Unit (ICU). However, studies outside the critical care setting are scarce. The aim of this study was to investigate the value of TUS for hospitalized or ambulatory community patients. MATERIALS AND METHODS This was a retrospective study conducted from 2016 to 2020 in the TUS clinic at Heraklion University Hospital. TUS examination was performed using a standard ultrasound machine (EUB HITACHI 8500), and a high-frequency microconvex probe (5-8 MHz). Patients had been referred by their primary physician to address a range of different questions. The various respiratory system entities were characterised according to internationally established criteria. RESULTS 762 TUS studies were performed on 526 patients due to underlying malignancy (n = 376), unexplained symptoms/signs (n = 53), pregnancy related issues (n = 42), evaluation of abnormal findings in X-ray (n = 165), recent surgery/trauma (n = 23), recent onset respiratory failure (n = 12), acute respiratory infection (n = 66) and underlying non-malignant disease (n = 25). Pleural effusion was the commonest pathologic entity (n = 610), followed by consolidation (n = 269), diaphragmatic dysfunction/paradox (n = 174) and interstitial syndrome (n = 53). Discrepancies between chest X-ray and ultrasonographic findings were demonstrated in 96 cases. The TUS findings guided invasive therapeutic management in 448 cases and non-invasive management in 43 cases, while follow-up monitoring was decided in 271 cases. CONCLUSIONS This study showed that TUS can identify the most common respiratory pathologic entities encountered in hospitalized and community ambulatory patients, and is especially useful in guiding the decision making process in a diverse group of patients.
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Affiliation(s)
- N Xirouchaki
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - M Bolaki
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - C Psarologakis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Pediaditis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - A Proklou
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Papadakis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Kondili
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - D Georgopoulos
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
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Vetrugno L, Biasucci DG, Deana C, Spadaro S, Lombardi FA, Longhini F, Pisani L, Boero E, Cereser L, Cammarota G, Maggiore SM. Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993-2023). Ultrasound J 2024; 16:7. [PMID: 38345653 PMCID: PMC10861418 DOI: 10.1186/s13089-023-00351-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
In critically ill patients with acute respiratory failure, thoracic images are essential for evaluating the nature, extent and progression of the disease, and for clinical management decisions. For this purpose, computed tomography (CT) is the gold standard. However, transporting patients to the radiology suite and exposure to ionized radiation limit its use. Furthermore, a CT scan is a static diagnostic exam for the thorax, not allowing, for example, appreciation of "lung sliding". Its use is also unsuitable when it is necessary to adapt or decide to modify mechanical ventilation parameters at the bedside in real-time. Therefore, chest X-ray and lung ultrasound are today's contenders for shared second place on the podium to acquire a thoracic image, with their specific strengths and limitations. Finally, electrical impedance tomography (EIT) could soon have a role, however, its assessment is outside the scope of this review. Thus, we aim to carry out the following points: (1) analyze the advancement in knowledge of lung ultrasound use and the related main protocols adopted in intensive care units (ICUs) over the latest 30 years, reporting the principal publications along the way, (2) discuss how and when lung ultrasound should be used in a modern ICU and (3) illustrate the possible future development of LUS.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100, Chieti, Via Dei Vestini, Italy
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Piazzale S. M. Della Misericordia 15, 33100, Udine, Italy.
| | - Savino Spadaro
- Department of Translational Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy
| | | | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Intensive Care Unit, Miulli Regional Hospital, Acquaviva Delle Fonti, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100, Chieti, Via Dei Vestini, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
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Al-Husinat L, Jouryyeh B, Rawashdeh A, Robba C, Silva PL, Rocco PRM, Battaglini D. The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients. Diagnostics (Basel) 2024; 14:398. [PMID: 38396437 PMCID: PMC10888003 DOI: 10.3390/diagnostics14040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/22/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Weaning patients from mechanical ventilation (MV) is a complex process that may result in either success or failure. The use of ultrasound at the bedside to assess organs may help to identify the underlying mechanisms that could lead to weaning failure and enable proactive measures to minimize extubation failure. Moreover, ultrasound could be used to accurately identify pulmonary diseases, which may be responsive to respiratory physiotherapy, as well as monitor the effectiveness of physiotherapists' interventions. This article provides a comprehensive review of the role of ultrasonography during the weaning process in critically ill patients.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Ahlam Rawashdeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
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Plantinga C, Klompmaker P, Haaksma ME, Mousa A, Blok SG, Heldeweg MLA, Paulus F, Schultz MJ, Tuinman PR. Use of Lung Ultrasound in the New Definitions of Acute Respiratory Distress Syndrome Increases the Occurrence Rate of Acute Respiratory Distress Syndrome. Crit Care Med 2024; 52:e100-e104. [PMID: 37962157 PMCID: PMC10793806 DOI: 10.1097/ccm.0000000000006118] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To assess the effect of incorporating bilateral abnormalities as detected by lung ultrasound (LUS) in the Kigali modification and the New Global definition of acute respiratory distress syndrome (ARDS) on the occurrence rate of ARDS. DESIGN Post hoc analysis of a previously published prospective cohort study. SETTING An academic mixed medical-surgical ICU. PATIENTS The original study included critically ill adults with any opacity on chest radiography in whom subsequent LUS was performed. Patients with ARDS according to the Berlin definition, COVID-19 patients and patients with major thorax trauma were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS LUS was performed within 24 hours of chest radiography and the presence of unilateral and bilateral abnormalities on LUS and chest radiograph (opacities) was scored. Subsequently, the Kigali modification and the New Global definition of ARDS were applied by two independent researchers on the patients with newly found bilateral opacities. Of 120 patients, 116 were included in this post hoc analysis. Thirty-three patients had bilateral opacities on LUS and unilateral opacities on chest radiograph. Fourteen of these patients had ARDS according to the Kigali modification and 12 had ARDS according to the New Global definition. The detected LUS patterns were significantly different between patients with and without ARDS ( p = 0.004). An A-profile with a positive PosteroLateral Alveolar and/or Pleural Syndrome was most prevalent in patients without ARDS, whereas heterogeneous and mixed A, B, and C patterns were most prevalent in patients with ARDS. CONCLUSION The addition of bilateral abnormalities as detected by LUS to the Kigali modification and the New Global definition increases the occurrence rate of the ARDS. The nomenclature for LUS needs to be better defined as LUS patterns differ between patients with and without ARDS. Incorporating well-defined LUS criteria can increase specificity and sensitivity of new ARDS definitions.
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Affiliation(s)
- Coen Plantinga
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Peter Klompmaker
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Mark E Haaksma
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Amne Mousa
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Siebe G Blok
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Micah L A Heldeweg
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
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Zaki HA, Albaroudi B, Shaban EE, Shaban A, Elgassim M, Almarri ND, Basharat K, Azad AM. Advancement in pleura effusion diagnosis: a systematic review and meta-analysis of point-of-care ultrasound versus radiographic thoracic imaging. Ultrasound J 2024; 16:3. [PMID: 38261109 PMCID: PMC10805747 DOI: 10.1186/s13089-023-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pleural effusion is a fluid buildup in the pleural space that mostly result from congestive heart failure, bacterial pneumonia, malignancy, and pulmonary embolism. The diagnosis of this condition can be challenging as it presents symptoms that may overlap with other conditions; therefore, imaging diagnostic tools such as chest x-ray/radiograph (CXR), point-of-care ultrasound (POCUS), and computed tomography (CT) have been employed to make an accurate diagnosis. Although POCUS has high diagnostic accuracy, it is yet to be considered a first-line diagnostic tool as most physicians use radiography. Therefore, the current meta-analysis was designed to compare POCUS to chest radiography. METHODS n extended search for studies related to our topic was done on five electronic databases, including PubMed, Medline, Embase, Scopus, and Google Scholar. A quality assessment using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was performed on all eligible articles obtained from the databases. Moreover, the diagnostic accuracy of POCUS and CXR was performed using STATA 16 software. RESULTS Our search yielded 1642 articles, of which only 18 were eligible for inclusion and analysis. The pooled analysis showed that POCUS had a higher diagnostic accuracy compared to CXR (94.54% (95% CI 91.74-97.34) vs. 67.68% (95% CI 58.29-77.08) and 97.88% (95% CI 95.77-99.99) vs. 85.30% (95% CI 80.06-90.54) sensitivity and specificity, respectively). A subgroup analysis based on the position of patients during examinations showed that POCUS carried out in supine and upright positions had higher specificity than other POCUS positions (99%). In comparison, lateral decubitus CXR had higher sensitivity (96%) and specificity (99%) than the other CXR positions. Further subgroup analyses demonstrated that CXR had higher specificity in studies that included more than 100 patients (92.74% (95% CI 85.41-100). Moreover, CXR tends to have a higher diagnostic accuracy when other CXR positions are used as reference tests (93.38% (95% CI 86.30-100) and 98.51% (95% CI 94.65-100) sensitivity and specificity, respectively). CONCLUSION POCUS as an imaging modality has higher diagnostic accuracy than CXR in detecting pleural effusion. Moreover, the accuracy is still high even when performed by physicians with less POCUS training. Therefore, we suggest it is considered a first-line imaging tool for diagnosing pleural effusion at the patients' bedside.
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Affiliation(s)
- Hany A Zaki
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bilal Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Eman E Shaban
- Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Doha, Qatar
| | - Ahmed Shaban
- Department of Internal Medicine, Mansoura General Hospital, Mansoura, Egypt
| | - Mohamed Elgassim
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nood Dhafi Almarri
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Kaleem Basharat
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Mohammad Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Hamad Medical Corporation, Collège of Medicine QU and Weil Cornell Medical College, Doha, Qatar
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Safai Zadeh E, Görg C, Prosch H, Kifjak D, Dietrich CF, Laursen CB, Findeisen H. Lung Ultrasound and Pleural Artifacts: A Pictorial Review. Diagnostics (Basel) 2024; 14:179. [PMID: 38248056 PMCID: PMC10814232 DOI: 10.3390/diagnostics14020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Lung ultrasound is a well-established diagnostic approach used in detecting pathological changes near the pleura of the lung. At the acoustic boundary of the lung surface, it is necessary to differentiate between the primary visualization of pleural parenchymal pathologies and the appearance of secondary artifacts when sound waves enter the lung or are reflected at the visceral pleura. The aims of this pictorial essay are to demonstrate the sonographic patterns of various pleural interface artifacts and to illustrate the limitations and pitfalls of the use of ultrasound findings in diagnosing any underlying pathology.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35037 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Daria Kifjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
- Department of Radiology, Mass Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Christoph Frank Dietrich
- Department of General Internal Medicine (DAIM), Hirslanden Clinics Bern, Beau Site, Salem and Permanence, 3018 Bern, Switzerland;
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
- Odense Respiratory Research Unit, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, 28199 Bremen, Germany
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Matthay MA, Arabi Y, Arroliga AC, Bernard G, Bersten AD, Brochard LJ, Calfee CS, Combes A, Daniel BM, Ferguson ND, Gong MN, Gotts JE, Herridge MS, Laffey JG, Liu KD, Machado FR, Martin TR, McAuley DF, Mercat A, Moss M, Mularski RA, Pesenti A, Qiu H, Ramakrishnan N, Ranieri VM, Riviello ED, Rubin E, Slutsky AS, Thompson BT, Twagirumugabe T, Ware LB, Wick KD. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2024; 209:37-47. [PMID: 37487152 PMCID: PMC10870872 DOI: 10.1164/rccm.202303-0558ws] [Citation(s) in RCA: 248] [Impact Index Per Article: 248.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/24/2023] [Indexed: 07/26/2023] Open
Abstract
Background: Since publication of the 2012 Berlin definition of acute respiratory distress syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high-flow nasal oxygen, the expansion of the use of pulse oximetry in place of arterial blood gases, the use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. Methods: A consensus conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021 to March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would 1) identify patients with the currently accepted conceptual framework for ARDS, 2) facilitate rapid ARDS diagnosis for clinical care and research, 3) be applicable in resource-limited settings, 4) be useful for testing specific therapies, and 5) be practical for communication to patients and caregivers. Results: The committee made four main recommendations: 1) include high-flow nasal oxygen with a minimum flow rate of ⩾30 L/min; 2) use PaO2:FiO2 ⩽ 300 mm Hg or oxygen saturation as measured by pulse oximetry SpO2:FiO2 ⩽ 315 (if oxygen saturation as measured by pulse oximetry is ⩽97%) to identify hypoxemia; 3) retain bilateral opacities for imaging criteria but add ultrasound as an imaging modality, especially in resource-limited areas; and 4) in resource-limited settings, do not require positive end-expiratory pressure, oxygen flow rate, or specific respiratory support devices. Conclusions: We propose a new global definition of ARDS that builds on the Berlin definition. The recommendations also identify areas for future research, including the need for prospective assessments of the feasibility, reliability, and prognostic validity of the proposed global definition.
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Affiliation(s)
- Michael A. Matthay
- Department of Medicine
- Department of Anesthesia
- Cardiovascular Research Institute, and
| | - Yaseen Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Gordon Bernard
- Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Lung Research, and
| | | | - Laurent J. Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn S. Calfee
- Department of Medicine
- Department of Anesthesia
- Cardiovascular Research Institute, and
| | - Alain Combes
- Médecine Intensive – Réanimation, Sorbonne Université, APHP Hôpital Pitié-Salpêtrière, Paris, France
| | - Brian M. Daniel
- Respiratory Therapy, University of California, San Francisco, San Francisco, California
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine and
- Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michelle N. Gong
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jeffrey E. Gotts
- Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | | | - John G. Laffey
- Anesthesia, University Hospital Galway, University of Galway, Galway, Ireland
| | | | - Flavia R. Machado
- Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thomas R. Martin
- Department of Medicine, University of Washington, Seattle, Washington
| | - Danny F. McAuley
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Alain Mercat
- Medical ICU, Angers University Hospital, Angers, France
| | - Marc Moss
- Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | | | - Antonio Pesenti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Haibo Qiu
- Critical Care Medicine, Zhongda Hospital, Nanjing, China
| | | | - V. Marco Ranieri
- Emergency and Intensive Care Medicine, Alma Mater Studorium University of Bologna, Bologna, Italy
| | - Elisabeth D. Riviello
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Arthur S. Slutsky
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B. Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Theogene Twagirumugabe
- Department of Anesthesia, Critical Care, and Emergency Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; and
| | - Lorraine B. Ware
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Katherine D. Wick
- Department of Medicine, University of California, Davis, Davis, California
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Schmidt S, Behnke N, Dieks JK. Chest X-rays and Lung Ultrasound Are Not Interchangeable in Intensive Care Practice. Diagnostics (Basel) 2023; 14:82. [PMID: 38201391 PMCID: PMC10795787 DOI: 10.3390/diagnostics14010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Data comparing lung ultrasound (LUS) and chest X-rays (CXRs) have increased over the past years. However, there still is a lack of knowledge as to how these modalities compare with one another in the critical care setting, and several factors, including artificial study conditions, limit the generalizability of most published studies. Our study aimed to analyze the performance of LUS in comparison with CXRs in real-world critical care practice. MATERIALS AND METHODS This study presents new data from the prospective FASP-ICU trial. A total of 209 corresponding datasets of LUS and CXR results from 111 consecutive surgical ICU patients were subanalyzed, and categorial findings were compared. Statistical analysis was performed on the rates of agreement between the different imaging modalities. RESULTS A total of 1162 lung abnormalities were detected by LUS in ICU patients compared with 1228 detected by CXR, a non-significant difference (p = 0.276; 95% CI -0.886 to 0.254). However, the agreement rates varied between the observed abnormalities: the rate of agreement for the presence of interstitial syndrome ranged from 0 to 15%, consolidation from 0 to 56%, basal atelectasis from 33.9 to 49.34%, pleural effusion from 40.65 to 50%, and compression atelectasis from 14.29 to 19.3%. The rate of agreement was 0% for pneumothorax and 20.95% for hypervolemia. CONCLUSIONS LUS does not detect more lung abnormalities in real-world critical care practice than CXRs, although a higher sensitivity of LUS has been reported in previous studies. Overall, low agreement rates between LUS and CXRs suggest that these diagnostic techniques are not equivalent but instead are complementary and should be used alongside each other.
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Affiliation(s)
- Stefan Schmidt
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany;
| | - Nico Behnke
- Institute for Diagnostic and Interventional Radiology, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany;
| | - Jana-Katharina Dieks
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany;
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