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Ma HR, Deng BY, Liu J, Jiang P, Xu YL, Song XY, Li J, Huang LH, Bao LY, Shan RY, Fu W. Lung ultrasound to diagnose infectious pneumonia of newborns: A prospective multicenter study. Pediatr Pulmonol 2023; 58:122-129. [PMID: 36169007 DOI: 10.1002/ppul.26168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Whether lung ultrasound (LUS) can be used for pathogenic diagnosis remains controversial. This study was conducted to clarify whether ultrasound has diagnostic value for etiology. METHODS A total of 135 neonatal pneumonia patients with an identified pathogen were enrolled from the newborn intensive care units of 10 tertiary hospitals in China. The study ran from November 2020 to December 2021. The infants were divided into various groups according to pathogens, time of infection, gestational age, and disease severity. The distribution of pleural line abnormalities, B-line signs, and pulmonary consolidation, as well as the incidence of air bronchogram and pleural effusion based on LUS, were compared between these groups. RESULTS There were significant differences in pulmonary consolidation. The sensitivity and specificity of the diagnosis of severe pneumonia based on the extent of pulmonary consolidation were 83.3% and 85.2%, respectively. The area under the receiver operating characteristic curve for the identification of mild or severe pneumonia based on the distribution of pulmonary consolidation was 0.776. CONCLUSION LUS has good performance in diagnosing and differentiating the severity of neonatal pneumonia but cannot be used for pathogenic identification in the early stages of pneumonia.
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Affiliation(s)
- Hai-Ran Ma
- Department of Paediatrics, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Central People's Hospital, Huizhou, China
| | - Bi-Ying Deng
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital, Guangdong Medical University, Dongguan, China
| | - Jing Liu
- Department of Paediatrics, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Jiang
- Department of Paediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Yan-Lei Xu
- Department of Neonatology and Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiu-Yun Song
- Children's hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China
| | - Jie Li
- Department of Neonatology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Li-Han Huang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
| | - Ling-Yun Bao
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Rui-Yan Shan
- Department of Pediatrics, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Wei Fu
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
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202
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Pollock GA, Lo J, Chou H, Kissen MS, Kim M, Zhang V, Betz A, Perlman R. Advanced diagnostic and therapeutic techniques for anaesthetists in thoracic trauma: an evidence-based review. Br J Anaesth 2023; 130:e80-e91. [PMID: 36096943 DOI: 10.1016/j.bja.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 07/02/2022] [Indexed: 01/06/2023] Open
Abstract
Anaesthetists play an important role in the evaluation and treatment of patients with signs of thoracic trauma. Anaesthesia involvement can provide valuable input using both advanced diagnostic and therapeutic interventions. Commonly performed interventions may be complicated in this setting including airway management, damage control resuscitation, and acute pain management. Anaesthetists must consider additional factors including airway injuries, vascular injuries, and coagulopathy when treating this population. This evidence-based review discusses traumatic thoracic injuries with a focus on new interventions and modern anaesthesia techniques. This review further serves to support the early involvement of anaesthetists in the emergency department and other areas where they can provide value to the trauma care pathway.
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Affiliation(s)
- Gabriel A Pollock
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jessie Lo
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Henry Chou
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael S Kissen
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michelle Kim
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vida Zhang
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Trauma Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander Betz
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ryan Perlman
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Trauma Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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203
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Kuroda Y, Kaneko T, Yoshikawa H, Uchiyama S, Nagata Y, Matsushita Y, Hiki M, Minamino T, Takahashi K, Daida H, Kagiyama N. Artificial intelligence-based point-of-care lung ultrasound for screening COVID-19 pneumoniae: Comparison with CT scans. PLoS One 2023; 18:e0281127. [PMID: 36928805 PMCID: PMC10019704 DOI: 10.1371/journal.pone.0281127] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/15/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation. Here, we aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19). METHODS We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study. RESULTS A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1%- 98.1%), sensitivity of 92.3% (79.7%- 97.3%), specificity of 100% (80.6%- 100%), positive predictive value of 95.0% (89.6% - 97.7%), and Kappa of 0.33 (0.27-0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2%- 91.3%), 77.5% (62.5%- 87.7%), and 100% (80.6%- 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4%- 69.1%), 37.2% (32.0%- 42.7%), and 97.8% (95.2%- 99.0%), respectively. INTERPRETATION AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.
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Affiliation(s)
- Yumi Kuroda
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hitomi Yoshikawa
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Saori Uchiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yuichi Nagata
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Matsushita
- Department of Emergency Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Internal Medicine and Rheumatology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Emergency Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Health and Telemedicine R&D, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Health and Telemedicine R&D, Juntendo University, Bunkyo-ku, Tokyo, Japan
- * E-mail:
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204
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Johannessen Ø, Uthaug Reite F, Bhatnagar R, Øvrebotten T, Einvik G, Myhre PL. Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:693-703. [PMID: 37128214 PMCID: PMC10148645 DOI: 10.2147/copd.s396855] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/15/2023] [Indexed: 05/03/2023] Open
Abstract
Purpose Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death. Patients and Methods In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥3 B-lines in ≥2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic- and Cox regression models. Results Forty-eight of 123 patients with AECOPD (age 75±9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6-16) vs 7(IQR 5-12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49-1.75), p=0.81. Conclusion LUS did not detect concurrent HF or predict risk in patients with AECOPD.
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Affiliation(s)
- Øyvind Johannessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Fride Uthaug Reite
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Rahul Bhatnagar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Tarjei Øvrebotten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Gunnar Einvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Peder L Myhre
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Correspondence: Peder L Myhre, Department of Cardiology, Akershus University Hospital, Lørenskog, 1478, Norway, Tel +47 93025644, Email
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205
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Huang Y, Liu T, Huang S, Qiu L, Luo F, Yin G, Xie Q. Screening value of lung ultrasound in connective tissue disease related interstitial lung disease. Heart Lung 2023; 57:110-116. [PMID: 36182861 DOI: 10.1016/j.hrtlng.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interstitial lung disease (ILD) is a common pulmonary complication of connective tissue disease (CTD) that can lead to poor quality of life and prognosis. OBJECTIVES To explore the screening value of lung ultrasound (LUS) for connective tissue disease-associated interstitial lung disease (CTD-ILD). METHODS Data of patients with CTD were collected, and each patient underwent LUS, high-resolution computed tomography (HRCT), and pulmonary function tests. Considering HRCT is the gold standard for diagnosing CTD-ILD, patients were divided into CTD-ILD and CTD-non-ILD groups. The LUS and HRCT results were assessed using semiquantitative and Warrick scores, respectively. Pulmonary function results were also collected. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of LUS diagnosis. Spearman correlation analysis was used to analyze the correlation between LUS, HRCT, and lung function indices. RESULTS A total of 88 patients (65 with CTD-ILD and 23 with CTD-non-ILD) were included in this study. The sensitivity and specificity of LUS for the diagnosis of CTD-ILD were 86.60% and 82.60%, respectively, which was consistent with the HRCT results (P < 0.05). The LUS results (total number of B-lines, frequency of B-line, pleural thickness, and pleural-line irregularity) were positively correlated with the HRCT Warrick score (r = 0.77, 0.76, 0.65 and 0.71, P < 0.05). CONCLUSIONS LUS may be a promising tool for screening patients with CTD-ILD.
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Affiliation(s)
- Yupeng Huang
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Songya Huang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fengming Luo
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Geng Yin
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maître B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez† M. Recommandations formalisées d’experts pour la prise en charge des pneumothorax spontanés primaires. ANNALES FRANCAISES DE MEDECINE D URGENCE 2023. [DOI: 10.3166/afmu-2022-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Introduction : Le pneumothorax spontané primaire (PSP) est un épanchement gazeux dans la cavité pleurale, survenant hors traumatisme et pathologie respiratoire connue. Des recommandations formalisées d'experts sur le sujet sont justifiées par les pluralités de moyens diagnostiques, stratégies thérapeutiques et disciplines médicochirurgicales intervenant dans leur prise en charge.
Méthodes : Revue bibliographique, analyse de la littérature selon méthodologie GRADE (Grading of Recommendation Assessment, Development and Evaluation) ; propositions de recommandations cotées par experts, patients et organisateurs pour obtenir un consensus. Seuls les avis d'experts avec accord fort ont été retenus.
Résultats : Un décollement sur toute la hauteur de la ligne axillaire et supérieur ou égal à 2 cm au niveau du hile à la radiographie thoracique de face définit la grande abondance. La stratégie thérapeutique dépend de la présentation clinique : exsufflation en urgence pour PSP suffocant ; en l'absence de signe de gravité : prise en charge conservatrice (faible abondance), exsufflation ou drainage (grande abondance). Le traitement ambulatoire est possible si organisation en amont de la filière. Les indications, procédures chirurgicales et l'analgésie périopératoire sont détaillées. Les mesures associées, notamment le sevrage tabagique, sont décrites.
Conclusion : Ces recommandations sont une étape de l'optimisation des stratégies de traitement et de suivi des PSP en France.
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207
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Gräger S, Pfirschke R, Lorenz M, Vilser D, Krämer M, Mentzel HJ, Glutig K. Lung ultrasound in children and adolescents with long-term effects of COVID-19: Initial results. Front Pediatr 2023; 11:1112881. [PMID: 37033176 PMCID: PMC10080098 DOI: 10.3389/fped.2023.1112881] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Chronic health effects following acute COVID-19 are increasingly observed as the pandemic continues and are grouped under long COVID. Although the acute course of the COVID disease is often milder, long COVID also affects children and adolescents. As the symptoms present in Long-COVID often seem to be non-specific and not limited to organ systems, clarification of the causes and the creation of a meaningful, efficient and targeted diagnostic algorithm is urgently needed. Methods Therefore, in this prospective observational study, we examined 30 children with long COVID using lung ultrasound and compared the results with those of 15 lung-healthy children. Results In our study, no significant difference was found between the two groups in the morphological criteria of lung ultrasound of the pleura or pleural lung structures. There was no significant correlation between the lung ultrasound findings and clinical Data. Discussion Our findings are congruent with the current, albeit sparse, data. It is possible that the causes of persistent thoracic symptoms in long COVID might be more likely to be present in functional examinations, but not morphologically imageable. Nonspecific symptoms do not appear to be due to changes in the lung parenchyma. In conclusion, lung ultrasound alone and without baseline in acute disease is not suitable as a standard in the follow-up of long COVID patients. Further investigations on the morphological and functional changes in patient with long COVID is needed.
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Affiliation(s)
- Stephanie Gräger
- Department of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
- Correspondence: Stephanie Gräger
| | - Rosalie Pfirschke
- Cystic Fibrosis Center for Children and Adults, University Hospital Jena, Jena, Germany
| | - Michael Lorenz
- Cystic Fibrosis Center for Children and Adults, University Hospital Jena, Jena, Germany
| | - Daniel Vilser
- Cardiology Section, Department of Child and Adolescent Medicine, University Hospital Jena, Jena, Germany
| | - Martin Krämer
- Department of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Hans-Joachim Mentzel
- Section Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Katja Glutig
- Section Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
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Škulec R. Point‑of‑Care Ultrasound - accuracy, education. VNITRNI LEKARSTVI 2023; 69:223-228. [PMID: 37468288 DOI: 10.36290/vnl.2023.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
A review article discussing the reliability of Point-of-Care ultrasound and education in this method in various fields of medicine.
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209
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Elsayed Y, Wahab MGA, Mohamed A, Fadel NB, Bhombal S, Yousef N, Fraga MV, Afifi J, Suryawanshi P, Hyderi A, Katheria A, Kluckow M, De Luca D, Singh Y. Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate-expert consensus statement of the international crashing neonate working group. Eur J Pediatr 2023; 182:53-66. [PMID: 36239816 PMCID: PMC9829616 DOI: 10.1007/s00431-022-04636-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/08/2022] [Accepted: 09/22/2022] [Indexed: 01/21/2023]
Abstract
Sudden unexpected clinical deterioration or cardiorespiratory instability is common in neonates and is often referred as a "crashing" neonate. The established resuscitation guidelines provide an excellent framework to stabilize and evaluate these infants, but it is primarily based upon clinical assessment only. However, clinical assessment in sick neonates is limited in identifying underlying pathophysiology. The Crashing Neonate Protocol (CNP), utilizing point-of-care ultrasound (POCUS), is specifically designed for use in neonatal emergencies. It can be applied both in term and pre-term neonates in the neonatal intensive care unit (NICU). The proposed protocol involves a stepwise systematic assessment with basic ultrasound views which can be easily learnt and reproduced with focused structured training on the use of portable ultrasonography (similar to the FAST and BLUE protocols in adult clinical practice). We conducted a literature review of the evidence-based use of POCUS in neonatal practice. We then applied stepwise voting process with a modified DELPHI strategy (electronic voting) utilizing an international expert group to prioritize recommendations. We also conducted an international survey among a group of neonatologists practicing POCUS. The lead expert authors identified a specific list of recommendations to be included in the proposed CNP. This protocol involves pre-defined steps focused on identifying the underlying etiology of clinical instability and assessing the response to intervention.Conclusion: To conclude, the newly proposed POCUS-based CNP should be used as an adjunct to the current recommendations for neonatal resuscitation and not replace them, especially in infants unresponsive to standard resuscitation steps, or where the underlying cause of deterioration remains unclear. What is known? • Point-of-care ultrasound (POCUS) is helpful in evaluation of the underlying pathophysiologic mechanisms in sick infants. What is new? • The Crashing Neonate Protocol (CNP) is proposed as an adjunct to the current recommendations for neonatal resuscitation, with pre-defined steps focused on gaining information regarding the underlying pathophysiology in unexplained "crashing" neonates. • The proposed CNP can help in targeting specific and early therapy based upon the underlying pathophysiology, and it allows assessment of the response to intervention(s) in a timely fashion.
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Affiliation(s)
- Yasser Elsayed
- grid.21613.370000 0004 1936 9609Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Muzafar Gani Abdul Wahab
- grid.25073.330000 0004 1936 8227Section of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Adel Mohamed
- grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Nadya Ben Fadel
- grid.28046.380000 0001 2182 2255Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Shazia Bhombal
- grid.168010.e0000000419368956Department of Pediatrics, Division of Neonatal and Behavioral Medicine, Stanford University School of Medicine, Palo Alto, CA USA
| | - Nadya Yousef
- grid.460789.40000 0004 4910 6535Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Medical Centre, APHP - Paris Saclay University Hospitals, Paris, France
| | - María V. Fraga
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Jehier Afifi
- grid.55602.340000 0004 1936 8200Department of Pediatrics, Division of Neonatal Perinatal Medicine, Dalhousie University, Halifax, NS Canada
| | - Pradeep Suryawanshi
- grid.411681.b0000 0004 0503 0903Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra India
| | - Abbas Hyderi
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, Division of Neonatology, University of Alberta, Edmonton, Canada
| | - Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA USA
| | - Martin Kluckow
- grid.412703.30000 0004 0587 9093Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Daniele De Luca
- grid.25073.330000 0004 1936 8227Section of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Canada ,grid.460789.40000 0004 4910 6535Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, School of Clinical Medicine, Loma Linda University, Loma Linda University Children's Hospital, Campus Street Coleman Pavillion, Loma Linda, CA, 11175, USA. .,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Caldas J, Rynkowski CB, Robba C. POCUS, how can we include the brain? An overview. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:55. [PMCID: PMC10245668 DOI: 10.1186/s44158-022-00082-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
Point-of-care ultrasound (POCUS) is an essential tool to assess and manage different pathologies in the intensive care unit, and many protocols have been proposed for its application in critical care literature. However, the brain has been overlooked in these protocols. Brain ultrasonography (BU) is easily available, and it allows a goal-directed approach thanks to its repeatability and immediate interpretation and provides a quick management and real time assessment of patients’ conditions. Based on recent studies, the increasing interest from intensivists, and the undeniable benefits of ultrasound, the main goal of this overview is to describe the main evidence and progresses in the incorporation of BU into the POCUS approach in the daily practice, and thus becoming POCUS-BU. This integration would allow a noninvasive global assessment to entail an integrated analysis of the critical care patients.
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Affiliation(s)
- Juliana Caldas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Instituto D’Or de Pesquisa e Ensino (IDOR), Salvador, Brazil
- Salvador, Brazil
| | - Carla Bittencourt Rynkowski
- Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil
- Intensive Care Unit, Hospital Ernesto Dornelles, Porto Alegre, Brazil
| | - Chiara Robba
- Italy Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Dipartimento di Scienze Chirurgiche Diagnostiche Integrate, University of Genoa, Genoa, Italy
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211
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Sofíudóttir BK, Harders SMW, Lage-Hansen PR, Christensen R, Munk HL, Sorensen GL, Davidsen JR, Ellingsen T. Using thoracic ultrasound to detect interstitial lung disease in patients with rheumatoid arthritis: a protocol for the diagnostic test accuracy AURORA study. BMJ Open 2022; 12:e067434. [PMID: 36564119 PMCID: PMC9791457 DOI: 10.1136/bmjopen-2022-067434] [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] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Pulmonary diseases are significant contributors to morbidity and mortality in patients with rheumatoid arthritis (RA). RA-associated interstitial lung disease (RA-ILD) may be prevalent in up to 30% and clinically evident in 10% of patients with RA. Feasible methods to detect concomitant ILD in RA are warranted. Our objective is to determine the diagnostic accuracy of thoracic ultrasound (TUS) for ILD in patients with RA with respiratory symptoms, by using chest high-resolution CT (HRCT) as the reference standard. Further, we aim to evaluate the diagnostic accuracy for the promising blood biomarkers surfactant protein-D and microfibrillar-associated protein 4 in the detection of ILD in this group of patients. METHODS AND ANALYSIS By use of a standardised 14 zone protocol patients suspected of having RA-ILD will undergo TUS as index test performed by a junior resident in rheumatology (BKS), who is certified by the European Respiratory Society in performing TUS assessments. Participants form a consecutive series of up to 80 individuals in total. The anonymised TUS images will be stored and scored by the junior resident as well as two senior rheumatologists, who have received training in TUS, and a TUS-experienced pulmonologist. HRCT will be used as the gold standard for ILD diagnosis (reference standard). The two basic measures for quantifying the diagnostic test accuracy of the TUS test are the sensitivity and specificity in comparison to the HRCT. ETHICS AND DISSEMINATION Data will be collected and stored in the Research Electronic Data Capture database. The study is approved by the Committees on Health Research Ethics and the Danish Data Protection Agency. The project is registered at clinicaltrials.gov (NCT05396469, pre-results) and data will be published in peer-reviewed journals.
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Affiliation(s)
- Bjørk Khaliqi Sofíudóttir
- Department of Rheumatology, PUlmo-REuma Clinic OUH (PURE), Odense University Hospital, Odense, Syddanmark, Denmark
- Section for Biostatistics and Evidence-Based Research, Parker Instituttet, Frederiksberg, Hovedstaden, Denmark
| | - Stefan M W Harders
- Department of Radiology, Odense University Hospital, Odense, Syddanmark, Denmark
| | | | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, Parker Instituttet, Frederiksberg, Hovedstaden, Denmark
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Grith Lykke Sorensen
- Department of Cancer and Inflammation Research, Institute for Molecular Medicine, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Jesper Rømhild Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS) and PUlmo-REuma Clinic OUH (PURE), Department of Respiratory Medicine, Odense University Hospital, Odense, Syddanmark, Denmark
| | - Torkell Ellingsen
- Department of Rheumatology, PUlmo-REuma Clinic OUH (PURE), Odense University Hospital, Odense, Syddanmark, Denmark
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212
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Imanishi J, Maeda T, Ujiro S, Masuda M, Kusakabe Y, Takemoto M, Fujimoto W, Kuroda K, Yamashita S, Iwasaki M, Todoroki T, Okuda M. Association between B-lines on lung ultrasound, invasive haemodynamics, and prognosis in acute heart failure patients. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 12:115-123. [PMID: 36548965 PMCID: PMC9910565 DOI: 10.1093/ehjacc/zuac158] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
AIMS Increased left atrial pressure leads to pulmonary congestion. Although the B-lines in lung ultrasound (LUS) are useful in detecting pulmonary congestion, data regarding the association between B-lines and invasive haemodynamics are inconsistent. This study aimed to explore the correlation of the B-line count by LUS with pulmonary capillary wedge pressure (PCWP) stratified for preserved and reduced ejection fraction (EF) in acute heart failure patients. METHODS AND RESULTS We performed a prospective observational study on 116 hospitalized patients with acute heart failure (mean age, 75.2 ± 10.3 years), who underwent right heart catheterization before discharge. LUS was performed in eight zones within 4 h of right heart catheterization and compared with PCWP separately in each EF group. Cardiac events were recorded 1 year after discharge. PCWP revealed a clear pivot point at which the B-lines began to increase in the overall cohort and each EF. Specific thresholds of the increase in B-lines were identified at 19 and 25 mmHg for preserved and reduced EF, respectively. Residual congestion at discharge was defined as the presence of ≥6 B-lines. Patients with residual congestion had a higher risk for cardiac events than those without residual congestion (hazard ratio, 12.6; 95% confidence interval, 4.71-33.7; log-rank, P < 0.0001). CONCLUSION A clear pivot point was associated with increased B-lines count in PCWP at 19 and 25 mmHg for preserved and reduced EF, respectively. Moreover, the increased B-line count above the defined cut-off used to quantify residual congestion was associated with significantly worse outcomes.
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Affiliation(s)
- Junichi Imanishi
- Corresponding author. Tel: +81-0799-22-1200, Fax: +81-0799-24-5704,
| | - Takanori Maeda
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Sae Ujiro
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Mayuka Masuda
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Yuta Kusakabe
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Makoto Takemoto
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Wataru Fujimoto
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Koji Kuroda
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Soichiro Yamashita
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Takahumi Todoroki
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
| | - Masanori Okuda
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, 1-1-137, Shioya, Sumoto-shi, Hyogo 656-0021, Japan
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Pastore MC, Ilardi F, Stefanini A, Mandoli GE, Palermi S, Bandera F, Benfari G, Esposito R, Lisi M, Pasquini A, Santoro C, Valente S, D’Andrea A, Cameli M. Bedside Ultrasound for Hemodynamic Monitoring in Cardiac Intensive Care Unit. J Clin Med 2022; 11:jcm11247538. [PMID: 36556154 PMCID: PMC9785677 DOI: 10.3390/jcm11247538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Thanks to the advances in medical therapy and assist devices, the management of patients hospitalized in cardiac intensive care unit (CICU) is becoming increasingly challenging. In fact, Patients in the cardiac intensive care unit are frequently characterized by dynamic and variable diseases, which may evolve into several clinical phenotypes based on underlying etiology and its complexity. Therefore, the use of noninvasive tools in order to provide a personalized approach to these patients, according to their phenotype, may help to optimize the therapeutic strategies towards the underlying etiology. Echocardiography is the most reliable and feasible bedside method to assess cardiac function repeatedly, assisting clinicians not only in characterizing hemodynamic disorders, but also in helping to guide interventions and monitor response to therapies. Beyond basic echocardiographic parameters, its application has been expanded with the introduction of new tools such as lung ultrasound (LUS), the Venous Excess UltraSound (VexUS) grading system, and the assessment of pulmonary hypertension, which is fundamental to guide oxygen therapy. The aim of this review is to provide an overview on the current knowledge about the pathophysiology and echocardiographic evaluation of perfusion and congestion in patients in CICU, and to provide practical indications for the use of echocardiography across clinical phenotypes and new applications in CICU.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
- Correspondence: (M.C.P.); (M.C.); Tel.: +39-057-758-5377 (M.C.P.)
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Andrea Stefanini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, 20122 Milan, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease—AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
- Correspondence: (M.C.P.); (M.C.); Tel.: +39-057-758-5377 (M.C.P.)
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Trirattanapikul A, Kongpetch S, Lukkanalikitkul E, Ahooja A, Seesuk P, Sharma A, Anutrakulchai S. Lung Ultrasound Estimates the Overhydration and Benefits Blood Pressure Control in Normal or Mild Symptomatic Hemodialysis Patients. Int J Nephrol Renovasc Dis 2022; 15:383-395. [PMID: 36570492 PMCID: PMC9784469 DOI: 10.2147/ijnrd.s374569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Lung ultrasound (LUS) is used for dry weight guidance by assessment of pulmonary congestion in hemodialysis (HD) patients. The aim of this study was to estimate amounts of accumulated fluid by total LUS scores (TLUSS), which were scarcely reported in HD patients who were normal or had a mild functional abnormality. In addition, the correlations between the LUS score of each area and TLUSS were determined to suggest fewer specific areas valuable to shorten the examination time of LUS. Methods This cohort study was conducted in adult HD patients who have New York Heart Association Classes I-II. LUS and multifrequency bioimpedance (BIA) were performed at baseline and the individual prescribed dry weight was set. Then each LUS was conducted at 28 areas of bilateral intercostal spaces and calculated as TLUSS weekly for eight weeks in which dry weight was adjusted. The second BIA was also measured at week eight. The difference of pre-HD weight and target weight (weight gain; WG) represented the amount of fluid accumulation. Results Twenty patients with a mean age of 62.2±14.0 years were enrolled. One hundred and sixty-six LUS were performed in which forty episodes of them were simultaneously measured with BIA. Optimum dry weight adjusted by TLUSS which benefited in mean reductions of blood pressure, and cardiothoracic ratios. WG amounts were significantly correlated with TLUSS (r=0.38), and with extracellular fluid (r=0.35) and overhydration fluid (r=0.39) assessed by BIA. Estimations of mean fluid overload were 2.18 (TLUSS ≤15), 2.72 (TLUSS 16-24), 3.17 (TLUSS 25-33), 3.65 (TLUSS 34-38) and 5.03 (TLUSS ≥39) in liters. The cut-off points of sum scores of 12 specific lung areas represented the none-mild were <8, moderate at 8-16, and severe pulmonary congestions were >16. Conclusion TLUSS estimated accumulated fluid useful for volume and blood pressure controls. Performance of LUS in 12 specific lung areas may reduce spending time and support routine uses of LUS in clinical practice.
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Affiliation(s)
| | - Sawinee Kongpetch
- Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand,Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Eakalak Lukkanalikitkul
- Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand,Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Anucha Ahooja
- Department of Radiology, Khon Kaen University, Khon Kaen, Thailand
| | - Patamapon Seesuk
- Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Amod Sharma
- Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) Project, Khon Kaen University, Khon Kaen, Thailand
| | - Sirirat Anutrakulchai
- Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand,Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) Project, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Sirirat Anutrakulchai, Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Email ;
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215
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Rubio-Gracia J, Ibáñez-Muñoz D, Giménez-López I, Garcés-Horna V, López-Delgado D, Sierra-Monzón JL, Crespo-Aznarez S, Peña-Fresneda N, Pérez-Calvo JI, Sánchez-Marteles M. Comparative analysis of chest radiography and lung ultrasound to predict intra-hospital prognosis of patients admitted for acute SARS-CoV-2 pneumonia (COVID-19). MEDICINA CLINICA (ENGLISH ED.) 2022; 159:515-521. [PMID: 36337157 PMCID: PMC9618450 DOI: 10.1016/j.medcle.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/27/2022] [Indexed: 11/06/2022]
Abstract
Background Point of care lung ultrasound (POCUS) has been recently used to assess prognosis in COVID-19 patients. However, there are no data comparing POCUS and chest-X ray, a technique widely used. Patients and methods Retrospective analysis in stable COVID-19 patients. Schalekamp radiological lung scale and LUZ-Score ultrasound scale were compared. Primary end-point was in-hospital death and/or need for Intensive Care Unit admission. Results A total of 138 patients were included. Median Schalekamp scale was 2 (2) and median LUZ-Score scale was 21 (10). No significant correlation was observed between both techniques. Patients with a LUZ-Score ≥ 21 points at admission had worse lung function and higher concentrations of LDH, CRP and Interleuquine-6. Schalekamp scale failed to identify patients at a higher risk at admission for the primary end-point. Addition of POCUS to a previous clinical model, improved risk prediction (AUC 0.805 [95% CI: 0.662-0.948]; P = <0.001). Conclusions Chest X-ray and POCUS showed no correlation at admission in this analysis. Only POCUS identified a group of patients with greater clinical and analytical involvement. POCUS improved, previous clinical model, while chest X-ray did not add relevant predictive information for the primary endpoint.
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Affiliation(s)
- Jorge Rubio-Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
| | - David Ibáñez-Muñoz
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
| | - Ignacio Giménez-López
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - Vanesa Garcés-Horna
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Daniel López-Delgado
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
| | - José Luis Sierra-Monzón
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
| | - Silvia Crespo-Aznarez
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | | | - Juan Ignacio Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - Marta Sánchez-Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
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Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia. Diagnostics (Basel) 2022; 12:diagnostics12123082. [PMID: 36553089 PMCID: PMC9776793 DOI: 10.3390/diagnostics12123082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/04/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background: In the setting of a coronary care unit (CCU), the early detection of pneumonia is of paramount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia and compared with chest X-ray (CXR). Method: We enrolled 110 consecutive patients admitted to the CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs. no pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n = 34). Results: The mean age was 70 ± 11 years old, and 68% were males. Pneumonia was clinically diagnosed in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92%, specificity 81%). Chest radiography was positive for pneumonia in nine patients (sensitivity 43%, specificity 95%). Using CT scan as a reference, LUS exhibited 92% sensitivity and a specificity of 96%. In ROC curve analysis, the diagnostic accuracy of CXR and LUS for the diagnosis of pneumonia was 0.86 (95% CI 0.77−0.94), which was higher than CXR 0.68 (95% CI 0.55−0.84), p < 0.05. Conclusion: Based on the findings of the present study, the accuracy of LUS in the detection of pneumonia was significantly higher than chest X-ray with comparable sensibility to CT scan.
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217
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Mercado-Longoria R, Galindo-Galindo JO, Ataxca-Gonzalez MA, Colunga-Pedraza PR, Peña-Lozano SP, Llaca-Díaz JM, Rendón-Ramírez EJ. Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients. Medicine (Baltimore) 2022; 101:e32149. [PMID: 36482529 PMCID: PMC9726279 DOI: 10.1097/md.0000000000032149] [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] [Indexed: 12/13/2022] Open
Abstract
In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17-82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.
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Affiliation(s)
- Roberto Mercado-Longoria
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Juan O. Galindo-Galindo
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario A. Ataxca-Gonzalez
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Perla R. Colunga-Pedraza
- Internal Medicine, Department, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Samantha P. Peña-Lozano
- Internal Medicine, Department, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Jorge M. Llaca-Díaz
- Clinical Pathology Department, Hospital Universitario, UANL, Monterrey, Nuevo León, México
| | - Erick J. Rendón-Ramírez
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
- * Correspondence: Erick J. Rendón-Ramírez, Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio, González, Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, C.P., Monterrey, N.L. 64460, México (e-mail: )
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218
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Lapostolle F, Petrovic T. [Prehospital ultrasound and cardiological emergencies]. Ann Cardiol Angeiol (Paris) 2022; 71:345-349. [PMID: 36273951 DOI: 10.1016/j.ancard.2022.09.007] [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: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.
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Affiliation(s)
- Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - Tomislav Petrovic
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
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Rattarasarn I, Yingchoncharoen T, Assavapokee T. Prediction of rehospitalization in patients with acute heart failure using point-of-care lung ultrasound. BMC Cardiovasc Disord 2022; 22:330. [PMID: 35871645 PMCID: PMC9310393 DOI: 10.1186/s12872-022-02781-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background More than 50% of patients admitted for acute heart failure are discharged with residual pulmonary congestion. Residual pulmonary congestion at discharge is associated with rehospitalization and death within 6 months after discharge. B-lines detected by lung ultrasound are the sonographic manifestation of pulmonary congestion, a major predictor of morbidity and mortality in patients with heart failure. The present study was performed to evaluate the prognostic value of B-lines at discharge for prediction of rehospitalization and death at 6 months in patients with acute heart failure. Methods This study involved a prospective cohort of 126 patients admitted to Ramathibodi Hospital for acute heart failure (mean age, 69 ± 15 years). B-lines and the size of the inferior vena cava were assessed within 24 h before discharge. The patients were followed up for 6 months after discharge. Results The mean number of B-lines at discharge was 9 ± 9, and the rate of rehospitalization within 6 months was significantly higher in patients with a significant number of B-lines (≥ 12) than in patients with a non-significant number of B-lines (< 12) (log rank χ2 = 7.74, P = 0.004). In the univariable analysis, the presence of ≥ 12 B-lines before discharge (hazard ratio = 2.15, 95% confidence interval = 1.27–3.63) was an independent predictor of events at 6 months. Conclusions Residual pulmonary congestion before discharge as detected by point-of-care lung ultrasound predicts rehospitalization for heart failure at 6 months. The presence of non-significant B-lines identifies a subgroup at low risk of rehospitalization for heart failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02781-9.
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Smith M, Hayward S, Innes S. A proposed framework for point of care lung ultrasound by respiratory physiotherapists: scope of practice, education and governance. Ultrasound J 2022; 14:24. [PMID: 35708815 PMCID: PMC9201799 DOI: 10.1186/s13089-022-00266-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/04/2022] [Indexed: 01/23/2023] Open
Abstract
Background Point of care ultrasound (PoCUS) has the potential to provide a step change in the management of patients across a range of healthcare settings. Increasingly, healthcare practitioners who are not medical doctors are incorporating PoCUS into their clinical practice. However, the professional, educational and regulatory environment in which this occurs is poorly developed, leaving clinicians, managers and patients at risk. Main body Drawing upon existing medical and non-medical literature, the authors present a proposed framework for the use of PoCUS. Throughout, mechanisms for applying the principles to other professionals and healthcare settings are signposted. Application of the framework is illustrated via one such group of healthcare practitioners and in a particular healthcare setting: respiratory physiotherapists in the UK. In defining the point of care LUS scope of practice we detail what structures are imaged, differentials reported upon and clinical decisions informed by their imaging. This is used to outline the educational and competency requirements for respiratory physiotherapists to safely and effectively use the modality. Together, these are aligned with the regulatory (professional, legal and insurance) arrangements for this professional group in the UK. In so doing, a comprehensive approach for respiratory physiotherapists to consolidate and expand their use of point of care LUS is presented. This provides clarity for clinicians as to the boundaries of their practice and how to train in the modality; it supports educators with the design of courses and alignment of competency assessments; it supports managers with the staffing of existing and new care pathways. Ultimately it provides greater accessibility for patients to safe and effective point of care lung ultrasound. For clinicians who are not respiratory physiotherapists and/or are not based in the UK, the framework can be adapted to other professional groups using point of care LUS as well as other point of care ultrasound (PoCUS) applications, thereby providing a comprehensive and sustainable foundation for PoCUS consolidation and expansion. Conclusion This paper presents a comprehensive framework to support the use of point of care LUS by respiratory physiotherapists in the UK. Mechanisms to adapt the model to support a wide range of other PoCUS users are outlined.
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221
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Nti B, Lehmann AS, Haddad A, Kennedy SK, Russell FM. Artificial Intelligence-Augmented Pediatric Lung POCUS: A Pilot Study of Novice Learners. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2965-2972. [PMID: 35429001 PMCID: PMC9790545 DOI: 10.1002/jum.15992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Respiratory symptoms are among the most common chief complaints of pediatric patients in the emergency department (ED). Point-of-care ultrasound (POCUS) outperforms conventional chest X-ray and is user-dependent, which can be challenging to novice ultrasound (US) users. We introduce a novel concept using artificial intelligence (AI)-enhanced pleural sweep to generate complete panoramic views of the lungs, and then assess its accuracy among novice learners (NLs) to identify pneumonia. METHODS Previously healthy 0- to 17-year-old patients presenting to a pediatric ED with cardiopulmonary chief complaint were recruited. NLs received a 1-hour training on traditional lung POCUS and the AI-assisted software. Two POCUS-trained experts interpreted the images, which served as the criterion standard. Both expert and learner groups were blinded to each other's interpretation, patient data, and outcomes. Kappa was used to determine agreement between POCUS expert interpretations. RESULTS Seven NLs, with limited to no prior POCUS experience, completed examinations on 32 patients. The average patient age was 5.53 years (±1.07). The median scan time of 7 minutes (minimum-maximum 3-43; interquartile 8). Three (8.8%) patients were diagnosed with pneumonia by criterion standard. Sensitivity, specificity, and accuracy for NLs AI-augmented interpretation were 66.7% (confidence interval [CI] 9.4-99.1%), 96.5% (CI 82.2-99.9%), and 93.7% (CI 79.1-99.2%). The average image quality rating was 2.94 (±0.16) out of 5 across all lung fields. Interrater reliability between expert sonographers was high with a kappa coefficient of 0.8. CONCLUSION This study shows that AI-augmented lung US for diagnosing pneumonia has the potential to increase accuracy and efficiency.
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Affiliation(s)
- Benjamin Nti
- Division of Pediatric Education, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
- Department of Emergency Medicine, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Amalia S. Lehmann
- Division of Pediatric Education, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Aida Haddad
- Division of Pediatric Education, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Sarah K. Kennedy
- Department of Emergency Medicine, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Frances M. Russell
- Department of Emergency Medicine, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
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Kessler D, Dessie A, Kanjanauptom P, Vindas M, Ng L, Youssef MM, Birger R, Shaman J, Dayan P. Lack of Association Between a Quantified Lung Ultrasound Score and Illness Severity in Pediatric Emergency Department Patients With Acute Lower Respiratory Infections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3013-3022. [PMID: 35620855 DOI: 10.1002/jum.16023] [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: 08/30/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) may help determine illness severity in children with acute lower respiratory tract infections (LRTI) but limited pediatric studies exist. Our objective was to determine the association between LUS findings and illness severity in children with LRTI. METHODS We conducted a prospective study of patients <20 years with LRTI. Trained investigators performed standardized LUS examinations of 12 regions. Blinded sonologists reviewed examinations for individual pathologic features and also calculated a Quantified Lung Ultrasound Score (QLUS). We defined focal severity as QLUS of ≥2 in ≥1 region, and diffuse severity as QLUS of ≥1 in ≥3 regions. The primary outcome was the Respiratory component of the Pediatric Early Warning Score (RPEWS), a 14-item scale measuring respiratory illness severity. Secondary outcomes included hospital admission, length of stay, supplemental oxygen, and antibiotic use. RESULTS We enrolled 85 patients with LRTIs, 46 (54%) whom were hospitalized (5.4% intensive care). Median RPEWS was 1 (interquartile range 2). Neither individual features on ultrasound nor total QLUS were associated with RPEWS, hospitalization, length of stay, or oxygen use. Mean RPEWS was similar for participants regardless of focal (1.46 versus 1.26, P = .57) or diffuse (1.47 versus 1.21, P = .47) severity findings, but those with focal or diffuse severity, or isolated consolidation, had greater antibiotic administration (P < .001). CONCLUSIONS In children with LRTI, neither individual features nor QLUS were associated with illness severity. Antibiotics were more likely in patients with either focal or diffuse severity or presence of consolidation on ultrasound.
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Affiliation(s)
- David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Panida Kanjanauptom
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marc Vindas
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Lorraine Ng
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mariam M Youssef
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Ruthie Birger
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Jeff Shaman
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Peter Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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Mento F, Khan U, Faita F, Smargiassi A, Inchingolo R, Perrone T, Demi L. State of the Art in Lung Ultrasound, Shifting from Qualitative to Quantitative Analyses. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2398-2416. [PMID: 36155147 PMCID: PMC9499741 DOI: 10.1016/j.ultrasmedbio.2022.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 05/27/2023]
Abstract
Lung ultrasound (LUS) has been increasingly expanding since the 1990s, when the clinical relevance of vertical artifacts was first reported. However, the massive spread of LUS is only recent and is associated with the coronavirus disease 2019 (COVID-19) pandemic, during which semi-quantitative computer-aided techniques were proposed to automatically classify LUS data. In this review, we discuss the state of the art in LUS, from semi-quantitative image analysis approaches to quantitative techniques involving the analysis of radiofrequency data. We also discuss recent in vitro and in silico studies, as well as research on LUS safety. Finally, conclusions are drawn highlighting the potential future of LUS.
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Affiliation(s)
- Federico Mento
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Umair Khan
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Andrea Smargiassi
- Department of Cardiovascular and Thoracic Sciences, Pulmonary Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Inchingolo
- Department of Cardiovascular and Thoracic Sciences, Pulmonary Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Libertario Demi
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy.
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Franchi R, Okoye C, Morelli V, Guarino D, Mazzarone T, Coppini G, Peta U, Rogani S, Fabbri A, Polini A, Monzani F. Utility of lung ultrasound in selecting older patients with hyperinflammatory phase in COVID-19 pneumonia. A monocentric, cross-sectional pilot study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Calamai I, Greco M, Finazzi S, Savi M, Vitiello G, Garbero E, Spina R, Montisci A, Mongodi S, Bertolini G. Thoracic UltrasONOgraphy Reporting: The TUONO Study. J Clin Med 2022; 11:jcm11237126. [PMID: 36498700 PMCID: PMC9739733 DOI: 10.3390/jcm11237126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Lung ultrasound (LUS) is a validated technique for the prompt diagnosis and bedside monitoring of critically ill patients due to its availability, safety profile, and cost-effectiveness. The aim of this work is to detect similarities and differences among LUS reports performed in ICUs and to provide a common ground for an integrated report form. We collected all LUS reports during an index week in 21 ICUs from the GiViTI network. First, we considered signs, chest areas, and terminology reported. Then, we compared different report structures and categorized them as structured reports (SRs), provided with a predefined model form, and free unstructured text reports (FTRs) that had no predetermined structure. We analyzed 171 reports from 21 ICUs, and 59 reports from 5 ICUs were structured. All the reports presented a qualitative description that mainly focused on the presence of B-lines, consolidations, and pleural effusion. Zones were defined in 66 reports (39%). In SRs, a complete examination of all the regions was more frequently achieved (96% vs. 74%), and a higher impact on therapeutic strategies was observed (17% vs. 6%). LUS reports vary significantly among different centers. Adopting an integrated SR seems to promote a systematic approach in scanning and reporting, with a potential impact on LUS clinical applications.
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Affiliation(s)
- Italo Calamai
- Anesthesia and Intensive Care Unit AUsl Toscana Centro, Ospedale San Giuseppe, Viale Boccaccio 16/20, 50053 Empoli, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20100 Milan, Italy
- Correspondence:
| | - Stefano Finazzi
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 24020 Ranica, Italy
| | - Marzia Savi
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20100 Milan, Italy
| | - Gaia Vitiello
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 24020 Ranica, Italy
| | - Elena Garbero
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 24020 Ranica, Italy
| | - Rosario Spina
- Anesthesia and Intensive Care Unit AUsl Toscana Centro, Ospedale San Giuseppe, Viale Boccaccio 16/20, 50053 Empoli, Italy
| | - Andrea Montisci
- Division of Cardiothoracic Intensive Care, Cardiothoracic Department, ASST Spedali Civili, 25121 Brescia, Italy
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, San Matteo Hospital, 27100 Pavia, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Mario Negri Institute of Pharmacological Research IRCCS, 24020 Ranica, Italy
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Clinical Decision-Making in Practice with New Critical Care Ultrasound Methods for Assessing Respiratory Function and Haemodynamics in Critically Ill Patients. Clin Pract 2022; 12:986-1000. [PMID: 36547110 PMCID: PMC9776659 DOI: 10.3390/clinpract12060102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
Situations often arise in intensive care units (ICUs) for which only sparse primary evidence or guidelines are applicable or to which existing evidence cannot be applied owing to interactions of multiple disease states. To improve and guide intensive care management in complex scenarios, ultrasonography and echocardiography are invaluable. In five clinical scenarios involving acute deterioration, serial ultrasound examinations of the respiratory system, general critical care ultrasound (GCCUS), and non-invasive haemodynamic critical care echocardiography (CCE) were used routinely. Ultrasonographic results were used to guide further management and initiate experimental therapy or transition from curative to supportive care. The process of initiation of ultrasound examinations to clinical decision-making in these complex scenarios is outlined. These case vignettes highlight the utility of ultrasound and echocardiography. When clinical management is not clear, or evidence is not available, the use of ultrasound for the evaluation of the respiratory system, GCCUS, and non-invasive haemodynamic CCE can help to guide management, reveal newly developed pathologies, lead to clinical management changes, and support the decision for employing experimental therapy approaches in a dynamic way of which few other imaging modalities or monitoring tools are currently capable.
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227
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Arthur L, Prodhan P, Blaszak R, Crawford B, Brown CC, Arthur J. Evaluation of lung ultrasound to detect volume overload in children undergoing dialysis. Pediatr Nephrol 2022:10.1007/s00467-022-05723-x. [PMID: 36434355 PMCID: PMC9702747 DOI: 10.1007/s00467-022-05723-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/13/2022] [Accepted: 08/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung ultrasound is a well-established technique to assess extravascular lung water, a proxy for volume status, in the adult population. Despite its utility, the data are limited supporting the use of ultrasound to evaluate fluid volume status among pediatric patients. Our study uses a simplified ultrasound protocol to evaluate changes in extravascular lung water, represented by b-lines, among pediatric patients undergoing hemodialysis. METHODS This prospective single-center study included children from birth to 18 years of age. The number of b-lines per ml/kg of fluid removed was compared prior to, at the midpoint, and following termination of dialysis. An 8-zone protocol was utilized, and b-lines were correlated to hemoconcentration measured by the CRIT-LINE® hematocrit. RESULTS Six patients with a total of 26 hemodialysis sessions were included in this study. The b-line measurements post-dialysis were 2.27 (p < 0.001; 94%CI -3.31, -1.22) lower relative to pre-dialysis. The number of b-lines was reduced by 1.69 (p < 0.001; -2.58, -0.80) between pre-dialysis and at the midpoint of dialysis and by 0.58 (p = 0.001; -0.90, -0.24) between the midpoint of dialysis and post-dialysis. A 1 mL/kg fluid loss correlated to a decrease in the original b-lines by 0.079. An inverse relationship (r = -0.54; 95% CI: -0.72, -0.34; p < 0.001) was noted between the b-lines and the patients' hematocrit levels. CONCLUSIONS A simplified 8-zone ultrasound protocol can assess fluid volume change in real time and correlates with hematocrit levels obtained throughout dialysis. This provides a valuable method for monitoring fluid status in volume overloaded patient populations. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Lindsay Arthur
- Section of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | - Parthak Prodhan
- Section of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205 USA ,Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Richard Blaszak
- Section of Pediatric Nephrology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Brendan Crawford
- Section of Pediatric Nephrology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Clare C. Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Jason Arthur
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR USA ,Section of Pediatric Emergency Medicine, Pharmacology, & Toxicology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
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228
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Messina G, Bove M, Natale G, Di Filippo V, Opromolla G, Rainone A, Leonardi B, Martone M, Fiorelli A, Vicidomini G, Santini M, Ronchi A, Massimilla E, Della Corte CM, Pirozzi M, Caterino M, Ciardiello F, Fasano M. Diagnosis of malignant pleural disease: Ultrasound as "a detective probe". Thorac Cancer 2022; 14:223-230. [PMID: 36415167 PMCID: PMC9870740 DOI: 10.1111/1759-7714.14735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic ultrasound (TUS) as an imaging modality with high sensitivity for the identification of malignant pleural involvement and in order to guide pleural biopsies. METHODS In this retrospective single-center study between January 2018 and June 2022, 51 consecutive patients with impassable circumferential pleural thickening underwent TUS at the Thoracic Surgery Unit of the Vanvitelli University of Naples. Pleural biopsies were performed, and then large and multiple samples were sent to the pathological anatomy for histological examination. RESULTS In all patients who underwent ultrasound examination, we chose the optimal point of entry to perform pleural biopsies and selected the areas of greater thickening without pleural effusion. No patient had any complications. No drainage tubes were placed after the pleural biopsies and no pneumothorax was present during the following days of hospitalization. The patients were discharged on the second postoperative day. CONCLUSION With TUS the precise pleural thickening localization, local infiltration, mass extent, its nature (solid, cystic or complex) and ultrasound features can be easily defined. Furthermore, ultrasound is more economical than computed tomography and avoids the risks associated with radiation. Thoracic ultrasound is an important component of the diagnostic procedure in detecting a safe entry site for biopsies of MPMs.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mary Bove
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giovanni Natale
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Vincenzo Di Filippo
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giorgia Opromolla
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Anna Rainone
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Beatrice Leonardi
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mario Martone
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Alfonso Fiorelli
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giovanni Vicidomini
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mario Santini
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive MedicineUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Eva Massimilla
- Otorhinolaryngology UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | | | - Mario Pirozzi
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Marianna Caterino
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Fortunato Ciardiello
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Morena Fasano
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
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Maly M, Mokotedi MC, Svobodova E, Flaksa M, Otahal M, Stach Z, Rulisek J, Brozek T, Porizka M, Balik M. Interpleural location of chest drain on ultrasound excludes pneumothorax and associates with a low degree of chest drain foreshortening on the antero-posterior chest X-ray. Ultrasound J 2022; 14:45. [DOI: 10.1186/s13089-022-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
The role of chest drain (CD) location by bedside imaging methods in the diagnosis of pneumothorax has not been explored in a prospective study yet.
Methods
Covid-19 ARDS patients with pneumothorax were prospectively monitored with chest ultrasound (CUS) and antero-posterior X-ray (CR) performed after drainage in the safe triangle. CD foreshortening was estimated as a decrease of chest drain index (CDI = length of CD in chest taken from CR/depth of insertion on CD scale + 5 cm). The angle of inclination of the CD was measured between the horizontal line and the CD at the point where it enters pleural space on CR.
Results
Of the total 106 pneumothorax cases 80 patients had full lung expansion on CUS, the CD was located by CUS in 69 (86%), the CDI was 0.99 (0.88–1.06). 26 cases had a residual pneumothorax after drainage (24.5%), the CD was located by CUS in 31%, the CDI was 0.76 (0.6–0.93),p < 0.01. The risk ratio for a pneumothorax in a patient with not visible CD between the pleural layers on CUS and an associated low CDI on CR was 5.97, p˂0.0001. For the patients with a steep angle of inclination (> 50°) of the CD, the risk ratio for pneumothorax was not significant (p < 0.17). A continued air leak from the CD after drainage is related to the risk for a residual pneumothorax (RR 2.27, p = 0.003).
Conclusion
Absence of a CD on CUS post drainage, low CDI on CR and continuous air leak significantly associate with residual occult pneumothorax which may evade diagnosis on an antero-posterior CR.
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Martocchia A, Bentivegna E, Sergi D, Luciani M, Barlattani M, Notarangelo MF, Piccoli C, Sesti G, Martelletti P. The Point-of-Care Ultrasound (POCUS) by the Handheld Ultrasound Devices (HUDs) in the COVID-19 Scenario: a Review of the Literature. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:1. [PMID: 36407770 PMCID: PMC9665043 DOI: 10.1007/s42399-022-01316-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/10/2023]
Abstract
The use of portable ultrasound (US) devices is increasing, due to its accessibility, versatility, non-invasiveness, and its significant support in the patient management, extending the traditional physical examination through the POCUS (point-of-care ultrasound). The pocket-size or handheld ultrasound devices (HUDs) can easily perform focused exams, not aiming to substitute for the high-end US systems (gold standard), since the HUDs usually have more limited functions. The HUDs are promising tools for the diagnosis, prognosis, and monitoring of the COVID-19 infection and its related disorders. In conclusion, the routine use of HUDs may ameliorate the management of COVID-19 pandemic, according to the guidelines for the POCUS approach and the procedures for the protection of the patients and the professionals.
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Affiliation(s)
- Antonio Martocchia
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Enrico Bentivegna
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Daniela Sergi
- Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michelangelo Luciani
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Michela Barlattani
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Fortunato Notarangelo
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Cinzia Piccoli
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
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Palacios García L, Enguita Germán M, Ruiz Sada P, Echeverría Echeverría A, González Gómez M, Rubio Obanos MT. Impact of clinical ultrasound in patients with heart failure treated in home. Med Clin (Barc) 2022; 159:420-425. [PMID: 35305810 DOI: 10.1016/j.medcli.2021.12.017] [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: 09/24/2021] [Revised: 12/18/2021] [Accepted: 12/27/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVE In Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC). PATIENTS AND METHODS A randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the UG-ultrasound group (SC and CU performed) and the CG-control group (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF. RESULTS A total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1-1) and mortality by 30% (RR 0.7; 95% CI: 0.2-2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power. CONCLUSION Our results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.
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Affiliation(s)
- Lara Palacios García
- FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, España
| | - Mónica Enguita Germán
- Navarrabiomed-Hospital Universitario de Navarra (HUN)-UPNA, Pamplona, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Navarra, España
| | - Pablo Ruiz Sada
- FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, España.
| | | | - María González Gómez
- FEA, Adjunto del Servicio de Medicina Interna, Hospital de Mérida, Mérida, Badajoz, España
| | - María Teresa Rubio Obanos
- FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, España
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232
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B-Lines Lung Ultrasonography Simulation Using Finite Element Method. Diagnostics (Basel) 2022; 12:diagnostics12112751. [DOI: 10.3390/diagnostics12112751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Lung Ultrasonography (LUS) is a fast technique for the diagnosis of patients with respiratory syndromes. B-lines are seen in response to signal reverberations and amplifications into sites with peripheral lung fluid concentration or septal thickening. Mathematical models are commonly applied in biomedicine to predict biological responses to specific signal parameters. Objective: This study proposes a Finite-Element numerical model to simulate radio frequency ultrasonic lines propagated from normal and infiltrated lung structures. For tissue medium, a randomized inhomogeneous data method was used. The simulation implemented in COMSOL® used Acoustic Pressure and Time-Explicit models, which are based on the discontinuous Galerkin method (dG). Results: The RF signals, processed in MATLAB®, resulted in images of horizontal A-lines and vertical B-lines, which were reasonably similar to real images. Discussion: The use of inhomogeneous materials in the model was good enough to simulate the scattering response, similar to others in the literature. The model is useful to study the impact of the lung infiltration characteristics on the appearance of LUS images.
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233
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Elsayed M, Hesham MA, Kamel KM, Nassar YS. Diagnostic Accuracy of Lung Ultrasound in Patients with Community-Acquired Pneumonia: A Single Center Observational Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: Pneumonia is a prevailing and severe infectious disease that can lead to increased fatality.
AIM: We conducted this study to assess the role of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP) in comparison to CXR and CT Chest.
METHODS: An observational study on 120 patients with suspected CAP was done in the ICU of the Critical care department at Cairo University Hospital. Clinical and laboratory data were recorded on admission including different scoring systems (SOFA, APACHE II, confusion, uremia, respiratory rate and blood pressure 65, and pulmonary severity index). All patients, within 6 h of admission, were investigated by a LUS, CXR, and CT Chest. All imaging techniques were repeated after 48 h if the initial CT chest was negative.
RESULTS: The study population had a mean age of 70.6 ± 6.9-years-old, most of them were male (75.8%). Using CT chest as a reference imaging tool to confirm the diagnosis of pneumonia, LUS showed 94.1% sensitivity, 97.1% specificity, positive predictive value (PPV) 98.8%, negative predictive value (NPV) 87.2%, accuracy 95.0%, and area under a curve (AUC) 0.92. LUS was found to be a highly significant imaging tool in predicting diagnosis of pneumonia (p < 0.001). Chest X-ray had 69.4% sensitivity, 94.3% specificity, PPV 96.7%, NPV 55.9%, 76.6% accuracy, and AUC 0.6 in the detection of pneumonia. CXR was found to be an insignificant Imaging tool in predicting diagnosis of pneumonia (P = 0.19).
CONCLUSION: LUS is a very promising, sensitive, and feasible imaging tool in the diagnosis of CAP in comparison with CT chest.
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234
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Ródenas Monteagudo MÁ, Albero Roselló I, Del Mazo Carrasco Á, Carmona García P, Zarragoikoetxea Jauregui I. Update on the use of ultrasound in the diagnosis and monitoring of the critical patient. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:567-577. [PMID: 36253286 DOI: 10.1016/j.redare.2022.01.003] [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: 06/22/2021] [Accepted: 01/07/2022] [Indexed: 06/16/2023]
Abstract
Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.
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235
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Gurbani N, Acosta-Sorensen M, Díaz-Pérez D, Figueira-Goncalves JM, Ramallo-Fariña Y, Trujillo-Castilla JL. Clinical outcomes and lung ultrasound findings in COVID-19 follow up: Calm comes after the storm? Respir Med Res 2022; 82:100907. [PMID: 35870365 PMCID: PMC9299820 DOI: 10.1016/j.resmer.2022.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Nikita Gurbani
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | - Marco Acosta-Sorensen
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - David Díaz-Pérez
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Marco Figueira-Goncalves
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Instituto Universitario de Enfermedades Tropicales y Salud Publica de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, ES, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), ES, Madrid, Spain
| | - José Luis Trujillo-Castilla
- Respiratory Medicine and Thoracic Surgery Department, Guy's and St Thomas NHS Foundation Trust, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Moutard N, Richard P, de Blay F, Kessler R, Ohana M. Échogénicité des pleurésies : facteur prédictif d’amélioration de la dyspnée ? Étude pilote concernant les pleurésies métastatiques. Rev Mal Respir 2022; 39:805-813. [DOI: 10.1016/j.rmr.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
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Palamattam DJ, Sreedhar R, Gadhinglajkar SV, Dash PK, Sukesan S. Bedside Chest Ultrasound in Postoperative Pediatric Cardiac Surgery Patients: Comparison With Bedside Chest Radiography. J Cardiothorac Vasc Anesth 2022; 36:4039-4044. [PMID: 35953404 DOI: 10.1053/j.jvca.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective was to study the degree of agreement between the chest ultrasound (CUS) studies and chest x-ray (CXR) studies in postoperative pediatric cardiac surgical patients regarding the diagnosis of thoracic abnormalities, and also to compare the diagnostic performance of CUS in reference to CXR for the detection of thoracic abnormalities. The secondary objective was to compare the necessity for interventions done on the basis of CUS and CXR findings in the postoperative setting. DESIGN A prospective observational study. SETTING At a postoperative pediatric cardiac surgical intensive care unit in a tertiary-care center. PARTICIPANTS One hundred sixty patients between the age of 2 months to 18 years undergoing elective cardiac surgery for various congenital heart diseases. INTERVENTIONS After obtaining permission from the institutional ethics committee, 160 pediatric cardiac surgical patients were studied prospectively in the postoperative period. On the day of surgery (postoperative day [POD] 0), bedside CXR was done in the immediate postoperative period. After bedside CXR, CUS examination was performed and then interpreted by the principal investigator. The CXR was interpreted by the surgical team. Provisional diagnosis was made by the principal investigator and surgical team. Any intervention required was decided based on CXR or CUS findings or both. The procedure was repeated in the morning of POD 1. MEASUREMENTS AND MAIN RESULTS The degree of agreement between CUS studies and CXR studies in detecting abnormalities was evaluated by Cohen's kappa (k) statistics. The diagnostic performance of CUS was compared with that of CXR using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Overall, kappa analysis (k) showed substantial agreement between the findings of the CUS and CXR studies (k = 0.749). The diagnostic performance of CUS, as compared with CXR, was found to have a sensitivity of 96.9%, specificity of 84.75%, PPV of 73.4%, NPV of 98.43%, and diagnostic accuracy of 88.44%. In 94 abnormal findings, the interventions were done based on CUS or CXR findings or both. Overall, there was a substantial agreement (k = 0.787) between CUS and CXR regarding the necessity for interventions. CONCLUSIONS The degree of agreement between CUS and CXR studies was substantial for atelectasis, interstitial edema, and diaphragmatic weakness. The degree of agreement between CUS and CXR studies was almost perfect for pneumothorax and fair for pleural effusion. More CUS studies detected intrathoracic pathologies than CXR studies. The CUS also detected abnormalities earlier than CXR and was found to be useful for the early institution of intervention therapy in patients with interstitial edema and atelectasis. It would be reasonable to conclude that CUS may be considered in some instances as an alternative to CXR.
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Affiliation(s)
- Don J Palamattam
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Rupa Sreedhar
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
| | - Shrinivas V Gadhinglajkar
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Prasanta K Dash
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Subin Sukesan
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Burgos LM, Baro Vila R, Goyeneche A, Muñoz F, Spaccavento A, Fasan MA, Ballari F, Vivas M, Riznyk L, Ghibaudo S, Trivi M, Ronderos R, Costabel JP, Botto F, Diez M. Design and rationale of the inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure (CAVAL US-AHF Study): a randomised controlled trial. Open Heart 2022; 9:openhrt-2022-002105. [PMID: 36344108 PMCID: PMC9644364 DOI: 10.1136/openhrt-2022-002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background Between 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment. Objective To evaluate if inferior vena cava (IVC) and lung ultrasound (CAVAL US)-guided therapy for AHF patients reduces subclinical congestion at discharge. Methods CAVAL US-AHF is a single-centre, single-blind randomised controlled trial designed to evaluate if an IVC and lung ultrasound-guided healthcare strategy is superior to standard care to reduce subclinical congestion at discharge. Fifty-eight patients with AHF will be randomised using a block randomisation programme that will assign to either lung and IVC ultrasound-guided decongestion therapy (‘intervention group’) or clinical-guided decongestion therapy (‘control group’), using a quantitative protocol and will be classified in three groups according to the level of congestion observed: none or mild, moderate or severe. The treating physicians will know the result of the test and the subsequent adjustment of treatment in response to those findings guided by a customised therapeutic algorithm. The primary endpoint is the presence of more than five B-lines and/or an increase in the diameter of the IVC, with and without collapsibility. The secondary endpoints are the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days, variation of pro-B-type natriuretic peptide at discharge, length of hospital stay and diuretic dose at 90 days. Analyses will be conducted as between-group by intention to treat. Ethics and dissemination Ethical approval was obtained from the Institutional Review Board and registered in the PRIISA.BA platform of the Ministry of Health of the City of Buenos Aires. Trial registration number NCT04549701.
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Affiliation(s)
- Lucrecia Maria Burgos
- Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Rocio Baro Vila
- Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Ailin Goyeneche
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Florencia Muñoz
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Ana Spaccavento
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Martin Andres Fasan
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Franco Ballari
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Martin Vivas
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Laura Riznyk
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Ghibaudo
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Trivi
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Ronderos
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pablo Costabel
- Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Botto
- Clinical Research, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mirta Diez
- Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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Wang J, Huang X, Hu W, Cheng X, Zhang B. Point-of-care ultrasound to confirm the position of bronchial blockers in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1391-1398. [PMID: 36054377 PMCID: PMC9804773 DOI: 10.1002/jcu.23305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/24/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE We described the accuracy of ultrasound in determining the position of bronchial blockers (BBs) in children underwent thoracoscopic surgery. METHODS We enrolled 52 children with ASA grade I-III who received thoracoscopic surgery with placement of BBs. Point-of-care ultrasound was performed according to the BLUE protocol. The ultrasound-guided lung sliding sign and curtain sign were used to assess the position of BBs. The accuracy of ultrasound in evaluating the position of BBs, as well as the accuracy and operating time of sliding sign and curtain sign at each examination point were recorded and compared. RESULTS The accuracy of ultrasound in evaluating the position of BBs was 88% (46/52, 95% CI 0.69-0.97). When using the curtain sign to assess the position of BBs, the accuracy was 90% (94/104, 95% CI 0.78-0.96), which was significantly higher than when using the sliding sign (65% (136/208), 95% CI 0.55-0.74) (p = 0.002). The accuracy of curtain sign at the left mid-axillary line-diaphragm and the right mid-axillary line-diaphragm was respectively 96% (50/52, 95% CI 0.80-0.99) and 84% (44/52, 95% CI 0.65-0.95), which were higher than that of sliding sign at upper blue points and lower blue points. There was no significant difference in the operating time between two ultrasound signs (the curtain sign, 13.4 ± 8.2 s vs. the lung sliding sign, 16.2 ± 10.0 s, p = 0.065). CONCLUSION Point-of-care ultrasound can effectively assess the position of BBs. The accuracy of using the curtain sign at the mid-axillary line-diaphragm is higher than that of using the lung sliding sign at the anterior chest wall.
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Affiliation(s)
- Junxia Wang
- Department of Pediatricsthe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshang HospitalJinanPeople's Republic of China
| | - Xin Huang
- Department of Biostatistics, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongPeople's Republic of China
| | - Weidong Hu
- Department of AnesthesiologyQilu Children's Hospital of Shandong UniversityJinanPeople's Republic of China
| | - Xianling Cheng
- Department of AnesthesiologyQilu Children's Hospital of Shandong UniversityJinanPeople's Republic of China
| | - Bin Zhang
- Department of AnesthesiologyQilu Children's Hospital of Shandong UniversityJinanPeople's Republic of China
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240
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Innocenti F, Lazzari C, Paolucci E, De Paris A, Lagomarsini A, Guerra F, Alleonato P, Casalini L, Buggea M, Caldi F, Zanobetti M, Pieralli F, Guazzini G, Lastraioli L, Luise F, Milia A, Sammicheli L, Maddaluni L, Lavorini F, Pini R. Role of prognostic scores in predicting in-hospital mortality and failure of non-invasive ventilation in adults with COVID-19. Intern Emerg Med 2022; 17:2367-2377. [PMID: 35918627 PMCID: PMC9345392 DOI: 10.1007/s11739-022-03058-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022]
Abstract
We tested the prognostic performance of different scores for the identification of subjects with acute respiratory failure by COVID-19, at risk of in-hospital mortality and NIV failure. We conducted a retrospective study, in the Medical High-Dependency Unit of the University-Hospital Careggi. We included all subjects with COVID-19 and ARF requiring non-invasive ventilation (NIV) between March 2020 and January 2021. Clinical parameters, the HACOR score (Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory Rate) and ROX index ((SpO2/FiO2)/respiratory rate) were collected 3 (-3) and 1 day (-1) before the NIV initiation, the first day of treatment (Day0) and after 1 (+1), 2 (+2), 5 (+5), 8 (+8) and 11 (+11) of treatment. The primary outcomes were in-hospital mortality and NIV failure. We included 135 subjects, mean age 69±13 years, 69% male. Patients, who needed mechanical ventilation, showed a higher HACOR score (Day0: 6 [5-7] vs 6 [6-7], p=.057; Day+2: 6 [6-6] vs 6 [4-6], p=.013) and a lower ROX index (Day0: 4.2±2.3 vs 5.1±2.3, p=.055; Day+2: 4.4±1.2.vs 5.5±1.3, p=.001) than those with successful NIV. An HACOR score >5 was more frequent among nonsurvivors (Day0: 82% vs 58%; Day2: 82% vs 48%, all p<0.01) and it was associated with in-hospital mortality (Day0: RR 5.88, 95%CI 2.01-17.22; Day2: RR 4.33, 95%CI 1.64-11.41) independent to age and Charlson index. In conclusion, in subjects treated with NIV for ARF caused by COVID19, respiratory parameters collected after the beginning of NIV allowed to identify those at risk of an adverse outcome. An HACOR score >5 was independently associated with increased mortality rate.
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Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy.
| | - Cristian Lazzari
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Elisa Paolucci
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Anna De Paris
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Alessia Lagomarsini
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Federica Guerra
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Patrizia Alleonato
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Lisa Casalini
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Michele Buggea
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Francesca Caldi
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Maurizio Zanobetti
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Giulia Guazzini
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Lisa Lastraioli
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Fabio Luise
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Alessandro Milia
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Lucia Sammicheli
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Lucia Maddaluni
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts. Crit Care Med 2022; 50:1607-1617. [PMID: 35866658 DOI: 10.1097/ccm.0000000000005620] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population. DESIGN A prospective diagnostic accuracy study with derivation and validation cohorts. SETTING Three academic mixed ICUs in the Netherlands. PATIENTS Consecutive adult ICU patients that received a lung ultrasound examination. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULT The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome ( n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS ( n = 29) from CPE ( n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77-0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS ( n = 98) from CPE ( n = 24) with a sensitivity of 31% (95% CI, 21-40%) and a specificity of 100% (95% CI, 86-100%). CONCLUSIONS Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.
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242
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Lo H, Eder N, Boten D, Jenssen C, Nuernberg D. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8:E68-E76. [PMID: 36937375 PMCID: PMC10023243 DOI: 10.1055/a-1999-7834] [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: 03/25/2022] [Accepted: 11/24/2022] [Indexed: 03/19/2023] Open
Abstract
Due to the severity of their disease, palliative care patients often present complex clinical symptoms and complaints like pain, shortness of breath, nausea, loss of appetite, and fatigue. Solely relying on the information available from the history and physical examination often causes uncertainty among palliative care physicians regarding treatment decisions during home visits, potentially leading to unnecessary hospitalizations or transfer to cross-sectional imaging in radiological practices. A rational approach is essential to avoid diagnostic aggressiveness while still providing the imaging information required for optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the potential to expand the diagnostic and therapeutic spectrum in the case of symptom exacerbation but is still underutilized. In this review, we evaluate the potential uses of HHUS in home care settings to provide a more accurate diagnosis of the most common symptoms in palliative patients and to guide bedside interventions such as bladder catheterization, thoracentesis, paracentesis, venous access, and regional anesthesia. Specific training programs for ultrasound in palliative care are currently not available. Adequate documentation is warranted but fraught with technological and privacy issues. Expert supervision and quality assurance are necessary. Despite its limitation and challenges, we suggest that HHUS leads to improved clinical decision-making, expedited symptom relief, and reduced complications without burdening of the patient and costly transfer to hospital or specialty consultations.
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Affiliation(s)
- Hendra Lo
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine – Gastroenterology, Diabetology
and Hepatology, Vivantes Hospital Neukölln, Berlin,
Germany
- Correspondence Mr. Hendra Lo Brandenburg
Medical University Theodor Fontane, Institute for Clinical Ultrasound
(BICUS) and Faculty of Health Sciences Brandenburg, Fehrbelliner
Straße 3816816NeuruppinGermany+ 49
3391 3914710
,
| | - Nicole Eder
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - David Boten
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
| | - Christian Jenssen
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - Dieter Nuernberg
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
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243
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Olesen ASO, Miger K, Fabricius-Bjerre A, Sandvang KD, Kjesbu IE, Sajadieh A, Høst N, Køber N, Wamberg J, Pedersen L, Schultz HHL, Abild-Nielsen AG, Wille MMW, Nielsen OW. Remote dielectric sensing to detect acute heart failure in patients with dyspnoea: a prospective observational study in the emergency department. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac073. [PMID: 36518260 PMCID: PMC9731402 DOI: 10.1093/ehjopen/oeac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/26/2022] [Accepted: 10/29/2022] [Indexed: 06/17/2023]
Abstract
AIMS Remote dielectric sensing (ReDS) enables quick estimation of lung fluid content. To examine if ReDS is superior to other methods in detecting acute heart failure. METHODS AND RESULTS We included consecutive patients with dyspnoea from the emergency departments at Bispebjerg Hospital, Copenhagen, and performed ReDS, low-dose chest computed tomography (CT), echocardiogram, lung ultrasound, NT-Pro-brain natriuretic peptide (NT-proBNP), and a Boston score evaluation (chest X-ray and clinical signs). ReDS values >35% were used as a cut-off to diagnose pulmonary congestion. Acute heart failure was adjudicated by experts' review of health records but independently of ReDS values. Sub-analyses investigated ReDS in acute heart failure patients with congestion on CT. We included 97 patients within a median of 4.8 h from admittance: 25 patients (26%) were ReDS-positive and 39 (40%) had adjudicated acute heart failure (21 with and 18 without CT congestion). Heart failure patients had median ReDS 33%, left ventricular ejection fraction 48%, and NT-proBNP 2935 ng/L. A positive ReDS detected heart failure with 46% sensitivity, 88% specificity, and 71% accuracy. The AUC for ReDS was like the Boston score (P = 0.88) and the lung ultrasound score (P = 0.74). CT-congested heart failure patients had higher ReDS values than patients without heart failure (median 38 vs. 28%, P < 0.001). Heart failure patients without CT-congestion had ReDS values like patients without heart failure (mean 30 vs. 28%, P = 0.07). CONCLUSION ReDS detects acute heart failure similarly to the Boston score and lung ultrasound score, and ReDS primarily identifies the acute heart failure patients who have congestion on a chest CT.
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Affiliation(s)
| | - Kristina Miger
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Andreas Fabricius-Bjerre
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Kathrine Dyrsting Sandvang
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Ingunn Eklo Kjesbu
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Nana Køber
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Jesper Wamberg
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Lars Pedersen
- Department of Pulmonary Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Hans Henrik Lawaetz Schultz
- Department of Pulmonary Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Annemette Geilager Abild-Nielsen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | | | - Olav Wendelboe Nielsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 4B, 2400 Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Blegdamsvej 3, 2200 Copenhagen, Denmark
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244
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Hypoxia and Polycythemia: A Pediatric Emergency Department Point of Care Ultrasound Diagnosis of Pulmonary Arteriovenous Malformation. Pediatr Emerg Care 2022; 38:633-635. [PMID: 35436766 DOI: 10.1097/pec.0000000000002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Point of care ultrasound (POCUS) can be useful in the differentiation between cardiac and pulmonary etiologies of hypoxia. Here, we present a child with signs of chronic hypoxia, found on POCUS to have multiple pulmonary arteriovenous malformations. A combination of POCUS and history supported a presumptive pediatric emergency department diagnosis of hereditary hemorrhagic telangiectasia. This case is the first case of a pulmonary arteriovenous malformation found on POCUS and reinforces the importance of POCUS as a first-line examination in the evaluation of chronic hypoxia in the pediatric emergency department.
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245
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Banai A, Lupu L, Shetrit A, Hochstadt A, Lichter Y, Levi E, Szekely Y, Schellekes N, Jacoby T, Zahler D, Itach T, Taieb P, Gefen S, Viskin D, Shidlansik L, Adler A, Levitsky E, Havakuk O, Banai S, Ghantous E, Topilsky Y. Systematic lung ultrasound in Omicron-type vs. wild-type COVID-19. Eur Heart J Cardiovasc Imaging 2022; 24:59-67. [PMID: 36288539 PMCID: PMC9620376 DOI: 10.1093/ehjci/jeac212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Preliminary data suggested that patients with Omicron-type-Coronavirus-disease-2019 (COVID-19) have less severe lung disease compared with the wild-type-variant. We aimed to compare lung ultrasound (LUS) parameters in Omicron vs. wild-type COVID-19 and evaluate their prognostic implications. METHODS AND RESULTS One hundred and sixty-two consecutive patients with Omicron-type-COVID-19 underwent LUS within 48 h of admission and were compared with propensity-matched wild-type patients (148 pairs). In the Omicron patients median, first and third quartiles of the LUS-score was 5 [2-12], and only 9% had normal LUS. The majority had either mild (≤5; 37%) or moderate (6-15; 39%), and 15% (≥15) had severe LUS-score. Thirty-six percent of patients had patchy pleural thickening (PPT). Factors associated with LUS-score in the Omicron patients included ischaemic-heart-disease, heart failure, renal-dysfunction, and C-reactive protein. Elevated left-filling pressure or right-sided pressures were associated with the LUS-score. Lung ultrasound-score was associated with mortality [odds ratio (OR): 1.09, 95% confidence interval (CI): 1.01-1.18; P = 0.03] and with the combined endpoint of mortality and respiratory failure (OR: 1.14, 95% CI: 1.07-1.22; P < 0.0001). Patients with the wild-type variant had worse LUS characteristics than the matched Omicron-type patients (PPT: 90 vs. 34%; P < 0.0001 and LUS-score: 8 [5, 12] vs. 5 [2, 10], P = 0.004), irrespective of disease severity. When matched only to the 31 non-vaccinated Omicron patients, these differences were attenuated. CONCLUSION Lung ultrasound-score is abnormal in the majority of hospitalized Omicron-type patients. Patchy pleural thickening is less common than in matched wild-type patients, but the difference is diminished in the non-vaccinated Omicron patients. Nevertheless, even in this milder form of the disease, the LUS-score is associated with poor in-hospital outcomes.
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Affiliation(s)
| | | | - Aviel Shetrit
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Yael Lichter
- The Intensive Care Unit, Tel-Aviv Sourasky Medical Center and Sackler school of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Erez Levi
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Yishay Szekely
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Nadav Schellekes
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Tammy Jacoby
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Tamar Itach
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Philippe Taieb
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Sheizaf Gefen
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Lia Shidlansik
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ekaterina Levitsky
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
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Zhirov IV, Nasonova SN, Tereshchenko SN. Acute decompensation of heart failure: state of the problem. TERAPEVT ARKH 2022; 94:1047-1051. [DOI: 10.26442/00403660.2022.09.201839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
Are presented the key aspects of the management of patients with acute decompensation of heart failure leading to improved clinical outcomes. Are described the existing problems and possible solutions.
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247
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Automatic deep learning-based consolidation/collapse classification in lung ultrasound images for COVID-19 induced pneumonia. Sci Rep 2022; 12:17581. [PMID: 36266463 PMCID: PMC9584232 DOI: 10.1038/s41598-022-22196-y] [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: 04/07/2022] [Accepted: 10/11/2022] [Indexed: 01/13/2023] Open
Abstract
Our automated deep learning-based approach identifies consolidation/collapse in LUS images to aid in the identification of late stages of COVID-19 induced pneumonia, where consolidation/collapse is one of the possible associated pathologies. A common challenge in training such models is that annotating each frame of an ultrasound video requires high labelling effort. This effort in practice becomes prohibitive for large ultrasound datasets. To understand the impact of various degrees of labelling precision, we compare labelling strategies to train fully supervised models (frame-based method, higher labelling effort) and inaccurately supervised models (video-based methods, lower labelling effort), both of which yield binary predictions for LUS videos on a frame-by-frame level. We moreover introduce a novel sampled quaternary method which randomly samples only 10% of the LUS video frames and subsequently assigns (ordinal) categorical labels to all frames in the video based on the fraction of positively annotated samples. This method outperformed the inaccurately supervised video-based method and more surprisingly, the supervised frame-based approach with respect to metrics such as precision-recall area under curve (PR-AUC) and F1 score, despite being a form of inaccurate learning. We argue that our video-based method is more robust with respect to label noise and mitigates overfitting in a manner similar to label smoothing. The algorithm was trained using a ten-fold cross validation, which resulted in a PR-AUC score of 73% and an accuracy of 89%. While the efficacy of our classifier using the sampled quaternary method significantly lowers the labelling effort, it must be verified on a larger consolidation/collapse dataset, our proposed classifier using the sampled quaternary video-based method is clinically comparable with trained experts' performance.
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248
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Hepworth-Warren KL, Nelson N, Dembek KA, Young KAS. Comparison of thoracic ultrasonography and thoracic radiography between healthy adult horses and horses with bacterial pneumonia using a novel, objective ultrasonographic scoring system. Front Vet Sci 2022; 9:991634. [PMID: 36311667 PMCID: PMC9608548 DOI: 10.3389/fvets.2022.991634] [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: 07/11/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background Thoracic ultrasonography (TUS) is widely used in equine practice but comparison to radiography is limited in horses. Objectives To validate a novel, objective scoring system for TUS in adult horses and to compare ultrasonographic and radiographic findings. Animals 13 healthy horses and 9 with confirmed bacterial pneumonia Methods Prospective study in which TUS and radiography were performed on healthy horses and those with bacterial pneumonia confirmed by clinical signs and results of transtracheal wash analysis. Ultrasonography was scored utilizing a novel scoring system evaluating number of comet tail lesions, the presence or absence of pleural effusion and/or pulmonary consolidation in each intercostal space. Eighteen horses had thoracic radiographs taken that were scored by a board-certified radiologist utilizing a previously described system. Total scores were recorded and compared between control and diseased patients. Results/Findings Ultrasonographic scores were significantly higher in the diseased group (median= 126) than in the control group (median = 20, p = 0.01). Receiver operating characteristics (ROC) analysis identified a sensitivity of 66.7% (95% CI 0.417–1) and specificity of 92.3% (95% CI 0.462–1) for the ability of ultrasonography to identify bacterial pneumonia utilizing a TUS score cutoff of 37. Conclusions and clinical importance TUS had moderate sensitivity and high specificity for identification of bacterial pneumonia in adult horses. TUS appears to be an acceptable stand-alone imaging modality for diagnosis of bacterial pneumonia in horses when radiography is not practical.
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Affiliation(s)
- Kate L. Hepworth-Warren
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States,*Correspondence: Kate L. Hepworth-Warren
| | - Nathan Nelson
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Katarzyna A. Dembek
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Kimberly A. S. Young
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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Cantinotti M, Marchese P, Assanta N, Pizzuto A, Corana G, Santoro G, Franchi E, Viacava C, Van den Eynde J, Kutty S, Gargani L, Giordano R. Lung Ultrasound Findings in Healthy Children and in Those Who Had Recent, Not Severe COVID-19 Infection. J Clin Med 2022; 11:jcm11205999. [PMID: 36294320 PMCID: PMC9605002 DOI: 10.3390/jcm11205999] [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: 08/04/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Lung ultrasound (LUS) is gaining consensus as a non-invasive diagnostic imaging method for the evaluation of pulmonary disease in children. Aim: To clarify what type of artifacts (e.g., B-lines, pleural irregularity) can be defined normal LUS findings in children and to evaluate the differences in children who did not experience COVID-19 and in those with recent, not severe, previous COVID-19. Methods: LUS was performed according to standardized protocols. Different patterns of normality were defined: pattern 1: no plural irregularity and no B-lines; pattern 2: only mild basal posterior plural irregularity and no B-lines; pattern 3: mild posterior basal/para-spine/apical pleural irregularity and no B-lines; pattern 4: like pattern 3 plus rare B-lines; pattern 5: mild, diffuse short subpleural vertical artifacts and rare B-lines; pattern 6: mild, diffuse short subpleural vertical artifacts and limited B-lines; pattern 7: like pattern 6 plus minimal subpleural atelectasis. Coalescent B-lines, consolidations, or effusion were considered pathological. Results: Overall, 459 healthy children were prospectively recruited (mean age 10.564 ± 3.839 years). Children were divided into two groups: group 1 (n = 336), those who had not had COVID-19 infection, and group 2 (n = 123), those who experienced COVID-19 infection. Children with previous COVID-19 had higher values of LUS score than those who had not (p = 0.0002). Children with asymptomatic COVID-19 had similar LUS score as those who did not have infections (p > 0.05), while those who had symptoms showed higher LUS score than those who had not shown symptoms (p = 0.0228). Conclusions: We report the pattern of normality for LUS examination in children. We also showed that otherwise healthy children who recovered from COVID-19 and even those who were mildly symptomatic had more “physiological” artifacts at LUS examinations.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
- Institute of Clinical Physiology, 56127 Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | | | - Giulia Corana
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, 3010 Leuven, Belgium
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Luna Gargani
- Cardiothoracic Department, University of Pisa, 56127 Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence: ; Tel./Fax: +39-08-1746-4702
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de Souza LAM, Paredes RG, Giraldi T, Franco MH, de Carvalho-Filho MA, Cecilio-Fernandes D, de Figueiredo LC, Santos TM. Implementation and Assessment of Lung Ultrasound Training Curriculum for Physiotherapists With a Focus on Image Acquisition and Calculation of an Aeration Score. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2119-2127. [PMID: 35948457 DOI: 10.1016/j.ultrasmedbio.2022.06.002] [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: 01/13/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Described here is the implementation of a lung ultrasound course for physiotherapists focused on the acquisition and retention of knowledge and skills. Initially, we provided online lectures in a virtual learning environment (VLE), in which we taught the semiquantification of edema through a lung ultrasound score (LUS). Afterward, the physiotherapists participated in face-to-face lectures (which resumed the online lectures), followed by hands-on training and simulation with ultrasound. We assessed knowledge acquisition through a multiple-choice test with 30 questions (totaling 10 points). The test was applied before accessing the VLE (pre-VLE), before the face-to-face course and at its end (pre- and post-course). Physiotherapists collected actual patients' ultrasound scans, which were uploaded to the VLE and assessed by three supervisors, who performed a consensus LUS calculation and gave virtual written feedback. Thirteen physiotherapists collected 59 exams. The test results were 3.60 ± 1.58 (pre-VLE), 5.94 ± 1.45 (pre-course) and 8.50 ± 0.71 (post-course), with p < 0.001 for all. The intraclass correlation coefficient for LUS between physiotherapists and supervisors was 0.814 (p < 0.001), with moderate-to-weak agreement for LUS of the lung apical, median and basal zones, with κ = 0.455.334, and 0.417 (p < 0.001 for all). Trainees were found to have increased short-term acquisition and retention of knowledge and skills, with a good intraclass correlation coefficient between them and the consensus of supervisors for the LUS of actual patients.
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Affiliation(s)
| | - Ramon Gonzalez Paredes
- Postgraduate Department in Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Tiago Giraldi
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mário Henrique Franco
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Dario Cecilio-Fernandes
- Postgraduate Department in Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Thiago Martins Santos
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
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