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Ozdemir M, Tepe T, Ozlu F, Yapicioglu H, Atmıs A, Demir F, Unal I, Narli N. Lung ultrasound score in the decision of patent ductus arteriosus closure in neonates. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:415-425. [PMID: 38385619 DOI: 10.1002/jcu.23653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE We aimed to investigate the role of lung ultrasound (LUS) score in the closure of hemodynamically insignificant patent ductus arteriosus (PDA) and the clinical findings of the patients before and after closure. METHODS The study groups (107 preterm neonates under 34 gestational weeks) were classified as hemodynamically significant PDA (group 1), hemodynamically insignificant PDA with closure therapy (group 2), hemodynamically insignificant PDA without closure therapy (group 3), and no PDA group (group 4) based on the echocardiography. 6- and 10-region LUS scores were compared for each group. RESULTS There was a significant difference between groups 1 and 3 on first, third, and seventh days. In contrast, groups 1 and 2 had similar LUS scores on the first, third, and seventh days. There was a negative correlation between LUS scores on the first and third days and gestational age, birth weight, the first- and fifth-minute APGAR scores, and there was a positive correlation between aortic root to left atrium ratio, and PDA diameter/weight ratio. CONCLUSION We observed that LUS scores in patients with hemodynamically insignificant PDA treated with closure therapy were similar to in patients with hemodynamically significant PDA. Thus, LUS score can have role in PDA closure in preterm neonates. However, more comprehensive studies are needed.
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Affiliation(s)
- Mustafa Ozdemir
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Tugay Tepe
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Ferda Ozlu
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Hacer Yapicioglu
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Anıl Atmıs
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Cukurova University, Adana, Turkey
| | - Fadli Demir
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Cukurova University, Adana, Turkey
| | - Ilker Unal
- Faculty of Medicine, Department of Biostatistics, Cukurova University, Adana, Turkey
| | - Nejat Narli
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
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2
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Bassiouny R, Mohamed A, Umapathy K, Khan N. An Interpretable Neonatal Lung Ultrasound Feature Extraction and Lung Sliding Detection System Using Object Detectors. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:119-128. [PMID: 38088993 PMCID: PMC10712663 DOI: 10.1109/jtehm.2023.3327424] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023]
Abstract
The objective of this study was to develop an interpretable system that could detect specific lung features in neonates. A challenging aspect of this work was that normal lungs showed the same visual features (as that of Pneumothorax (PTX)). M-mode is typically necessary to differentiate between the two cases, but its generation in clinics is time-consuming and requires expertise for interpretation, which remains limited. Therefore, our system automates M-mode generation by extracting Regions of Interest (ROIs) without human in the loop. Object detection models such as faster Region Based Convolutional Neural Network (fRCNN) and RetinaNet models were employed to detect seven common Lung Ultrasound (LUS) features. fRCNN predictions were then stored and further used to generate M-modes. Beyond static feature extraction, we used a Hough transform based statistical method to detect "lung sliding" in these M-modes. Results showed that fRCNN achieved a greater mean Average Precision (mAP) of 86.57% (Intersection-over-Union (IoU) = 0.2) than RetinaNet, which only displayed a mAP of 61.15%. The calculated accuracy for the generated RoIs was 97.59% for Normal videos and 96.37% for PTX videos. Using this system, we successfully classified 5 PTX and 6 Normal video cases with 100% accuracy. Automating the process of detecting seven prominent LUS features addresses the time-consuming manual evaluation of Lung ultrasound in a fast paced environment. Clinical impact: Our research work provides a significant clinical impact as it provides a more accurate and efficient method for diagnosing lung diseases in neonates.
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Affiliation(s)
- Rodina Bassiouny
- Department of Electrical, Computer, and Biomedical EngineeringToronto Metropolitan UniversityTorontoONM5B 2K3Canada
| | - Adel Mohamed
- Mount Sinai HospitalUniversity of TorontoTorontoONM5S 1A1Canada
| | - Karthi Umapathy
- Department of Electrical, Computer, and Biomedical EngineeringToronto Metropolitan UniversityTorontoONM5B 2K3Canada
| | - Naimul Khan
- Department of Electrical, Computer, and Biomedical EngineeringToronto Metropolitan UniversityTorontoONM5B 2K3Canada
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3
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Ostras O, Shponka I, Pinton G. Ultrasound imaging of lung disease and its relationship to histopathology: An experimentally validated simulation approach. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:2410-2425. [PMID: 37850835 PMCID: PMC10586875 DOI: 10.1121/10.0021870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
Lung ultrasound (LUS) is a widely used technique in clinical lung assessment, yet the relationship between LUS images and the underlying disease remains poorly understood due in part to the complexity of the wave propagation physics in complex tissue/air structures. Establishing a clear link between visual patterns in ultrasound images and underlying lung anatomy could improve the diagnostic accuracy and clinical deployment of LUS. Reverberation that occurs at the lung interface is complex, resulting in images that require interpretation of the artifacts deep in the lungs. These images are not accurate spatial representations of the anatomy due to the almost total reflectivity and high impedance mismatch between aerated lung and chest wall. Here, we develop an approach based on the first principles of wave propagation physics in highly realistic maps of the human chest wall and lung to unveil a relationship between lung disease, tissue structure, and its resulting effects on ultrasound images. It is shown that Fullwave numerical simulations of ultrasound propagation and histology-derived acoustical maps model the multiple scattering physics at the lung interface and reproduce LUS B-mode images that are comparable to clinical images. However, unlike clinical imaging, the underlying tissue structure model is known and controllable. The amount of fluid and connective tissue components in the lung were gradually modified to model disease progression, and the resulting changes in B-mode images and non-imaging reverberation measures were analyzed to explain the relationship between pathological modifications of lung tissue and observed LUS.
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Affiliation(s)
- Oleksii Ostras
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina 27514, USA
| | - Ihor Shponka
- Department of Pathology and Forensic Medicine, Dnipro State Medical University, Dnipro, Ukraine
| | - Gianmarco Pinton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina 27514, USA
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4
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Zong H, Huang Y, Huang Z, Zhao J, Lin B, Fu Y, Lin Y, Yu Y, Sun H, Yang C. Lung ultrasound score predicts patent ductus arteriosus ligation among neonates ≤25 weeks. Pediatr Pulmonol 2023; 58:2487-2494. [PMID: 37265422 DOI: 10.1002/ppul.26531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/27/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This prospective study aimed to investigate whether lung ultrasound score (LUSs) can predict the patent ductus arteriosus (PDA) ligation. METHODS Preterm infants ≤25 weeks of gestational age (GA) were enrolled. A lung ultrasound was performed on the 14th day of life. Each lung zone was given a score between 0 and 4. A receiver-operating characteristic (ROC) curve was constructed to evaluate the ability of the LUSs for predicting ligation. RESULTS A total of 81 infants were eligible with a median GA and birth weight (BW) of 25 weeks (24.1-25.2) and 710 g (645-770), respectively. The median time from birth to ligation was 35 days (32-51). Those who underwent ligation had a longer time of mechanical ventilation (34 [26-39] vs. 19 [12-30], p < 0.001), shorter time of noninvasive respiratory support (39 [32-51] vs. 50 [41.5-57], p < 0.01), higher incidence of the bronchopulmonary dysplasia (BPD) (p < 0.01), and severe BPD (p < 0.001). The LUSs had an area under the ROC of 0.96 (95% confidence interval: 0.93-0.99) for the prediction of ligation. A LUSs cutoff of 36 has a sensitivity and specificity of 96% and 86% and positive and negative predictive values of 82% and 98%, respectively. CONCLUSIONS LUSs at an early stage of life can predict PDA ligation in extremely preterm infants. It would be helpful to reduce morbidity by reducing the duration and magnitude of respiratory support.
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Affiliation(s)
- Haifeng Zong
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yichu Huang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Zhifeng Huang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jie Zhao
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yongping Fu
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanqing Lin
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanliang Yu
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Hongyan Sun
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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Barbieri G, Gargani L, Lepri V, Spinelli S, Romei C, De Liperi A, Chimera D, Pistelli F, Carrozzi L, Corradi F, Ghiadoni L. Long-term lung ultrasound follow-up in patients after COVID-19 pneumonia hospitalization: A prospective comparative study with chest computed tomography. Eur J Intern Med 2023; 110:29-34. [PMID: 36564240 PMCID: PMC9729593 DOI: 10.1016/j.ejim.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
During COVID-19 pandemic, lung ultrasound (LUS) proved to be of great value in the diagnosis and monitoring of patients with pneumonia. However, limited data exist regarding its use to assess aeration changes during follow-up (FU). Our study aims to prospectively evaluate 232 subjects who underwent a 3-month-FU program after hospitalization for COVID-19 at the University Hospital of Pisa. The goals were to assess the usefulness of standardized LUS compared with the gold standard chest computed tomography (CT) to evaluate aeration changes and to verify LUS and CT agreement at FU. Patients underwent in the same day a standardized 16-areas LUS and high-resolution chest CT reported by expert radiologists, assigning interpretative codes. Based on observations distribution, LUS score cut-offs of 3 and 7 were selected, corresponding to the 50th and 75th percentile, respectively. Patients with LUS scores above both these thresholds were older and with longer hospital stay. Patients with a LUS score ≥3 had more comorbidities. LUS and chest CT showed a high agreement in identifying residual pathological findings, using both cut-off scores of 3 (OR 14,7; CL 3,6-64,5, Sensitivity 91%, Specificity 49%) and 7 (OR 5,8; CL 2,3-14,3, Sensitivity 65%, Specificity 79%). Our data suggest that LUS is very sensitive in identifying pathological findings at FU after a hospitalization for COVID-19 pneumonia, compared to CT. Given its low cost and safety, LUS could replace CT in selected cases, such as in contexts with limited resources or it could be used as a gate-keeper examination before more advanced techniques.
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Affiliation(s)
- Greta Barbieri
- Emergency Medicine Department, Pisa University Hospital, Italy; Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
| | - Luna Gargani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Vittoria Lepri
- Emergency Medicine Department, Pisa University Hospital, Italy
| | | | - Chiara Romei
- 2nd Radiology Unit, Department of Radiology, Pisa University Hospital, Italy
| | - Annalisa De Liperi
- 2nd Radiology Unit, Department of Radiology, Pisa University Hospital, Italy
| | - Davide Chimera
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Italy
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Lorenzo Ghiadoni
- Emergency Medicine Department, Pisa University Hospital, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
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6
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Parri N, Allinovi M, Giacalone M, Corsini I. To B or not to B. The rationale for quantifying B-lines in pediatric lung diseases. Pediatr Pulmonol 2023; 58:9-15. [PMID: 36253340 DOI: 10.1002/ppul.26185] [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: 11/11/2021] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
Lung ultrasound (LUS) is emerging as adjunct tool to be used during clinical assessment. Among the different hallmarks of LUS, B-lines are well known artifacts, which are not correlated with identifiable structures, but which can be used for pathological classification. The presence of multiple B-lines is a sonographic sign of lung interstitial syndrome. It has been demonstrated in adults that there is a direct correlation between the number of B-lines and the severity of the interstitial involvement of lung disease. Counting B-lines is an attempt to enrich the clinical assessment and clinical information, beyond obtaining a simple dichotomous answer. Semiquantitative or quantitative B-line assessment has been shown to correlate with fluid overload and demonstrated prognostic implications in specific neonatal and pediatric conditions. LUS with quantitative B-lines assessment is promising. Current evidence allows for quantification of B-lines in a limited number of neonatal and pediatric diseases.
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Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy
| | - Martina Giacalone
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
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7
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Fang J, Ting YN, Chen YW. Quantitative Assessment of Lung Ultrasound Grayscale Images Based on Shannon Entropy for the Detection of Pulmonary Aeration: An Animal Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1699-1711. [PMID: 34698398 DOI: 10.1002/jum.15851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Lung ultrasound (LUS) is a radiation-free, affordable, and bedside monitoring method that can detect changes in pulmonary aeration before hypoxic damage. However, visual scoring methods of LUS only enable subjective diagnosis. Therefore, quantitative analysis of LUS is necessary for obtaining objective information on pulmonary aeration. Because raw data are not always available in conventional ultrasound systems, Shannon entropy (ShanEn) of information theory without the requirement of raw data is valuable. In this study, we explored the feasibility of ShanEn estimated through grayscale histogram (GSH) analysis of LUS images for the quantification of pulmonary aeration. METHODS Different degrees of pulmonary aeration caused by edema was induced in 32 male New Zealand rabbits intravenously injected with 0.1 mL/kg saline (the control group) and 0.025, 0.05, and 0.1 mL/kg oleic acid (mild, moderate, and severe groups, respectively). In vivo grayscale LUS images were acquired using a commercial point-of-care ultrasound system for estimation of GSH and corresponding ShanEn. Both lungs of each rabbit were dissected, weighed, and dried to determine the wet weight-to-dry weight ratio (W/D) through gravimetry. RESULTS The determination coefficients of linear correlations between ShanEn and W/D increased from 0.0487 to 0.7477 with gain and dynamic range (DR). In contrast to visual scoring methods of pulmonary aeration that use median gain and low DR, ShanEn for quantifying pulmonary aeration requires high gain and DR. CONCLUSION The current findings indicate that ShanEn estimated through GSH analysis of LUS images acquired using conventional ultrasonic imaging systems has great potential to provide objective information on pulmonary aeration.
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Affiliation(s)
- Jui Fang
- x-Dimension Center for Medical Research and Translation, China Medical University Hospital, Taichung City, Taiwan
| | - Yen-Nien Ting
- x-Dimension Center for Medical Research and Translation, China Medical University Hospital, Taichung City, Taiwan
| | - Yi-Wen Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung City, Taiwan
- High Performance Materials Institute for xD Printing, Asia University, Taichung City, Taiwan
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8
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Ma HR, Liu J, Yan WK. Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review. Am J Perinatol 2022; 39:973-979. [PMID: 33242910 DOI: 10.1055/s-0040-1721134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. STUDY DESIGN We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. RESULTS Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92-1.00) and a specificity of 0.99 (CI: 0.91-1.00). The area under the curve for LUS was 1.00 (0.98-1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. CONCLUSION The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. KEY POINTS · Lung ultrasound is a highly accurate diagnostic tool, which may be a viable and superior alternative to CXR, in diagnosing TTN.. · Lung ultrasound can help differentiate TTN from other etiologies of respiratory distress in neonates.. · There are still some controversies on the ultrasound diagnostic criteria of TTN..
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Affiliation(s)
- Hai-Ran Ma
- Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou Guangdong, Republic of China
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing and National Neonatal Lung Ultrasound Training Center, Beijing, Republic of China
| | - Jing Liu
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing and National Neonatal Lung Ultrasound Training Center, Beijing, Republic of China
| | - Wen-Kang Yan
- Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou Guangdong, Republic of China
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Mao JY, Zhang HM, Liu DW, Wang XT. Visual Rounds Based on Multiorgan Point-of-Care Ultrasound in the ICU. Front Med (Lausanne) 2022; 9:869958. [PMID: 35692540 PMCID: PMC9174546 DOI: 10.3389/fmed.2022.869958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) is performed by a treating clinician at the patient's bedside, provides a acquisition, interpretation, and immediate clinical integration based on ultrasonographic imaging. The use of POCUS is not limited to one specialty, protocol, or organ system. POCUS provides the treating clinician with real-time diagnostic and monitoring information. Visual rounds based on multiorgan POCUS act as an initiative to improve clinical practice in the Intensive Care Unit and are urgently needed as part of routine clinical practice.
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Affiliation(s)
- Jia-Yu Mao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiao-Ting Wang
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10
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Huang Q, Lei Y, Xing W, He C, Wei G, Miao Z, Hao Y, Li G, Wang Y, Li Q, Li X, Li W, Chen J. Evaluation of Pulmonary Edema Using Ultrasound Imaging in Patients With COVID-19 Pneumonia Based on a Non-local Channel Attention ResNet. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:945-953. [PMID: 35277285 PMCID: PMC8818339 DOI: 10.1016/j.ultrasmedbio.2022.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 05/16/2023]
Abstract
Recent research has revealed that COVID-19 pneumonia is often accompanied by pulmonary edema. Pulmonary edema is a manifestation of acute lung injury (ALI), and may progress to hypoxemia and potentially acute respiratory distress syndrome (ARDS), which have higher mortality. Precise classification of the degree of pulmonary edema in patients is of great significance in choosing a treatment plan and improving the chance of survival. Here we propose a deep learning neural network named Non-local Channel Attention ResNet to analyze the lung ultrasound images and automatically score the degree of pulmonary edema of patients with COVID-19 pneumonia. The proposed method was designed by combining the ResNet with the non-local module and the channel attention mechanism. The non-local module was used to extract the information on characteristics of A-lines and B-lines, on the basis of which the degree of pulmonary edema could be defined. The channel attention mechanism was used to assign weights to decisive channels. The data set contains 2220 lung ultrasound images provided by Huoshenshan Hospital, Wuhan, China, of which 2062 effective images with accurate scores assigned by two experienced clinicians were used in the experiment. The experimental results indicated that our method achieved high accuracy in classifying the degree of pulmonary edema in patients with COVID-19 pneumonia by comparison with previous deep learning methods, indicating its potential to monitor patients with COVID-19 pneumonia.
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Affiliation(s)
- Qinghua Huang
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Ye Lei
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Wenyu Xing
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chao He
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Gaofeng Wei
- Naval Medical Department, Naval Medical University, Shanghai, China
| | - Zhaoji Miao
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Yifan Hao
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Guannan Li
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China
| | - Xuelong Li
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Wenfang Li
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiangang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
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11
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Corradi F, Vetrugno L, Isirdi A, Bignami E, Boccacci P, Forfori F. Ten conditions where lung ultrasonography may fail: limits, pitfalls and lessons learned from a computer-aided algorithmic approach. Minerva Anestesiol 2022; 88:308-313. [PMID: 35164490 DOI: 10.23736/s0375-9393.22.16195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung ultrasonography provides relevant information on morphological and functional changes occurring in the lungs. However, it correlates weakly with pulmonary congestion and extra vascular lung water. Moreover, there is lack of consensus on scoring systems and acquisition protocols. The automation of this technique may provide promising easy-to-use clinical tools to reduce inter- and intra-observer variability and to standardize scores, allowing faster data collection without increased costs and patients risks.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy - .,Anaesthesia and Intensive Care Unit, Galliera Hospital, Genoa, Italy -
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.,Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Alessandro Isirdi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Elena Bignami
- Section of Anesthesiology, Division of Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Patrizia Boccacci
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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12
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Pryor EJ, Blank DA, Hooper SB, Crossley KJ, Badurdeen S, Pollock JA, Stainsby AV, Croton LCP, O'Connell DW, Hall CJ, Maksimenko A, Hausermann D, Davis PG, Kitchen MJ. Quantifying lung aeration in neonatal lambs at birth using lung ultrasound. Front Pediatr 2022; 10:990923. [PMID: 36245717 PMCID: PMC9554403 DOI: 10.3389/fped.2022.990923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a safe and non-invasive tool that can potentially assess regional lung aeration in newborn infants and reduce the need for X-ray imaging. LUS produces images with characteristic artifacts caused by the presence of air in the lung, but it is unknown if LUS can accurately detect changes in lung air volumes after birth. This study compared LUS images with lung volume measurements from high-resolution computed tomography (CT) scans to determine if LUS can accurately provide relative measures of lung aeration. METHODS Deceased near-term newborn lambs (139 days gestation, term ∼148 days) were intubated and the chest imaged using LUS (bilaterally) and phase contrast x-ray CT scans at increasing static airway pressures (0-50 cmH2O). CT scans were analyzed to calculate regional air volumes and correlated with measures from LUS images. These measures included (i) LUS grade; (ii) brightness (mean and coefficient of variation); and (iii) area under the Fourier power spectra within defined frequency ranges. RESULTS All LUS image analysis techniques correlated strongly with air volumes measured by CT (p < 0.01). When imaging statistics were combined in a multivariate linear regression model, LUS predicted the proportion of air in the underlying lung with moderate accuracy (95% prediction interval ± 22.15%, r 2 = 0.71). CONCLUSION LUS can provide relative measures of lung aeration after birth in neonatal lambs. Future studies are needed to determine if LUS can also provide a simple means to assess air volumes and individualize aeration strategies for critically ill newborns in real time.
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Affiliation(s)
- Emily J Pryor
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Douglas A Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Monash Newborn, Monash Children's Hospital, Clayton, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Kelly J Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Shiraz Badurdeen
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - James A Pollock
- School of Physics and Astronomy, Monash University, Clayton, VIC, Australia
| | - Andrew V Stainsby
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Linda C P Croton
- School of Physics and Astronomy, Monash University, Clayton, VIC, Australia
| | - Dylan W O'Connell
- School of Physics and Astronomy, Monash University, Clayton, VIC, Australia
| | | | | | | | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Marcus J Kitchen
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,School of Physics and Astronomy, Monash University, Clayton, VIC, Australia
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13
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Vetrugno L, Mojoli F, Cortegiani A, Bignami EG, Ippolito M, Orso D, Corradi F, Cammarota G, Mongodi S, Boero E, Iacovazzo C, Vargas M, Poole D, Biasucci DG, Persona P, Bove T, Ball L, Chiumello D, Forfori F, de Robertis E, Pelosi P, Navalesi P, Giarratano A, Petrini F. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO). JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8611396 DOI: 10.1186/s44158-021-00015-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-021-00015-6.
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14
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Niyogi SG, Kumar B, Puri GD, Negi S, Mishra AK, Singh Thingnam SK. Utility of Lung Ultrasound in the Estimation of Extravascular Lung Water in a Pediatric Population-A Prospective Observational Study. J Cardiothorac Vasc Anesth 2021; 36:2385-2392. [PMID: 34895834 DOI: 10.1053/j.jvca.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lung ultrasound (LUS) is a promising bedside modality for the estimation of extravascular lung water index (EVLWI), but has not been validated against objective measures in children. This study aimed to investigate the correlation of LUS B-line scoring with EVLWI, thresholds indicating elevated EVLWI, and its outcome following pediatric cardiac surgery. DESIGN Prospective observational study. SETTING Cardiothoracic surgical intensive care unit in a tertiary care teaching hospital. PARTICIPANTS Children younger than 12 years undergoing elective complete surgical correction of cyanotic or acyanotic congenital heart disease (Aristotle score ≤9), excluding neonates, those weighing <3.5 kg, and those with thoracic deformities, pulmonary pathology, and hemodynamic instability. INTERVENTIONS Extravascular lung water index measurement by transpulmonary thermodilution, along with concurrent LUS B-line and Chest-X ray (CXR) scoring. MEASUREMENTS AND MAIN RESULTS LUS B-line score had a moderate correlation with EVLWI (Pearson's correlation coefficient 0.57; 95% CI 0.44-0.69). LUS B-line scores showed acceptable discrimination only for higher thresholds of EVLWI (sensitivity 82% and 79%, respectively, for EVLWI >20 mL/kg v sensitivity and specificity 57% and 80% for EVLWI >10 mL/kg). Age, body surface area, vasoactive-inotropic score (VIS), chest X-ray score, and EVLWI but not LUS B-line score were significant predictors for duration of mechanical ventilation in this cohort. CONCLUSIONS LUS B-line scoring has limited utility in semiquantitative estimation of EVLWI at lower thresholds of EVLWI in pediatric cardiac surgical patients. It may have better discrimination and acceptable sensitivity and specificity at higher thresholds of EVLWI. Contrasting with multiple reports of clinical utility, these results call for wider evaluation of LUS and its clinical modifiers like age, pathology, and pretest probability in estimation of EVLWI.
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Affiliation(s)
| | - Bhupesh Kumar
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India.
| | | | - Sunder Negi
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Anand Kumar Mishra
- Department of Cardiothoracic and Vascular Surgery, PGIMER, Chandigarh, India
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15
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Abstract
Lung ultrasound is increasingly used in emergency departments, medical wards, and critical care units-adult, pediatric, and neonatal. In vitro and in vivo studies show that the number and type of artifacts visualized change with lung density. This has led to the idea of a quantitative lung ultrasound approach, opening up new prospects for use not only as a diagnostic but also as a monitoring tool. Consequently, the multiple scoring systems proposed in the last few years have different technical approaches and specific clinical indications, adaptable for more or less time-dependent patients. However, multiple scoring systems may generate confusion among physicians aiming at introducing lung ultrasound in their clinical practice. This review describes the various lung ultrasound scoring systems and aims to clarify their use in different settings, focusing on technical aspects, validation with reference techniques, and clinical applications.
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16
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Chen J, He C, Yin J, Li J, Duan X, Cao Y, Sun L, Hu M, Li W, Li Q. Quantitative Analysis and Automated Lung Ultrasound Scoring for Evaluating COVID-19 Pneumonia With Neural Networks. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2507-2515. [PMID: 33798078 PMCID: PMC8864919 DOI: 10.1109/tuffc.2021.3070696] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/28/2021] [Indexed: 05/18/2023]
Abstract
As being radiation-free, portable, and capable of repetitive use, ultrasonography is playing an important role in diagnosing and evaluating the COVID-19 Pneumonia (PN) in this epidemic. By virtue of lung ultrasound scores (LUSS), lung ultrasound (LUS) was used to estimate the excessive lung fluid that is an important clinical manifestation of COVID-19 PN, with high sensitivity and specificity. However, as a qualitative method, LUSS suffered from large interobserver variations and requirement for experienced clinicians. Considering this limitation, we developed a quantitative and automatic lung ultrasound scoring system for evaluating the COVID-19 PN. A total of 1527 ultrasound images prospectively collected from 31 COVID-19 PN patients with different clinical conditions were evaluated and scored with LUSS by experienced clinicians. All images were processed via a series of computer-aided analysis, including curve-to-linear conversion, pleural line detection, region-of-interest (ROI) selection, and feature extraction. A collection of 28 features extracted from the ROI was specifically defined for mimicking the LUSS. Multilayer fully connected neural networks, support vector machines, and decision trees were developed for scoring LUS images using the fivefold cross validation. The model with 128×256 two fully connected layers gave the best accuracy of 87%. It is concluded that the proposed method could assess the ultrasound images by assigning LUSS automatically with high accuracy, potentially applicable to the clinics.
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17
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Guarracino F, Vetrugno L, Forfori F, Corradi F, Orso D, Bertini P, Ortalda A, Federici N, Copetti R, Bove T. Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach. J Cardiothorac Vasc Anesth 2021; 35:1866-1874. [PMID: 32624431 PMCID: PMC7289113 DOI: 10.1053/j.jvca.2020.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used-the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care.
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Affiliation(s)
- Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy.
| | - Francesco Forfori
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Federici
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Roberto Copetti
- Emergency Department, Azienda Sanitaria Universitaria Friuli Centrale, Latisana General Hospital, Latisana, Italy
| | - Tiziana Bove
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
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18
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Yu LF, Xu CK, Zhao M, Niu L, Huang XM, Zhang ZQ. Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus. World J Clin Cases 2021; 9:1827-1834. [PMID: 33748231 PMCID: PMC7953406 DOI: 10.12998/wjcc.v9.i8.1827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights. When PDA persists, interstitial lung water content increases, which could lead to abnormal circulation hemodynamics and pulmonary edema. It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.
AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.
METHODS From January 2018 to March 2020, 69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group. At the same time, 89 very low-weight preterm neonates without PDA were randomly selected as the control group. All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth. The clinical characteristics and main ultrasonography results were compared between the two groups. Pearson’s analysis was used to analyze the correlation between lung ultrasonography score (LUS) and other related clinical and ultrasonography results in all neonates. In the PDA group, PDA diameters were recorded, and the correlation with LUS and left atrium to aortic (LA/AO) dimension ratio were also analyzed. LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA. When the ratio is ≥ 1.5, it suggests the possibility of hemodynamic changes in persistent PDA. A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.
RESULTS A total of 158 neonates were enrolled in this study, including 69 in the PDA group and 89 in the control group. There were no statistical differences in sex, gestational age, birth weight, ventilator dependence, hospitalization length and left ventricular ejection fraction between the two groups (P > 0.05). The LUS and LA/AO ratio in the PDA group were higher than those in the control group (P < 0.05), but there was no difference of LUS in neonates with or without use of the ventilator (t = 0.58, P = 0.16). In all cases, LUS was negatively correlated with gestational age (r = -0.28, P < 0.01) and birth weight (r = -0.36, P < 0.01), while positively correlated with the LA/AO ratio (r = 0.27, P < 0.01). In the PDA group, PDA diameter was positively correlated with the LA/AO ratio (r = 0.39, P < 0.01) and LUS (r = 0.31, P < 0.01). Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA (area under the curve = 0.741; sensitivity = 93.75%; specificity = 50.94%).
CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.
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Affiliation(s)
- Li-Fang Yu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chen-Ke Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Min Zhao
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Lin Niu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xian-Mei Huang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Zhi-Qun Zhang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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19
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Second-order grey-scale texture analysis of pleural ultrasound images to differentiate acute respiratory distress syndrome and cardiogenic pulmonary edema. J Clin Monit Comput 2020; 36:131-140. [PMID: 33313979 PMCID: PMC8894303 DOI: 10.1007/s10877-020-00629-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022]
Abstract
Discriminating acute respiratory distress syndrome (ARDS) from acute cardiogenic pulmonary edema (CPE) may be challenging in critically ill patients. Aim of this study was to investigate if gray-level co-occurrence matrix (GLCM) analysis of lung ultrasound (LUS) images can differentiate ARDS from CPE. The study population consisted of critically ill patients admitted to intensive care unit (ICU) with acute respiratory failure and submitted to LUS and extravascular lung water monitoring, and of a healthy control group (HCG). A digital analysis of pleural line and subpleural space, based on the GLCM with second order statistical texture analysis, was tested. We prospectively evaluated 47 subjects: 16 with a clinical diagnosis of CPE, 8 of ARDS, and 23 healthy subjects. By comparing ARDS and CPE patients' subgroups with HCG, the one-way ANOVA models found a statistical significance in 9 out of 11 GLCM textural features. Post-hoc pairwise comparisons found statistical significance within each matrix feature for ARDS vs. CPE and CPE vs. HCG (P ≤ 0.001 for all). For ARDS vs. HCG a statistical significance occurred only in two matrix features (correlation: P = 0.005; homogeneity: P = 0.048). The quantitative method proposed has shown high diagnostic accuracy in differentiating normal lung from ARDS or CPE, and good diagnostic accuracy in differentiating CPE and ARDS. Gray-level co-occurrence matrix analysis of LUS images has the potential to aid pulmonary edemas differential diagnosis.
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20
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Wolfram F, Braun C, Gutsche H, Lesser TG. In Vivo Assessment of Lung Ultrasound Features Mimicking Viral Pneumonia Using a Large Animal Model. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2258-2264. [PMID: 32746213 DOI: 10.1109/tuffc.2020.3010299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Lung ultrasound (LUS) is a practical tool for lung diagnosis when computer tomography (CT) is not available. Recent findings suggest that LUS diagnosis is highly advantageous because of its mobility and correlation with radiological findings for viral pneumonia. Simple models for both educational evaluation and technical evaluation are needed. Therefore, this work investigates the usability of a large animal model under aspects of LUS features of viral pneumonia using saline one lung flooding. Six pigs were intubated with a double-lumen tube, and the left lung was instilled with saline. During the instillation of up to 12.5 ml/kg, the sonographic features were assessed. All features present during viral pneumonia were found, such as B-lines, white lung syndrome, pleural thickening, and the formation of pleural consolidations. Sonographic findings correlate well with current LUS scores for COVID19. The scores of 1, 2, and 3 were dominantly present at 1-4-, 4-8-, and 8-12-ml/kg saline instillation, respectively. The noninfective animal model can be used for further investigation of the LUS features and can serve in education, by helping with the appropriate handling of LUS in clinical practice during management of viral pneumonia.
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21
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Zong HF, Guo G, Liu J, Bao LL, Yang CZ. Using lung ultrasound to quantitatively evaluate pulmonary water content. Pediatr Pulmonol 2020; 55:729-739. [PMID: 31917899 DOI: 10.1002/ppul.24635] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Increases in extravascular lung water (EVLW) can lead to respiratory failure. This study aimed to investigate whether the B-line score (BLS) was correlated with the EVLW content determined by the lung wet/dry ratio in a rabbit model. METHODS A total of 45 New Zealand rabbits were randomly assigned to nine groups. Among the animals, models of various lung water content levels were induced by the infusion of different volumes of warm sterile normal saline (NS) via the endotracheal tube. The arterial blood gas, spontaneous respiratory rate, and PaO2 /FiO2 ratio were detected before and after infusion. In addition, the B-lines were determined before and immediately after infusion in each group. Finally, both lungs were resected to determine the wet/dry ratio. In addition, all lung specimens were analyzed histologically, and EVLW was quantified using the BLS based on the number and confluence of B-lines in the intercostal space. RESULTS The BLS increased with increasing infusion volume. The BLS was statistically correlated with the wet/dry ratio (r2 = .946) and with the PaO2 /FiO2 ratio (r2 = .916). Furthermore, a repeatability study was performed for the lung ultrasound (LUS) technology (Bland-Altman plots), and the results suggest that LUS had favorable intraobserver and interobserver reproducibility. CONCLUSIONS This study is the first to suggest that the BLS can serve as a sensitive, quantitative, noninvasive, and real-time indicator of EVLW in a rabbit model of lung water accumulation. Notably, the BLS displayed an obvious correlation with the experimental gravimetry results and could also be used to predict the pulmonary oxygenation status.
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Affiliation(s)
- Hai-Feng Zong
- Department of Paediatrics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Paediatrics, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthecare Hospital, Beijing, China
- Department of Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Guo Guo
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthecare Hospital, Beijing, China
- Department of Paediatrics, Medical School of Chinese PLA, Beijing, China
- Department of Neonatology, The Fifth Medical Center of The PLA General Hospital, Beijing, China
| | - Jing Liu
- Department of Paediatrics, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthecare Hospital, Beijing, China
| | - Lin-Lin Bao
- Department of Dermatology, Shenzhen People's Hospital, Shenzhen, China
| | - Chuan-Zhong Yang
- Department of Paediatrics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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22
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Grune J, Beyhoff N, Hegemann N, Lauryn JH, Kuebler WM. From bedside to bench: lung ultrasound for the assessment of pulmonary edema in animal models. Cell Tissue Res 2020; 380:379-392. [PMID: 32009189 PMCID: PMC7210222 DOI: 10.1007/s00441-020-03172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
Traditionally, the lung has been excluded from the ultrasound organ repertoire and, hence, the application of lung ultrasound (LUS) was largely limited to a few enthusiastic clinicians. Yet, in the last decades, the recognition of the previously untapped diagnostic potential of LUS in intensive care medicine has fueled its widespread use as a rapid, non-invasive and radiation-free bedside approach with excellent diagnostic accuracy for many of the most common causes of acute respiratory failure, e.g., cardiogenic pulmonary edema, pneumonia, pleural effusion and pneumothorax. Its increased clinical use has also incited attention for the potential usefulness of LUS in preclinical studies with small animal models mimicking lung congestion and pulmonary edema formation. Application of LUS to small animal models of pulmonary edema may save time, is cost-effective, and may reduce the number of experimental animals due to the possibility of serial evaluations in the same animal as compared with traditional end-point measurements. This review provides an overview of the emerging field of LUS with a specific focus on its application in animal models and highlights future perspectives for LUS in preclinical research.
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Affiliation(s)
- Jana Grune
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany
| | - Niklas Beyhoff
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany.,Institute of Pharmacology, Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Hessische St 3-4, 10115, Berlin, Germany
| | - Niklas Hegemann
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353, Berlin, Germany
| | - Jonathan H Lauryn
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany. .,The Keenan Research Centre for Biomedical Science at St. Michael's, Toronto, Canada. .,Departments of Surgery and Physiology, University of Toronto, Toronto, Canada.
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23
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Brusasco C, Santori G, Bruzzo E, Trò R, Robba C, Tavazzi G, Guarracino F, Forfori F, Boccacci P, Corradi F. Quantitative lung ultrasonography: a putative new algorithm for automatic detection and quantification of B-lines. Crit Care 2019; 23:288. [PMID: 31455421 PMCID: PMC6712728 DOI: 10.1186/s13054-019-2569-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pilot study was designed to develop a fully automatic and quantitative scoring system of B-lines (QLUSS: quantitative lung ultrasound score) involving the pleural line and to compare it with previously described semi-quantitative scores in the measurement of extravascular lung water as determined by standard thermo-dilution. METHODS This was a prospective observational study of 12 patients admitted in the intensive care unit with acute respiratory distress and each provided with 12 lung ultrasound (LUS) frames. Data collected from each patient consisted in five different scores, four semi-quantitative (nLUSS, cLUSS, qLUSS, %LUSS) and quantitative scores (QLUSS). The association between LUS scores and extravascular lung water (EVLW) was determined by simple linear regression (SLR) and robust linear regression (RLR) methods. A correlation analysis between the LUS scores was performed by using the Spearman rank test. Inter-observer variability was tested by computing intraclass correlation coefficient (ICC) in two-way models for agreement, basing on scores obtained by different raters blinded to patients' conditions and clinical history. RESULTS In the SLR, QLUSS showed a stronger association with EVLW (R2 = 0.57) than cLUSS (R2 = 0.45) and nLUSS (R2 = 0.000), while a lower association than qLUSS (R2 = 0.85) and %LUSS (R2 = 0.72) occurred. By applying RLR, QLUSS showed an association for EVLW (R2 = 0.86) comparable to qLUSS (R2 = 0.85) and stronger than %LUSS (R2 = 0.72). QLUSS was significantly correlated with qLUSS (r = 0.772; p = 0.003) and %LUSS (r = 0.757; p = 0.005), but not with cLUSS (r = 0.561; p = 0.058) and nLUSS (r = 0.105; p = 0.744). Moreover, QLUSS showed the highest ICC (0.998; 95%CI from 0.996 to 0.999) among the LUS scores. CONCLUSIONS This study demonstrates that computer-aided scoring of the pleural line percentage affected by B-lines has the potential to assess EVLW. QLUSS may have a significant impact, once validated with a larger dataset composed by multiple real-time frames. This approach has the potentials to be advantageous in terms of faster data analysis and applicability to large sets of data without increased costs. On the contrary, it is not useful in pleural effusion or consolidations.
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Affiliation(s)
- Claudia Brusasco
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genova, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Elisa Bruzzo
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Rosella Trò
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Guido Tavazzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences. Intensive Care Unit, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Cardiothoracic and Vascular Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Patrizia Boccacci
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy. .,Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, Genova, Italy.
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24
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Corradi F, Robba C, Tavazzi G, Via G. Combined lung and brain ultrasonography for an individualized "brain-protective ventilation strategy" in neurocritical care patients with challenging ventilation needs. Crit Ultrasound J 2018; 10:24. [PMID: 30221312 PMCID: PMC6139291 DOI: 10.1186/s13089-018-0105-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/23/2018] [Indexed: 01/27/2023] Open
Abstract
When intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may positively or negatively affect intracranial pressure, based on the final repercussions on PaO2 and cerebral perfusion pressure (through changes in cardiac output, mean arterial pressure, venous return, PaO2 and PaCO2), also according to the baseline conditions of cerebral autoregulation. Lung ultrasound (LUS) and brain ultrasound (BUS, as a combination of optic nerve sheath diameter assessment and cerebrovascular Doppler ultrasound) have independently proven their potential in respectively monitoring lung aeration and brain physiology at the bedside. In this narrative review, we describe how the combined use of LUS and BUS on neurocritical patients with demanding mechanical ventilation needs can contribute to ventilation management, with the aim of a tailored "brain-protective ventilation strategy."
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Affiliation(s)
- Francesco Corradi
- Servizio di Anestesia e Rianimazione, Ente ospedaliero Ospedali Galliera, Genoa, Italy
| | - Chiara Robba
- Anaesthesia and Intensive Care, IRCSS S. Martino Hospital, Genoa, Italy.,Neurocritical Care Unit, Addenbrookes Hospital Cambridge, Cambridge, UK
| | - Guido Tavazzi
- Emergency Department, Anaesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Anaesthesia, Intensive Care and Pain Therapy Unit, University of Pavia, Pavia, Italy
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete, 48, Lugano, Switzerland.
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Ball L, Braune A, Spieth P, Herzog M, Chandrapatham K, Hietschold V, Schultz MJ, Patroniti N, Pelosi P, Gama de Abreu M. Magnetic Resonance Imaging for Quantitative Assessment of Lung Aeration: A Pilot Translational Study. Front Physiol 2018; 9:1120. [PMID: 30150943 PMCID: PMC6099446 DOI: 10.3389/fphys.2018.01120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Computed tomography is the gold standard for lung aeration assessment, but exposure to ionizing radiation limits its application. We assessed the ability of magnetic resonance imaging (MRI) to detect changes in lung aeration in ex vivo isolated swine lung and the potential of translation of the findings to human MRI scans. Methods: We performed MRI scans in 11 isolated non-injured and injured swine lungs, as well as 6 patients both pre- and post-operatively. Images were obtained using a 1.5 T MRI scanner, with T1 – weighted volumetric interpolated breath-hold examination (VIBE) and T2 – weighted half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. We scanned swine lungs, with reference samples of water and muscle, at different airway pressure levels: 0, 40, 10, 2 cmH2O. We investigated the relations between MRI signal intensity and both lung density and gas content fraction. We analyzed patients’ images according to the findings of the ex vivo model. Results: In the ex vivo samples, the lung T1 – VIBE signal intensity normalized to water or muscle reference signal correlated with lung density (r2 = 0.98). Thresholds for poorly and non-aerated lung tissue, expressed as MRI intensity attenuation factor compared to the deflated lung, were estimated as 0.70 [95% CI: 0.65–0.74] and 0.28 [95% CI: 0.27–0.30], respectively. In patients, dorsal versus ventral regions had a higher MRI signal intensity both pre- and post-operatively (p = 0.031). Comparing post- versus pre-operative scans, lung volume decreased (p = 0.028), while the following increased: MRI signal intensity in ventral (p = 0.043) and dorsal (p < 0.0001) regions, and percentages of non-aerated (p = 0.028) and poorly aerated tissue volumes (p = 0.028). Conclusion: Magnetic resonance imaging signal intensity is a function of lung density, decreasing linearly with increasing gas content. Lung MRI might be useful for estimating lung aeration. Compared to CT, this technique is radiation-free but requires a longer acquisition time and has a lower spatial resolution.
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Affiliation(s)
- Lorenzo Ball
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy.,Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anja Braune
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Spieth
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Moritz Herzog
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Karthikka Chandrapatham
- Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Volker Hietschold
- Department of Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus J Schultz
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolò Patroniti
- Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Goffi A, Kruisselbrink R, Volpicelli G. The sound of air: point-of-care lung ultrasound in perioperative medicine. Can J Anaesth 2018; 65:399-416. [DOI: 10.1007/s12630-018-1062-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/04/2017] [Accepted: 01/07/2018] [Indexed: 12/30/2022] Open
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Ball L, Vercesi V, Costantino F, Chandrapatham K, Pelosi P. Lung imaging: how to get better look inside the lung. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:294. [PMID: 28828369 DOI: 10.21037/atm.2017.07.20] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the last years, imaging has played a key role in the diagnosis and monitoring and critical illness, including acute respiratory distress syndrome (ARDS). Chest X-ray (CXR) and computed tomography (CT) are the conventional techniques most performed in the critically ill patients, the latter being the gold standard to assess lung aeration in ARDS patients. In addition, two bedside techniques are now gaining popularity alongside the conventional ones: lung ultrasound (LUS) and electrical impedance tomography (EIT). These techniques do not involve the use of ionizing radiations, are non-invasive and relatively easy to use, and are under extensive investigation as a complement, and for some application a substitution of conventional techniques. At last, positron emission tomography (PET) and magnetic resonance imaging (MRI) can provide functional information on the lung and respiratory function, and are increasingly used in research to improve the understanding of the pathophysiological mechanisms underlying ARDS. The purpose of this review is to give an up-to-date overview of the conventional and emerging imaging techniques available the diagnosis and management of patients with ARDS.
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Affiliation(s)
- Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Veronica Vercesi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Federico Costantino
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Karthikka Chandrapatham
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
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28
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Computer-Aided Quantitative Ultrasonography for Detection of Pulmonary Edema in Mechanically Ventilated Cardiac Surgery Patients. Chest 2016; 150:640-51. [DOI: 10.1016/j.chest.2016.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/22/2016] [Accepted: 04/14/2016] [Indexed: 01/23/2023] Open
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Abdel Kader M, Osman NMM. Implementation of chest ultrasound with color Doppler in diagnosis of pneumonia in adults. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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30
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Ma H, Huang D, Guo L, Chen Q, Zhong W, Geng Q, Zhang M. Strong correlation between lung ultrasound and chest computerized tomography imaging for the detection of acute lung injury/acute respiratory distress syndrome in rats. J Thorac Dis 2016; 8:1443-8. [PMID: 27499930 DOI: 10.21037/jtd.2016.05.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is a clinical imaging technique for diagnosing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In humans and several large animals, LUS demonstrates similar specificity and sensitivity to computerized tomography (CT) scanning. Current study evaluated the degree of agreement between LUS and CT imaging in characterizing ALI/ARDS in rats. METHODS Thirty male Sprague-Dawley rats were imaged by LUS before randomization into three groups to receive intratracheal saline, 3 or 6 mg/kg LPS respectively (n=10). LUS and CT imaging was conducted 2 hours after instillation. Cross table analyses and kappa statistics were used to determine agreement levels between LUS and CT assessments of lung condition. RESULTS Before instillation, rats presented with a largely A-pattern in LUS images, however, a significantly increase B-lines were observed in all groups after instillation and showed dose response to LPS or to saline. One rat treated with 6 mg/kg lipopolysaccharide (LPS) presented with lung consolidation. The agreement between the LUS and the CT in detecting the main characteristics of ALI/ARDS in rat was strong (r=0.758, P<0.01, k=0.737). CONCLUSIONS In conclusion, LUS detects ALI/ARDS with high agreement with micro PET/CT scanning in a rat model, suggesting that LUS represents a positive refinement in rat ALI/ARDS disease models.
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Affiliation(s)
- Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;; Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Daozheng Huang
- Department of Intensive Care, Guangdong Geriatric Institute, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Liheng Guo
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Quanfu Chen
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Minzhou Zhang
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
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32
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Elkholy MM, Mohammad HA, Osman NM, Ibraheem B, Emam R. Accuracy of gray scale and color Doppler sonographic mapping in diagnosis of pneumonia in adult. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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33
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Ma H, Huang D, Zhang M, Huang X, Ma S, Mao S, Li W, Chen Y, Guo L. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol 2015; 15:162. [PMID: 26563098 PMCID: PMC4643534 DOI: 10.1186/s12871-015-0146-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung ultrasound (LUS) can diagnose extravacular lung water (EVLW) through the visualization of B lines in both humans and large animals. However, there are no published data on the use of ultrasound to detect EVLW in rats, the gold standard to evaluate of EVLW in rats is post-mortem gravimetric analysis. The present study was designed to determine the similarity between lung sonography and gravimetric measurements of EVLW in rats in an acute lung injury (ALI) model. METHODS Thirty male Sprague-Dawley rats were randomized into control and experimental groups. The B lines were measured byLUS at baseline. ALI was induced by the intravenous administration of oleic acid (OA) at a dose of 9 ul/100 mg, and controls were injected the same amount of isotonic saline. After 1 h, B-lines were measured by LUS in each rat following the induction of ALI. At the end of each experiment, both lungs were dissected, weighed and dried to determine wet/dry weight ratio according to the standard gravimetric methodology. Lung samples from three rats in each group were examined histologically. RESULTS B-lines were present in all rats from experimental group at 1 h point after OA injection. The statistical correlation between the two methods of assessing EVLW provided an r = 0.834 (p < 0.001). Repeatability studies of the LUS technique (Bland-Altman plots) showed good intra-observer and inter-observer reproducibility. CONCLUSION The data suggest that, in an experimental rat model of ALI, B lines score as assessed by LUS can provide an easy, semi-quantitative, noninvasive. Real-time index of EVLW which is strongly correlated to experimental gravimetric assessments.
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Affiliation(s)
- Huan Ma
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Daozheng Huang
- The Department of Critical Care Medicine, Guangdong Provincial Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Minzhou Zhang
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Xin Huang
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Shiyu Ma
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Shuai Mao
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Wenhui Li
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yanfen Chen
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Liheng Guo
- The Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
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Abstract
Abstract
In the intensive care unit, patient lung ultrasound provides accurate information on lung morphology with diagnostic and therapeutic relevance. It enables clinicians easy, rapid, and reliable evaluation of lung aeration and its variations at the bedside.
Supplemental Digital Content is available in the text.
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Quantitative analysis of lung ultrasonography for the detection of community-acquired pneumonia: a pilot study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:868707. [PMID: 25811032 PMCID: PMC4355628 DOI: 10.1155/2015/868707] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/26/2014] [Accepted: 02/05/2015] [Indexed: 12/14/2022]
Abstract
Background and Objective. Chest X-ray is recommended for routine use in patients with suspected pneumonia, but its use in emergency settings is limited. In this study, the diagnostic performance of a new method for quantitative analysis of lung ultrasonography was compared with bedside chest X-ray and visual lung ultrasonography for detection of community-acquired pneumonia, using thoracic computed tomography as a gold standard.
Methods. Thirty-two spontaneously breathing patients with suspected community-acquired pneumonia, undergoing computed tomography examination, were consecutively enrolled. Each hemithorax was evaluated for the presence or absence of abnormalities by chest X-ray and quantitative or visual ultrasonography.
Results. Quantitative ultrasonography showed higher sensitivity (93%), specificity (95%), and diagnostic accuracy (94%) than chest X-ray (64%, 80%, and 69%, resp.), visual ultrasonography (68%, 95%, and 77%, resp.), or their combination (77%, 75%, and 77%, resp.). Conclusions. Quantitative lung ultrasonography was considerably more accurate than either chest X-ray or visual ultrasonography in the diagnosis of community-acquired pneumonia and it may represent a useful first-line approach for confirmation of clinical diagnosis in emergency settings.
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Corradi F, Brusasco C, Manca T, Nicosia F, Vezzani A, Brusasco V. Quantitative ultrasonography for pneumonia. Crit Care 2015. [PMCID: PMC4472821 DOI: 10.1186/cc14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Corradi F, Brusasco C, Manca T, Nicolini F, Nicosia F, Gherli T, Brusasco V, Vezzani A. Lung ultrasonography as a marker of pulmonary edema in cardiac surgery patients: visual versus quantitative evaluation. Crit Care 2015. [PMCID: PMC4471414 DOI: 10.1186/cc14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sutherasan Y, D'Antini D, Pelosi P. Advances in ventilator-associated lung injury: prevention is the target. Expert Rev Respir Med 2014; 8:233-48. [PMID: 24601663 DOI: 10.1586/17476348.2014.890519] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Mechanical ventilation (MV) is the main supportive treatment in respiratory failure due to different etiologies. However, MV might aggravate ventilator-associated lung injury (VALI). Four main mechanisms leading to VALI are: 1) increased stress and strain, induced by high tidal volume (VT); 2) increased shear stress, i.e. opening and closing, of previously atelectatic alveolar units; 3) distribution of perfusion and 4) biotrauma. In severe acute respiratory distress syndrome patients, low VT, higher levels of positive end expiratory pressure, long duration prone position and neuromuscular blockade within the first 48 hours are associated to a better outcome. VALI can also occur by using high VT in previously non injured lungs. We believe that prevention is the target to minimize injurious effects of MV. This review aims to describe pathophysiology of VALI, the possible prevention and treatment as well as monitoring MV to minimize VALI.
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Affiliation(s)
- Yuda Sutherasan
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, IRCCS San Martino - IST, Genoa, Italy
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Lung Ultrasound Predicts Well Extravascular Lung Water but Is of Limited Usefulness in the Prediction of Wedge Pressure. Anesthesiology 2014; 121:320-7. [DOI: 10.1097/aln.0000000000000300] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abstract
Background:
Pulmonary congestion is indicated at lung ultrasound by detection of B-lines, but correlation of these ultrasound signs with pulmonary artery occlusion pressure (PAOP) and extravascular lung water (EVLW) still remains to be further explored. The aim of the study was to assess whether B-lines, and eventually a combination with left ventricular ejection fraction (LVEF) assessment, are useful to differentiate low/high PAOP and EVLW in critically ill patients.
Methods:
The authors enrolled 73 patients requiring invasive monitoring from the intensive care unit of four university-affiliated hospitals. Forty-one patients underwent PAOP measurement by pulmonary artery catheterization and 32 patients had EVLW measured by transpulmonary thermodilution method. Lung and cardiac ultrasound examinations focused to the evaluation of B-lines and gross estimation of LVEF were performed. The absence of diffuse B-lines (A-pattern) versus the pattern showing prevalent B-lines (B-pattern) and the combination with normal or impaired LVEF were correlated with cutoff levels of PAOP and EVLW.
Results:
PAOP of 18 mmHg or less was predicted by the A-pattern with 85.7% sensitivity (95% CI, 70.5 to 94.1%) and 40.0% specificity (CI, 25.4 to 56.4%), whereas EVLW 10 ml/kg or less with 81.0% sensitivity (CI, 62.6 to 91.9%) and 90.9% specificity (CI, 74.2 to 97.7%). The combination of A-pattern with normal LVEF increased sensitivity to 100% (CI, 84.5 to 100%) and specificity to 72.7% (CI, 52.0 to 87.2%) for the prediction of PAOP 18 mmHg or less.
Conclusions:
B-lines allow good prediction of pulmonary congestion indicated by EVLW, whereas are of limited usefulness for the prediction of hemodynamic congestion indicated by PAOP. Combining B-lines with estimation of LVEF at transthoracic ultrasound may improve the prediction of PAOP.
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Ball L, Sutherasan Y, Pelosi P. Monitoring respiration: what the clinician needs to know. Best Pract Res Clin Anaesthesiol 2014; 27:209-23. [PMID: 24012233 DOI: 10.1016/j.bpa.2013.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/07/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
A recent large prospective cohort study showed an unexpectedly high in-hospital mortality after major non-cardiac surgery in Europe, as well as a high incidence of postoperative pulmonary complications. The direct effect of postoperative respiratory complications on mortality is still under investigation, for intensive care unit (ICU) and in the perioperative period. Although respiratory monitoring has not been actually proven to affect in-hospital mortality, it plays an important role in patient care, leading to appropriate setting of ventilatory support as well as risk stratification. The aim of this article is to provide an overview of various respiratory monitoring techniques including the role of conventional and most recent methods in the perioperative period and in critically ill patients. The most recent techniques proposed for bedside respiratory monitoring, including lung imaging, are presented and discussed, comparing them to those actually considered as gold standards.
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Affiliation(s)
- Lorenzo Ball
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Response to Trovato et al.: “Is it time to measure lung water by ultrasound?”. Intensive Care Med 2013; 39:1875-6. [DOI: 10.1007/s00134-013-3029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
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