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Mousa A, Klompmaker P, Tuinman PR. Setting positive end-expiratory pressure: lung and diaphragm ultrasound. Curr Opin Crit Care 2024; 30:53-60. [PMID: 38085883 PMCID: PMC10962429 DOI: 10.1097/mcc.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the role of lung ultrasound and diaphragm ultrasound in guiding ventilator settings with an emphasis on positive end-expiratory pressure (PEEP). Recent advances for using ultrasound to assess the effects of PEEP on the lungs and diaphragm are discussed. RECENT FINDINGS Lung ultrasound can accurately diagnose the cause of acute respiratory failure, including acute respiratory distress syndrome and can identify focal and nonfocal lung morphology in these patients. This is essential in determining optimal ventilator strategy and PEEP level. Assessment of the effect of PEEP on lung recruitment using lung ultrasound is promising, especially in the perioperative setting. Diaphragm ultrasound can monitor the effects of PEEP on the diaphragm, but this needs further validation. In patients with an acute exacerbation of chronic obstructive pulmonary disease, diaphragm ultrasound can be used to predict noninvasive ventilation failure. Lung and diaphragm ultrasound can be used to predict weaning outcome and accurately diagnose the cause of weaning failure. SUMMARY Lung and diaphragm ultrasound are useful for diagnosing the cause of respiratory failure and subsequently setting the ventilator including PEEP. Effects of PEEP on lung and diaphragm can be monitored using ultrasound.
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Affiliation(s)
- Amne Mousa
- Department of Intensive Care, Amsterdam UMC location Vrije Universiteit Amsterdam
- Amsterdam Cardiovascular Sciences research institute, Amsterdam UMC
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Peter Klompmaker
- Department of Intensive Care, Amsterdam UMC location Vrije Universiteit Amsterdam
- Amsterdam Cardiovascular Sciences research institute, Amsterdam UMC
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Pieter R. Tuinman
- Department of Intensive Care, Amsterdam UMC location Vrije Universiteit Amsterdam
- Amsterdam Cardiovascular Sciences research institute, Amsterdam UMC
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
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2
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Sartini S, Ferrari L, Cutuli O, Castellani L, Bagnasco M, Moisio Corsello L, Bracco C, Cristina ML, Arboscello E, Sartini M. The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment. J Clin Med 2024; 13:750. [PMID: 38337444 PMCID: PMC10856192 DOI: 10.3390/jcm13030750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Acute respiratory failure (ARF) is a challenging condition that clinicians, especially in emergency settings, have to face frequently. Especially in emergency settings, many underlying diseases can lead to ARF and life-threatening conditions have to be promptly assessed and correctly treated to avoid unfavorable outcomes. In recent years, point-of-care ultrasound (POCUS) gained growing consideration due to its bedside utilization, reliability and reproducibility even in emergency settings especially in unstable patients. Research on POCUS application to assess ARF has been largely reported mainly with observational studies showing heterogeneous results from many different applications. This narrative review describes the wide potentiality of POCUS to face airways and breathing life-threatening conditions such as upper airway management, pulmonary and pleural pathologies and diaphragm impairment. We conducted extensive research of the literature to report from major studies to case reports deemed useful in practical clinical utilization of POCUS in ARF. Due to the huge amount of the literature found, we focused on airways and breathing assessment trying to systematize the evidence according to clinical care of ARF in emergency settings. Further studies, possibly trials, should determine how POCUS is crucial in clinical practice in terms of standard of care improvements, patient safety and cost-benefit analysis.
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Affiliation(s)
- Stefano Sartini
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Lorenzo Ferrari
- Emergency Medicine Post-Graduate School, University of Genoa, Via Balbi 5, 16126 Genoa, Italy;
| | - Ombretta Cutuli
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Luca Castellani
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Maddalena Bagnasco
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
- Emergency Medicine Post-Graduate School, University of Genoa, Via Balbi 5, 16126 Genoa, Italy;
| | - Luca Moisio Corsello
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Cristina Bracco
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
| | - Eleonora Arboscello
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (M.B.); (L.M.C.); (C.B.); (E.A.)
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
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3
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Patel D, Bailitz J, Ymson S, Neichin J, Peksa GD, Gottlieb M. Diagnostic accuracy of real-time ultrasound for detecting pulmonary edema by lung region. Am J Emerg Med 2024; 75:181-182. [PMID: 37516628 DOI: 10.1016/j.ajem.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 07/31/2023] Open
Affiliation(s)
- Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | | | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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4
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Di Serafino M, Dell’Aversano Orabona G, Caruso M, Camillo C, Viscardi D, Iacobellis F, Ronza R, Sabatino V, Barbuto L, Oliva G, Romano L. Point-of-Care Lung Ultrasound in the Intensive Care Unit-The Dark Side of Radiology: Where Do We Stand? J Pers Med 2023; 13:1541. [PMID: 38003856 PMCID: PMC10672373 DOI: 10.3390/jpm13111541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Patients in intensive care units (ICUs) are critically ill and require constant monitoring of clinical conditions. Due to the severity of the underlying disease and the need to monitor devices, imaging plays a crucial role in critically ill patients' care. Given the clinical complexity of these patients, who typically need respiratory assistance as well as continuous monitoring of vital functions and equipment, computed tomography (CT) can be regarded as the diagnostic gold standard, although it is not a bedside diagnostic technique. Despite its limitations, portable chest X-ray (CXR) is still today an essential diagnostic tool used in the ICU. Being a widely accessible imaging technique, which can be performed at the patient's bedside and at a low healthcare cost, it provides additional diagnostic support to the patient's clinical management. In recent years, the use of point-of-care lung ultrasound (LUS) in ICUs for procedure guidance, diagnosis, and screening has proliferated, and it is usually performed at the patient's bedside. This review illustrates the role of point-of-care LUS in ICUs from a purely radiological point of view as an advanced method in ICU CXR reports to improve the interpretation and monitoring of lung CXR findings.
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Affiliation(s)
- Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Martina Caruso
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Costanza Camillo
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Daniela Viscardi
- Department of Intensive Care and Resuscitation, “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Roberto Ronza
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Luigi Barbuto
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Gaspare Oliva
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (G.D.O.); (M.C.); (C.C.); (F.I.); (R.R.); (V.S.); (L.B.); (G.O.); (L.R.)
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5
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Beye SA, Diallo B, Keita M, Cissoko Y, Ouattara K, Dicko H, Shabani M, Sidibé A, Berthé M, Coulibaly YI, Diani N, Keita M, Toloba Y, Dao S, Suttels V, Coulibaly Y, Dessap AM. Assessment of lung injury severity using ultrasound in critically ill COVID-19 patients in resource limited settings. Ann Intensive Care 2023; 13:33. [PMID: 37103717 PMCID: PMC10134692 DOI: 10.1186/s13613-023-01133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting. METHODS We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings. RESULTS The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound score < 3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23 ± 5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of - 0.38, p < 0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patients' age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score. CONCLUSION Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality.
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Affiliation(s)
- Seydina Alioune Beye
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali.
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali.
| | - Boubacar Diallo
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Modibo Keita
- Department of Public Health, Teaching Hospital (CHU) Dermatology, Bamako, Mali
| | - Yacouba Cissoko
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Infectious Diseases and Tropical Diseases, Point G Teaching Hospital, Bamako, Mali
| | - Khadidia Ouattara
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Pneumology, Point G Teaching Hospital, Bamako, Mali
| | - Hammadoun Dicko
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Majaliwa Shabani
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
| | - Amadou Sidibé
- Department of Intensive Care and Anesthesia/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Modibo Berthé
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
| | - Yaya Ibrahim Coulibaly
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Public Health, Teaching Hospital (CHU) Dermatology, Bamako, Mali
| | - Nouhoum Diani
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Intensive Care and Anesthesia/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mohamed Keita
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yacouba Toloba
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Pneumology, Point G Teaching Hospital, Bamako, Mali
| | - Sounkalo Dao
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Infectious Diseases and Tropical Diseases, Point G Teaching Hospital, Bamako, Mali
| | - Veronique Suttels
- National Teaching Hospital for Tuberculosis and Respiratory Diseases (CNHU-PPC), Cotonou, Benin
| | - Youssouf Coulibaly
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, 94010, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
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6
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Heldeweg MLA, Lopez Matta JE, Pisani L, Slot S, Haaksma ME, Smit JM, Mousa A, Magnesa G, Massaro F, Touw HRW, Schouten V, Elzo Kraemer CV, van Westerloo DJ, Heunks LMA, Tuinman PR. The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study. Crit Care Med 2023; 51:357-364. [PMID: 36562620 DOI: 10.1097/ccm.0000000000005760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the impact of thoracic ultrasound (TUS) examinations on clinical management in adult ICU patients. DESIGN A prospective international observational study. SETTING Four centers in The Netherlands and Italy. PATIENTS Adult ICU patients (> 18 yr) that received a clinically indicated lung ultrasound examination. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinicians performing TUS completed a pre- and post-examination case report form. Patient characteristics, TUS, and resulting clinical effects were recorded. First, change of management, defined as a TUS-induced change in clinical impression leading to a change in treatment plan, was reported. Second, execution of intended management changes within 8 hours was verified. Third, change in fluid balance after 8 hours was calculated. A total of 725 TUS performed by 111 operators across 534 patients (mean age 63 ± 15.0, 70% male) were included. Almost half of TUS caused a change in clinical impression, which resulted in change of management in 39% of cases. The remainder of TUS confirmed the clinical impression, while a minority (4%) did not contribute. Eighty-nine percent of management changes indicated by TUS were executed within 8 hours. TUS examinations that led to a change in fluid management also led to distinct and appropriate changes in patient's fluid balance. CONCLUSIONS In this international observational study in adult ICU patients, use of TUS had a major impact on clinical management. These results provide grounds for future randomized controlled trials to determine if TUS-induced changes in decision-making also lead to improved health outcomes.
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Affiliation(s)
- Micah L A Heldeweg
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
| | - Jorge E Lopez Matta
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Luigi Pisani
- Department of Intensive Care Medicine, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Stefanie Slot
- Department of Intensive Care Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Mark E Haaksma
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
| | - Jasper M Smit
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
| | - Amne Mousa
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
| | - Giovanna Magnesa
- Department of Intensive Care Medicine, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Fabrizia Massaro
- Department of Intensive Care Medicine, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Hugo R W Touw
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Hospital, Nijmegen, The Netherlands
| | - Viviane Schouten
- Department of Intensive Care Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Carlos V Elzo Kraemer
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - David J van Westerloo
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com ), Amsterdam, The Netherlands
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Chen J, Shen M, Hou S, Duan X, Yang M, Cao Y, Qin W, Niu Q, Li Q, Zhang Y, Wang Y. Intelligent interpretation of four lung ultrasonographic features with split attention based deep learning model. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Dugar S, Fox S, Koratala A, Moghekar A, Mehta AC. Lung Ultrasonographic Signs in Pulmonary Disease - A Video Review. J Intensive Care Med 2023; 38:220-231. [PMID: 35950723 DOI: 10.1177/08850666221120221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung ultrasound (US) is a well-established imaging tool in the inpatient and critical care setting. It has proven its worth in the rapid bedside diagnosis of a variety of conditions pertaining to the lungs and the thorax. Lung US was initially introduced as a bedside imaging tool to evaluate the size and characteristics of pleural effusion. Over the years, the field of lung ultrasonography has rapidly expanded introducing nuances in image interpretation. Numerous primary and secondary signs have been described in the literature to identify both normal and abnormal findings. The primary signs can help narrow the list of differential diagnoses, whereas the addition of secondary signs help create an imaging pattern facilitating the confirmation of diagnosis or recognition of the underlying disease process. These wide variety of signs and patterns can present a challenge to the learning of lung ultrasonography, particularly to a novice user. We sought to compile a comprehensive list of these findings to serve as a useful resource to aid effortless adoption of lung ultrasonography in clinical practice. In this review, we narrate the evolution of lung US, describe common protocols applied in performance of the lung US, and illustrate a comprehensive list of common lung US signs and patterns along with their differential diagnosis and clinical utility.
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Affiliation(s)
- Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Steven Fox
- Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Abhilash Koratala
- Division of Nephrology, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ajit Moghekar
- Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA
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9
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Kok B, Wolthuis D, Bosch F, van der Hoeven H, Blans M. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Eur J Intern Med 2022; 106:9-38. [PMID: 35927185 DOI: 10.1016/j.ejim.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has been adopted as a powerful tool in acute medicine. This systematic review aims to critically appraise the existing literature on point-of-care ultrasound in respiratory or circulatory deterioration. METHODS Original studies on POCUS and dyspnea, nontraumatic hypotension, and shock from March 2002 until March 2022 were assessed in the PubMed and Embase Databases. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTS We included 89 articles in this review. Point-of-care ultrasound in the initial workup increases the diagnostic accuracy in patients with dyspnea, nontraumatic hypotension and shock in the ED, ICU and medical ward setting. No improvement is found in patients with severe sepsis in the ICU setting. POCUS is capable of narrowing the differential diagnoses and is faster, and more feasible in the acute setting than other diagnostics available. Results on outcome measures are heterogenous. The quality of the included studies is considered low most of the times, mainly because of performance and selection bias and absence of a gold standard as the reference test. CONCLUSION We conclude that POCUS contributes to a higher diagnostic accuracy in dyspnea, nontraumatic hypotension, and shock. It aides in narrowing the differential diagnoses and shortening the time to correct diagnosis and effective treatment. TRIAL REGISTRY INPLASY; Registration number: INPLASY202220020; URL: https://inplasy.com/.
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Affiliation(s)
- Bram Kok
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands.
| | - David Wolthuis
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands
| | - Frank Bosch
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands; Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands
| | | | - Michiel Blans
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands; Intensive Care Unit, Rijnstate, Arnhem, the Netherlands
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10
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Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts. Crit Care Med 2022; 50:1607-1617. [PMID: 35866658 DOI: 10.1097/ccm.0000000000005620] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population. DESIGN A prospective diagnostic accuracy study with derivation and validation cohorts. SETTING Three academic mixed ICUs in the Netherlands. PATIENTS Consecutive adult ICU patients that received a lung ultrasound examination. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULT The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome ( n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS ( n = 29) from CPE ( n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77-0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS ( n = 98) from CPE ( n = 24) with a sensitivity of 31% (95% CI, 21-40%) and a specificity of 100% (95% CI, 86-100%). CONCLUSIONS Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.
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Athanasia V, Savvas DP, Soultana F, Marianna SR, Maria A, Katerina K. Neonatal intensive care unit nurse training in identifying ultrasound landmarks in the neonatal mediastinum. Α training program for nurses in North-Eastern Greece. J Pediatr Nurs 2022; 66:e22-e26. [PMID: 35811186 DOI: 10.1016/j.pedn.2022.06.016] [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: 01/29/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To demonstrate methods and landmarks for mediastinum ultrasound as part of ultrasound examination of the lung for nurses. This will be the first step in their education to detect finally the tubes and lines malpositioning in order to distinguish emergency conditions of the lungs in neonates hospitalized in neonatal intensive care units. DESIGN AND METHODS Theoretical and practical interventions were developed to create a 3-month training program based on similar medical courses. The study was approved by the hospital's ethics committee.The program was performed in the neonatal intensive care unit of a single academic institution. Participating nurse was supervised by a paediatric surgeon and trained in lung ultrasound (a safe method without radiation) by a paediatric radiologist. RESULTS During the practical period (2 months), the neonatal intensive care unit nurse examined 50 neonates (25 + 6-40 + 4 weeks gestational age; 21 males) separated into two subgroups of 25 neonates each for each training month. In the first month under supervision, the nurse was trained to recognise the aortic arch, the right pulmonary artery, the esophagus, the tracheal air, and the 'sliding lung sign' in the anterior, lateral, and posterolateral aspects of the thoracic cage. In the second month, the nurse recorded the ultrasound examinations. The identified structures were then assessed and graded by the supervising radiologist. The overall estimated success rate (5 landmarks × 25 neonates = 125) was 90.4%. CONCLUSIONS Although this is the first report of the design of a 'hands-on', lung ultrasound training program for neonatal intensive care unit nurses, our findings demonstrate that it is a safe and useful program for all neonatal intensive care unit nurses because theoverall success rate of the 3-month program was determined by accurate identification of basic anatomical structures (90,4%) by the nurse. PRACTICE IMPLICATIONS This study describes the first educational training program for NICU nurses designed to recognise basic structures in the neonatal mediastinum. If the program is effective, NICU nurses will be able to identify respiratory emergencies. NICU nurses can inform doctors about emergencies according to tubes and lines malpositioning in a timely manner to avoid negative consequences.
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Affiliation(s)
- Voulgaridou Athanasia
- Neonatal Intensive Care Unit, Alexandroupolis University General Hospital, Alexandroupolis, Greece
| | - Deftereos P Savvas
- Department of Radiology, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Foutzitzi Soultana
- Department of Radiology, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Skordala-Riti Marianna
- Neonatal Intensive Care Unit, Alexandroupolis University General Hospital, Alexandroupolis, Greece
| | - Aggelidou Maria
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kambouri Katerina
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece.
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Musso G, Taliano C, Molinaro F, Fonti C, Veliaj D, Torti D, Paschetta E, Castagna E, Carbone G, Laudari L, Aseglio C, Zocca E, Chioni S, Giannone LC, Arabia F, Deiana C, Benato FM, Druetta M, Campagnola G, Borsari M, Mucci M, Rubatto T, Peyronel M, Tirabassi G. Early prolonged prone position in noninvasively ventilated patients with SARS-CoV-2-related moderate-to-severe hypoxemic respiratory failure: clinical outcomes and mechanisms for treatment response in the PRO-NIV study. Crit Care 2022; 26:118. [PMID: 35488356 PMCID: PMC9052189 DOI: 10.1186/s13054-022-03937-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background Whether prone position (PP) improves clinical outcomes in COVID-19 pneumonia treated with noninvasive ventilation (NIV) is unknown. We evaluated the effect of early PP on 28-day NIV failure, intubation and death in noninvasively ventilated patients with moderate-to-severe acute hypoxemic respiratory failure due to COVID-19 pneumonia and explored physiological mechanisms underlying treatment response. Methods In this controlled non-randomized trial, 81 consecutive prospectively enrolled patients with COVID-19 pneumonia and moderate-to-severe (paO2/FiO2 ratio < 200) acute hypoxemic respiratory failure treated with early PP + NIV during Dec 2020–May 2021were compared with 162 consecutive patients with COVID-19 pneumonia matched for age, mortality risk, severity of illness and paO2/FiO2 ratio at admission, treated with conventional (supine) NIV during Apr 2020–Dec 2020 at HUMANITAS Gradenigo Subintensive Care Unit, after propensity score adjustment for multiple baseline and treatment-related variables to limit confounding. Lung ultrasonography (LUS) was performed at baseline and at day 5. Ventilatory parameters, physiological dead space indices (DSIs) and circulating inflammatory and procoagulative biomarkers were monitored during the initial 7 days. Results In the intention-to-treat analysis. NIV failure occurred in 14 (17%) of PP patients versus 70 (43%) of controls [HR = 0.32, 95% CI 0.21–0.50; p < 0.0001]; intubation in 8 (11%) of PP patients versus 44 (30%) of controls [HR = 0.31, 95% CI 0.18–0.55; p = 0.0012], death in 10 (12%) of PP patients versus 59 (36%) of controls [HR = 0.27, 95% CI 0.17–0.44; p < 0.0001]. The effect remained significant within different categories of severity of hypoxemia (paO2/FiO2 < 100 or paO2/FiO2 100–199 at admission). Adverse events were rare and evenly distributed. Compared with controls, PP therapy was associated with improved oxygenation and DSIs, reduced global LUS severity indices largely through enhanced reaeration of dorso-lateral lung regions, and an earlier decline in inflammatory markers and D-dimer. In multivariate analysis, day 1 CO2 response outperformed O2 response as a predictor of LUS changes, NIV failure, intubation and death.
Conclusion Early prolonged PP is safe and is associated with lower NIV failure, intubation and death rates in noninvasively ventilated patients with COVID-19-related moderate-to-severe hypoxemic respiratory failure. Early dead space reduction and reaeration of dorso-lateral lung regions predicted clinical outcomes in our study population.
Clinical trial registration ISRCTN23016116. Retrospectively registered on May 1, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03937-x.
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Affiliation(s)
- Giovanni Musso
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy.
| | - Claudio Taliano
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Federica Molinaro
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Caterina Fonti
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | | | - Davide Torti
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Elena Paschetta
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Elisabetta Castagna
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Giorgio Carbone
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Luigi Laudari
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | | | - Edoardo Zocca
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | - Sonia Chioni
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | | | | | - Cecilia Deiana
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | | | - Marta Druetta
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | | | | | - Martina Mucci
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | | | - Mara Peyronel
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Gloria Tirabassi
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
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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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