Background: Interstitial syndrome is a common and significant finding in critically ill patients with respiratory distress. Early and accurate diagnosis is crucial to guide management. While computed tomography (CT) is the reference standard, it has notable limitations in ICU settings, including radiation exposure and patient transport risks. Aim/Objectives: To evaluate the diagnostic performance of bedside lung ultrasonography (LUS) in detecting interstitial syndrome compared to CT in ICU patients. Methods: A cross-sectional study was conducted on 70 mechanically ventilated ICU patients in Sylhet MAG Osmani Medical College Hospital who underwent both LUS and thoracic CT. LUS findings were compared with CT, considered the reference standard. Results: LUS detected interstitial syndrome with a sensitivity of 71.4%, specificity of 91.8%, positive predictive value of 79%, negative predictive value of 88.2%, and diagnostic accuracy of 85.7%. Conclusion: LUS is a feasible, rapid, and reasonably accurate bedside tool for detecting interstitial syndrome in ICU patients, offering a practical alternative to CT.

Point-of-care ultrasound (POCUS) has evolved from a simple tool for fluid localization to a comprehensive modality for hemodynamic assessment and real-time clinical decision-making. The Bedside Lung Ultrasound in Emergency (BLUE) protocol enables clinicians to diagnose causes of cardiorespiratory failure more accurately than clinical examination alone. In patients presenting with shock and hypotension, POCUS facilitates rapid identification of the underlying aetiology. This allows for targeted treatment in these critically ill patients. In complex patients presenting with concurrent cardiac failure and renal dysfunction, the venous excess ultrasound (VExUS) score provides a valuable assessment of volume status, guiding fluid management and therapeutic interventions. The increasing availability of handheld ultrasound devices, cloud-based services and artificial intelligence (AI) is driving POCUS beyond the traditional hospital settings into the community. Associated healthcare professionals already perform initial scans in community settings with remote expert review. In future models of care, patients or carers could use AI-assisted handheld devices to enable self-monitoring and early disease management at home. This review examines the expanding role of POCUS in acute and critical care settings, with a focus on key protocols that enhance diagnostic accuracy and guide clinical management, and considers future expansion of POCUS into the community.

Abstract Background Shock is a serious state that arises from a failure in circulation. If not swiftly treated, it may result in tissue hypoxia and the risk of multi-organ failure. It is generally divided into four classifications: hypovolemic, distributive, cardiogenic, and obstructive. Objectives This study evaluates the role of chest ultrasonography in managing patients in shock in a respiratory intensive care unit (RICU). Methods This clinical prospective observational study study included 50 patients who were shocked and admitted to the RICU at Kafrelsheikh University Hospital. Bedside ultrasonography was done on admission and during the period of resuscitation using the BLUE (Bedside Lung Ultrasound in Emergency) and FALLS (Fluid Administration Limited by Lung Sonography) protocols to identify shock types and assess inferior vena cava (IVC) diameters. Results The mean age of patients was 65.3 years, with an equal gender distribution. Smoking prevalence was 38%. Bedside ultrasonography showed lung sliding in 90% of cases, pleural effusion in 32%, and consolidation in 48%. Shock patient types were identified as 13 hypovolemic, 17 septic, 15 cardiogenic, and five obstructive shock. Creatinine, TLC (total leukocytic count), CRP (C-reactive protein), procalcitonin, and dimer were predictive factors for improvement in either septic or hypovolemic patients. IVC min was lowest in hypovolemic shock ( p -value = 0.001), IVC ci was highest in septic shock ( p -value = 0.002), and there was no significant difference regarding IVC max. In the hypovolemic and septic shock patients, there was a substantial increase in MAP (mean arterial pressure), central venous pressure (CVP), IVC maximum (max), IVC minimum (min), and UOP (urine output ( p < 0.05). At the same time, there was a significant decrease in IVC CI(collapsibility index). RConclusion Lung ultrasound is a valuable tool for differentiating between various types of shock, particularly hypovolemic and septic shock, and is useful in guiding fluid resuscitation. Predictive factors like procalcitonin, complete blood counts, CRP, D-dimer, creatinine levels, and IVC parameters can aid in assessing shock improvement, vitals parameters like MAP, IVC diameters, UOP, and CVP increasing during fluid resuscitation, while IVC ci decreases.

ObjectiveTo investigate the diagnostic value of bedside lung ultrasound and chest computed tomography (CT) for subpleural lesions and lung consolidation in intensive care unit (ICU) patients with severe pneumonia.MethodsA retrospective selection was made of 100 ICU patients with severe pneumonia who were treated in our hospital from June 2020 to July 2024 as the research subject group. All patients underwent bedside lung ultrasound and chest CT examinations, and the CT imaging manifestations of the patients were observed. Using the CT examination results as the gold standard, the patients were divided into the lung consolidation group and non-lung consolidation group. The relevant data were collected and the clinical data of the two groups were observed. The positive predictive value, negative predictive value, specificity, sensitivity and accuracy of bedside lung ultrasound in the diagnosis of subpleural lesions and lung consolidation were analyzed.ResultsChest CT showed that 73.00% of the patients had ≥2 lung lobes involved, mainly in the right lung (61.00%). 56.00% patients had 1–2 organs involved, mainly kidney (77.00%) or heart (87.00%). 69.00% of patients had pulmonary consolidation, 86.00% had bronchial shadow, and 82.00% had mass, patchy or nodular shadow. Compared with the non-lung consolidation group, the lung ultrasound score of the lung consolidation group was significantly increased (P<0.05), and the proportion of lung parenchyma, the number of subpleural lesions and the number of pleural intercostal changes were significantly increased (P<0.05). The consistency test showed that bedside ultrasound had a high consistency with chest CT in the diagnosis of subpleural lesions and lung consolidation (Kappa=0.678, P<0.05; Kappa=0.743, P< 0.05).ConclusionBedside lung ultrasound and chest CT had a high consistency in the diagnosis of subpleural lesions and lung consolidation, which may be used as an important method to judge the development of severe pneumonia in ICU.

BACKGROUNDLung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).AIMTo assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.METHODSAn observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H2O)] were applied. Baseline characteristics, including oxygen saturation (SpO2), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.RESULTSIn this study, 45.9% of patients required a PEEP of 5 cm H2O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H2O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (P < 0.001 for 5 and 10 cm H2O and P = 0.032 for 15 cm H2O). SpO2 increased significantly with higher PEEP levels (P < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.CONCLUSIONIncreasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.

Background: Pneumonia remains a major cause of under-five mortality, particularly in low-resource settings where early diagnosis is crucial. While chest X-ray (CXR) is the conventional imaging modality, it is limited by radiation exposure and accessibility. Bedside lung ultrasound (LUS) has emerged as a promising, radiation-free alternative, offering real-time pulmonary assessment.Objectives: To evaluate the diagnostic accuracy of bedside LUS compared to CXR in children under five presenting with clinical signs of pneumonia, and to analyze the sonographic features associated with pneumonia.Methods: A prospective observational study was conducted on 161 children aged one month to five years with clinical suspicion of pneumonia at a tertiary care hospital over 18 months. LUS was performed at the bedside using a standardized 10-zone protocol. Chest radiographs were interpreted by radiologists blinded to LUS findings. Statistical analysis included sensitivity, specificity, predictive values, and logistic regression for significant predictors.Results: LUS showed significantly higher sensitivity (86.2%, n=139/161, p=0.0001) and specificity (94.4%, n=85/90, p=0.0001) than CXR (75.6%, n=122/161, and 85.4%, n=77/90, respectively). Key sonographic markers such as shred sign and air bronchograms demonstrated strong diagnostic value. Subpleural consolidations and pleural effusions were better detected with LUS. Shred sign (odds ratio (OR)=8.45) and CRP >20 mg/L (OR=3.50) emerged as strong independent predictors of pneumonia.Conclusion: Bedside LUS is a reliable and accurate diagnostic modality for pediatric pneumonia. It is especially valuable in early detection and in resource-limited settings, supporting its broader clinical integration.

To estimate the diagnostic accuracy of nurse-performed lung ultrasound (LUS) for detecting pulmonary congestion in adults with acute kidney injury (AKI) and to relate ultrasound findings to the defining characteristics of the NANDA-I nursing diagnosis excess fluid volume. In this prospective exploratory diagnostic accuracy study, conducted between October 2022 and September 2023, a critical care nurse performed bedside LUS, following the bedside lung ultrasound in emergency protocol, in a convenience sample of 64 intensive care unit patients with AKI in a general hospital in Brazil. Pulmonary congestion was defined as ≥3 B-lines in ≥2 intercostal spaces per hemithorax. The reference standard was radiological evidence of vascular congestion on chest radiograph or computed tomography interpreted by blinded intensivists. Sensitivity, specificity, positive and negative predictive values were calculated with 95% confidence intervals. Agreement between LUS and radiologic findings was assessed using Gwet's AC1 coefficient. The COVID-19 pandemic limited patient flow; therefore, no formal sample-size calculation was feasible. Results should be considered preliminary. Pulmonary congestion was present in 14/64 patients (21.9%). LUS sensitivity was 50% (95% CI23%-77%) and specificity 94% (89%-99%). Positive and negative predictive values were 70% and 87%, respectively. Agreement between LUS and radiology was substantial (AC1=0.77, 0.63-0.92). No LUS-related adverse events occurred. Presence of ≥3 B-lines-an objective ultrasonographic marker of interstitial fluid-corresponded to the defining characteristic "pulmonary congestion" of NANDA-I diagnosis 00026. A single well-trained nurse achieved high specificity using LUS to rule out pulmonary congestion in critically ill patients with AKI. Limited sensitivity and wide confidence intervals highlight the need for larger, multicenter studies with sufficient positive cases. Linking B-lines to the defining characteristic of Excess Fluid Volume supports integration of point-of-care ultrasound into nursing diagnostic reasoning. Bedside nurse-performed LUS can strengthen clinical decision-making by quickly excluding pulmonary congestion-thereby informing volume-management interventions aligned with the NANDA-I taxonomy.

The use of point-of-care ultrasound, particularly lung ultrasound (LUS), has grown in pediatric and neonatal intensive care units and also in pre-hospital settings. However, its application in pre-hospital care of pediatric population remains understudied. The objective of the study is to analyze the utility of the LUS in a Paediatric and Neonatal Transport Unit. This is a prospective observational study conducted in a specialized Paediatric and Neonatal advanced life support Transport Unit in Catalonia, Spain, between March 2021 and September 2023. Patients who underwent bedside LUS during stabilization or transfer for medical reasons were included. Epidemiologic variables, clinical data, transport-related data, and LUS-related data were recorded and analyzed. During the study period, 2452 patients were transferred. In 89 (3.6%) LUS was performed. Seventy LUS were performed for respiratory distress or cyanosis, 50 of these were in neonatal patients in which transient tachypnea and meconium aspiration were the most frequent diagnoses. LUS was also used during hemodynamic assessment of unstable patients and during cardiac arrest resuscitation. Exactly 87.1% of LUS results were confirmed at the receiving hospital. LUS findings led to a change in patient management in 32 (35.9%) patients. The rational use of lung ultrasound performed by a pediatric and neonatal transport team can help in diagnostic orientation, management assessment, and improve patient safety.

BackgroundPulmonary ultrasound techniques have historically been applied to acute lung diseases to describe lung lesions, particularly in critical care.ObjectivesTo explore the role of lung ultrasound (LUS) in hospitalised patients with hypoxaemic pneumonia during the COVID-19 pandemic.MethodsThis was a single-centre prospective, observational study of two groups of adult patients with hypoxaemic pneumonia: those with COVID-19 pneumonia, and those with non-COVID-19 community-acquired pneumonia (CAP). A pulmonologist performed bedside LUS using the Bedside Lung Ultrasound in Emergency (BLUE) protocol, and the findings were verified by an independent study-blinded radiologist.ResultsWe enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID CAP. The COVID-19 patients were significantly older than those with non-COVID CAP (median (interquartile range (IQR)) age 52 (42 - 62.5) years v. 42.5 (36 - 52.5) years, respectively; p=0.007), and had a lower prevalence of HIV infection (25% v. 54%, respectively; p=0.01) and higher prevalences of hypertension (54% v. 7%; p=0.002) and diabetes mellitus (19% v. 8%; p=0.04). In both groups, close to 30% of the patients had severe acute respiratory distress syndrome. A confluent B-line pattern in the right upper lobe was significantly associated with COVID-19 pneumonia compared with the C pattern (relative risk (RR) 3.8; 95% confidence interval (CI) 1.7 - 8.6). Bilateral changes on LUS rather than unilateral or no changes were associated with COVID-19 pneumonia (RR 1.55; 95% CI 1.004 - 2.387). There were no statistically significant differences in median (IQR) lung scores between patients with COVID-19 pneumonia and those with non-COVID CAP (8 (4 - 11.5) v. 7.5 (4.5 - 12.5), respectively). Patients with COVID-19 pneumonia had a higher than predicted mortality. Logistic regression analysis showed a higher Simplified Acute Physiology Score (SAPS II) (RR 1.11; 95% CI 1.02 - 1.21) and a lower total LUS score indicating B lines v. consolidation (RR 0.80; 95% CI 0.65 - 0.99) to be associated with mortality.ConclusionPatients with right upper zone consolidation were more likely to have non-COVID CAP than COVID-19 pneumonia. Finding a B pattern as opposed to consolidation was associated with mortality. The admission LUS score was unable to discriminate between COVID-19 and non-COVID CAP, and did not correlate with the ratio of partial pressure of oxygen to fractional inspired oxygen, clinical severity or mortality.Study synopsisWhat the study adds. During the COVID-19 pandemic, in a resource-limited, high-prevalence setting, lung ultrasound (LUS) patterns on admission to hospital were used to distinguish between COVID-19 and other causes in patients with hypoxaemic pneumonia. Patients with right upper zone consolidation were more likely to have non-COVID-19 community-acquired pneumonia (CAP) than COVID-19 pneumonia.Implications of the findings. The admission LUS score was unable to discriminate between COVID-19 pneumonia and non-COVID CAP, and did not correlate with the ratio of partial pressure of oxygen to fractional inspired oxygen, clinical severity or mortality. The pattern was more valuable than the total LUS score in understanding the disease process.

Background Emergency rooms frequently see cases of chest trauma, which require prompt and precise assessment to determine the best course of action. Traditional diagnostic techniques like CT scans and chest X-rays have restrictions related to radiation exposure, cost, and mobility. Due to its mobility, radiation-free nature, and real-time imaging capabilities, bedside lung ultrasonography (LUS) has become a potential modality for assessing chest injuries. The main goal is to evaluate the accuracy of bedside LUS and high-resolution computed tomography (HRCT) thorax in patients with acute chest trauma. Materials and methods A bedside LUS will be performed on 45 adult patients over the age of 18 who present to the emergency department with severe chest trauma. An HRCT thorax will be done at the radiodiagnosis division. To evaluate LUS's diagnostic accuracy in identifying different traumatic conditions such as pneumothorax, hemothorax, and pulmonary contusion, its results will be compared with those of HRCT thorax. Results After the study is completed in 2025, conclusions will be made. Conclusions The accuracy of bedside LUS in diagnosing traumatic lung injury will be compared to HRCT thorax findings, and conclusions will be drawn.

IntroductionSome children with community-acquired pneumonia (CAP) experience progression to complicated community-acquired pneumonia (CCAP). It is characterized by local pulmonary or systemic complications such as para-pneumonic effusion, empyema, necrotizing pneumonia, and lung abscess. Imaging has an essential contribution to both the diagnosis and treatment of CCAP. While chest radiography and lung ultrasound (LUS) are commonly used for initial evaluation, chest computed tomography (CT), although valuable, raises concerns due to ionizing radiation exposure. Against the backdrop of increasing awareness regarding radiation risks in pediatric patients and the growing availability of bedside LUS, we conducted this study.ObjectiveThe aim of this study was to assess the agreement between LUS and contrast-enhanced chest CT in identifying specific findings in patients of complicated pneumonia, such as pleural effusion, pleural thickening, parenchymal consolidation, cavities, atelectasis, and hydropneumothorax.MethodsWe retrospectively compared CT and LUS images from 50 patients under 18 years of age admitted with clinical and radiological diagnosis of complicated pneumonia between January 2022 and June 2023, who underwent both imaging modalities within a seven-day interval. Images were assessed for pleural effusion, septations, pleural thickening, parenchymal consolidation, cavities, hydropneumothorax, and atelectasis.ResultsPleural effusion without septations was found in 25 (50%) patients on chest CT, whereas it was noted in 20 (40%) patients on LUS. Pleural effusion with septations was found in 21 (42%) patients on chest CT, whereas it was noted in 27 (54%) patients on LUS. Pleural thickening was found in 19 (38%) patients on chest CT, whereas it was noted in 9 (18%) patients on LUS. Lung parenchymal consolidation was found in 30 (60%) patients on chest CT, whereas it was noted in 16 (32%) patients on LUS. Atelectasis was found in 25 (50%) patients on chest CT, whereas it was noted in 26 (52%) patients on LUS. Parenchymal cavities were found in six (12%) patients on chest CT, whereas it was noted in two (4%) patients on LUS. Hydropneumothorax was found in six (12%) patients on chest CT, whereas it was noted in one (2%) patients on LUS.ConclusionsLUS can be used as an initial investigation in complicated pneumonia, while chest CT is reserved for cases with suspicion of specific complications of pneumonia.

Ultrasound has become an indispensable tool in modern emergency departments, significantly enhancing diagnostic accuracy, reducing patient waiting times, and facilitating the identification and treatment of life-threatening conditions. Point-of-care ultrasound (POCUS), which involves using ultrasound directly at the patient's bedside, has revolutionized the approach to emergency medicine. By using specific POCUS protocols for different organ systems, clinicians can deliver swift and accurate diagnoses, ensuring timely interventions. Among these protocols, the BLUE (Bedside Lung Ultrasound in Emergency) protocol is particularly effective in diagnosing lung-related conditions, such as pleural effusion. This case study highlights the critical role of POCUS in detecting atypical presentations of pleural effusion, a condition that can sometimes present in unconventional ways, complicating timely diagnosis. By recognizing specific signs during a lung ultrasound, clinicians can achieve an early and accurate diagnosis, ultimately leading to more effective interventions during resuscitation. Early detection of pleural effusion using the BLUE protocol can greatly improve patient outcomes, allowing for life-saving measures to be taken swiftly within the emergency department setting. We present a case where the identification of a particular sign during POCUS led to the early diagnosis of pleural effusion, enabling rapid intervention in a resuscitation scenario. This case underscores the significance of incorporating POCUS into emergency practice, as it enhances diagnostic capabilities and expedites treatment for critical conditions. The use of POCUS has the potential to save lives, particularly in high-stakes situations where time is of the essence.

Introduction: This study aimed to evaluate the effectiveness of lung ultrasonography (US) in detecting the cause of acute respiratory distress in the emergency department. Methods: This cross-sectional analytical study was carried out on 195 adult patients who were admitted to the Emergency Department of a University Hospital with acute respiratory failure in 6months period. The validity of the US diagnoses was assessed by comparing the decisions made by researchers according to the BLUE protocol classification with the final judgments made by the primary doctors using gold-standard diagnostic techniques suggested by the guidelines. Results: The diagnostic accuracy of lung US was 89.7%. While Congestive Heart Failure (CHF) (n=91), Chronic Obstructive Pulmonary Disease (COPD) (n=53), pneumonia (n=69), and Pneumothorax (PTX) (n=5) could be diagnosed by ultrasound with high sensitivity and specificity, its specificity in the diagnosis of Pulmonary Thromboembolism (PTE)(n=18) was low (67%). Ultrasonography could also diagnose combined pathologies such as pneumonia associated with CHF, or pneumonia associated with COPD, with high sensitivity and specificity. It has been determined that the diagnostic accuracy of the routine physical examination and lung radiography used in the emergency room to assess bedside respiratory distress is lower than that of ultrasonography. Discussion: In this study, we found that lung US was effective in the diagnosis of CHF, COPD, pneumonia, PTE, and PTX. Compared to the gold standard tests, it shortened the duration of the diagnosis. Finally, US can also be applied safely in centers where advanced diagnostic facilities are not available.

Aims: A significant portion of respiratory system infections seen in intensive care units is ventilator-associated pneumonia, which has a high mortality rate and diagnosis may be delayed. Bedside lung ultrasonography offers the advantages of standard diagnostic methods as chest radiography or thorax tomography. We aim to evaluate the bedside lung ultrasonography correlation with the chest radiography or thorax tomography Methods: It was conducted prospectively on 60 patients between the ages of 18-85 who were admitted to intensive care with respiratory failure within an 8-month period. Anterioposterior chest radiographs were taken on the first day of mechanical ventilation for the patients included in the study. Ultrasonographic (USG) examination was performed separately for both hemithoraxes and recorded digitally. Simultaneously with the ultrasonographic examination, PEEP, FiO2, blood gas examination results and the highest body temperatures in the last 24 hours were recorded. The quality and quantity of tracheal secretions were evaluated, and sampling was performed for complete blood examination and tracheal aspirate culture-antibiogram. Lung injury score (LIS) and pulmonary infection score (CPIS) were calculated from the data obtained. In this process, independent of the research, the same day examination results of patients who required thorax tomography (CT) for diagnosis and treatment planning were evaluated together with USG and chest radiography. Tomographic examinations were evaluated by a radiologist. Results: In the examination of 120 hemithoraxes of 60 patients we included in the study, we were able to detect 74.17% of the pathological images obtained with chest radiography and ultrasonographic examination with bedside ultrasonography and 70.84% with chest radiography. Of the 20 patients who underwent tomographic evaluation, pathology was observed in 40 hemithoraxes in 92.5% by tomography, in 85% by ultrasonography, and in 75% by chest radiography. While isolated consolidation was detected equally on USG and CT imaging, there was a high false-positive rate of 48% on chest radiography. 58.8% of the patients with consolidation detected by CT, we observed that there was growth in the tracheal aspirate of 56.2% of the patients whose ultrasonographic examination revealed consolidation. Conclusion: Bedside lung ultrasonography is a fast, non-invasive, repeatable and reliable diagnostic method in patients followed in intensive care, and is compatible with traditionally used laboratory and clinical parameters. This reveals that USG, which is known to have other advantages such as cost, applicability, and not using radiopaque, will become an indispensable examination for ICU.

Bedside lung ultrasound (POCUS) offers advantages over chest X-ray, including better cost-effectiveness for diagnosing certain pulmonary pathologies. This study compares the diagnostic concordance between portable chest X-rays and bedside lung ultrasounds in the intensive care unit (ICU). Adult ICU patients were included. POCUS was performed using the abbreviated BLUE protocol. Diagnostic results from POCUS and chest radiographies were compared using the intensivist clinical diagnosis - based on clinical examinations and lung ultrasounds - as the reference. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasounds were calculated. A total of 100 patients were included, 71 with pulmonary pathologies. The average time to perform the ultrasound was 308 seconds. Ultrasound identified pathology in 20 patients with a normal chest radiographs. Diagnostic discrepancies occurred in 30 patients, highlighting ultrasound´s superior sensitivity in detecting atelectasis, pleural effusions, and pulmonary edema. Ultrasound demonstrated sensitivity (S) of 85%, specificity (E) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 55%. Lung point-of-care ultrasound at ICU admission detects more pathologies and does not miss significant abnormalities seen on chest X-rays. It also shows good diagnostic accuracy. These findings suggest that pulmonary POCUS, using an abbreviated protocol, could be a viable alternative to chest radiography for initial evaluation and follow-up of pulmonary pathologies in critically ill patients, potentially improving care quality and management.

Background: Pneumonia is an acute inflammation of the lung parenchyma caused by microorganisms. In 2020, pneumonia was included in the top 10 diseases requiring hospitalization in Indonesia with a mortality rate of 23% for patients treated in the intensive care unit. The diagnosis of pneumonia is based on anamnesis, physical examination, and supporting examinations. However, in practice, diagnostic procedures in patients with immobilization or patients with unstable hemodynamics are difficult to perform. Lung ultrasound (LUS) with bedside lung ultrasonography in emergency (BLUE) protocol is a simple and portable supporting examination that is known to be able to diagnose pneumonia more easily, accurately, and quickly. Therefore, a study related to the validity of LUS in diagnosing pneumonia needs to be conducted. Methods: This study is a diagnostic test. The study was conducted over a period of 6 months (August 2023 to February 2024) at Prof. Dr. I.G.N.G. Ngoerah hospital. In this study, the validity was assessed consisting of sensitivity, specificity, and accuracy of LUS in diagnosing pneumonia. Data were analyzed using STATA MP 17. Results: The total subjects in this study were 70 people. The sensitivity of LUS in diagnosing pneumonia was 86.8% (CI95%=74.7-94.5%) and the specificity was 70.6% (CI95%=44-89.7%), with an accuracy of 82.8%. The positive test predictive value was 90.2% (CI95%=78.6-96.7%) and the negative test predictive value was 63.2% (CI95%=38.4-83.7%). Thus, in subjects with LUS suggestive of pneumonia, pneumonia management can be done immediately. However, in subjects with LUS results not showing pneumonia, further supporting examinations are needed to confirm the diagnosis of pneumonia. Sensitivity, specificity, and accuracy varies based on age, body mass index, immunocompromised status, and degree of pneumonia Conclusions: LUS with BLUE protocol is a valid supporting examination in diagnosing pneumonia (rule in disease).

Background: Pulmonary oedema is one of the major causes of mortality and morbidity. Acute heart failure is the major cause of pulmonary oedema. NT-pro B-type natriuretic peptide has been found to be effective in distinguishing acute pulmonary oedema from other causes of dyspnea in the emergency care setting. But it is costly and time consuming. Bedside lung ultrasonography (LUS) is being considered as noninvasive, radiation-free and easy to perform tool to diagnosis pulmonary oedema. Objective: To determine the role of bedside LUS in diagnosis of patients with acute pulmonary oedema. Methods: This observational cross-sectional study was carried out in ICU, Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka from August 2018 to October 2019. Ethical approval was sought before conduction of the study. One hundred critically-ill patients with pulmonary oedema, detected by clinical examination &amp; chest X-ray, due to heart failure were included in the study. Routine labs including NT-pro B-type natriuretic peptide level were sent. Bedside LUS was done with a portable ultrasound machine. Data was collected by using a semi-structured data sheet. Observation and Results: The median age was 42 years (IQR 18-66). Among them, 67.71% were male. 90.0% of patients diagnosed as acute pulmonary oedema by NT-pro B-type natriuretic peptide levels findings and 88.5% of patients were diagnosed as acute pulmonary oedema by bedside lung ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasonography findings alone statistically significant as 94.2%, 66.7%, 96.4% &amp; 54.5% and 91.66% respectively in detection of pulmonary oedema. Conclusions: Bed side lung ultrasonography can be an effective adjunct tool for rapid and high diagnostic accuracy for diagnosis of acute pulmonary oedema along with NT pro BNP level in ICU. Bangladesh Crit Care J September 2024; 12 (2): 113-117

BackgroundAt present, preterm infants with respiratory distress syndrome (RDS) in China present higher mortality and morbidity rates than those in high-income countries. The aim of this nationwide survey was to assess the clinical management of RDS in China.MethodsA nationwide cross-sectional survey to assess adherence to RDS management recommendations was performed. One neonatologist per hospital was randomly selected. The primary outcome was the key care of RDS management.ResultsAmong the 394 participating hospitals, 88·3% were birthing centres. The number of doctors and nurses per bed were 0·27 and 0·72, respectively. Antenatal corticosteroids (any dose) were administered to 90% of the women at risk of preterm birth at < 34 weeks of gestation (90·0% inborn vs. 50·0% outborn, p < 0·001). The median fraction of inspired oxygen (FiO2) for initial resuscitation was 0·30 for babies born at ≤ 32 weeks of gestation and 0·25 for those born at > 32 weeks. T-piece resuscitators were available in 77·8% of delivery rooms (DRs) (tertiary hospitals: 82·5% vs. secondary hospitals: 63·0%, p < 0·001). Surfactant was used in 51·6% of the DRs. Less invasive surfactant administration (LISA) was used in 49·7% of the hospitals (tertiary hospitals: 55·3% vs. secondary hospitals: 31·5%, p < 0·001). Primary non-invasive ventilation was initiated in approximately 80·0% of the patients. High-frequency oscillation ventilation was primarily reserved for rescue after conventional mechanical ventilation (MV) failure. Caffeine was routinely used during MV in 59·1% of the hospitals. Bedside lung ultrasonography was performed in 54·3% of the health facilities (tertiary hospitals: 61·6% vs. secondary hospitals: 30·4%, p < 0·001). Qualified breast milk banks and Family Integrated Care (FICare) were present in 30·2% and 63·7% of the hospitals, respectively.ConclusionsSignificant disparities in resource availability and guidelines adherence were evident across hospitals. Future strategies should address DR facilities and medication access, technical training, staff allocation, and ancillary facility development for a better management of RDS patients in China.

Bedside lung ultrasonography has been widely used in neonatal intensive care units (NICUs). Lung ultrasound scores (LUS) may predict the need for pulmonary surfactant (PS) application. PS replacement therapy is the key intervention for managing moderate to severe neonatal respiratory distress syndrome (NRDS), with early PS administration playing a positive role in improving patient outcomes. Lung ultrasonography aids in the prompt diagnosis of NRDS, while LUS offers a semi-quantitative assessment of lung health. However, the specific methodologies for utilizing LUS in clinical practice remain controversial. This study hypothesizes that, in very preterm infants [<32 weeks gestational age (GA)] exhibiting respiratory distress symptoms, determining PS application through early postnatal LUS combined with clinical indicators, as opposed to relying solely on clinical signs and chest x-rays, can lead to more timely PS administration, reduce mechanical ventilation duration, improve patient outcomes, and lower the occurrence of bronchopulmonary dysplasia (BPD). This is a protocol for a prospective, non-blinded, randomized controlled trial that will be conducted in the NICU of a hospital in China. Eligible participants will include very preterm infants (< 32 weeks GA) exhibiting signs of respiratory distress. Infants will be randomly assigned in a 1:1 ratio to either the ultrasound or control group. In the ultrasonography group, the decision regarding PS administration will be based on a combination of lung ultrasonography and clinical manifestations, whereas in the control group, it will be determined solely by clinical signs and chest x-rays. The primary outcome measure will be the mechanical ventilation duration. Statistical analysis will employ independent sample t-tests with a significance level set at α = 0.05 and a power of 80%. The study requires 30 infants per group (in total 60 infants). This study aims to demonstrate that determining PS application based on a combination of LUS and clinical indicators is superior to traditional approaches. This approach may enhance the accuracy of NRDS diagnosis and facilitate early prediction of PS requirements, thereby reducing the duration of mechanical ventilation. The findings of this research may contribute valuable insights into the use of LUS to guide PS administration.

Background: Acute respiratory distress syndrome (ARDS) requires rapid diagnosis for early intervention and improved outcomes. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS but the effectiveness of lung ultrasound in ARDS diagnosis is still uncertain. The objective of the study is to explore the efficacy of lung ultrasound (LUS) for diagnosis of ARDS in mechanically ventilated patients. Methods: A cross sectional study was conducted among 75 patients in Critical Care Centre, Combined Military Hospital, Dhaka from September 2021 to January 2022. The study was approved by the ethical committee in the hospital. In this study, the Bedside Lung Ultrasound in Emergency (BLUE) protocol for the immediate diagnosis of acute respiratory failure was followed. Purposive sampling technique was used. Data were analyzed by using Statistical Package For Social Sciences (SPSS) version 25.0. Results: A total of 75 patients were assessed. Among them male were 42(56%) and female 33(44%). The median age of patients was 48 years (Interquartile range 30-60). Primary diagnoses were pneumonia (22.67%), pulmonary oedema (20%), sepsis (20%) and trauma (17.33%). A total of 34(45.33%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 36(48%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as reference standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of lung ultrasound were 85.29%, 82.92%, 80.55%, 87.18% and 84% respectively. Conclusion: Lung ultrasound can be an effective tool for the diagnosis &amp; management of ARDS in the intensive care unit. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 51-57