Confluent B-lines Research Articles

Proportion of confluent B-Lines predicts respiratory support in term infants shortly after birth

ObjectiveTo develop and evaluate the predictive value of a simplified lung ultrasound (LUS) method for forecasting respiratory support in term infants.MethodsThis observational, prospective, diagnostic accuracy study was conducted in a tertiary academic hospital between June and December 2023. A total of 361 neonates underwent LUS examination within 1 h of birth. The proportion of each LUS sign was utilized to predict their respiratory outcomes and compared with the LUS score model. After identifying the best predictive LUS sign, simplified models were created based on different scan regions. The optimal simplified model was selected by comparing its accuracy with both the full model and the LUS score model.ResultsAfter three days of follow-up, 91 infants required respiratory support, while 270 remained healthy. The proportion of confluent B-lines demonstrated high predictive accuracy for respiratory support, with an area under the curve (AUC) of 89.1% (95% confidence interval [CI]: 84.5-93.7%). The optimal simplified model involved scanning the R/L 1–4 region, yielding an AUC of 87.5% (95% CI: 82.6-92.3%). Both the full model and the optimal simplified model exhibited higher predictive accuracy compared to the LUS score model. The optimal cut-off value for the simplified model was determined to be 15.9%, with a sensitivity of 76.9% and specificity of 91.9%.ConclusionsThe proportion of confluent B-lines in LUS can effectively predict the need for respiratory support in term infants shortly after birth and offers greater reliability than the LUS score model.

Gamified Crowdsourcing as a Novel Approach to Lung Ultrasound Data Set Labeling: Prospective Analysis.

Machine learning (ML) models can yield faster and more accurate medical diagnoses; however, developing ML models is limited by a lack of high-quality labeled training data. Crowdsourced labeling is a potential solution but can be constrained by concerns about label quality. This study aims to examine whether a gamified crowdsourcing platform with continuous performance assessment, user feedback, and performance-based incentives could produce expert-quality labels on medical imaging data. In this diagnostic comparison study, 2384 lung ultrasound clips were retrospectively collected from 203 emergency department patients. A total of 6 lung ultrasound experts classified 393 of these clips as having no B-lines, one or more discrete B-lines, or confluent B-lines to create 2 sets of reference standard data sets (195 training clips and 198 test clips). Sets were respectively used to (1) train users on a gamified crowdsourcing platform and (2) compare the concordance of the resulting crowd labels to the concordance of individual experts to reference standards. Crowd opinions were sourced from DiagnosUs (Centaur Labs) iOS app users over 8 days, filtered based on past performance, aggregated using majority rule, and analyzed for label concordance compared with a hold-out test set of expert-labeled clips. The primary outcome was comparing the labeling concordance of collated crowd opinions to trained experts in classifying B-lines on lung ultrasound clips. Our clinical data set included patients with a mean age of 60.0 (SD 19.0) years; 105 (51.7%) patients were female and 114 (56.1%) patients were White. Over the 195 training clips, the expert-consensus label distribution was 114 (58%) no B-lines, 56 (29%) discrete B-lines, and 25 (13%) confluent B-lines. Over the 198 test clips, expert-consensus label distribution was 138 (70%) no B-lines, 36 (18%) discrete B-lines, and 24 (12%) confluent B-lines. In total, 99,238 opinions were collected from 426 unique users. On a test set of 198 clips, the mean labeling concordance of individual experts relative to the reference standard was 85.0% (SE 2.0), compared with 87.9% crowdsourced label concordance (P=.15). When individual experts' opinions were compared with reference standard labels created by majority vote excluding their own opinion, crowd concordance was higher than the mean concordance of individual experts to reference standards (87.4% vs 80.8%, SE 1.6 for expert concordance; P<.001). Clips with discrete B-lines had the most disagreement from both the crowd consensus and individual experts with the expert consensus. Using randomly sampled subsets of crowd opinions, 7 quality-filtered opinions were sufficient to achieve near the maximum crowd concordance. Crowdsourced labels for B-line classification on lung ultrasound clips via a gamified approach achieved expert-level accuracy. This suggests a strategic role for gamified crowdsourcing in efficiently generating labeled image data sets for training ML systems.

Clinical, functional and imaging parallels in the objective status of patients after community-acquired COVID-19-associated pneumonia

OBJECTIVE. To determine the dynamics of clinical symptoms in patients with community-acquired COVID-19-associated pneumonia, imaging and functional examination methods in the early post-acute period of the disease, establishing clinical, functional and imaging parallels in the objective status of patients.&#x0D; MATERIALS AND METHODS. We examined 56 patients after coronavirus disease (COVID-19). The severity of dyspnoea, anamnesis, objective status, pulse oximetry, lung ultrasound (LUS), computed tomography (CT) data, spirometry, body plethysmography, lung diffusion capacity were assessed. Non-parametric methods were used.&#x0D; RESULTS AND DISCUSSION. According to LUS 6 (10.7 %) patients had no pathological changes. Other patients had changes ranging from 3 to 11 points; 24 (48.0 %) had mild interstitial lung lesions, other – moderate. Every second patients showed signs of interstitial inflammation (single, multifocal, confluent B-lines), no more than three segments. Almost all patients (98.0 %) had single A-lines. LUSS was “recruited” mainly due to the LUS-pattern of consolidation (76.0 %) or thickened/ uneven pleura (90.0 %). The area of lung lesions on CT correlated with LUS (r=0.79; p&lt;0.001).&#x0D; CONCLUSIONS. LUS is a highly sensitive method for visualising interstitial changes in the lungs in the post-acute period after COVID-19-associated pneumonia. Most often, there are no impairments in lung ventilation function, but about 20 % of patients require further examination.

1762. Clinical application of handheld ultrasound devices during the 2022 Sudan Virus disease Ebola outbreak in Uganda

Abstract Background The fluid status and causes of respiratory failure in patients with Ebola disease can be challenging to determine due to concomitant severe diarrhea, vascular leakage, and multiorgan failure. Point-of-care ultrasound (POCUS) could guide fluid resuscitation for patients in resource-limited settings. We present the clinical application of POCUS in the 2022 Sudan Virus disease Ebola outbreak in Uganda. Figure. Ultrasound findings from patient 2. 2A: Discrete B lines observed with an irregular pleural line; 2B: Inferior vena cava collapsibility &amp;lt;50% suggestive of adequate fluid resuscitation; 2C: parasternal short cardiac view with small pericardial effusion identified; 2D: apical cardiac view with small pericardial effusion redemonstrated. Methods A clinical research team in Fort Portal, Uganda was trained in advanced Infection Prevention and Control (IPC) to care for patients with Ebola disease and in POCUS for septic shock. The clinical team learned a standardized lung and cardiac critical care ultrasound approach to evaluate patients in septic shock. The scanning procedure was used during the care of 6 patients with confirmed Sudan virus disease within 2 weeks of outbreak declaration to make critical patient care decisions like fluid management. Chest X-ray services and mechanical ventilation were not accessible. A handheld Philips Lumify device was kept in the biocontainment area and was used in full personal protective equipment. Scanning procedures included 12-zone lung ultrasound and 4-view cardiac ultrasound scans to determine causes of respiratory disease and evaluate fluid status. Results Among 6 patients (age range 27 to 58 years; 1/6 female), 5/6 were in their third week of illness, and 1/6 was in his second week of illness. Lung ultrasound abnormalities included discrete B-lines (5/6 patients), confluent B-lines (1/6), irregular pleural lines (3/6 patients), and subpleural consolidations (1/6 patients). Two participants in respiratory distress had cardiac POCUS. Both had hyperdynamic left ventricular function and one had a small pericardial effusion (Figure). One patient had inferior vena cava (IVC) collapsibility &amp;lt; 50% (1.5 cm diameter), and another with a &amp;gt;50% IVC collapsibility (1.3 cm diameter). These findings contributed to a decision to continue fluid resuscitation. Conclusion Portable handheld ultrasound devices identified previously undescribed ultrasound features of Sudan virus disease. POCUS helped determine causes of respiratory failure and guided fluid resuscitation in a biocontainment ward without access to mechanical ventilation. Disclosures All Authors: No reported disclosures

COVID-19 in Infants and Children under 2 Years-Could Lung Ultrasound Score Be Correlated with Biomarkers and Symptoms?

It is already well known that infants and children infected with COVID-19 develop mild to moderate forms of the disease, with fever and oropharyngeal congestion being the most common symptoms. However, there are instances when patients claim to be experiencing respiratory symptoms. Because of the repeated lung examinations required in these situations, non-irradiating imaging techniques are preferred. This study's objective is to ascertain the value of lung ultrasonography (LUS) in the medical management of these specific cases. Infants and children under two years old with SARS-CoV-2 infection were evaluated using LUS. Patients with other respiratory pathologies were excluded by using specific tests. The LUS score (LUSS) was correlated with biomarkers and clinical findings using the Mann-Whitney U test and Spearman's rank correlation rho. The LUSS for each patient varied from 1 to 8 points out of a maximum of 36 points. The arithmetic mean was 4.47 ± 2.36 (S.D), while the 95% CI for the arithmetic mean was 3.33 to 5.61. Sparse B-lines were present in all enrolled infants and children (100%), while only 36.84% developed alveolar syndrome (confluent B-lines). The lung changes were correlated with their biomarkers, specifically inflammatory markers. The correlation between LUSS and LDH, D-dimers, and IL-6 was a strongly positive one with rho = 0.55 (p = 0.001, 95% CI 0.13 to 0.80) between the LUSS and D-dimer levels and rho = 0.60 (p = 0.03, 95% CI 0.04 to 0.87) between LUSS and D-dimer levels at symptomatic infants and children (with respiratory involvement). Infants and children under the age of two are prone to develop mild forms of COVID-19 disease with a B-line pattern on LUS, although inflammatory markers have elevated blood levels. Despite the small sample, D-dimer levels and O2 saturation were correlated with LUSS in patients with respiratory involvement, while similar results were also found in the entire lot.

Machine Learning Algorithm Detection of Confluent B-Lines

B-lines are a ring-down artifact of lung ultrasound that arise with increased alveolar water in conditions such as pulmonary edema and infectious pneumonitis. Confluent B-line presence may signify a different level of pathology compared with single B-lines. Existing algorithms aimed at B-line counting do not distinguish between single and confluent B-lines. The objective of this study was to test a machine learning algorithm for confluent B-line identification. This study used a subset of 416 clips from 157 subjects, previously acquired in a prospective study enrolling adults with shortness of breath at two academic medical centers, using a hand-held tablet and a 14-zone protocol. After exclusions, random sampling generated a total of 416 clips (146 curvilinear, 150 sector and 120 linear) for review. A group of five experts in point-of-care ultrasound blindly evaluated the clips for presence/absence of confluent B-lines. Ground truth was defined as majority agreement among the experts and used for comparison with the algorithm. Confluent B-lines were present in 206 of 416 clips (49.5%). Sensitivity and specificity of confluent B-line detection by algorithm compared with expert determination were 83% (95% confidence interval [CI]: 0.77-0.88) and 92% (95% CI: 0.88-0.96). Sensitivity and specificity did not statistically differ between transducers. Agreement between algorithm and expert for confluent B-lines measured by unweighted κ was 0.75 (95% CI: 0.69-0.81) for the overall set. The confluent B-line detection algorithm had high sensitivity and specificity for detection of confluent B-lines in lung ultrasound point-of-care clips, compared with expert determination.

Lung Ultrasound in the Evaluation of Lung Disease Severity in Children with Clinically Stable Cystic Fibrosis: A Prospective Cross-Sectional Study.

With the increasing longevity of cystic fibrosis (CF), there is a growing need to minimise exposure to ionising radiation in patients who undergo regular imaging tests while monitoring the course of the lung disease. This study aimed to define the role of lung ultrasounds (LUS) in the evaluation of lung disease severity in children with clinically stable CF. LUS was performed on 131 patients aged 5 weeks to 18 years (study group) and in 32 healthy children of an equivalent age range (control group). Additionally, an interobserver study was performed on 38 patients from the study group. In CF patients, the following ultrasound signs were identified: I-lines; Z-lines; single, numerous and confluent B-lines; Am-lines; small and major consolidations; pleural line abnormalities and small amounts of pleural fluid. The obtained results were evaluated against an original ultrasound score. LUS results were correlated with the results of chest X-ray (CXR) [very high], pulmonary function tests (PFTs) [high] and microbiological status [significant]. The interobserver study showed very good agreement between investigators. We conclude that LUS is a useful test in the evaluation of CF lung disease severity compared to routinely used methods. With appropriate standardisation, LUS is highly reproducible.

Inter-Rater Variability in the Evaluation of Lung Ultrasound in Videos Acquired from COVID-19 Patients

Lung ultrasound (LUS) allows for the detection of a series of manifestations of COVID-19, such as B-lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the performance of the test in a longitudinal or transverse orientation. Thirty-three physicians with advanced experience in LUS independently evaluated ultrasound videos previously acquired using the ULTRACOV system on 20 patients with confirmed COVID-19. For each patient, 24 videos of 3 s were acquired (using 12 positions with the probe in longitudinal and transverse orientations). The physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (κ = 0.74), with only a fair IRR for the presence of individual B-lines (κ = 0.36) and for confluent B-lines occupying &lt; 50% (κ = 0.26) and a moderate IRR in consolidations and B-lines &gt; 50% (κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR for LUS of COVID-19 patients may benefit from more standardized clinical protocols.

Lung ultrasound findings in children with foreign body aspiration.

Foreign body aspiration (FBA) has a wide clinical spectrum, patients may be asymptomatic or present with cardiopulmonary arrest. Radiological imaging methods are used in addition to history and physical examination findings for certain diagnosis. Lung ultrasonography (LUS), whose usage area is increasing year by year, can be included in these. This study aimed to investigate ultrasonography findings in FBA and hypothesized that LUS may have a standard place in FBA diagnosis. Patients who administered to the pediatric emergency department between August 2019-August 2021, considered according to the clinical findings and physical examination possible FBA, and who undergone rigid bronchoscopy by pediatric surgery were included in the study. Thirty-two patients were included in the study. According to the results of bronchoscopy, FBA was detected in 25 patients. The most common finding in radiography was hyperinflation on one side, while LUS findings were confluent-B lines in eight patients, barcode-sign in five patients, pleural line abnormalities in two patients, and pleural consolidation in two patients. This study is the first study aiming to evaluate LUS findings in FBA to the best of our knowledge. The B-lines, barcode sign, pleural line abnormalities and consolidation are seen findings in LUS of the patients with FBA. Although it is far from replacing chest radiography in these patients, it is possible to say that it has an equivalent value with chest radiography.

Use of point-of-care ultrasound in the diagnosis and treatment of pulmonary oedema in an infant.

This case demonstrates the value of perioperative point-of-care ultrasound for rapid bedside evaluation and treatment of pulmonary oedema in an infant. A nine-week-old male infant undergoing cleft lip repair received significant intravenous fluid resuscitation for intraoperative hypotension. After uneventful extubation, he developed increased work of breathing and a gradual decline in oxygen saturation despite supplemental oxygen by way of a facemask. Lung point-of-care ultrasound revealed confluent B-lines in multiple lung fields, consistent with pulmonary oedema, likely from fluid overload. He was treated with furosemide resulting in clinical improvement within 30 minutes.

THE ULTRASOUND GRADING OF NEONATAL RESPIRATORY DISTRESS SYNDROME

TYPE: Abstract TOPIC: Pediatrics PURPOSE: Respiratory distress syndrome (RDS) used to be diagnosed by chest X-ray,can now be diagnosed by ultrasound with higher accuracy and reliability.With the increasing application of lung ultrasound,it is necessary to master the methods and standards of ultrasound grading in order to better manage RDS patients. METHODS: RDS was divided into three degrees by ultrasound manifestations and whether has resulted in severe complications. RESULTS: Grade Ⅰ RDS: mainly presents as GOS-like lung consolidation on ultrasound.GOS is a kind of mild lung consolidation with no obvious air bronochograms,the echogenicity in the near-field is higher and gradually decreases from shallow to deep,which looks-like the groundglass opacity. Grade Ⅱ RDS:mainly manifests as a kind of snowflake signs-like lung consolidation on ultrasound,but the consolidation has not yet involved all of the lung fields. Grade Ⅲ RDS: Those with any one or more of the following points are determined as grade Ⅲ RDS :(1)snowflake signs (SFS)-like lung consolidation already affecting 12 regions of the lung.(2)If SFS-like lung consolidation does not involve all of the lung fields,but has caused serious complications,such as pulmonary hemorrhage,or/and pneumothorax or/and persistent pulmonary hypertension of newborn or/and large area of atelectasis,etc. CONCLUSIONS: How to grade the RDS bu ultrasound was also described here,which is useful for ultrasound and clinical physicians to manage the neonatal RDS patients.Grade Ⅰ RDS is easy to misdiagnose as TTN,that is the GOS is easy to was mistaken for confluent B-lines,which was introduced clear in this short paper. CLINICAL IMPLICATIONS: Management of RDS under the monitoring of LUS can improve patient outcomes. DISCLOSURE: Nothing to declare. KEYWORD: respiratory distress syndrome;transient tachypnea of the newborn;lung ultrasound; ultrasound graduat

Lung ultrasound findings following COVID-19 hospitalization: A prospective longitudinal cohort study

BackgroundLung ultrasound (LUS) is a useful tool for diagnosis and monitoring in patients with active COVID-19-infection. However, less is known about the changes in LUS findings after a hospitalization for COVID-19. MethodsIn a prospective, longitudinal study in patients with COVID-19 enrolled from non-ICU hospital units, adult patients underwent 8-zone LUS and blood sampling both during the hospitalization and 2–3 months after discharge. LUS images were analyzed blinded to clinical variables and outcomes. ResultsA total of 71 patients with interpretable LUS at baseline and follow up (mean age 64 years, 61% male, 24% with acute respiratory distress syndrome (ARDS)) were included. The follow-up LUS was performed a median of 72 days after the initial LUS performed during hospitalization. At baseline, 87% had pathologic LUS findings in ≥1 zone (e.g. ≥3 B-lines, confluent B-lines or subpleural or lobar consolidation), whereas 30% had pathologic findings at follow-up (p < 0.001). The total number of B-lines and LUS score decreased significantly from hospitalization to follow-up (median 17 vs. 4, p < 0.001 and 4 vs. 0, p < 0.001, respectively). On the follow-up LUS, 28% of all patients had ≥3 B-lines in ≥1 zone, whereas in those with ARDS during the baseline hospitalization (n = 17), 47% had ≥3 B-lines in ≥1 zone. ConclusionLUS findings improved significantly from hospitalization to follow-up 2–3 months after discharge in COVID-19 survivors. However, persistent B-lines were frequent at follow-up, especially among those who initially had ARDS. LUS seems to be a promising method to monitor COVID-19 lung changes over time. Clinicaltrials.gov IDNCT04377035.

LUNG ULTRASOUND IN NEONATES WITH COVID-19 PNEUMONIA – THE START OF A NEW ERA

ObjectivesNewborns with SARS-CoV-2 infection that developed respiratory symptoms are a special category of patients, due to the fact that irradiating imaging tools are not recommended at their age. Because of their high cellular division rate, the X-ray and computer tomography scans should be avoided. The aim of this paper is to investigate the relevance of lung ultrasound (LU) in surveillance of neonates with SARS-CoV-2 infection.MaterialsIn our study we searched PubMed, ScienceDirect and Embase databases based on the following keyword: ‘newborn’, ‘neonate’, ‘COVID-19’, ‘sonography’, ‘lung ultrasound’. The found articles were selected using inclusion and exclusion criteria, such as: lung ultrasound as diagnostic tool, newborns, neonates and <28 days of life as population of interest and COVID-19 pneumonia as pathology criteria.Moreover, we analysed a group of 11 patients with infection who was admitted at ‘Pius Brinzeu’ County Emergency Clinical Hospital at Neonatology Department.ResultsFrom the total of articles, we selected 8 of them, based on the inclusion and exclusion criteria, and we analysed their results. After that, we compared their resulted data with the ultrasound findings from our evaluated newborns. The main changes found using LU include decreasing to disappearing physiological A-lines, rare or confluent B-lines, subpleural consolidations, and pleura abnormalities such as thickening and irregularities. Furthermore, the severity of lung injuries was analysed based on a 12-area score.ConclusionsRegarding neonates, lung ultrasound is an important tool in the evaluation of lung injuries associated with this infection, being demonstrated in several reviewed studies. Also, this imaging technique come with the benefits of being a repetitive, radiation-free, easy-to-use and reliable procedure for observing the impact and surveillance of COVID-19 on the neonates’ respiratory system.This imaging method was proved useful also in other respiratory diseases and could eventually be an indispensable item in the management and monitoring of newborns with respiratory infections, contouring new horizons in using it.

LUNG ULTRASOUND IN OUTPATIENTS WITH COVID-19 INFECTION ASSOCIATED PNEUMONIA

ObjectivesThe method of lung ultrasound (LUS) has been known for more than 20 years, but attracted attention during the epidemic of COVID-19 infection. LUS safe and low cost method assisting in the diagnosis of some acute respiratory diseases. The aim of the study is to evaluate the possibility of detecting LUS features using a 12-zone protocol in outpatients with pneumonia associated with COVID-19 infection.MaterialsWe examined 39 outpatients with diagnostic criteria for COVID-19 infection (17 men and 22 women) aged 31-75 years (median 49 years). The SARS-CoV-2 reverse transcriptase polymerase chain reaction obtained from the oropharynx or nasopharynx according to WHO standards was performed in all patients. All patients underwent LUS immediately after computer tomography (CT) scan by a blinded specialist. LUS score was calculated according to presence and severity of abnormalities for 12 zones (maximum 36 points). Correlation analysis of the results of quantitative assessment was performed. We also calculated the diagnostic accuracy for LUS using CT as a reference for diagnosing interstitial abnormalities in COVID-19 pneumonia.ResultsCT diagnosis of pneumonia was found in 25 patients (64%; 95% CI 47-79). Ultrasounds abnormalities were detected in 31 patients, the most common were focal areas of nonconfluent B-lines, diffuse confluent B-lines, subpleural microconsolidations and in one case large parenchymal consolidations with air bronchograms. LUS false positive results were found in nonviral interstitial lung diseases and in one due chronic heart failure (in all cases LUS score=2). When evaluating the LUS, the optimal sensitivity/specificity cut-off was ≥2 points, the area under the curve (AUC) = 0.970 (95% CI 0.858-0.999; p <0.0001). The score of lung ultrasound significantly correlated with the quantitative assessment on CT scan (r = 0.928, p <0.001).ConclusionsLUS has excellent diagnostic accuracy for interstitial abnormalities in COVID-19 pneumonia in outpatients with disease mild and moderate grade. The results obtained are probably due to the typical localization of interstitial abnormalities in the lungs in COVID-19. LUS could represent a valid diagnostic aid in setting of a significant number of admitting patients.

Lung Ultrasound for Pleural Line Abnormalities, Confluent B-Lines, and Consolidation: Expert Reproducibility and a Method of Standardization.

Discrete B-lines have clear definitions, but confluent B-lines, consolidations, and pleural line abnormalities are less well defined. We proposed definitions for these and determined their reproducibility using COVID-19 patient images obtained with phased array probes. Two raters collaborated to refine definitions, analyzing disagreements on 107 derivation scans from 10 patients. Refined definitions were used by those raters and an independent rater on 1260 validation scans from 105 patients. Reliability was evaluated using intraclass correlation coefficients (ICC) or Cohen's kappa. The agreement was excellent between collaborating raters for B-line abnormalities, ICC=0.97 (95% confidence interval [CI] 0.97-0.98) and pleural line to consolidation abnormalities, ICC=0.90 (95% CI 0.87-0.92). The independent rater's agreement for B-line abnormalities was excellent, ICC=0.97 (95% CI 0.96-0.97) and for pleural line to consolidation was good, ICC=0.88 (95% CI 0.84-0.91). Agreement just on pleural line abnormalities was weak (collaborators, κ=0.54, 95% CI 0.48-0.60; independent, κ=0.54, 95% CI 0.49-0.59). With proposed definitions or via collaboration, overall agreement on confluent B-lines and pleural line to consolidation abnormalities was robust. Pleural line abnormality agreement itself was persistently weak and caution should be used interpreting pleural line abnormalities with only a phased array probe.

Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality.

As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality. In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject. Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses. Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).

Quantitative assessment of COVID-19 pneumonia in neonates using lung ultrasound score.

BackgroundLung ultrasound (LUS) and lung ultrasound score (LUSS) have been successfully used to diagnose neonatal pneumonia, assess the lesion distribution, and quantify the aeration loss. The present study design determines the diagnostic value of LUSS in the semi‐quantitative assessment of pneumonia in coronavirus disease 2019 (COVID‐19) neonates.MethodsEleven COVID‐19 neonates born to mothers with COVID‐19 infection and 11 age‐ and gender‐matched controls were retrospectively studied. LUSS was acquired by assessing the lesions and aeration loss in 12 lung regions per subject.ResultsMost of the COVID‐19 newborns presented with mild and atypical symptoms, mainly involving respiratory and digestive systems. In the COVID‐19 group, a total of 132 regions of the lung were examined, 83 regions (62.8%) of which were detected abnormalities by LUS. Compared with controls, COVID‐19 neonates showed sparse or confluent B‐lines (83 regions), disappearing A‐lines (83 regions), abnormal pleural lines (29 regions), and subpleural consolidations (2 regions). The LUSS was significantly higher in the COVID‐19 group. In total, 49 regions (37%) were normal, 73 regions (55%) scored 1, and 10 regions (8%) scored 2 by LUSS. All the lesions were bilateral, with multiple regions involved. The majority of the lesions were located in the bilateral inferior and posterior regions. LUS detected abnormalities in three COVID‐19 neonates with normal radiological performance. The intra‐observer and inter‐observer reproducibility of LUSS was excellent.ConclusionsLUS is a noninvasive, convenient, and sensitive method to assess neonatal COVID‐19 pneumonia, and can be used as an alternative to the use of diagnostic radiography. LUSS provides valuable semi‐quantitative information on the lesion distribution and severity.

Comparison of Lung Ultrasound versus Chest X-ray for Detection of Pulmonary Infiltrates in COVID-19.

Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.

Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients.

Background:The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.Method:This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death.Results:We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001).Conclusions:Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

Ultrasonography: An Unchartered Modality in the Current Pandemic - A Study among Patients Admitted in the COVID-19 Intensive Care Unit.

Background:The objectives were to perform an analysis of lung ultrasonography (LUS) findings in severely ill patients with novel coronavirus disease-2019 (COVID-19) and to compare the accuracy with high-resolution computed tomography (HRCT) of the thorax.Methods:Sixty-two intensive care unit (ICU) patients with COVID-19 were evaluated during their hospital stay. LUS was performed with convex and linear transducers using a designated ultrasonography machine placed in the COVID-19 ICU. The thorax was scanned in 12 areas. Initial LUS was performed on admission and follow-up LUS was done in 7 (mean) days. At the time of the initial LUS, HRCT was performed in 28/62 patients and a chest radiography in 19/62 patients.Results:On admission, LUS detected pleural line thickening (>6 lung areas) in 49/62, confluent B-lines in 38/62, and separate B-lines in 34/62, consolidation in 12/62, C prime profile in 19/62, and pleural and cardiac effusions in 4/62 and 1/62, respectively. The single beam “torchlight” artifact was seen in 16/62, which may possibly be a variation of the B-line which has not been described earlier. Follow-up LUS detected significantly lower rates (P < 0.05) of abnormalities.Conclusion:Ultrasound demonstrated B-lines, variable consolidations, and pleural line irregularities. This study also sheds light on the appearance of the C prime pattern and “torchlight” B-lines which were not described in COVID-19 earlier. LUS findings were significantly reduced by the time of the follow-up scan, insinuating at a rather slow but consistent reduction in some COVID-19 lung lesions. However, the lung ultrasound poorly correlated with HRCT as a diagnostic modality in COVID-19 patients.