Lung Ultrasound Examination Research Articles

Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome

BackgroundLung ultrasound and echocardiography are mainly applied in critical care and emergency medicine. However, the diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome (ARDS) is still unclear.MethodsConsecutive patients admitted to ICU with the diagnosis of suspected ARDS based on clinical grounds were enrolled. Cardiopulmonary ultrasound was performed as part of monitoring on day 1, day 2 and day 3. On each day a bedside ultrasound was performed to examine the lungs and calculate the Left Ventricular Ejection Fraction (LVEF). On day 3, a thoracic CT was performed on each patient as gold standard for ARDS imaging diagnosis. According to the results from CT scan, patients were grouped into ARDS group or Non-ARDS group. The relation between the cardiopulmonary ultrasound results on each day and the results of CT scan was analyzed.ResultsFifty one consecutive patients aged from 73 to 97 years old were enrolled. Based on CT criteria, 33 patients were classified into the ARDS group, while 18 patients were included in non-ARDS group. There was no significant difference between the two groups in baseline characteristics, including gender, age, underlying disease, comorbidities, APACHE II score, SOFA score, and PaO2/FiO2 ratio (P > 0.05). Lung ultrasound (LUS) examination results were consistent with the CT scan results in diagnosis of pulmonary lesions. The Kappa values were 0.55, 0.74 and 0.82 on day 1, day 2 and day 3, respectively. The ROC analysis showed that the sensitivity, specificity and area under curve of ROC (AUROC) for lung ultrasound in diagnose ARDS were 0.788,0.778,0.783;0.909,0.833,0.871;0.970,0.833,0.902 on day 1, day 2 and day 3, respectively. However, cardiopulmonary ultrasound performed better in diagnosing ARDS in elderly patients. The sensitivity, specificity and AUROC were 0.879,0.889,0.924;0.939,0.889,0.961;and 0.970,0.833,0.956 on day 1, day 2 and day 3, respectively. The combined performances of cardiopulmonary ultrasound, N-terminal pro-brain natriuretic peptide (NT-proBNP), and PaO2/FiO2 ratio improved the specificity of the diagnosis of ARDS in elderly patients.ConclusionsLUS examination results were consistent with the CT scan results in diagnosis of pulmonary lesions. Cardiopulmonary ultrasound has a greater diagnostic accuracy in elderly patients with ARDS, compared with LUS alone. The combined performances of cardiopulmonary ultrasound, NT-proBNP, and PaO2/FiO2 increased the specificity of the diagnosis of ARDS in elderly patients.

Evaluating Bedside Lung Ultrasound Examination (BLUE Protocol) Training and Learning among Emergency Medicine Residents of Iran University of Medical Sciences

Introduction: Research conducted in the department of emergency over the past years has shown that ultrasound in the patient's bedside can improve care in the hospital's department of emergency. The purpose of this study was to examine the learning of the BLUE protocol in the emergency medicine resident.Material & Methods: This study was designed as a qualitative study of pretest and posttest type that was conducted on emergency medical assistants who were employed in teaching hospitals of Iran University of Medical Sciences. In this study, sampling was done as a whole. In this study, patients' data was collected through pre-designed questionnaires. Then, after teaching the theory and practice of sonography by faculty of emergency medicine, the learning curve of ultra-sonographies performed by the assistants were studied separately until they reached the full competencies and confirmed by the corresponding professor.Results: In this study, a total of 85 emergency medical assistants were evaluated in terms of education and chest sonography (blue protocol) learning. The agreement between the performance of each assistant and the corresponding teacher was evaluated in 23 consecutive steps for assessing Lung sliding, determining the lung profile, and also identifying the B lines, and eventually identifying the complication in 747 patients with a mean age of 48.2 ± 6.1 which required pulmonary examination. The agreement rate increased by 0.09, 0.43, 0.08, and 0.371 respectively. There was a significant difference in the statistical analysis of the mean changes in the blue protocol. In the study of changes in the mean of the agreement coefficients, we reduced these changes and the average of the total coefficients of the agreement was increasing the convergence coefficient.Conclusion: The course of lung ultrasonography in the patient's bedside, according to the BLUE protocol, in the emergency medicine resident shows that during the training, the experience of the assistants has been increased and the professors are close to recognizing the BLUE protocol profiles.

Transthoracic lung and pleura ultrasonography as a diagnostic tool of pulmonary edema in dogs and cats

Despite the consensus on the role of lung and pleura ultrasound in human medicine, veteri- nary medicine questions credibility of the pulmonary evaluation in ultrasound examination, based on the analysis of artifacts in animals with clinical signs of respiratory failure and possibility of pulmonary edema diagnosis with recognition of the degree of its severity. The study was conduct- ed on 47 animals (29 dogs and 18 cats) of different breeds, age and sex. In all of animals prior to the transthoracic lung and pleura ultrasound examination (TLPUS), all animals were subjected to a clinical examination and hematological blood test as well as chest radiography examination in three projections. Ultrasound imaging of the chest in each animal was performed at designated four defined segments. TLPUS in dogs and cats based on an analysis of artifacts allows recogni- tion of pulmonary edema, to the degree comparable to chest X-ray examination. The number of depicted B-lines artifacts is proportional to the degree of pulmonary edema. These results allow to reduce the number of radiographs and allow the shortening of the diagnostic process for pa- tients in life-threatening condition.

Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A Randomized Controlled Trial.

Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery. In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis. Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048). Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients. An online visual overview is available for this article at http://links.lww.com/ALN/B682.

Accuracy of Medical Students in Detecting Pleural Effusion Using Lung Ultrasound as an Adjunct to the Physical Examination.

This study compared the accuracy of medical students in identifying pleural effusion in hospitalized patients using the physical examination versus lung ultrasound (US). Fourth-year medical students (n = 14) received 20 hours of general practical US training (including 2 hours of specialized lung US training) plus theoretical and video documentation. The students used the physical examination alone versus the physical examination plus lung US to document the presence or absence of pleural effusion in the right and left hemithoraces of hospitalized patients (n = 11 patients; 22 hemithoraces examined 544 times in total). The reference standard for identification of pleural effusion was a lung US examination by 2 expert point-of-care sonographers. The odds of correctly identifying the presence versus absence of pleural effusion was 5 times greater with lung US as an adjunct to the physical examination compared to the physical examination alone (odds ratio [OR], 5.1 from multivariate logistic regression; 95% confidence interval, 3.3-8.0). The addition of lung US to the physical examination resulted in an increase in sensitivity from 48% to 90%, in specificity from 73% to 86%, and in accuracy from 60% to 88%. The benefits of using US were greater when pleural effusion was present versus absent (OR, 10.8 versus 2.4) and when examining older versus younger patients (OR, 10.2 versus 2.8). These results demonstrate that medical students' ability to detect the presence or absence of pleural effusion is superior when using lung US as an adjunct to the physical examination than when using the physical examination alone.

Lung ultrasound reclassification of chest X-ray data after pediatric cardiac surgery.

Lung ultrasound is gaining consensus for the diagnosis of some pulmonary conditions. Pulmonary complications are common in pediatric cardiac surgery. However, its use remains limited in this setting. Our aim was to test the feasibility of lung ultrasound following pediatric cardiac surgery and to compare lung ultrasound and chest X-ray findings, assessing whether lung ultrasound may provide additional information. One hundred and thirty-eight lung ultrasound examinations were performed in 79 children (median age 9.3months) at different time points after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) have been evaluated in the upper and lower halves of the chest (for a total of 6 scanning sites per side). Pleural effusion, atelectasis, and the number of B-lines were investigated. Lung ultrasound was feasible in all cases in at least 1 of the 3 areas. Feasibility was different for the lateral, posterior, and anterior areas (100%, 90%, and 78%, respectively). The posterior areas were more sensitive than anterior and lateral ones in the diagnosis of effusion/atelectasis. In 81 cases, lung ultrasound allowed reclassification of chest X-ray findings, including 40 new diagnoses (diagnosis of effusion/atelectasis with negative chest X-ray reports) and 41 changes in diagnosis (effusions reclassified as atelectasis/severe congestion or vice versa). Although new diagnosis of small-to-moderate effusion/atelectasis was of limited clinical value, in 29 cases the new diagnosis changed the therapeutic approach. Lung ultrasound is feasible and accurate for the diagnosis of common pulmonary conditions after pediatric cardiac surgery, allowing reclassification of chest X-ray findings in a significant number of patients.

Ultrasound Fissure Observation: Assessment of Lung by Pleural-Hub Affiliates

Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice. Ten operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects. We found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90%to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection. Lung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound.

The role of lung ultrasound in the diagnosis of interstitial lung disease

Current data have shown that lung ultrasound (LUS) is an emerging tool in the diagnosis of interstitial lung disease (ILD) by evaluating numbers of B-lines, pleural irregularities and nodules or consolidations. These features can distinguish between ILD and others different pulmonary conditions (i.e., patients with heart failure or end-stage renal disease accompanied by pulmonary congestion). Although there is not a standardized approach for diagnosis of ILD by LUS examination and most studies has been made on rheumatologic patients, we discuss utility of LUS in detecting ILD and its correlation to classical radiological finding, especially to high-resolution computed tomography (HRCT).

Application of lung ultrasound examination in severe high altitude pulmonary edema

To investigate the application value of lung ultrasonic on severe high altitude pulmonary edema. A prospective, single-blind, case-control study was conducted. Sixty patients with severe high altitude pulmonary edema admitted to Qinghai University Affiliated Hospital from February 2015 to May 2017 were enrolled. The patients were divided into 2 500-3 000 m group, 3 000-3 500 m group and 3 500-4 200 m group according to different altitudes,with 20 patients in each group. The acute physiology and chronic health evaluation II (APACHE II) score was recorded before and 12 hours and 24 hours after treatment. The arterial partial pressure of oxygen (PaO2) was determined by blood gas analysis, and the oxygenation index (PaO2/FiO2) was calculated. Bedside ultrasound scanning was used to determine B line number and pulmonary artery pressure (PAP), and B line score was calculated to reflect lung water content. The correlation between B line score and PaO2/FiO2, PAP and APACHE II scores at each time point was analyzed by Pearson correlation analysis. None of 60 patients died or exited, all of them were enrolled in the final analysis. There was no significant difference in PaO2/FiO2, PAP, APACHE II score or B line score among different altitudes groups (all P > 0.05). Repeated measurement variance analysis showed that the effects of different altitudes on PaO2/FiO2, PAP, APACHE II score and B line score were not statistically significant (F value was 0.312, 0.014, 1.098, 0.236, and P value was 0.340, 0.791, 0.733, and 0.986, respectively). The PaO2/FiO2, PAP, APACHE II score and B line score in all groups were improved obviously from 12 hours after treatment, and the improvements at 24 hours were more than those at 12 hours (all P < 0.05). Repeated measurement variance analysis showed that the effect at different time points on PaO2/FiO2, PAP, APACHE II score and B line score was statistically significant (F value was 1 844.270, 121.690, 1 173.175, 19 426.968, all P < 0.001). The interaction effects of different altitudes and different time points on PaO2/FiO2, PAP, APACHE II score and B line score were not statistically significant (F value was 0.304, 0.404, 1.172, 1.403, and P value was 0.875, 0.805, 0.327, and 0.591, respectively). Pearson correlation analysis showed that there was a significant negative correlation between B line score and PaO2/FiO2 before and after treatment (r value was -0.579, -0.522, and -0.386, all P < 0.01), indicating that the more the B line, the more severe the pulmonary edema, and the worse the oxygenation; with the decrease in B line after treatment, the pulmonary edema was gradually alleviated, and oxygenation was gradually improved. There was a significant positive correlation between B line score and APACHE II score before and 24 hours after treatment (r value was 0.484 and 0.536, both P < 0.01), indicating that the more the B line, the more severe the patient; with the decrease in B line after treatment, the patient's condition improved after treatment. There was only a weak correlation between B line score and PAP at 24 hours after treatment (r = 0.317, P = 0.014), indicating that PAP was not a sensitive indicator in the degree of pulmonary edema in patients. The more the B line in patients with severe high altitude pulmonary edema, the more severe of the pulmonary edema, and the more severe of the patient. There was no significant correlation between the B line score and PAP. Pulmonary ultrasonography can still be used not only in the plain and low elevation areas, but in the high altitude areas, as a reliable method to evaluate the severity of pulmonary edema.

Frequency and number of B-lines using a regionally based lung ultrasound examination in cats with radiographically normal lungs compared to cats with left-sided congestive heart failure.

To establish a baseline lung ultrasound (LUS) artifact profile using a regionally based protocol in cats without clinical signs of respiratory disease and with radiographically normal lungs compared to a cohort of cats with left-sided congestive heart failure (CHF). Prospective case series. Forty-nine cats without clinical signs of respiratory disease and with radiographically normal lungs and 7 cats with radiographic evidence of left-sided CHF. Application of a previously published LUS protocol. Frequency of B-lines was compared based on signalment, body condition score, investigator, and reasons for radiography and between 49 cats with radiographically normal lungs to 7 cats with radiographic evidence of left-sided CHF. Overall frequency of B-lines was 12% (95% confidence interval, 5-24%) in cats without respiratory disease versus 100% (95% confidence interval, 65-100%) in those with left-sided CHF. Six cats (6/49) had B-lines with 5/6 having B-lines at a single site; and 4/5 having a single B-line at 1 site, 1/5 having 2 B-lines at 1 site; and the sixth cat having 2 positive sites with a single B-line at each. In the cohort of cats with left-sided CHF, all cats (7/7) had >3 B-lines detected at every site. The lack of B-lines in cats without respiratory disease (with radiographically normal lungs) and the predominance of B-lines in cats with left-sided CHF suggest that a regionally based LUS protocol may be clinically useful for the identification and evaluation of feline respiratory conditions.

Lung ultrasonography to diagnose pneumothorax of the newborn

ObjectiveTo explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. MethodsThis study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. Results(1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. ConclusionLung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.

Objective and Structured Assessment of Lung Ultrasound Competence. A Multispecialty Delphi Consensus and Construct Validity Study.

Point-of-care lung ultrasound imaging has substantial diagnostic value and is widely used in respiratory, emergency, and critical care medicine. Like other ultrasound examinations, lung ultrasound is operator dependent. The current recommendations for competence in lung ultrasound set a fixed number of ultrasound procedures to be performed without considering different learning rates. Recommendations do not consider different uses of lung ultrasound across specialties. To create a reliable, valid, and feasible instrument to assess lung ultrasound competence that includes the diverse use of lung ultrasound among medical specialties. A Delphi consensus survey was undertaken with participation of 11 experts from four different specialties to design an objective and structured assessment ultrasound tool. The construct validity of the assessment tool was examined by scoring 23 ultrasound operators of different competence levels. Examination time was measured and skill level rated by experienced observers using the assessment tool. Interrater agreement was examined by two observers in nine lung ultrasound examinations. Consensus was obtained within three Delphi rounds. Five elements were excluded. Two new elements were proposed, and one gained consensus. Two elements were rephrased. We found that the lung ultrasound competence evaluation tool could differentiate between levels of competence (P < 0.001). Examination time differed significantly between experts and intermediate operators (P = 0.005), but not between novices and intermediate operators (P = 0.06). The assessment tool had good interrater agreement (Pearson's r = 0.85; P < 0.005). This assessment tool provides a relevant, valid, and feasible method for evaluation of operator competence in point-of-care lung ultrasound across multiple specialties. This allows for a more individualized assessment of competence than current recommendations.

Assessment of Lung Ultrasound B-Lines in Dogs with Different Stages of Chronic Valvular Heart Disease.

BackgroundIn dogs with chronic valvular heart disease (CVHD), early recognition of pulmonary edema (PE) is of paramount importance. Recent studies in dogs showed that lung ultrasound examination (LUS) is a useful technique to diagnose cardiogenic PE.ObjectivesTo describe LUS features in dogs with different stages of CVHD, and to determine its diagnostic accuracy in detecting PE using thoracic radiography as the reference standard.AnimalsSixty‐three dogs with CVHD.MethodsProspective, multicenter, cross‐sectional study. Each dog underwent physical examination, echocardiography, thoracic radiography, and LUS. The LUS findings were classified as absent, rare, numerous, or confluent B‐lines. Sensitivity, specificity, and positive and negative predictive values of LUS B‐lines to identify PE were calculated using thoracic radiography as the reference standard.ResultsDogs in stage B1 had absent or rare B‐lines in 14 of 15 cases (93.3%). Dogs in stage B2 had absent or rare B‐lines in 16 of 18 cases (88.9%). All dogs in stage C, without radiographic signs of PE, had absent or rare B‐lines. Dogs in stage C, with radiographic signs of PE, had numerous or confluent B‐lines in 18 of 20 cases (90%). Lung ultrasound examination detected PE with a sensitivity of 90%, specificity of 93%, and with positive and negative predictive values of 85.7 and 95.2%, respectively.Conclusions and Clinical ImportanceLung ultrasound examination showed good diagnostic accuracy to identify cardiogenic PE and might be helpful in staging dogs with CVHD. Lung ultrasound examination should be considered as a new, noninvasive diagnostic tool for clinicians managing CVHD in dogs.

A Pilot Assessment of 3 Point-of-Care Strategies for Diagnosis of Perioperative Lung Pathology.

Lung ultrasonography is superior to clinical examination and chest X-ray (CXR) in diagnosis of acute respiratory pathology in the emergency and critical care setting and after cardiothoracic surgery in intensive care. Lung ultrasound may be useful before cardiothoracic surgery and after discharge from intensive care, but the proportion of significant respiratory pathology in this setting is unknown and may be too low to justify its routine use. The aim of this study was to determine the proportion of clinically significant respiratory pathology detectable with CXR, clinical examination, and lung ultrasound in patients on the ward before and after cardiothoracic surgery. In this prospective observational study, patients undergoing elective cardiothoracic surgery who received a CXR as part of standard care preoperatively or after discharge from the intensive care unit received a standardized clinical assessment and then a lung ultrasound examination within 24 hours of the CXR by 2 clinicians. The incidence of collapse/atelectasis, consolidation, alveolar-interstitial syndrome, pleural effusion, and pneumothorax were compared between clinical examination, CXR, and lung ultrasound (reference method) based on predefined diagnostic criteria in 3 zones of each lung. In 78 participants included, presence of any pathology was detected in 56% of the cohort by lung ultrasound; 24% preoperatively and 94% postoperatively. With lung ultrasound as a reference, the sensitivity of the 5 different pathologies ranged from 7% to 69% (CXR), 7% to 76% (clinical examination), and 14% to 94% (combined); the specificity of the 5 different pathologies ranged from 91% to 98% (CXR), from 90% to 99% (clinical examination), and from 82% to 97% (combined). For clinical examination and lung ultrasound, intraobserver agreements beyond chance ranged from 0.28 to 0.70 and from 0.84 to 0.97, respectively. The agreements beyond chance of pathologic diagnoses between modalities ranged from 0.11 to 0.64 (CXR and lung ultrasound), from 0.08 to 0.7 (CXR and lung ultrasound), and from 0 to 0.58 (clinical examination and CXR). Clinically important respiratory pathology is detectable by lung ultrasound in a substantial number of noncritically ill, pre or postoperative cardiothoracic surgery participants with high estimate of interobserver agreement beyond that expected by chance, and we showed clinically significant diagnoses may be missed by the contemporary practice of clinical examination and CXR.

THE ULTRASONIC IMAGING METHOD OF THE LUNGS IN NEWBORNS (REVIEW)

Most radiologists and clinicians stay skeptical about lung ultrasound (US) examination, since they are sure that US visualization of pathological changes in lungs is poor. According to other authors, lung US is a reliable method in different acute and chronic pathologies assessment and for quick diagnostics of such an urgent pathology as acute respiratory failure. It also helps to differentiate cardiogenic pulmonary edema, acute lung trauma, pneumothorax and pneumonia, interstitial lung disease and lung contusion. Lung US takes only several minutes to perform and ensues emergency treatment. It is important that lung US is technically simple, can be performed in any position of the patient, shows high tissue contrast and can evaluate structures in motion. And last, but not least for the dynamic screening method – lung US has no radiation exposure.

Routine application of lung ultrasonography in the neonatal intensive care unit.

The aim of this study was to study the features of lung ultrasonography (LUS) in lung disease and to evaluate the usefulness of LUS in the neonatal intensive care unit (NICU).All of 3405 neonates included in this study underwent an LUS examination. Diagnoses were based on medical history, clinical manifestation, laboratory examination, and signs on chest radiography (CR) and/or computed tomography (CT). A single expert physician performed all LUS examinations.There were 2658 cases (78.9%) with lung disease and 747 cases (21.9%) without lung disease. The main signs of neonates with lung disease on LUS were as follows: absence of A-lines, pleural-line abnormalities, interstitial syndrome, lung consolidation, air bronchograms, pulmonary edema, and lung pulse. These abnormal signs were reduced or eliminated on LUS as patient conditions improved. There were 81 cases that could not be diagnosed as lung disease by CR but were discovered as pneumonia, respiratory distress syndrome (RDS), or transient tachypnea of newborn (TTN) on LUS. Likewise, 23 cases misdiagnosed as RDS by CR were diagnosed as TTN on LUS. Among 212 cases of long-term oxygen dependence (LTOD) that failed to yield signs of pulmonary edema and lung consolidation on CR, 103 cases showed abnormal signs on LUS. Among 747 cases without lung disease, B-lines of 713 neonates (95.4%) could be found within 3 days after birth, and 256 neonates (34.3%) could be observed from 3 days to 1 week after birth. B-lines of 19 cases could be detected from 1 to 2 weeks after birth. The longest time at which B-lines could still be observed was 19 days after birth.LUS has clinical value for the diagnosis of lung disease and the discrimination of causes of LTOP in premature infants, particularly for the diagnosis and identification of RDS and TTN. Moreover, LUS has additional advantages, including its lack of radiation exposure and its ability to noninvasively monitor treatment progress. Therefore, LUS should be routinely used in the NICU.

Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome.

BackgroundIt is very important to assess the effectiveness of prone positioning (PP) in patients with severe acute respiratory distress syndrome (ARDS). However, it is difficult to identify patients who may benefit from PP. The purpose of this study was to investigate whether prone positioning potential (PPP) can be predicted by lung ultrasound in patients with ARDS.MethodsIn this prospective study, 45 patients with ARDS were included for the assessment of PPP. A PP lung ultrasound examination (PLUE) protocol was performed in the dorsal regions of the lung in 16 areas at H0, H3, and H6 (0, 3, and 6 h after PP). The ultrasonography videos were blindly evaluated by two expert clinicians to classify the lung regions as normal pattern (N), moderate loss of lung aeration (B1), severe loss of lung aeration (B2), and consolidation (C). The aeration scores were collected at H0, H3, and H6. According to the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) at 7 days, patients were classified into PPP-positive (P/F ratio >300) and PPP-negative groups; also, the patients were classified into survival and nonsurvival groups according to 28-day mortality.ResultsAeration scores was compared at H0, H3, and H6. The scores were significantly reduced between H3 and H0, but there was no difference between H3 and H6. The aeration score variation (ASV) of the PPP-positive group between H3 and H0 was significantly higher than that in the PPP-negative group, and the sensitivity and specificity of ASV ≥5.5 for the PPP-positive group were 73.9% and 86.4%, respectively. The area under the receiver operating characteristic curve (AUROC) was 0.852 for the ASV. The ASV between H3 and H0 in the survival group was significantly higher than in the nonsurvival group. The sensitivity and specificity of ASV ≥7 for survival were 51.5% and 75%, respectively. The AUROC was 0.702 for the ASV.ConclusionsThe PLUE protocol can be used to predict PPP and assess prognosis in patients with ARDS.

Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial.

Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia-induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume-controlled ventilation with 5 cmH2 O positive end-expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical ventilation of the lungs and the second at the end of surgery. Patients in the recruitment manoeuvre group received ultrasound-guided recruitment manoeuvres after each lung ultrasound examination. The incidence of significant anaesthesia-induced atelectasis at the second lung ultrasound examination was less in the recruitment manoeuvre group compared with the control group (25% vs. 80%; p = 0.001; odds ratio (OR) 0.083; 95% confidence interval (CI): 0.019-0.370). The median (IQR [range]) lung ultrasound scores for consolidation and B-lines on the second examination were lower in the recruitment manoeuvre group compared with the control group; 6.0 (3.0-9.3 [0.0-14.0]) vs. 13.5 (11.0-16.5 [8.0-23.0]); p < 0.001 and 6.5 (3.0-12.0 [0.0-28.0]) vs. 15.0 (10.8-20.5 [7.0-28.0]); p < 0.001, respectively. The lung ultrasound scores for consolidation on the first and second examinations showed a negative correlation with age (r = -0.340, p = 0.008; r = -0.380, p = 0.003). We conclude that ultrasound-guided recruitment manoeuvres with positive end-expiratory pressure proved useful in reducing the incidence of anaesthesia-induced atelectasis in infants, although 5 cmH2 O positive end-expiratory pressure alone was not sufficient to eliminate it. In addition, the younger the patient, the more susceptible they were to atelectasis.

The Utility of Bedside Lung Ultrasound Findings in Bronchiolitis

Recent literature suggests that bedside lung ultrasound may have a role in the evaluation of infants with bronchiolitis. B lines, which are multiple and diffuse vertical artifacts spreading from the lung pleural interface to the edge of the ultrasound screen, have been associated with thickened interlobular septa, extravascular lung water, and diffuse parenchymal disease. The aims of this study were (1) to describe the prevalence of B lines in children younger than 24 months presenting to the emergency department with wheezing, (2) to determine the interrater reliability of lung ultrasound findings in this setting, and (3) to determine the association of B lines with atopy and other clinical findings. This was a pilot, prospective, observational study of a convenience sample of patients younger than 2 years presenting with wheezing to a large academic pediatric hospital emergency department. Investigators performed lung ultrasound examinations, and a second provider reviewed the ultrasound examinations to determine interrater reliability. We performed univariate analyses to test for associations between ultrasound findings and atopy, acute illness severity, age, and treatment response. Studies were obtained on 29 patients (mean [SD] age, 291 [187] days; 62% male). Twenty-one patients (72%) had compact B lines. B lines were significantly associated with older age and an absence of atopic features. There was poor correlation of lung ultrasound examination interpretation among enrolling providers. In this small sample of patients with bronchiolitis, B lines were associated with older age and an absence of atopic features. Lung ultrasound interpretation had poor interrater reliability.

The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

Abstract Optimal timing of hospital discharge in patient with acute heart failure (AHF) is an important factor of preventing rehospitalizations. Aim. To evaluate the value of a simplified lung ultrasound (LUS) protocol in assessing pre-discharge status of patients with AHF, correlating the US findings with the values of NT-proBNP levels. Methods. 24 patients (18 men, 6 women, mean age 68,2 years) hospitalized with acute heart failure underwent LUS examination in the afternoon of the day before hospital discharge, applying a simplified LUS protocol, using three basal examination areas on the right side (anterior, lateral and posterior) and two basal examination areas on the left side (lateral and posterior). The LUS score was represented by the sum of B lines. In the next morning the value of NT-proBNP was also determined. The correlation between LUS findings and NT-proBNP values was analyzed using Fisher's exact test (significant if alpha&lt;0,05). Results. 6 patients had &lt;15 B lines, 16 patients had &gt;15 B lines and 2 patients had pleural effusion on LUS, while 16 patients had the value of NT-proBNP &gt;1000pg/ml at discharge. The results of LUS examination correlated significantly (p=0.0013) with the NT-proBNP values – only one patient not having increased NT-proBNP in the group with &gt;15 B lines. Conclusions. Despite a relatively good clinical status, the majority of patients had high NT-proBNP values at the time of hospital discharge. LUS proved to be a useful tool in identifying patients with subclinical congestion reflected also by the high NT-proBNP levels. These patients may need a prolongation of hospitalization and/or a more careful follow-up to prevent early readmission.