Lung Ultrasound Patterns Research Articles

Delivery Room Lung Ultrasound-Feasibility, Normal Patterns, and Predictive Value for Respiratory Support in Term and Near-Term Neonates: A Monocentric Study.

our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001-delivery room; r = 4.0443, p < 0.001-one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support.

The Role of POCUS to Face COVID-19: A Narrative Review.

COVID-19 has been a challenging outbreak to face, with millions of deaths among the globe. Acute respiratory failure due to interstitial pneumonia was the leading cause of death other than prothrombotic activation and complications. Lung ultrasound (LUS) and point-of-care ultrasound (POCUS) are widely used not only to triage, to identify, and to monitor lungs involvement but also to assess hemodynamic status and thrombotic and hemorrhagic complications, mainly in critically ill patients. POCUS has gained growing consideration due to its bedside utilization, reliability, and reproducibility even in emergency settings especially in unstable patients. In this narrative review, we aim to describe LUS and POCUS utilization in COVID-19 infection based on the literature found on this topic. We reported the LUS patterns of COVID-19 pulmonary infection, the diagnostic accuracy with respect to CT lung scan, its prognostic value, the variety of scores and protocols proposed, and the utilization of POCUS to investigate the extra-lung complications.

Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound-A Prospective Observational Study.

This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions.

Community-Acquired Pneumonia Associated with COVID-19: Diagnostic Significance of Imaging Methods (CT, LUS) and Comparative Characteristics of CT- and LUS-Patterns

Objective — to determine the imaging changes in community-acquired pneumonia in different severity of COVID-19; to define the diagnostic significance of CT, LUS, establish the correspondence of CT- and LUS-patterns. Materials and methods. We examined 22 patients (pts) (men — 11 (50.0 %), women — 11 (50.0 %), mean age — 67.0 (54.0; 74.0) years) with COVID-19 pneumonia. Clinical examination — general investigation, assessment of dyspnea severity (mMRC), pulse oximetry. The spread of lung lesions was determined by CT and LUS. Changes were described as CT- and LUS-patterns. Non-parametric. Results and discussion. In severe COVID-19 cases (end of the 1st week of illness), the extent of lung lesions aligned with CT-1, revealing bilateral subpleural «ground glass» opacities. Bilateral changes were observed in lung ultrasound (LUS), with a Lung Ultrasound Score (LUSS) of 2—4 points. The CT pattern of «ground glass» corresponded to LUS patterns indicating mild to moderate interstitial changes (IC).By the 2nd and 3rd weeks, the area of lung lesions corresponded to CT-1 and 2, and the CT pattern of «ground glass» became diffuse and bilateral. Bilateral LUS changes were noted, with LUSS ranging from 4 to 18 points. The CT pattern of «ground glass» aligned with LUS patterns indicating mild to moderate IC, pleural thickening, and the absence of A-lines. The CT pattern of consolidation corresponded to a similar LUS pattern.In patients with a critical course during the 2nd and 3rd weeks, the lesion area extended to 60–90 %. Bilateral LUS changes persisted, with LUSS ranging from 16 to 22 points. There was a significant correlation between the area of lung lesions observed on CT and LUS (p &lt; 0.0001). Conclusions. In the 1st week of illness, verification of severe COVID-19 should be grounded in the presence of severe dyspnea and decreased saturation. During the 2nd and 3rd weeks, verification can be based on decreased saturation and the extent of lung lesions as assessed by CT and lung ultrasound (LUS). In critical patients, the area of lung lesions ranged from 60 to 90 % on CT and/or exceeded 15 points on the LUSS. The CT pattern of «ground glass» corresponded to interstitial changes (IC), pleural thickening, and the absence of A-lines on LUS. Similarly, the CT pattern of consolidation corresponded to a consolidation pattern on LUS.

Lung ultrasound score in dogs and cats: A reliability study.

Lung ultrasound (LUS) is a noninvasive tool for examining respiratory distress patients. The lung ultrasound score (LUSS) can be used to quantify and monitor lung aeration loss with good reliability. Assess the reliability of a new LUSS among raters with different levels of experience and determine how well the same raters agree on identifying patterns of LUS abnormalities. Forty LUS examinations of dogs and cats and 320 videos were reviewed from a digital database. Retrospective reliability study with post hoc analysis. Protocolized LUS were randomly selected; intrarater and interrater reliability of the LUSS and pattern recognition agreement among 4 raters with different levels of experience in LUS were tested. The intrarater intraclass correlation coefficient (ICC) single measurement, absolute agreement, and 2-way mixed effects model was 0.967 for the high-experience rater (H-Exp), 0.963 and 0.952 for the medium-experience raters (M-Exp-1; M-Exp-2), and 0.950 for the low-experience rater (L-Exp). The interrater ICC average measurement, absolute agreement, and 2-way random effects model among the observers was 0.980. The Fleiss' kappa (k) values showed almost perfect agreement (k = 1) among raters in identifying pleural effusion and translobar tissue-like pattern, strong agreement for A-lines (k = 0.881) and B-lines (k = 0.806), moderate agreement (k = 0.693) for subpleural loss of aeration, and weak agreement (k = 0.474) for irregularities of the pleural line. Our results indicate excellent intra- and interrater reliability for LUS scoring and pattern identification, providing a foundation for the use of the LUSS in emergency medicine and intensive care.

Use of Lung Ultrasound in the New Definitions of Acute Respiratory Distress Syndrome Increases the Occurrence Rate of Acute Respiratory Distress Syndrome.

To assess the effect of incorporating bilateral abnormalities as detected by lung ultrasound (LUS) in the Kigali modification and the New Global definition of acute respiratory distress syndrome (ARDS) on the occurrence rate of ARDS. Post hoc analysis of a previously published prospective cohort study. An academic mixed medical-surgical ICU. The original study included critically ill adults with any opacity on chest radiography in whom subsequent LUS was performed. Patients with ARDS according to the Berlin definition, COVID-19 patients and patients with major thorax trauma were excluded. None. LUS was performed within 24 hours of chest radiography and the presence of unilateral and bilateral abnormalities on LUS and chest radiograph (opacities) was scored. Subsequently, the Kigali modification and the New Global definition of ARDS were applied by two independent researchers on the patients with newly found bilateral opacities. Of 120 patients, 116 were included in this post hoc analysis. Thirty-three patients had bilateral opacities on LUS and unilateral opacities on chest radiograph. Fourteen of these patients had ARDS according to the Kigali modification and 12 had ARDS according to the New Global definition. The detected LUS patterns were significantly different between patients with and without ARDS ( p = 0.004). An A-profile with a positive PosteroLateral Alveolar and/or Pleural Syndrome was most prevalent in patients without ARDS, whereas heterogeneous and mixed A, B, and C patterns were most prevalent in patients with ARDS. The addition of bilateral abnormalities as detected by LUS to the Kigali modification and the New Global definition increases the occurrence rate of the ARDS. The nomenclature for LUS needs to be better defined as LUS patterns differ between patients with and without ARDS. Incorporating well-defined LUS criteria can increase specificity and sensitivity of new ARDS definitions.

Lung ultrasound and postoperative follow-up of congenital diaphragmatic hernia.

Lung ultrasound (LU) has emerged as a valuable tool for assessing pulmonary aeration noninvasively, rapidly, and reliably in different neonatal conditions. However, its role in the preoperative and postoperative evaluation in congenital diaphragmatic hernia (CDH) is still poorly analyzed. We present a cohort of 8 patients diagnosed with CDH who underwent lung ultrasound examinations at various time points before and after surgical correction. The lung ultrasound patterns were compared between two groups: mechanical ventilation ≤ 7days (MV ≤ 7) and mechanical ventilation > 7days (MV > 7). The ultrasound findings were also compared to CT scans and chest X-ray images to assess its diagnostic capacity for identifying postoperative complications: pneumothorax, pleural effusion, and pneumonia. Group MV ≤ 7 exhibited a normal pattern even at 48h postsurgery, while group MV > 7 presented interstitial or alveolointerstitial pattern in both lungs for prolonged periods (2-3weeks). Furthermore, contralateral LU pattern may be predictive of respiratory evolution. Conclusion: Lung ultrasound is a valuable tool for evaluating the progressive reaeration of the lung following surgical correction in CDH patients. It demonstrates the ability to diagnose common postoperative complications without the need for radiation exposure while offering the advantages of quick and serial assessments. These findings highlight the potential of lung ultrasound as an effective alternative to conventional imaging methods in the management of CDH. What is Known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in neonatal patients. What is New: • Lung ultrasound is useful in the postsurgical management of congenital diaphragmatic hernia patients, detecting reaeration and respiratory complications.

Simplified lung ultrasound method to predict the respiratory support needs of neonates whose mothers had pregnancy complications: a diagnostic accuracy study

Objective: Some pregnancy complications are associated with respiratory problems in infants. Early identification and implementation of respiratory support are needed for these infants. This study aimed to (1) use lung ultrasound (LU) for predicting the respiratory support requirements of infants and (2) simplify the examination method to facilitate its clinical application. Methods: Neonates underwent LU examinations within 1 hour of birth. The infants were divided into a pregnancy complication (PC) group and a control group according to their mothers’ clinical data. The primary outcome measure was the need for respiratory support. Predictive models were established based on the differences in LU patterns between the two groups. The predictive value of the models was compared with that of the LU score (LUS) system, which has been widely used in other studies. Simplified models were established by analyzing the predictive effects of LU patterns in different parts of the lungs. Predictive reliability was tested using the receiver operating characteristic curve analysis. Results: PC and control groups had 29 and 117 neonates, respectively; a total of 22 neonates required respiratory support. The PC and control groups showed differences in respiratory support requirements, A-lines, and coalesced B-lines. The percentages of A-lines and coalesced B-lines were associated with respiratory support requirements. The optimal cutoff values for the percentages of the A-lines and coalesced B-lines were 55.7% and 24.5%, respectively. Similar effects were obtained by calculating the percentage of coalesced B-lines in four areas (R3, R4, L3, and L4). These methods were judged as more visual and convenient than LUS assessment. Conclusion: The percentages of A-line and coalesced B-lines on LU images can be used to predict the respiratory support needs of neonates whose mothers had pregnancy complications. Only four areas (R3, R4, L3, and L4) had similar predictive values.

The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review.

Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain. This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria. We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating "halo sign" or "reverse halo sign"). Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted.

Ultra-high frequency lung ultrasound in preterm neonates: a test validation study on interpretation agreement and reliability

ObjectiveTo verify if increasing frequency, through the use of ultra-high frequency transducers, has an impact on lung ultrasound pattern recognition.DesignTest validation study.SettingTertiary academic referral neonatal intensive care unit.PatientsNeonates admitted with...

The importance of lung recruitability: A novel ultrasound pattern to guide lung recruitment in neonates.

Lung Ultrasound (LUS)-guided Lung Recruitment Maneuver (LRM) has been shown to possibly reduce ventilator-induced lung injury in preterm infants. However, to avoid potential hemodynamic and pulmonary side effects, the indication to perform the maneuver needs to be supported by early signs of lung recruitability. Recently, a new LUS pattern (S-pattern), obtained during the reopening of collapsed parenchyma, has been described. This study aims to evaluate if this novel LUS pattern is associated with a higher clinical impact of the LUS-guided LRMs. All the LUS-guided rescue LRMs performed on infants with oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this cohort study. The primary outcome was to determine if the presence of the S-pattern is associated with the success of LUS-guided recruitment, in terms of the difference between the final and initial S/F ratio (Delta S/F). We reported twenty-two LUS-guided recruitments, performed in nine patients with a median gestational age of 34 weeks, interquartile range (IQR) 28-35 weeks. The S-pattern could be obtained in 14 recruitments (64%) and appeared early during the procedure, after a median of 2 cmH2O (IQR 1-3) pressure increase. The presence of the S-pattern was significantly associated with the effectiveness of the maneuver as opposed to the cases in which the S-pattern could not be obtained (Delta S/F 110 +/- 47 vs 44 +/- 39, p = 0.01). Our results suggest that the presence of the S-pattern may be an early sign of lung recruitability, predicting LUS-guided recruitment appropriateness and efficacy.

Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study.

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.

Lung Ultrasound Patterns in Multisystem Inflammatory Syndrome in Children (MIS-C)-Characteristics and Prognostic Value.

Objective and design: Following COVID-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described, but data describing the LUS findings of MIS-C are limited. The aim of this retrospective observational study conducted between 1 March and 31 December 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. The secondary objective is to evaluate concordance of LUS with Chest X-ray (CXR). Methodology: Clinical and laboratory data were collected for all patients (age 0–18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, needed for respiratory support and inotrope administration, hospital, and PICU length of stay, were considered as outcomes and evaluated in the different LUS patterns. An agreement between LUS and CXR evaluation was assessed with Cohen’ k. Results: 24 children, who had a LUS examination upon admission, were enrolled. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. Conclusion: LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity; under this aspect, LUS can be used at admission to stratify risk of severe disease.

One Year of Lung Ultrasound in Children with SARS-CoV-2 Admitted to a Tertiary Referral Children's Hospital: A Retrospective Study during 2020-2021.

During the COVID-19 pandemic, the lung ultrasound (LU) turned out to be a pivotal tool to study the lung involvement in the adult population, but the same was not well evaluated in children. We detected the LU patterns through an integrated approach with clinical–laboratory features in children hospitalized for COVID-19 in relation to the temporal trend of the Italian epidemic. We conducted a retrospective study which took place at a pediatric tertiary hospital from 15 March 2020 to 15 March 2021. We compared the characteristics of the initial phase of the first COVID-19 year—in the spring and summer (15 March–30 September 2020)—and those of the second phase—in the autumn and winter (1 October 2020–15 March 2021). Twenty-eight patients were studied both in the first and in the second phase of the first COVID-19 year. The disease severity score (DSS) was significantly greater in the second phase (p = 0.015). In the second phase of the first COVID-19 year, we detected a more significant occurrence of the following LU features than in the first phase: the irregular pleural line (85.71% vs. 60.71%; p = 0.035), the B-lines (89.29% vs. 60%; p = 0.003) and the several but non-coalescent B-lines (89.29% vs. 60%; p = 0.003). The LU score correlated significantly with the DSS, with a moderate relationship (r = 0.51, p < 0.001). The combined clinical, laboratory and ultrasound approaches might be essential in the evaluation of pulmonary involvement in children affected by COVID-19 during different periods of the pandemic.

Role of lung ultrasound patterns in monitoring coronavirus disease 2019 pneumonia and acute respiratory distress syndrome in children.

Background During the coronavirus disease 2019 (COVID-19) pandemic, lung ultrasonography (US) has been gaining importance in pediatric intensive care and emergency settings for the screening, diagnosis, and monitoring of pulmonary pathology.Purpose To describe the pattern of lung US changes in patients with COVID-19 pneumonia and its potential role in monitoring ventilated patients.Methods This prospective observational study included children aged 1 month to 12 years with a confirmed diagnosis of COVID-19. Lung US was performed using a high-frequency linear probe (5–12 MHz) in all children with moderate/severe respiratory symptoms within 24 hours of admission and then daily until the patient required oxygen therapy. Lung involvement severity was assessed using lung US scores, while lung aeration improvement or deterioration was measured using lung ultrasound reaeration scores (LUSReS).Results Of 85 children with moderate to severe disease, 54 with pulmonary disease were included. Of them, 50 (92.5%) had an interstitial pattern, followed by pleural line abnormalities in 44 (81.5%), reduced or absent lung sliding in 31 (57.4%), and consolidation in 28 (51.8%). A significantly higher lung US score (median, 18; interquartile range [IQR], 11–22) was observed in ventilated versus nonventilated patients (median, 9; IQR, 6–11). LUSReS improvement after positive end-expiratory pressure titration was positively correlated with improved dynamic lung compliance and oxygenation indices and negatively correlated with the requirement for driving pressure. Successful weaning could be predicted with 100% specificity if loss of LUSReS ≤ 5.Conclusion Interstitial syndrome, fragmented pleural line, and subpleural microconsolidation were the most prevalent lung US findings in children with COVID-19 pneumonia. Thus, lung US may have the ability to monitor changes in lung aeration caused by mechanical ventilation and predict its successful weaning in children with COVID-19.

Utility of lung ultrasound in following up COVID-19 patients over a 3-month period

Lung ultrasound (LUS) examination has been shown to have a potential diagnostic and prognostic role in SARS-CoV-2 pneumonia disease. We evaluated the role of a new LUS score protocol (14 windows evaluation, graded score 0–3) in patients with SARS-CoV-2 pneumonia and the association of LUS patterns with clinical findings in acute stage and after three month from disease recovery. First, a cohort of 52 consecutive laboratory-confirmed SARS-CoV-2 patients underwent LUS examination upon the admission in an Internal Medicine ward. A total LUS score as the sum of the scores at each explored area was computed,and we investigated the association between LUS score and the clinical worsening. Then 47 patients who survived the first COVID-19 wave and who underwent a 3-stage LUS examination (T0 “access to ER”; T1 “ward hospitalization”; T2 “post-COVID outpatient”) were enrolled for the longitudinal study. In the acute stage, we observed that a median LUS score above 24 was associated with an almost 6-fold increase in the odds of worsening. In the longitudinal observation, we seen that LUS score's variation between T0 and T2 resulted to be statistically significant, as well a difference of LUS score between patients with or without pleural effusion, maintained over time.

A standardised and evidenced-based lung ultrasound acquisition protocol and scoring system for the monitoring and stratification of COVID-19 and post-COVID-19 patients

Lung ultrasound (LUS) is currently utilized worldwide to assess COVID-19 patients. However, imaging protocols are often defined arbitrarily, and studies on post-COVID-19 are lacking. In this work, we report on the capabilities of standardized LUS to monitor and stratify COVID-19 and post-COVID-19 patients. A validated and standardized imaging protocol based on 14 scanning-areas and a 4-level scoring system were utilized to collect and analyze data from 220 patients, 100 COVID-19 positive, and 120 post-COVID-19. Next, the capability of five imaging protocols (based on 4, 8, 10, 12, and 14 scanning-areas) to intercept the most significant LUS findings was compared. Moreover, a longitudinal-study was conducted aiming at investigating the possibility to simplify the protocol during follow-up. Results on the agreement between AI-models and LUS experts with respect to LUS data evaluation are also reported. In conclusion, a 12-areas protocol emerges as the optimal trade-off between a time-efficient and an accurate LUS examination. However, it appears not to be possible to reduce further the number of scanning-areas during follow-up. Finally, COVID-19 and post-COVID-19 data seem to show differences capable to confuse AI models that were not trained on post-COVID-19 data, supporting the hypothesis of the existence of LUS patterns specific to post-COVID-19.

Association Between Lung Ultrasound Patterns and Pneumonia.

Pneumonia is a common respiratory infection that affects the lungs. Lung ultrasound (LUS) is a portable, cost-effective imaging method, which is free of ionizing radiation and has been shown to be useful for evaluating pneumonia. The aim of this retrospective analytical study was to determine the association between lung ultrasound patterns and pneumonia. For the purpose of performing the required analysis, LUS patterns including consolidations, pleural line irregularities, A lines and B lines from 90 subjects (44 patients with confirmed pneumonia and 46 controls) were retrieved from a published open-access data set, which was reviewed and approved by medical experts. A χ 2 test was used for the comparison of categorical variables to determine the association between each LUS pattern and the presence of pneumonia. There is a significant association between LUS consolidation and the presence of pneumonia ( P < 0.0001). Lung ultrasound A lines are significantly associated with the absence of pneumonia ( P < 0.0001), whereas there are no associations between B lines or pleural line irregularities with pneumonia. Lung ultrasound consolidation is found to be associated with the presence of pneumonia. A lines are associated with healthy lungs, and there is no association of B lines and pleural irregularities with the presence of pneumonia. Further studies investigating LUS patterns with clinical information and symptoms of patients with pneumonia are required.

Point-of-Care Lung Ultrasound Pattern in Healthy Parturients: Prevalence of Pulmonary Interstitial Syndrome Following Vaginal Delivery, Elective and Unplanned Intrapartum Cesarean Delivery

(Anesth Analg. 2021;133:739–746. doi: 10.1213/ANE.0000000000005464) The risk of pulmonary edema for parturient women increases near term, and factors during and post labor lead to even greater risk of pulmonary edema in the early postpartum period. Lung ultrasound (LUS) is a tool that helps to diagnose pulmonary edema earlier. Data on the effect of labor and early postpartum fluid shifts and hormonal changes on the occurrence of pulmonary interstitial syndrome is unknown. This exploratory study seeks to estimate the prevalence of pulmonary interstitial syndrome following vaginal delivery (VD), elective cesarean delivery (eCD), and unplanned intrapartum cesarean delivery (uCD). Secondary aims of the study include finding associations between positive lung regions found on lung ultrasound and several variables (eg, mode of delivery, duration) and estimating the prevalence of positive lung regions.

Effects of positive end-expiratory pressure on lung ultrasound patterns and their correlation with intracranial pressure in mechanically ventilated brain injured patients

BackgroundThe effects of positive end-expiratory pressure (PEEP) on lung ultrasound (LUS) patterns, and their relationship with intracranial pressure (ICP) in brain injured patients have not been completely clarified. The primary aim of this study was to assess the effect of two levels of PEEP (5 and 15 cmH2O) on global (LUStot) and regional (anterior, lateral, and posterior areas) LUS scores and their correlation with changes of invasive ICP. Secondary aims included: the evaluation of the effect of PEEP on respiratory mechanics, arterial partial pressure of carbon dioxide (PaCO2) and hemodynamics; the correlation between changes in ICP and LUS as well as respiratory parameters; the identification of factors at baseline as potential predictors of ICP response to higher PEEP.MethodsProspective, observational study including adult mechanically ventilated patients with acute brain injury requiring invasive ICP. Total and regional LUS scores, ICP, respiratory mechanics, and arterial blood gases values were analyzed at PEEP 5 and 15 cmH2O.ResultsThirty patients were included; 19 of them (63.3%) were male, with median age of 65 years [interquartile range (IQR) = 66.7–76.0]. PEEP from 5 to 15 cmH2O reduced LUS score in the posterior regions (LUSp, median value from 7 [5–8] to 4.5 [3.7–6], p = 0.002). Changes in ICP were significantly correlated with changes in LUStot (rho = 0.631, p = 0.0002), LUSp (rho = 0.663, p < 0.0001), respiratory system compliance (rho = − 0.599, p < 0.0001), mean arterial pressure (rho = − 0.833, p < 0.0001) and PaCO2 (rho = 0.819, p < 0.0001). Baseline LUStot score predicted the increase of ICP with PEEP.ConclusionsLUS-together with the evaluation of respiratory and clinical variables-can assist the clinicians in the bedside assessment and prediction of the effect of PEEP on ICP in patients with acute brain injury.