Number Of B-lines Research Articles

Predicting factors of intradialytic hypotension in the last half of hemodialysis therapy

BackgroundIntradialytic hypotension (IDH) is one of the most frequent complications of hemodialysis. IDH alters a patient’s quality of life and has a strong association with mortality. IDH mainly occurs when ultrafiltration during hemodialysis exceeds the pace of the plasma refill. Ultrasonography has been used to evaluate the intravascular volume status. We evaluated the association between IDH and baseline laboratory data or ultrasound findings during IDH during the latter half of a hemodialysis session.MethodsSixty-two patients who underwent hemodialysis were enrolled in this study. The peak early mitral inflow wave velocity (peak E-velocity), the inferior vena cava (IVC) dimensions, and number of B-lines were estimated at two time points (just after the start and at the midpoint of the hemodialysis session). We compared the parameters between the patients without IDH throughout the hemodialysis session (non-IDH group) and patients with IDH only during the latter half of the hemodialysis session (IDH in the latter half group).ResultsOf the 62 study participants, 28 patients were in non-IDH group, and 16 patients were in IDH in the latter half group. The serum sodium level was significantly lower in the IDH in the latter half group (135 ± 4 mEq/L) than in the non-IDH group (138 ± 4 mEq/L) (P = 0.015). The rate of decrease of the peak E-velocity was significantly higher in the IDH in the latter half group (0.33 ± 0.13) than in the non-IDH group (0.24 ± 0.14) (P = 0.037). The best cutoff point of the serum level of sodium was 137 mEq/L, with a sensitivity of 68.8% and specificity of 64.3%. The area under the receiver operating characteristic (ROC) curve was 0.71. The best cutoff point of the rate of decrease of the peak E-velocity was 0.295, with a sensitivity of 73.3% and a specificity of 71.4%. The area under the ROC curve was 0.71.ConclusionsA low serum level of sodium at baseline and an early decrease in the peak E-velocity during hemodialysis may be related to intradialytic hypotension in the latter half of a hemodialysis session. Careful observation may be needed in the hemodialysis patients in whom the serum level of sodium is below 137 mEq/L or the rate of decrease of the peak E-velocity is over 0.295.

Clinical Correlation of Lung Ultrasound Profiles in Patients with COVID-19 Infection

Background: Lung ultrasound is a popular point of care test that correlates well with computed tomography for lung pathologies. While previous studies have shown its ability to detect COVID-19 related lung pathology, we aimed to evaluate the utility of lung ultrasound in the triage and prognostication of COVID-19 patients by determining its ability to predict clinical severity and outcomes.Methods: This was a prospective, cross-sectional, observational, single centre study done at JPNATC and AIIMS, New Delhi, India. Consenting eligible patients aged 18 years or more were included if hospitalised with microbiologically confirmed COVID-19 and classified as mild, moderate (respiratory rate >24/min OR SpO230/min OR SpO2 Findings: Between October 1, 2020, and January 31,2021, patients were screened for inclusion and total n=60 patients were evaluated and included in the final analysis. The most common abnormality seen were B lines, seen in at least one zone in n=53 (88.33%) of cases. A median of 9 (IQR: 5-12) zones of the 14 assessed had a B-profile. The total number of abnormal areas (zones with a B or C profile) correlated significantly with the PaO2/FiO2 ratio (ρ= -0.7232, pInterpretation: In patients with COVID-19, increasing involvement of the lungs as assessed by ultrasonography correlates significantly with clinical severity and outcomes. These findings may be utilized in future prospective studies to validate the use of lung ultrasound to triage and prognosticate patients with COVID-19 infection.Funding Statement: No funding source was involved.Declaration of Interests: The authors have nothing to discloseEthics Approval Statement: The study was reviewed and cleared by the Institute Ethics Committee (IEC).

Lung Ultrasound in Left Ventricular Assist Device Patients: A Feasibility Study

PurposeSpeed optimization in left ventricular assist device (LVAD) recipients remains a key feature in patient management. Noninvasive evaluation with echocardiography is routinely performed, however, around 38% of LVAD patients considered stable had non-optimal hemodynamics at baseline speed. Pulmonary congestion can be seen on lung ultrasound (LUS) in the form of B-lines. In heart failure (HF) patients, the number of B-lines has proven to be an excellent prognostic marker and a strategy of treatment guided by LUS appears to decrease the number of HF admissions. LUS, a noninvasive point of care test, seems an attractive tool to complement echocardiographic assessment in LVAD recipients; however, this has never been studied.MethodsThis is a single center, observational, prospective study. Heart Mate 3 (HM3) patients 18 years or older were invited to participate during an outpatient clinic visit or during a right heart catheterization. Patients with known severe pulmonary diseases were excluded. We examined eight thoracic sites (4 in each hemithorax) and the number of B-lines was reported in real time as the sum of the B-lines visualized in each site.ResultsThis is the report of the first 10 patients included. Mean age was 49 ± 11 years. 80% of patients were male, 80% had a nonischemic cardiomyopathy, and 20% had a history of COPD. The median BMI was 36 kg/m^2 (25-37). 100% of the thoracic sites examined were interpretable and the median number of B-lines was 2.5 (1-7). 2 patients also had a pleural effusion. In contrast, patients had very few signs of congestion on physical examination (Figure).ConclusionLUS in HM3 patients is feasible and no interference with the LVAD has been encountered in an 8-site protocol. Whether LUS can help LVAD optimization and improve outcomes in this challenging population remains to be determined. Speed optimization in left ventricular assist device (LVAD) recipients remains a key feature in patient management. Noninvasive evaluation with echocardiography is routinely performed, however, around 38% of LVAD patients considered stable had non-optimal hemodynamics at baseline speed. Pulmonary congestion can be seen on lung ultrasound (LUS) in the form of B-lines. In heart failure (HF) patients, the number of B-lines has proven to be an excellent prognostic marker and a strategy of treatment guided by LUS appears to decrease the number of HF admissions. LUS, a noninvasive point of care test, seems an attractive tool to complement echocardiographic assessment in LVAD recipients; however, this has never been studied. This is a single center, observational, prospective study. Heart Mate 3 (HM3) patients 18 years or older were invited to participate during an outpatient clinic visit or during a right heart catheterization. Patients with known severe pulmonary diseases were excluded. We examined eight thoracic sites (4 in each hemithorax) and the number of B-lines was reported in real time as the sum of the B-lines visualized in each site. This is the report of the first 10 patients included. Mean age was 49 ± 11 years. 80% of patients were male, 80% had a nonischemic cardiomyopathy, and 20% had a history of COPD. The median BMI was 36 kg/m^2 (25-37). 100% of the thoracic sites examined were interpretable and the median number of B-lines was 2.5 (1-7). 2 patients also had a pleural effusion. In contrast, patients had very few signs of congestion on physical examination (Figure). LUS in HM3 patients is feasible and no interference with the LVAD has been encountered in an 8-site protocol. Whether LUS can help LVAD optimization and improve outcomes in this challenging population remains to be determined.

Perioperative lung ultrasound pattern changes in patients undergoing gynecological procedures - a prospective observational study.

General anesthesia and positive pressure ventilation are associated with perioperative pulmonary complications. Lung ultrasound (LUS) is a method used to evaluate lung parenchyma. The purpose of this study was to evaluate LUS patterns in a cohort of women undergoing gynecological surgery with uncomplicated general anesthesia. Patients were assessed according to the 8-zone LUS assessment protocol used to detect lung sliding, A-lines, B-lines, interstitial syndrome and lung consolidation. Each patient was screened at specific time intervals: before induction of anesthesia, at induction, 30 and 60 minutes after induction and within two hours after recovery. A total of 99 patients undergoing gynecological surgery with uneventful anesthesia from November 2017 to November 2018 were included in this study. A total of 426 LUS records were retained for further analysis. Overall, no significant changes to patients' A-line appearance were detected, regardless of the time of assessment. There was, however, an increase in the number of B-lines at the screening times of 30 and 60 minutes after induction, as compared to initial assessments (p = 0.011 and p < 0.001 respectively), and an increase in the number of positive regions (≥ 3 B-lines) at 30 and 60 minutes after induction and after recovery, as compared to initial assessment (p < 0.001; p < 0.001 and p = 0.001 respectively). An uneventful anesthesia may predispose to abnormal LUS findings and should be considered while interpreting of LUS results in cases with perioperative pulmonary complications.

Utility of pulmonary ultrasound to identify interstitial lung disease in patients with rheumatoid arthritis.

To analyze the diagnostic utility of lung ultrasound (US) to detect interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients comparing with high-resolution computed tomography (HRCT) PATIENTS AND METHODS: We performed a cross-sectional, observational study in patients with RA-ILD (cases) controlled with a group of RA patients without ILD (controls) paired by sex, age, and time of disease evolution. Patients were assessed using HRCT, PFT, and US. The main variables were B-line number, evaluation of the lung-US score already described, pleural irregularities, and A pattern US lost. ROC curve analysis was performed to establish the cut-off point of the US B-lines number for detecting the presence of significant RA-ILD in relation to HRCT, and logistic regression analysis was performed to identify the intercostal spaces. Seventy-one patients were included, 35 (49.2%) with ILD-RA and 36 (50.8%) RA controls. Regarding US score, we found that the detection of 5.5 lines in a reduced score of 8 intercostal spaces had a sensitivity = 62.2%, specificity = 91.3%, PPV = 88.4%, and NPV = 69.5%. In multivariate analysis, the intercostal spaces which showed independent association with ILD were 3rd right anterior axillary space (OR [IC 95%] 19.0 [1.3-27.5]), 8th right posterior axillary space (OR [IC 95%] 0.04 [0.0-0.6]), 8th right subscapular space (OR [IC 95%] 16.5 [1.8-45.5]), 9th right paravertebral space (OR [IC 95%] 7.11 [1.0-37.1]), and 2nd left clavicular middle space (OR [IC 95%] 21.9 [1.26-37.8]). Lung ultrasound could be a useful tool for ILD diagnosis associated with rheumatoid arthritis. A 8-space reduced score showed a similar total predictive capacity than 72-space score. Key Points • Lung ultrasound could be a useful tool for ILD diagnosis associated with rheumatoid arthritis. • The 72-space evaluation is highly sensitive, whereas a simplified score enables a more specific and faster diagnosis. • The number of B lines is correlated with DLCO, ACPA, inflammatory activity, and physical function.

Use of Lung Ultrasound with Tissue Doppler Echocardiography to Follow up Cardiovascular State of Haemodialysis Patient

Background: Chronic hypervolemia is the main cause of cardiovascular complications in haemodialysis patients. Objectives: We aimed to study the effect of lung ultrasound-guided dry weight reduction strategy on the cardiovascular state of hypertensive haemodialysis patients. Patients and Methods: We carried out a single-blind two-arm randomized trial on 50 hypertensive haemodialysis patients in Qena University Hospital dialysis centre over 8 weeks from 1/11/2020 to 1/1/2021. Patients were divided into usual care group (control arm) and active group(study arm). In study group, dry weight reduction was assessed weekly by lung ultrasonography guided by the total number of B-lines, before the midweek session ofhaemodialysis. In the controlgroup, dry weight probing was done according to clinical criteria. To assess outcomes,we compared the clinical and echocardiographic improvement in both groups including full clinical assessment, etc at baseline and at the study end. Results: In study group, dry weight wassignificantly reduced in comparison with the control group (−0.41 ± 0.32 vs. 0.04 ± 0.09 kg; P < 0.001), resulting in a statistically significant reduction in systolic and diastolic blood pressures (P < 0.001). Furthermore, a statistically significant reduction in echocardiographic indices of cardiac chambers dimensions occurred in study group,in addition to improvement of the diastolic function of both ventricles. Conclusion: Ultrafiltration based on assessment of fluid status using lung ultrasound dry weight reduction is better than that based on conventional method regarding both clinical and echocardiographic parameters.

The prognostic value of lung ultrasound in aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic stenosis (AS) is a progressive disease and once symptomatic and heart failure (HF) develops is associated with poor prognosis. The degree of the pathophysiological and structural changes in AS are associated with poor survival. Pulmonary congestion is an almost universal finding in patients with HF. Lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, non-invasive tool to assess pulmonary congestion. Aim To assess pulmonary congestion with LUS in patients with AS and to define the prognostic value of B-lines. Methods 84 consecutive patients (43 women, mean age 74 ± 9 years) with moderate or severe AS were enrolled. Exclusion criteria were as follows: moderate or severe aortic regurgitation, moderate or severe mitral regurgitation, cardiomyopathies, pulmonary disease, renal failure. At baseline, all patients underwent comprehensive echocardiography examination and LUS according to 28 scanning-site assessment. Patients were followed-up after enrollment to establish the prognostic value of LUS. A composite endpoint was considered, including: aortic valve replacement due to deterioration of patient condition or progression of AS from moderate to severe, death (any cause), hospitalization due to acute heart failure or progression of chronic heart failure which required hospitalization. Results We found a severe number of B-lines (total B-lines ≥30) in 31% of AS patients. The number of B-lines was correlated with estimated pulmonary artery systolic pressure (p &amp;lt; 0,005, r= 0,52) and increased along with NYHA class (p &amp;lt; 0,001) Figure 1. Patients with ≥30 B-lines had more events during the 13,4 ± 6 months follow-up (p &amp;lt; 0,001, Log-rank: 10,7; Figure 2). Conclusion Assessing B-lines in AS is a simple, feasible method to detect pulmonary congestion. The number of B-lines correlates with hemodynamic changes caused by AS and with the functional status of the patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events. Abstract Figure. FC class vs. Blines and prognostic value

The prognostic value of B-lines in heart failure with preserved ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Despite its common occurrence, HFpEF remained a challenge in every aspect. The evaluation of B-lines with lung ultrasound (LUS) is a promising diagnostic and prognostic tool in this population. Objectives The aim of our study was to assess the diagnostic and prognostic performance of B-lines compared with traditional clinical, echocardiographic parameters and natriuretic peptide levels in patients with clinical suspicion of HFpEF. Methods 78 consecutive patients (70.45 ± 6.75 years, 72% female) with suspected HFpEF were prospectively enrolled. Exclusion criteria were: ejection fraction ≤55%, more than mild mitral and/or aortic valve disease, cardiomyopathy, pulmonary disease, pulmonary arterial hypertension, renal failure and anemia. All patients underwent comprehensive echocardiography, lung ultrasound exam and NT-proBNP measurement during their first appointment. Our endpoint was a composite of acute heart failure (HF), hospitalization for the worsening HF symptoms and intensification of diuretic therapy. Also, traditional major cardiac adverse events such as death, myocardial infarction, stroke and revascularization were collected. Results We detected 11 events during 12 ± 6 months follow up. The number of B-lines showed a good correlation with NT-proBNP levels (p &amp;lt; 0,001, r = 0.693). B-lines were found to have similar performance to NT-proBNP in predicting events (AUC = 0.778 vs. 0.770, respectively). Those who had more than 30 B-lines on LUS had significantly worse event-free survival p = 0.004. Having more than 30 B-lines at baseline was associated with 7 times greater hazard of adverse outcomes. Conclusions LUS is a simple, feasible tool to detect pulmonary congestion in patients with HFpEF. In our prospective cohort study, LUS was found to be a useful tool for prognostic stratification. Abstract Figure. Prognostic value of B-lines

Effects of repairing ventricular septal defects with right vertical infra-axillary mini-incision on lung function and postoperative analgosedation.

The present study aimed to assess the effects of repairing ventricular septal defects (VSDs) with right vertical infra-axillary mini-incision (RVAI). A total of 116 patients with VSDs were prospectively enrolled and underwent cardiac surgery between June 2017 and December 2018 at the cardiac intensive care unit of Shanghai Children's Medical Center (Shanghai, China). Of these, 58 patients underwent the RVAI procedure and 58 patients matched 1:1 underwent the standard median sternotomy incision (MSI) procedure and were designated as the control group. The demographic data and clinical outcomes intra- and postoperatively were compared. A bedside lung ultrasound was performed to evaluate the degree of lung injury and the number of B-lines was quantified and compared between the two groups. The sedation and analgesia levels were also assessed after the operation. No significant difference was identified between the two groups regarding the overall cardiopulmonary bypass or aortic cross-clamp time. All patients were extubated within 8 h. The RVAI group had shorter incision lengths (median, 4.6 cm) and less drainage (median, 15 ml) than the MSI group. Furthermore, compared to the MSI group, the RVAI group had a significantly higher number of B-lines in the right lung regions immediately after surgery and at 12 h postsurgery (24.1 and 5.2%, respectively) but eventually exhibited no differences at 24 and 36 h postsurgery; by contrast, there were no differences in the left lung regions. The bedside bispectral index score and the Face, Legs, Activity, Cry, Consolability scale score exhibited no significant differences after the operation. In conclusion, the RVAI procedure appears to be a safe alternative for repairing VSDs in addition to satisfactory cosmetic results and the incision does not interfere with postoperative analgosedation.

Point-of-care lung ultrasound patterns in late third-trimester gravidas with and without preeclampsia

Transthoracic point-of-care ultrasonography of the lungs has become a standard technique in critical care medicine for the evaluation of patients with respiratory signs or symptoms but has not been well studied in pregnancy. To compare lung ultrasound patterns in third-trimester gravidas with and without preeclampsia and assess interobserver agreement between 3 obstetrical providers and a physician expert in critical care lung ultrasound. This is a prospective observational study of 262 women with singleton pregnancies between 32 0/7 and 41 6/7 weeks' gestation. Lung ultrasound examinations were performed and interpreted by a team of obstetrical care providers and then interpreted by an expert in point-of-care lung ultrasound. The number of B-lines in each of the 4 lung fields, indicating the accumulation of fluid in the interstitial space and the alveoli, was evaluated. The primary outcome was a positive study for pulmonary interstitial edema, defined as an ultrasound study with 3 or more B-lines in 2 or more bilateral lung fields. The secondary outcome was a lung ultrasound study with 1 or 2 B-lines in 1 or more lung fields or 3 B-lines in 1 lung field. Interobserver agreement in lung ultrasound interpretation between obstetrical care providers and an expert in critical care point-of-care ultrasonography of the lung was assessed. Among healthy gravidas, no subject had a lung ultrasound examination positive for pulmonary interstitial edema. Notably, 2 patients with preeclampsia had positive lung ultrasound studies, and both had respiratory symptoms or signs of pulmonary edema. One or 2 B-lines or 3 B-lines in 1 lung field were identified in 11.4% of healthy gravidas and 18.6% of patients with preeclampsia. There was no difference in lung ultrasound patterns between healthy gravidas and those with preeclampsia. The obstetrical care providers and the lung ultrasound expert had a high proportion of agreement regarding the interpretation of negative lung ultrasound examinations. The 2 patients with clinical signs of pulmonary edema were judged to have positive studies by both the obstetrical team and the expert; however, the obstetrical team classified more studies as positive. Lung ultrasound patterns in women with preeclampsia without respiratory symptoms or clinical signs of pulmonary edema are similar to the lung ultrasound patterns of healthy gravidas. Point-of-care lung ultrasound can be used to evaluate third-trimester gravidas with preeclampsia and respiratory complaints or signs concerning for pulmonary edema. Formal training is important before the widespread adoption of point-of-care lung ultrasound by obstetrical healthcare providers.

Assessment of extravascular lung water by measuring the number of pulmonary ultrasound B-lines before and after CBP in patients with MODS.

To determine whether the change in the number of pulmonary ultrasound B-line can accurately assess the extravascular lung water (EVLW) before and after continuous bedside blood purification (CBP) in patients with multiple organ dysfunction syndrome (MODS).Seventy-six patients with MODS who underwent CBP were examined within 24 hours before and after CBP using pulmonary ultrasound to detect the number of ultrasound B-line or using pulse indicator continuous cardiac output method to examine extravascular lung water, blood oxygenation index, and B-type natriuretic peptide (BNP) content. The correlation of the change in the number of B lines before and after CBP treatment with the negative balance of 24 hours liquid, the change of oxygenation index, and BNP content were analyzed.In the 76 patients, CBP treatment significantly decreased EVLW, the number of B-line, and BNP (P < .05 for all), while it significantly increased the oxygenation index (P < .05). Correlation analysis showed that the decrease in B-line number after CBP treatment was positively correlated with the 24 hours negative lung fluid balance, decrease of EVLW, oxygenation index improvement, and decreased BNP content. The change in the numbers of pulmonary ultrasound B-line can accurately assess the change of EVLW before and after CBP treatment and reflect the efficiency of ventilation in the lungs and the risk of heart failure.Thus, it can replace pulse indicator continuous cardiac output as an indicator for evaluating EVLW in patients with MODS treated with CBP.

Volume status and arterial stiffness evaluation in peritoneal dialysis patients.

Arterial stiffness represents an independent risk factor for cardiovascular mortality in dialysis patients and is strongly connected to hypervolemia. The aim of the study was to evaluate different methods for fluid status assessment and their association with arterial stiffness parameters in peritoneal dialysis patients. In 16 peritoneal dialysis patients (53 ± 18 years, 9/16 men) fluid status was determined by clinical examination, lung ultrasound (number of B-lines, normal up to 4), overhydration degree by bioimpedance monitor device, estimation of central venous pressure by ultrasound measurement of vena cava inferior, measurement of serum N-terminal pro b-type natriuretic peptide (NT-proBNP), and albumin level. Pulse wave velocity and augmentation index were measured non-invasively with an oscillometric device to indirectly assess arterial stiffness, blood pressure (BP) was obtained by the same device. Clinical evaluation (BP 136 ± 15/93 ± 15 mmHg, edema in 2/16 patients) and lung ultrasound (on average 3 ± 6 B-lines) showed mostly normal fluid status of patients. Patients had slightly lower albumin values (37 ± 4 g/L), slightly elevated central venous pressure (10 ± 4 mmHg), and elevated NT-proBNP (11,596 ± 13,635 ng/L). Body composition evaluation showed mild overhydration (1.5 ± 2 L), which significantly correlated with central venous pressure (p = 0.046) and NT-proBNP (p = 0.004). Lung ultrasound significantly negatively correlated with albumin (r = -0.82, p < 0.001) and positively with NT-proBNP (r = 0.62, p = 0.011). Augmentation index (22 ± 11%) and augmentation pressure correlated with lung ultrasound (r = 0.54, p = 0.032 and r = 0.67, p = 0.004, respectively), although pulse wave velocity (8.4 ± 2.5 m/s) showed no significant correlation with fluid status parameters. The multivariate model showed that lung ultrasound B-lines were an independent determinant of augmentation pressure (β = 0.58, p = 0.043). Fluid status evaluated with lung ultrasound showed good correlation with augmentation index and augmentation pressure, which are markers of arterial stiffness. The lung ultrasound B-lines were found to be an independent determinant of augmentation pressure. Overall arterial stiffness evaluated with pulse wave velocity and augmentation index was not markedly elevated in our patients, which could be due to a good euvolemic status. We conclude that different methods for fluid status evaluation are complementary, with lung ultrasound as a beneficial tool in routine clinical practice in peritoneal dialysis patients.

Diagnostic validity of lung ultrasonogram in comparison with high-resolution computed tomography in interstitial lung disease associated with connective tissue disease

Background: Lung ultrasonography (LUS) may be a useful tool in identifying interstitial lung disease (ILD) in patients with Connective tissue disorder (CTD). The aim of the current study was to determine the diagnostic validity of LUS findings in comparison with high-resolution computed tomography (HRCT) in CTD-ILD and also determine the correlation between forced vital capacity (FVC) and 6-min walk test (6MWT) to LUS. Patients and Methods: Patients with connective tissue disorder and ILD diagnosed by HRCT were included and evaluated by physical examination, LUS, spirometry, and 6MWT. Results: Of 41 patients included, 38 (92.7%) were females. The mean age was 49.7 years. Systemic sclerosis was the most common diagnosis in 25 (61%) patients. LUS score was calculated as the total number of B-lines counted in all zones. The mean score was 20.83. B-line score showed a negative correlation with 6MWT distance (R = −0.501, P = 0.001) and FVC (R = −0.434, P = 0.005). There was a strong positive correlation between LUS and HRCT scores (R = 0.878, P = 0.0001). A LUS score of 39.5 or above has 83% sensitivity and 100% specificity (Youden index of 0.83, P = 0.001) for predicting a Class V HRCT pattern. Conclusions: There was a significant correlation between ILD with reticular pattern and honeycombing on HRCT and higher LUS B-line scores. LUS B-line scores also correlated significantly with functional parameters such as lower FVC values and 6MWT distance.

The Diagnostic Value of Lung Ultrasonography in Children Community-Acquired Pneumonia

To explore the diagnostic value of lung ultrasonography in children community-acquired pneumonia is the objective of the study. A total of 126 children who were diagnosed with community-acquired pneumonia and underwent lung ultrasonography examination during the course of the disease were selected. All patients underwent lung ultrasonography and chest X-ray examination within 24 h of admission. The clinical characteristics of lung ultrasonography examination of community-acquired pneumonia were analyzed and the sensitivity, specificity, correct index and diagnostic coincidence rate of lung consolidation with lung ultrasonography and chest X-ray were compared. The lung ultrasonography imaging features of severe community-acquired pneumonia in children are the disappearance of A-line, increase of B-line, waterfall sign, lung consolidation, bronchial inflation sign, pleural effusion, etc. 53 cases of patients chest computed tomography results were used as the gold standard. The sensitivity, correct index and diagnostic coincidence rate of lung ultrasonography in the diagnosis of lung consolidation were all higher than those of X-ray diagnosis and the differences were statistically significant (p<0.05). Lung ultrasonography determined abnormal changes in the lungs of 124 children and chest X-ray determined abnormal changes in the lungs of 122 children. The chest X-rays of 2 children showed normal, while the lung ultrasonography showed a large number of B-line and lung consolidation in both lungs. A total of 17 cases of pleural effusion were determined by lung ultrasonography and 1 case of pleural effusion was determined by chest X-ray. The difference between the two groups was statistically significant (p<0.05). Lung ultrasonography in children community-acquired pneumonia is superior to chest X-ray in lung consolidation and pleural effusion and can be used for diagnosis of children community-acquired pneumonia.

Experience in using focused cardiac ultrasound in patients with acute heart failure in the intensive care unit

Portable ultrasound devices in initial cardiac patient examination in intensive care units are seen as an essential addition to conventional physical examinations. Aim. To assess the potential of using focused cardiac ultrasound for patients admitted in the intensive care unit with a clinical performance of acute heart failure. Material and methods . The study included 180 patients, 110 of whom were men. The mean age was 57 (40; 74) years. The patients included in the study were divided into 2 groups: group 1 consisted of patients who, upon admission, underwent a general clinical examination and an ultrasound with a portable device; group 2 — patients who, upon admission, underwent only a conventional examination. Using portable ultrasound scanners, the doctors evaluated ventricular contractility, the presence of significant valve regurgitation, the diameter and degree of inferior vena cava collapse, as well as the presence, prevalence and number of B-lines. The differences in the time required for the diagnosis using various methods were determined. Structural changes in the heart and lungs, identified using a portable ultrasound device, were also assessed. Results . In the group of patients who underwent focused cardiac ultrasound, the time from admission to initiation of therapy was 11 (7; 18) minutes. In the group 2, the median time from admission to initiation of intravenous diuretic administration was 86 (52; 116) min (p&lt;0,001). According to the results of an ultrasound with a portable device, the following changes were noted: significant left ventricular contractility decrease were found in 32,4% of patients; a decrease in right ventricle contractility — in 16,2%. In 50% of patients, the left ventricular contractility was sufficient. In 43,3% of patients, bilateral B lines were identified as a sign of interstitial pulmonary syndrome; in 38,8%, there were signs of hypervolemia when assessing the inferior vena cava. Hemodynamically relevant mitral regurgitation was noted in 28,8% of cases; hemodynamically relevant tricuspid regurgitation — 21,1%; relevant aortic regurgitation — 6,6%. In 10% of patients, there was restricted mobility of aortic valve leaflets, which was suspected as aortic stenosis. In 18% of cases, no significant intracardiac hemodynamic changes were noted. Conclusion . It has been shown that examination with focused cardiac ultrasound in the intensive care unit reduces decision time by more than an hour. Initial examination of a patient with acute heart failure using pocket cardiac ultrasound devices reveals clinically relevant intracardiac hemodynamic disorders.

Prognostic value of the ultrasonic determination of the degree of interstitial edema in patients with intermediate ejection fraction of the left ventricle after treating acute decompensation of heart failure

Aim To study ultrasonic characteristics of lung tissue in patients with heart failure with left ventricular (LV) mid-range ejection fraction (HFmEF) and predictive value of these characteristics after reversing acute decompensated heart failure (ADHF).Material and methods Ultrasonic characteristics of lung tissue were studied by prospective observation in 71 patients (mean age, 65.2±3.6 years; men, 64.3 %) with HFmEF (LVEF from 40 to 49 %) following ADHF reversal. Semiquantitative evaluation of B-lines was performed by the E. Picano (2016) method at 5+2 days after hospitalization and on discharge from the hospital. The distance between B-lines was 3 mm (В3 lines) and 7 mm (В7 lines). Patients' catamnesis was studied for determining the predictive value of lung tissue ultrasonic characteristics for two years since the index hospitalization. Statistical analysis was performed using the McNemar's χ2 test (for evaluation of linked samples and of changes in the presence/absence of B-lines as determined by lung ultrasound examination (USE)) and the Wilcoxon test (for evaluation of quantitative changes). Differences were considered significant at p&lt;0.05.Results B7-lines characteristic of interstitial component of pulmonary parenchymal edema prevailed in patients with HFmEF. В3-lines characteristic of alveolar edema were found in a small amount. In the anterior-superior segment, B7-lines predominated over B3-lines (80 % vs. 20 %, p&lt;0.01) on the right; however, on the lest, significant differences were not observed (64 % vs. 36 %, p&gt;0.05). In the anterior-inferior segment, В7-lines prevailed over В3-lines on the right (75 % vs. 25 %, p&lt;0.05); however, on the left, the difference was not significant (67 % vs. 33 %, p=0.05). In the lateral superior segment on the right, В7-lines predominated over В3-lines (75 % vs. 25 %, p&lt;0.01); in contrast, on the left, there were no differences (67 % vs. 33 %, p&gt;0.05). In lateral-basal segments on both sides, significant differences were present (73 % vs. 27 % on the right, p&lt;0.05; 72 % vs. 28 % on the lest, p&lt;0.05). The results of lung ultrasound were also used for evaluation of the B-line predictive value in patients with ADHF and mid-range EF on discharge from the hospital after reversal of X-ray and clinical symptoms of pulmonary congestion. In the next two years, 35 patients (49.2 % of sample) were rehospitalized with signs of ADHF (39 hospitalizations, 1.1 hospitalizations per patient). The rehospitalized patients were divided into two subgroups, with an increased number of B-lines and small congestion on discharge (6-15 В-lines) and without signs of congestion (&lt;5 В-lines). For patients with a minimal (small) congestion on pulmonary ultrasound but regression of clinical and X-ray congestion, the number of rehospitalizations was 25 vs. 11 in patients with the number of B7-lines &lt;5. In the ROC-analysis, the area under the curve was 0.706, which corresponded to the expert assessment as "good". The position sensitivity was 78.6 % and the specificity was 79.7 %.Conclusion "Ultrasonic pulmonary edema syndrome" in patients with LV mid-range ejection fraction after reversing ADHF was characterized by predomination of the interstitial component, despite the absence of X-ray congestion, correlated with the blood level of NT-proBNP measured at the same time, and was associated with rehospitalizations.

Simple and additive diagnostic modalities for the screening of heart failure with preserved ejection fraction

Abstract Background Nearly half of all patients with heart failure (HF) symptoms have an EF that is preserved (HFpEF). The prevalence of HFpEF is rising, with high morbidity, mortality. The diagnosis of HFpEF is particularly challenging. Lung ultrasound (LUS) and left atrial strain are promising screening and diagnostic tools to assess pulmonary congestion and left atrial dysfunction in patients with suspected HFpEF. Aim To evaluate the relationship between patients symptoms, pro-BNP level with LUS and left atrial strain, as well to assess the diagnostic power of B-lines in HFpEF population. Methods 82 consecutive patients (57 women, mean age 70±6 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction &amp;lt;55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-LASr), lung ultrasound assessment of B-lines on the anterolateral and posterior chest wall, and NT-proBNP levels. Results In 45 patients (54%) a significant number of B-lines (≥15) were observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p&amp;lt;0.0001, r=0.67), left atrial volume (p&amp;lt;0.0001, r=0.45), and LASr (p&amp;lt;0.005, r=−0.4). We also found week correlation between the number of B-lines and E/e' ratio (p&amp;lt;0.003, r=0.3), and between E/e' ratio and NT-proBNP level (p&amp;lt;0.05, r=0.2). We also assessed the diagnostic ability of B-lines to predict markedly elevated pro-BNP level (≥125pg/ml), AUC was 0.85, with specificity of 64% and sensitivity of 85% (Figure 1). The number of B lines also correlated with the H2FPEF score (p&amp;lt;0.001, r=0.4). Conclusion LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it has an adequate diagnostic power to predict elevated NTpro-BNP level. LASr is promising too, which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameters. Figure 1. ROC curve Blines predict high NTproBNP Funding Acknowledgement Type of funding source: None

Right ventricular function and its coupling with the pulmonary circulation in acute heart failure

Abstract Background The right ventricle (RV) is extremely sensitive to hemodynamic changes and increased impedance. In acute heart failure (AHF), the development of pulmonary venous congestion and the increase of left ventricular (LV) filling pressures favors pulmonary vascular adverse remodeling and ultimately RV dysfunction, leading to the onset of symptoms and to a further decay of cardiac dynamics. Purpose The aim of the study was to evaluate RV morphology and functional dynamics at admission and discharge in patients hospitalized for AHF, analyzing the role and the response to treatment of the RV and its coupling with pulmonary circulation (PC). Methods Eighty-one AHF patients (mean age 75.75±10.6 years, 59% males) were prospectively enrolled within 24–48 hours from admission to the emergency department (ED). In either the acute phase and at pre-discharge all patients underwent M-Mode, 2-Dimensional and Doppler transthoracic echocardiography (TTE), as well as lung ultrasonography (LUS), to detect an increase of extravascular lung water (EVLW) and development of pleural effusion. Laboratory tests were performed in the acute phase and at pre-discharge including the evaluation of NT-proBNP. Results At baseline we observed a high prevalence of RV dysfunction as documented by a reduced RV systolic longitudinal function [mean tricuspid annular plane systolic excursion (TAPSE) at admission of 16.47±3.86 mm with 50% of the patients exhibiting a TAPSE&amp;lt;16mm], a decreased DTI-derived tricuspid lateral annular systolic velocity (50% of the subjects showed a tricuspid s' wave&amp;lt;10 cm/s) and a reduced RV fractional area change (mean FAC at admission of 36.4±14.6%). Furthermore, an increased pulmonary arterial systolic pressure (PASP) and a severe impairment in terms of RV coupling to PC was detected at initial evaluation (mean PASP at admission: 38.8±10.8 mmHg; average TAPSE/PASP at admission: 0.45±0.17 mm/mmHg). At pre-discharge a significant increment of TAPSE (16.47±3.86 mm vs. 17.45±3.88; p=0.05) and a reduction of PASP (38.8±10.8 mmHg vs. 30.5±9.6mmHg, p&amp;lt;0.001) was observed. Furthermore, in the whole population we assisted to a significant improvement in terms of RV function and its coupling with PC as demonstrated by the significant increase of TAPSE/PASP ratio (TAPSE/PASP: 0.45±0.17 mm/mmHg vs 0.62±0.20 mm/mmHg; p&amp;lt;0.001). Patients significantly reduced from admission to discharge the number of B-lines and NT-proBNP (B-lines: 22.2±17.1 vs. 6.5±5 p&amp;lt;0.001; NT-proBNP: 8738±948 ng/l vs 4227±659 ng/l p&amp;lt;0.001) (Figure 1). Nonetheless, no significant changes of left atrial and left ventricular dimensions and function were noted. Conclusions In AHF, development of congestion and EVLW significantly impact on the right heart function. Decongestion therapy is effective for restoring acute reversal of RV dysfunction, but the question remains on how to impact on the biological properties of the RV. Funding Acknowledgement Type of funding source: None

Diagnosis of pulmonary contusions with point-of-care lung ultrasonography and thoracic radiography compared to thoracic computed tomography in dogs with motor vehicle trauma: 29 cases (2017-2018).

To determine the accuracy of lung ultrasound (LUS) using the Veterinary Bedside Lung Ultrasound Examination (VetBLUE) protocol and 3-view thoracic radiographs (TXR) compared to thoracic computed tomography (TCT) for diagnosing the presence and quantification of pulmonary contusions (PC). Prospective cohort study conducted from February 2017 to June 2018. Private emergency and referral center. Thirty-two dogs having sustained motor vehicle trauma were consecutively enrolled. Three dogs were excluded from statistical analysis. All dogs survived to hospital discharge. Within 24hours of sustaining trauma, dogs had LUS, TXR, and TCT performed. Using the VetBLUE protocol, LUS PC were scored according to the presence and number of B-lines and C-lines, indicating extravascular lung water. Thoracic radiographs and TCT were scored for PC in a similar topographical pattern to the VetBLUE protocol. Lung ultrasound and TXR were compared to "gold standard" TCT for the presence and quantification of PC. On TCT, 21 of 29 (72.4%) dogs were positive and 8 of 29 (27.6%) dogs were negative for PC. When LUS was compared to TCT, 19 of 21 dogs were positive for PC (90.5% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. LUS PC score correlated strongly with TCT PC score (R=0.8, P<0.001). When TXR was compared to TCT, 14 of 21 dogs were positive for PC (66.7% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. TXR PC score correlated strongly with TCT PC score (R=0.74, P<0.001). In this population of dogs with motor vehicle trauma, LUS had high sensitivity for diagnosis of PC when compared to "gold standard" TCT. LUS provides reliable diagnosis of PC after trauma. More patients with PC were identified with LUS than with TXR, and additional studies are warranted to determine whether this increased sensitivity is statistically significant.

Valor pronóstico de la ecografía de pulmón en pacientes ambulatorios con insuficiencia cardiaca crónica estable

Introduction and objectivesThe role of lung ultrasound (LUS) in acute heart failure (HF) has been widely studied, but little is known about its usefulness in chronic HF. This study assessed the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients. MethodsWe included consecutive outpatients who attended a scheduled follow-up visit in a HF clinic. LUS was performed in situ. The operators were blinded to clinical data and examined 8 thoracic areas. The sum of B-lines across all lung zones and the quartiles of this addition were used for the analyses. Linear regression and Cox regression analyses were performed. The main clinical outcomes were a composite of all-cause death or hospitalization for HF and mortality from any cause. ResultsA total of 577 individuals were included (72% men; 69± 12 years). The mean number of B-lines was 5±6. During a mean follow-up of 31±7 months, 157 patients experienced the main clinical outcome and 111 died. Having ≥ 8 B-lines (Q4) doubled the risk of experiencing the composite primary event (P <.001) and increased the risk of death from any cause by 2.6-fold (P <.001). On multivariate analysis, the total sum of B-lines remained independent predictive factor of the composite endpoint (HR, 1.04; 95%CI, 1.02-1.06; P=.002) and of all-cause death (HR, 1.04; 95%CI, 1.02-1.07; P=.001), independently of whether or not N-terminal pro-B-type natriuretic peptide (NT-proBNP) was included in the model (P=.01 and P=.008, respectively), with a 3% to 4% increased risk for each 1-line addition. ConclusionsLUS identified patients with stable chronic HF at high risk of death or HF hospitalization.