Transthoracic Ultrasonography Research Articles

Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine (EFSUMB) Guidelines: Rare Malignant Pulmonal and Pleural Tumors: Primary Pulmonary Sarcoma and Mesothelioma, Imaging Features on Transthoracic Ultrasound.

Primary pulmonary sarcoma and mesothelioma are rare malignancies. The review article discusses the appearance of these tumors in B-mode ultrasound (US), color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). In particular, the article is intended to inspire the examination of thoracic wall tumors and pleural masses with the possibilities of ultrasonography and to obtain histologically evaluable material using US or CEUS-guided sampling.

Role of pleural manometry and transthoracic ultrasonography to predict entrapped lung

IntroductionUnexpandable lung is a complication by which the lung does not expand to the chest wall with pleural space drainage, which will result in adverse events or intervention failure if not well recognized prior to the intervention.Aim of the workThis study aimed to assess the role of pleural manometry and transthoracic ultrasonography in predicting abnormal lung expansion during pleural drainage.Patients and methodsThis was a prospective observational analytical study involving 50 patients that aims to predict abnormal lung expansion during pleural drainage using pleural manometry and transthoracic ultrasound.ResultsRegarding pleural manometry (pleural elastance), all patients in the entrapped lung group (100%) had pleural elastance > 14.5 cmH2o/L, while in the non-entrapped lung group, all patients (100%) had pleural elastance ≤ 14.5 cmH2o/L. Regarding ultrasonography, pleural thickening > 0.5 cm was found in all patients with entrapped lung (100%) and 50% of patients with non-entrapped lung with statistically significant difference. In the entrapped lung group, 20%, 35%, and 45% of patients had simple, complex non-septated, and complex septated pleural effusion, respectively, while in the non-entrapped lung group, 63.35%, 33.33%, and 3.32% of patients had simple, complex non-septated, and complex septated effusion, respectively, with statistically significant difference (p-value 0.0005).ConclusionPleural manometry and transthoracic ultrasound can guide decision-making regarding the timing of pleural interventions and management of cases with entrapped lung.

Low Diagnostic Accuracy of Transthoracic Ultrasound for the Assessment of Spontaneous Pneumothorax in the Emergency Setting: A Multicentric Study.

Background: Pneumothorax (PNX) represents a common clinical condition in emergency departments (EDs), requiring prompt recognition and treatment. The role of transthoracic ultrasounds (TUSs) in the diagnosis of PNX is still debated. We aimed to prospectively evaluate the accuracy of TUSs in the detection of spontaneous PNX in EDs. Methods: A total of 637 consecutive adult patients who presented to the EDs of four Italian hospitals complaining of acutely onset chest pain and dyspnoea were included in the study. Exclusion criteria were previous traumatic events, cardiogenic causes of pain/dyspnoea and suspected tension PNX. The absence of "lung sliding" (B-mode) and the "bar-code" sign (M-mode) were considered indicative of PNX in a TUS. Accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs, NPVs) were calculated using a chest CT scan as reference. Results: Spontaneous PNX occurred in 93 patients: of those, 83 (89.2%) were correctly identified by TUSs. However, 306 patients with suspected PNX at TUS were not confirmed by chest CTs. The diagnostic accuracy of both the absence of "lung sliding" and "bar-code" sign during TUS was 50.4% (95% CI: 46.4-54.3), sensitivity was 89.2% (95% CI: 81.1-94.7), specificity was 43.8% (95% CI: 39.5-48.0), the PPV was 21.3% (95% CI: 19.7-23.1) and the NPV was 96.0% (95% CI: 92.9-97.7). Conclusions: TUS showed high sensitivity but low specificity in the identification of PNX in EDs. Relying exclusively on TUSs results for patients' management in ED settings is neither suitable nor recommendable. TUS examination can be useful to strengthen the clinical suspicion of PNX, but its results should be confirmed by a chest X-ray or CT scan.

Intrapleural Fibrinolytic Interventions for Retained Hemothoraces in Rabbits.

Bleeding within the pleural space may result in persistent clot formation called retained hemothorax (RH). RH is prone to organization, which compromises effective drainage, leading to lung restriction and dyspnea. Intrapleural fibrinolytic therapy is used to clear the persistent organizing clot in lieu of surgery, but fibrinolysin selection, delivery strategies, and dosing have yet to be identified. We used a recently established rabbit model of RH to test whether intrapleural delivery of single-chain urokinase (scuPA) can most effectively clear RH. scuPA, or single-chain tissue plasminogen activator (sctPA), was delivered via thoracostomy tube on day 7 as either one or two doses 8 h apart. Pleural clot dissolution was assessed using transthoracic ultrasonography, chest computed tomography, two-dimensional and clot displacement measurements, and gross analysis. Two doses of scuPA (1 mg/kg) were more effective than a bolus dose of 2 mg/kg in resolving RH and facilitating drainage of pleural fluids (PF). Red blood cell counts in the PF of scuPA, or sctPA-treated rabbits were comparable, and no gross intrapleural hemorrhage was observed. Both fibrinolysins were equally effective in clearing clots and promoting pleural drainage. Biomarkers of inflammation and organization were likewise comparable in PF from both groups. The findings suggest that single-agent therapy may be effective in clearing RH; however, the clinical advantage of intrapleural scuPA remains to be established by future clinical trials.

Associations between Ultrasonographically Diagnosed Lung Lesions, Clinical Parameters and Treatment Frequency in Veal Calves in an Austrian Fattening Farm.

This study evaluated the significance and predictive value of ultrasonographic and physical examination on arrival at an Austrian fattening farm. Treatment frequency and average daily weight gain (ADG) were related to physical and ultrasonographic examination results. Additionally, the effect of an intranasal vaccination in half of the examined calves was studied. The clinical and ultrasonographic health status 600 calves was recorded at the beginning and end of fattening. Half of the calves received an intranasal vaccination (Bovalto® Respi Intranasal). Overall, 44.5% showed an abnormal respiratory scoring (RS) and 56.0% showed signs of respiratory diseases in transthoracic ultrasonography (TUS) at arrival on the farm. For both RS and TUS, a categorization between ILL and HEALTHY was conducted. Results showed lower ADG in ILL calves (RS median: 0.93 kg/d; TUS median: 0.96 kg/d) compared to HEALTHY calves (RS median: 1.01 kg/d; TUS median: 1.01 kg/d). The median ADG was lower in not treated and ILL calves (RS median 0.90 kg/d; TUS: 0.93 kg/d) compared to treated and ILL calves (RS median 1.01 kg/d; TUS: 1.02 kg/d). Vaccination did not affect growth performance or occurrence of ILL, though treatment frequency was lower in VAC calves (17.0% in NVAC; 11.3% in VAC). The implementation of examination protocols for respiratory diseases may have a positive impact on production parameters (e.g., treatment frequency and ADG).

Role of chest ultrasound in the diagnosis of pulmonary embolism: a cohort study

BackgroundPulmonary embolism (PE) is a common and usually fatal condition that is commonly misdiagnosed and consequently ignored. Lung ultrasonography is quickly becoming a valuable tool in the ER and ICU for assisting in emergency decisions.MethodsOne hundred fourteen patients with moderate/high probability of PE in the Critical Care Department meeting the inclusion/exclusion criteria were enrolled in the study. A detailed medical history and a full physical examination involving vital signs, transthoracic ultrasound, CT pulmonary angiography (CTPA), and echocardiography were done for the eligible participants. The goal of this study was to evaluate the diagnostic role of transthoracic ultrasound (TUS) in PE and to compare its specificity and sensitivity with CT pulmonary angiography. Multivariate logistic regression analysis was performed.ResultsWithin the 75 patients with confirmed PE based on CTPA, 30 had LUS findings of confirmed PE (40%), and 45 had LUS findings not consistent with confirmed PE (60%). Within the 39 patients with no PE based on CTPA, all patients had LUS findings of non-confirmed PE (100%), and no patients had LUS findings of confirmed PE (0%). The diagnosis of pulmonary embolism based on confirmed LUS signs had sensitivity and specificity of 40% and 100% respectively with 100% positive predictive value and 46.4% negative predictive value.ConclusionPositive TUS findings with moderate/high suspicion for PE may prove a valuable tool in the diagnosis of PE at the bedside, especially in the emergency setting, but a negative TUS study cannot rule out PE with certainty.

Significance of transthoracic ultra-sonography in early detection of patients with interstitial lung diseases in Aswan University Hospital

BackgroundRecently, the diagnosis and follow-up of numerous pulmonary diseases such as pneumothorax, pneumonia, and pleural effusion were easily by use of conventional ultrasound, and the maximum usefulness of transthoracic ultrasonography (TUS) in pulmonary diseases especially diffuse parenchymal lung disease has not been detected yet. This study was conducted to determine the value of transthoracic ultrasonography in patients with interstitial lung disease (ILD). Moreover, the viable correlations of the ultrasound findings with the functional and radiological findings of ILDs had been assessed.ResultsTUS diagnosis was positive in 73 cases, there was a substantial variation between the two groups classified according to ultrasonographic diagnosis regarding age and smoking history (p = 0.003 and 0.013 respectively). All the patients with usual interstitial pneumonia (n = 42) and Indeterminate UIP (n = 49) had positive ultra-sonographic findings [p = 0.041 and 0.001 accordingly]. Regarding pulmonary function tests, there was a considerable variance between both groups regarding FVC, PEF, FEF25-75, FEV1/VC (p = 0.037, 0.029, 0.015, and 0.000 accordingly). The most positive US diagnosis areas were upper lateral, lateral basal, and interscapular areas. There was a weak negative correlation between TUS diagnosis and FVC [r = − 0.25, p = 0.026].ConclusionWe concluded the great significant value of TUS in the diagnosis and follow-up of patients with interstitial lung diseases. It had an extremely thoughtful role in the diagnosis of ILD by detection of multiple B-lines distribution emerging from pleura and extending in the entire lung surface. The use of TUS in early detection and follow-up of ILDs reduced the cost.

Transthoracic Ultrasound Improves Cardiac Function in Mice.

Cardiac dysfunction is a severe complication that is associated with an increased risk of mortality in multiple diseases. Cardioprotection solution that has been researched is the electrical stimulation of the vagus nerve to exert cardio protection. This method has been shown to reduce the systemic inflammatory response and maintain the immune homeostasis of the heart. However, the invasive procedure of electrode implantation poses a risk of nerve or fiber damage. Here, we propose transthoracic ultrasound stimulation (US) of the vagus nerve to alleviate cardiac dysfunction caused by lipopolysaccharide (LPS). We developed a noninvasive transthoracic US system and exposed anesthetized mice to ultrasound protocol or sham stimulation 24 h after LPS treatment. Results showed that daily heart targeting US for 4 days significantly increased left ventricular systolic function ( p = 0.01) and improved ejection fraction ( p = 0.03) and shortening fraction ( p = 0.04). Furthermore, US significantly reduced inflammation cytokines, including IL-6 ( p = 0.03) and IL- 1β ( p = 0.04). In addition, cervical vagotomy abrogated the effect of US, suggesting the involvement of the vagus nerve's anti-inflammatory effect. Finally, the same ultrasound treatment but for a longer period (14 days) also significantly increased cardiac function in naturally aged mice. Collectively, these findings suggest the potential of transthoracic US as a possible novel noninvasive approach in the context of cardiac dysfunction with reduced systolic function and provide new targets for rehabilitation of peripheral organ function.

Transthoracic ultrasonography in the assessment of interstitial lung disease in patients with systemic sclerosis

Background: Transthoracic ultrasonography was considered, sometimes in the past as unsuitable for the assessment of lung but it eventually emerged as an important tool in the diagnosis and in guiding treatment of various lung and pleural diseases. Several studies in the past proved it to be a useful complementary tool in the detection of interstitial pulmonary fibrosis. Aims and Objectives: This study aims to assess the utility of transthoracic uultrasonography (TUS) in comparison to high-resolution computed tomography (HRCT) thorax in the detection of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients. Materials and Methods: SSc patients with HRCT proven ILD were identified and classified according to Warrick’s score. Sonographic evidence of ILD in these patients were judged by the presence of B-lines or ultrasonic lung comets (ULCs). Each procedure was studied and interpreted by two independent examiners blinded about the patient’s clinical and radiological features. Standard spirometric measurements were performed in all patients. Results: A highly significant positive linear correlation between ULCs and Warrick’s score was found in this study (r=0.83, P≤0.001). ULC score had moderate negative correlation with forced expiratory volume in 1 s (FEV1) % p (r=−0.60, P=0.001) and weak negative correlation with forced vital capacity (FVC) % p (r=−0.45, P=0.01) and FEV1/FVC % (r=−0.42, P=0.02). Conclusion: USG lung can be suggested as a useful non-invasive tool in the detection of ILDs in scleroderma patients.

Investigation of Childhood Pneumonia With Thoracic Ultrasound: A Comparison Between X-ray and Ultrasound.

Childhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q 1 : 8 and Q 3 : 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different ( P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment ( κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia.

Clinical Utility of Chest Sonography in Chronic Obstructive Pulmonary Disease Patients Focusing on Diaphragmatic Measurements.

There are many methods of evaluating diaphragmatic function, including trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis. We studied the clinical usefulness of chest ultrasonography in evaluating stable chronic obstructive pulmonary disease (COPD) patients and those in exacerbation, focusing on diaphragmatic measurements and their correlation with spirometry and other clinical parameters. In a prospective case-control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was performed for all included subjects. Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, as was the case for B-lines. TUS significantly showed high specificity, negative predictive value, positive predictive value, and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion displayed a significant negative correlation with body mass index and the dyspnea scale, and a positive correlation with spirometry measures. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D showed lower diaphragmatic measurements (thickness and excursion). The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.

The Value of Left Internal Mammary Artery Flow Velocity in Predicting the Prognosis of Patients After Coronary Artery Bypass Grafting.

The purpose of this study was to explore the value of the left internal mammary artery flow velocity (LIMAV) measured by ultrasound before coronary artery bypass grafting (CABG) in predicting the prognosis of patients after left internal mammary artery (LIMA) bypass grafting. One hundred and four patients who underwent CABG with LIMA as the bridge vessel in the cardiovascular surgery department of our hospital between May 2018 and June 2019 were selected. All patients underwent transthoracic Doppler ultrasonography to measure LIMAV preoperatively. Intraoperatively, mean graft flow (MGF) and pulsatility index (PI) of the LIMA bridge were measured using transit time flow measurement (TTFM). The primary endpoint event in this study was cardiac death within 18 months after surgery. The Cox survival analysis showed that the MGF, the LIMAV and left ventricular ejection fraction (LVEF) were risk factors for death after CABG. The cut-offs of MGF, LIMAV and LVEF for the prediction of death after CABG were ≤ 14 mL/min (area under the curve (AUC): 0.830; sensitivity: 100%; specificity: 65.6%), ≤ 60 cm/s (AUC: 0.759; sensitivity: 65.5%; specificity: 85.3%), and ≤ 44% (AUC: 0.724; sensitivity: 50%; specificity: 88.5%), respectively. Compared with the use of MGF, MGF + LIMAV, combination of the MGF + LIMAV + LVEF (AUC: 0.929; sensitivity: 100%; specificity: 81.1%) resulted in a stronger predictive value (MGF vs. MGF + LIMAV + LVEF: P = 0.02). LIMAV measured by preoperative transthoracic ultrasound combined with intraoperative MGF and LVEF may have a greater value in predicting patients' risk of cardiac death after CABG.

Role of Transthoracic Ultrasound in Patient with Acute Dyspnea in Emergency Department

Role of Transthoracic Ultrasound in Patient with Acute Dyspnea in Emergency Department

The Accuracy of Various Lung Ultrasonography Findings in Predicting the Necessity for Surfactant Treatment in Neonates With Respiratory Distress Syndrome

Objective: The study was conducted to determine the value of various lung ultrasonography (LUS) findings in diagnosing neonatal respiratory distress syndrome (RDS) and to assess the ability of ultrasonography to predict the need for surfactant treatment. Materials and Methods: This cohort study was conducted on 164 neonates with RDS with a gestational age of over 28 weeks. Transthoracic sonography was performed in all patients in the infant isolet immediately after admission and stabilization of the infant and during the first 6 hours before surfactant treatment. Immediately after the sonogram, the neonates underwent an anterior–posterior view chest radiograph, before and after surfactant treatment. Results: In comparison with clinical manifestations and radiographic findings as the references, the sensitivity and specificity of each of the LUS-related parameters for detecting RDS were as follows: Faded A-lines (95.4% and 76.7%), abnormal B-lines (91.7% and 71.6%), the presence of consolidation (90.9% and 88.3%), the presence of pleural effusion (95% and 86.7%), and alveolar–interstitial syndrome (AIS) (98% and 96%). Conclusion: LUS findings were valuable in assessing and grading the severity of neonatal RDS alongside clinical evaluation. LUS may assist in selecting infants for surfactant therapy and monitoring treatment response.

Diagnostic performance of transthoracic ultrasound in patients with pulmonary embolism

Abstract Background Pulmonary embolism (PE) is an acute, significant, and life-threatening condition. Transthoracic ultrasound (TUS) is one of the noninvasive diagnostic modalities that has been presented for detection of numerous chest disorders as well as PE. Objectives The goal of this work was to estimate the accuracy, sensitivity, and specificity of bedside TUS in PE detection. Patients and methods Fifty patients with moderate-to-high clinical suspicion of PE were examined by TUS. Diagnosis of PE depended on clinical suspicion and was confirmed by computed tomography pulmonary angiography. Results Most of the lesions related to PE and detected by US examination were on the right side (60%) and posterior lower lobe (70%) with predominance of A profile. Sensitivity, specificity, accuracy, negative, and positive predictive values of TUS in diagnosis of PE were 93.3, 65, 82, 86.7, and 80%, respectively. Conclusion TUS is an important diagnostic tool as a noninvasive bedside test in detecting PE principally for critically ill or unmoving patients with high sensitivity and moderate specificity.

Using lung ultrasound to guide PEEP determination in mechanically ventilated patients with acute respiratory distress syndrome

Supportive care with mechanical ventilation is the cornerstone of management for acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) is often applied in mechanically ventilated patients with ARDS to improve oxygenation; however, determining the optimal PEEP level—the pressure that maximizes clinical benefit while minimizing risks of ventilator-induced lung injury and other harms—for each patient can be challenging. Recently, transthoracic lung ultrasonography (also called lung ultrasound) has been proposed as a tool to guide PEEP determination in patients with ARDS. This paper reviews the history of use of lung ultrasound as a method to guide PEEP determination and the four published studies which compared it to other techniques of PEEP determination, such as the oxygenation and PV-curve methods.

Ultrasonographic Applications in the Thorax.

Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units, it is also utilized in many clinical branches dealing with the respiratory system-due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations-and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound.

Assessment of Diaphragmatic Mobility by Transthoracic Ultrasound in Patients with Interstitial Lung Diseases

Background: As interstitial lung diseases may promote respiratory muscles dysfunction due to increased lung elastic recoil, chronic hypoxemia, systemic inflammation, physical inactivity, malnutrition and corticosteroids therapy. Therefore, measuring diaphragmatic function is quite helpful when assessing patients with interstitial lung disorders. Aim of the work: was to compare the diaphragmatic mobility which assessed by ultrasonography between healthy individuals and patients with interstitial lung diseases. Patients and Methods: this case-control trial, whereas Thirty patients with clinically stable interstitial lung diseases and twenty healthy persons as a control. Whereas age, sex and body mass index matched apparently in control group. Pulmonary functions tests: as six-minute walk test, ultrasonographic measurement of both diaphragmatic excursion and thicknesses at residual functional capacity and total lung capacity, with calculation of the diaphragmatic thickening fraction were done for all participants. Results: Diaphragmatic kinetics are greatly impaired in interstitial lung diseases patients at total lung capacity, but almost not affected at functional residual capacity. Diaphragmatic excursion and thickness at total lung capacity, as well as diaphragmatic thickening fraction showed considerable positive correlations with forced vital capacity and 6-minute walk distance, whereas they exhibited considerable negative correlations with modified Medical Research Council dyspnea scale. Conclusion: Diaphragmatic kinetics measured at total lung capacity and thickening fraction have good correlations with degree of dyspnea, forced vital capacity and exercise tolerance.

Utility of lung ultrasound in adjustment of the initial mechanical ventilation settings in patients with acute respiratory distress syndrome

Background Bedside lung ultrasound (US) is an essential tool in assessing lung aeration in severely ill patients. Aim The goal of this study was to determine the use of lung US in evaluating changes in lung aeration in dependent lung areas during positive end expiratory pressure (PEEP) titration in patients with acute respiratory distress syndrome (ARDS). Patients and methods A total of 52 mechanically ventilated patients with ARDS admitted in the ICU of Abbassia Chest Hospital were enrolled in this study. Transthoracic sonography was performed at the posterior axillary line on either side after 30 min of initial ventilator settings; recruitment at the end of expiration was sonographically assessed while changing PEEP. Arterial blood gases were performed before and after recruitment maneuver along with continuous monitoring of hemodynamics and oxygen saturation throughout the procedure. The procedure was terminated if the plateau pressure exceeded 30 cmH2O or if there was hemodynamic compromise. Results A total of 52 mechanically ventilated patients with ARDS were enrolled in the study. Overall, 80% had severe ARDS. Initial US assessments were done, and subpleural consolidation (C) was found in 18 patients, whereas exaggerated B lines (B) were found in 33 patients. After PEEP titration, under US guidance, 13 patients changed the US pattern from C to B and 22 patients changed from B to A (A-line pattern). These results correlated with improvement of PaO2/FiO2 ratio from 69.98 ± 27.93 to 86.21 ± 31.64 and increased compliance from 26.49 ± 8.63 to 28.73 ± 8.74. However, there was an increase in plateau pressure from 25.12 ± 3.88 to 27.98 ± 3.18, and also PaCO2 increased from 51.00 ± 16.05 to 58.52 ± 15.93. The mean arterial blood pressure decreased from 84.87 ± 7.91 to 81.60 ± 8.72. Conclusion US is an effective tool in achieving PEEP titration in mechanically ventilated patients with ARDS. US finding of aeration correlates well with improvement in oxygenation and compliance. However, the patients should be monitored for safe limits of pressures, hemodynamics, and PaCO2 level that may rise.

Prognostic implications of elevated pulmonary artery systolic pressure on 6-month mortality in elderly patients with acute myocardial infarction

Abstract Background Pulmonary artery systolic pressure (PASP) has often been evaluated as an indicator of heart failure, but the relationship between PASP and the prognosis of elderly patients with acute myocardial infarction (AMI) is not well understood. Methods The medical data of 3460 hospitalized elderly patients diagnosed with AMI between January 2013 and June 2018 were reviewed. PASP was calculated using transthoracic color Doppler ultrasonography. Patients were grouped according to their admission PASP results as follows: Group A, PASP ≤30 mmHg; Group B, 30 mmHg &lt;PASP ≤50 mmHg; and Group C, PASP ≥51 mmHg. The primary endpoint was all-cause death 6 months following AMI. Multiple Cox regression analysis was used to identify independent risk factors for 6-month mortality in elderly patients with AMI. Results PASP was associated with age, Killip classification, AMI site, and decreased ejection fraction in elderly patients. After adjusting for clinical and echocardiographic parameters in the Cox model, PASP was found to be significantly related to all-cause mortality. In receiver operating characteristic analysis, a PASP of &gt;34 mmHg had a sensitivity of 62.3% and specificity of 65.7% for predicting 6-month all-cause death after AMI. Conclusion PASP at admission is a useful marker for predicting short-term mortality in elderly patients with AMI. This finding could be used to help identify high-risk patients and make appropriate clinical decisions.