Transthoracic Lung Ultrasonography Research Articles

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.

Concise, Practical Review on Transthoracic Lung Ultrasound in Prehospital Diagnosis of Dyspnea in Adults.

Ultrasonography is a relatively young but widely recognized method of imaging parenchymal organs, including the lungs. Our concise, practical review on transthoracic lung ultrasound (LUS) in the prehospital diagnosis of dyspnea in adults attempts to summarize current knowledge in the field. Furthermore, we discussed POCUS protocols in the analyzed context, discussing their usefulness. We concluded that bedside ultrasonography, or point of care (POCUS), is developing rapidly; however, the knowledge about the use of LUS in a pre-hospital setting is scarce, highlighting the need for further research in this field. Additionally, despite the possibility of using various ultrasound protocols in diagnosing a patient with dyspnea, there is no comprehensive and, at the same time, highly sensitive and specific protocol covering a satisfactory saccade of differential diagnosis of this symptom. It seems reasonable to conduct further targeted research to create such a dedicated solution.

IMPAIRMENT OF PULMONARY AERATION IN ADULT CARDIAC SURGERY DETECTED BY TRANSESOPHAGEAL LUNG ULTRASOUND (TELUS): AN OBSERVATIONAL STUDY

IMPAIRMENT OF PULMONARY AERATION IN ADULT CARDIAC SURGERY DETECTED BY TRANSESOPHAGEAL LUNG ULTRASOUND (TELUS): AN OBSERVATIONAL STUDY

Evaluation the Frequency of Atelectasis by Transthoracic Lung Ultrasound in Patients Undergoing Laparoscopic Bariatric Surgery Under General Anesthesia

Evaluation the Frequency of Atelectasis by Transthoracic Lung Ultrasound in Patients Undergoing Laparoscopic Bariatric Surgery Under General Anesthesia

Comparison Study between Chest Ultrasonography and High Resolution CT in Diagnosis and Assessment of Interstitial Lung Diseases

Background: Chest high-resolution computed tomography [HRCT] is considered the “gold” standard for radiological diagnosis of interstitial lung disease [ILD]. However, it is not available in all health care facilities and its high cost is a limitation for its wide use. Ultrasound could provide a suitable alternative. Aim of the work: To detect the role of transthoracic lung ultrasonography [LUS] in diagnosis and assessment of ILD and to correlate it with HRCT as a gold-standard diagnostic modality.Methods:This included fifty patients who were admitted with clinical features suggestive of ILD. All were clinically evaluated [by full history and physical examination], submitted to pulmonary functions, arterial blood gases, lung ultrasound and HRCT. Results: The total sum of B-lines was 72.64 ± 39.45 and the total positive chest areas [> 3 B-lines] 6.47 ± 2.35. The most common ultrasound finding was thick pleural line. Finally, there was positive [proportional], moderate, significant correlation between Warrick’s score [HRCT] and B-lines distance [LUS]. However, Warrick score correlated negatively with each of six-minute walk test, partial arterial oxygen tension and forced vital capacity. Conclusions: Lung ultrasound as a diagnostic modality for ILD reveled that, it is a useful tool, as there was good correlation between LUS and HRCT. LUS is cheap, accessible and radiation-free diagnostic tool. It could play a stand alone or a complementary role in the diagnosis and monitoring of ILD.

Transthoracic ultrasonographic features of typical high-resolution computed tomography signs of interstitial lung diseases

Objective: To investigate the accuracy of bedside transthoracic lung ultrasonography (TLU) in different typical high resolution computed tomography (HRCT) signs of interstitial lung diseases (ILDs). Methods: Fifty patients first diagnosed with ILDs were enrolled from January 2016 to December 2018. There were 21 males and 29 females. The mean age was (56±14) years(rang 42-73 years). TLU was performed in inspiration for the characters of A-lines and B-lines as well as pleural at anterior, lateral and dorsal chest walls, respectively. HRCT was selected at three levels according to the upper, middle, and lower lung fields. The range of each level needing to be evaluated corresponded to the TLU scanning field one by one, and recording the signs of HRCT. Early change of ILDs was definite as the HRCT score was no more than 1 and no honeycomb was present. The correlation between A-lines, B-lines, pleural abnormal and HRCT signs was evaluted. Spearman's correlation coefficient was used to evaluate the relationship between B-lines and HRCT score. Results: The sensitivity and specificity of A-lines for HRCT normality were 83.9% and 84.9%, respectively. Coincidence rate was 84.6%. The sensitivity and specificity of B-lines for HRCT abnormality were 84.9% and 83.9%, respectively. Coincidence rate was 84.6%. Interlobular septal thickening shadow had fewer B-lines and narrower interval than other HRCT signs, while the other HRCT signs had no differences in B-lines. And the sensitivity and specificity of B-lines for detection the early change of HRCT in ILDs were 89.5% and 89.2%, respectively. Coincidence rate was 89.3%. A positive correlation was found between the number of B-lines and HRCT scores (R=0.827, P<0.001), and the width of B-lines and HRCT score (R=0.951, P<0.001). Meanwhile, a negative correlation was found between the interval of B-lines and HRCT score (R=-0.831, P<0.001). The sensitivity and specificity of TLU for HRCT pleural abnormality were 100.0% and 90.0%, respectively. Coincidence rate was 93.6%. Conclusions: TLU showed high sensitivity and specificity in finding interstitial changes of the lung. It gives a new view on the diagnostic possibilities of ILDs and may be used to evaluate the severity and the therapeutic effect of treatment. However, TLU could not differentiate HRCT signs of ILDs.

Assessment of the applicability of transthoracic lung ultrasound for diagnosing purulent lobar pneumonia – A case study

Introduction: Purulent lobar pneumonia is an inflammation of pulmonary tissue that may progress to parenchymal necrosis and abscess formation. The authors present a case of purulent lobar pneumonia diagnosed using transthoracic lung ultrasound (TLU). Abscess-type lesions had not been visualized in previous computed tomography (CT) scans. Aim: To analyze the potential of TLU as a diagnostic tool for purulent lobar pneumonia. Case study: A 55-year-old patient with a several-week history of cough, abdominal pain, and diarrhea was admitted to the intensive care unit due to rapidly progressing cardiopulmonary failure. CT revealed merging parenchymal/interstitial densities within the right lung. Broad-spectrum antibiotics were initiated. TLU revealed the presence of lesions characteristic of pneumonia with the development of abscesses and acute respiratory distress syndrome. Despite treatment initiation, the patient’s condition progressively worsened. On the 3rd day of hospitalization, the patient passed away. At autopsy, purulent lobar pneumonia was identified as the direct cause of death. Results and discussion: Despite broad and well-documented knowledge regarding its applicability, ultrasound has not been widely used as a diagnostic tool. Conclusions: TLU is a safe, repeatable, and inexpensive diagnostic tool. The use of ultrasound in diagnosing pneumonia is well documented, and based on specific diagnostic criteria. As a diagnostic tool for pneumonia, dynamic air bronchogram had a high specificity and positive predictive value. The high sensitivity and specificity of TLU, as pertains to detecting necrosis or abscesses in the course of pneumonia, is comparable with CT. TLU facilitated visualization of small-diameter abscesses.

Perioperative Transthoracic Lung Ultrasound for Assessment of Pulmonary Outcome in Adolescent Idiopathic Scoliosis Patients: Prospective, Observational Pilot Study

The purpose of study was to evaluate the perioperative lung ultrasound findings of patients undergoing scoliosis correction. LUS examination was performed examined three 3 times for each patient: 20 min after starting mechanical ventilation of the lungs(preoperative), after surgery when the patient was placed in the supine position(postoperative), and 20 min after arrival in the post-anaesthesia care unit. Arterial blood gas analyses, mechanical ventilation parameters, peripheral oxygen saturation(SpO2) were also checked. Twenty-six patients completed the study. The changes of LUS score(20 min) was significantly negatively correlated with the partial pressure of arterial oxygen(PaO2)/fraction of inspired oxygen(FiO2) ratio change(P = 0.039, r = −0.40). The change in mean convex side LUS score was significantly greater than that of the concave side as determined by two-factor repeated measures analysis of variance(p = 0.001). Multiple regression analysis revealed perioperative LUS change was the significant factor related to the oxygen index change (p = 0.042). One case of pneumothorax was diagnosed and pleural thickening more than 5 mm was detected in 8 patients and five patients of those were diagnosed pleural effusion and performed thoracentesis after surgery. Postoperative increase of LUS score was related with deteriorating of oxygenation at one day after surgery, and it suggests that lung ultrasound allows prediction of postoperative hypoxia and facilitates the diagnosis of pulmonary complications at operation room in AIS patients.

Role of Ultrasound Lung Comets in the Diagnosis of Acute Heart Failure in Emergency Department: A Systematic Review and Meta-analysis

ObjectiveA new technique of transthoracic lung ultrasonography (TLS) has emerged and demonstrated promising results in acute heart failure diagnosis at an early stage. However, the diagnostic value of ultrasound lung comets (ULCs) for acute heart failure (AHF) performed in busy emergency department (ED) is uncertain. The present meta-analysis aimed to assess the diagnostic efficiency of ULCs in AHF. MethodsWe conducted a search on online journal databases to collect the data on TLS performed for diagnosing AHF published up to the end of July 2017. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and summary receiver operating characteristic (SROC) curve were calculated. The post-test probability of AHF was calculated by using Bayes analysis. ResultsWe enrolled a total of 15 studies involving 3,309 patients. The value of sensitivity, specificity, PLR, NLR, DOR, area under the SROC curve, and Q* index was 85%, 91%, 8.94, 0.14, 67.24, 0.9587, and 0.9026, respectively. We detected significant heterogeneity among included studies, and therefore, all these results were analyzed under the random-effect model. We also explored possible sources of heterogeneity among the studies by using meta-regression analysis. Results suggest that the time interval between patient's admission to bedside TLS examination was closely related to TLS accuracy. ConclusionThis meta-analysis demonstrated that detecting ULCs is a convenient bedside tool and has high accuracy for early AHF diagnosis in ED. TLS could be recommended to be applied for early diagnosis of AHF in ED.

Comparative study in left heart failure patients with or without pulmonary edema by integrative cardiopulmonary ultrasound

Objective To compare the clinical and echocardiographic parameters in left heart failure patients with or without pulmonary edema by cardiopulmonary ultrasound. Methods All patients underwent transthoracic lung ultrasonography and echocardiography examination. The following echocardiographic parameters were determined: left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV), left ventricular ejection fraction (LVEF), left atrial volume index (LAVindex), systolic pulmonary artery pressure (SPAP) and the degree of mitral regurgitation, the peak Doppler velocities of early (E) and late (A) diastolic flow, early (e′) diastolic velocity of the mitral annulus, and the average E/e′ ratio was calculated. The NYHA functional classification and N-terminal pro B-type natriuretic peptide (NT-proBNP) were also recorded. Results A total of 113 heart failure patients, included 72 patients (63.7%) combined with pulmonary edema revealed by lung ultrasonography. Compared with patients without pulmonary edema, those with pulmonary edema were with higher plasma concentrations of NT-proBNP, NYHA functional class, left ventricular diastolic function classification, SPAP and E/e′, larger LVEDD and the diameter of right ventricle, more severe mitral regurgitation, and lower LVEF(all P<0.05). By multivariate logistic regression analysis, E/e′, SPAP and NT-proBNP were independent echocardiographic predictors of pulmonary edema in patients with heart failure. Conclusions Cardiopulmonary ultrasound can evaluate heart and pulmonary condition in patients with heart failure. Left ventricular diastolic function is an important determinant of pulmonary edema in patients with left heart failure. Key words: Ultrasonography; Heart failure; Pulmonary edema

Application of transthoracic lung ultrasound in the diagnosis of pulmonary edema at ICU patients – Literature review

Pulmonary edema (PED) is one of the potential causes of acute respiratory failure at ICU patients. Transthoracic lung ultrasound (TUS) is a useful method of evaluating the condition of the respiratory system, because especially in the critically ill patients, this study should be simple, fast and easily accessible. Hence the study design is simplified and presented as a treatment protocol known by the acronym BLUE (Lung Bedside Ultrasound in Emergency). Study under this scheme reduces testing time for even 1 min, and at the same time allows for the diagnosis of the causes of acute respiratory failure. The aim of this work is to describe the basics of actual techniques of medical ultrasound for diagnosis PED. A literature review. We presented how to identify with ultrasonography the most common types of PED at ICU patients. Medical ultrasound is a simple, fast, cheap and reproducible method of evaluating the respiratory system and seems to be one of the most promising imaging techniques for the diagnosis of lung diseases and monitoring of respiratory functions.

Transesophageal lung ultrasonography: a novel technique for investigating hypoxemia.

Acute deterioration in respiratory status commonly occurs in patients who cannot be transported for imaging studies, particularly during surgical procedures and in critical care settings. Transthoracic lung ultrasonography has been developed to allow rapid diagnosis of respiratory conditions at the bedside. Nevertheless, the thorax is not always accessible, especially in the perioperative setting. Transesophageal lung ultrasonography (TELU) can be used to circumvent this problem. The aim of this narrative review is to provide a complete description of the TELU technique by summarizing the existing literature on the subject and describing our own experience that extrapolates from transthoracic lung ultrasonography. The use of TELU can provide point-of-care real-time information for quickly establishing the etiology of acute hypoxemia. The transesophageal probe is placed in close proximity to the posterior regions of the lungs where lung consolidation and pleural effusions are most often seen; however, most of the artefacts relied on by transthoracic ultrasound have yet to be validated with TELU. Moreover, the relative invasiveness of TELU compared with transthoracic ultrasonography may limit its use to specific situations when the probe is already in place, as during cardiac anesthesia or when the anterior thorax is inaccessible. The main advantage of TELU may lie in the ability to integrate both cardiac and pulmonary assessments in one single examination. Anesthesiologists and intensivists who already use transesophageal echocardiography on a regular basis should consider adding TELU to their clinical assessment of hypoxemia and related pulmonary pathologies. Nevertheless, the literature specifically supporting TELU is relatively limited, and further validation studies are needed.

A novel approach to assess pulmonary function in patients with chronic obstructive pulmonary disease using tissue velocity imaging.

To explore the feasibility of quantitative evaluation of pulmonary function in patients with chronic obstructive pulmonary disease (COPD) using tissue velocity imaging (TVI) and strain rate imaging (SRI) via transthoracic lung ultrasonography. Eighty inpatients with clinically diagnosed COPD underwent pulmonary function test and transthoracic lung ultrasound on the same day. Lung ultrasound variables and pulmonary function parameters were analyzed. All patients with COPD had faster breathing and significant reduced lung function compared with healthy participants (p<0.05). The lung ultrasound parameters, velocity (max-min, cm/s), displacement (max-min, mm), strain (max-min, %) and strain rate (max-min, 1/s) were significantly higher in patients with COPD (p<0.05). A good negative correlation was found between lung ultrasound variables and pulmonary function parameters in patients with COPD. Stepwise multiple regression analysis indicated that the velocity (max-min, cm/s) was the only independent determinant of FEV1/FVC (%). With the use of FEV1/FVC<70% as the criteria of irreversible pulmonary function impairment to distinguish an abnormal pulmonary function, the area under the ROC was 0.99 for the velocity (max-min, cm/s) of the lung tissue in the process of breathing. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the cut off value (1.19 cm/s) was 97.63%, 100%, 100%, 80%, and 98%, respectively (p<0.001). Tissue velocity imaging via transthoracic lung ultrasound is a useful modality in the assessment of pulmonary function in patients with COPD.

Lung Ultrasonography in the Evaluation of Interstitial Lung Disease in Systemic Connective Tissue Diseases: Criteria andSeverity of Pulmonary Fibrosis - Analysis of 52 Patients.

Patients with a diagnosed systemic connective tissue disease require regular monitoring from the point of view of interstitial lung disease. The main aim of this work is a description of the criteria for pulmonary fibrosis and the degree of the severity of the fibrosis during the course of interstitial lung disease through the TLU (transthoracic lung ultrasound). 52 patients with diagnosed diffuse interstitial lung disease were qualified for this research, together with 50 volunteers in the control group. The patients in both groups were over 18 years of age and were of both sexes. The results of the TLU of the patients underwent statistical analysis and were compared to High-Resolution Computed Tomography (HRCT) results. As a consequence of the statistical analysis, we defined our own criteria for pulmonary fibrosis in TLU: irregularity of the pleura line, tightening of the pleura line, the fragmentary nature of the pleura line, blurring of the pleura line, thickening of the pleura line, artifacts of line B ≤ 3 and ≥ 4, artifacts of Am line and subpleural consolidations < 5 mm. As a result of the conducted research, a scale of severity of pulmonary fibrosis in TLU was devised (UFI - Ultrasound Fibrosis Index), enabling a division to be made into mild, moderate and severe cases. Transthoracic Lung Ultrasonography (TLU) gives a new outlook on the diagnostic possibilities, non-invasive and devoid of ionising radiation, of pulmonary fibrosis. This research work has allowed to discover two new ultrasound symptoms of pulmonary fibrosis (blurred pleural line and Am lines).

Usefulness of Lung Ultrasound in Diagnosing Causes of Exacerbation in Patients with Chronic Dyspnea

Dyspnea is a non-specific symptom that requires fast diagnostics, accurate diagnosis and proper treatment. The most common causes of dyspnea include exacerbation of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Distinction between these two medical conditions seems to be critical in diagnostics of emergencies. At the same time, basic diagnostic tools available in emergency room, such as classic radiography (X-ray) of the chest, electrocardiography (ECG) or b-type natriuretic peptide test, are sometimes ambiguous. Therefore looking for additional diagnostic tool seems to be justified and necessary. Transthoracic lung ultrasound assessment is a simple and easily accessible examination, enabling the early and explicit diagnostics of pulmonary oedema and its distinction from other, non-cardiac causes of dyspnea. This review outlines the current knowledge on the subject of transthoracic lung ultrasound (TLUS), particularly in respect of its clinical usefulness in distinction of causes of dyspnea exacerbation.

Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis.

BackgroundPulmonary embolism (PE) is a potentially life-threatening condition. Although computed tomography pulmonary angiography (CTPA) is the reference standard for diagnosis, its early diagnosis remains a challenge, and the concerns about the radiation exposures further limit the general use of CTPA. The primary aim of this meta-analysis was to evaluate the overall diagnostic accuracy of transthoracic lung ultrasound (TLS) in the diagnosis of PE.MethodsPubMed, Web of science, OvidSP, ProQuest, EBSCO, Cochrane Library and Clinicaltrial.gov were searched systematically. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were used to examine the TS performance. The Bayes analysis was used to calculate the post-test probability of PE. Publication bias was assessed with Deeks funnel plot.ResultsThe results indicated that the sensitivity, specificity, PLR and NLR were 0.85 (95% confidence interval (CI), 0.78 to 0.90), and 0.83 (95% CI, 0.73 to 0.90). And the DOR and HSROC were 28.82 (95% CI, 17.60 to 47.21), 0.91(95% CI, 0.88, 0.93).ConclusionsThe present meta-analysis suggested that transthoracic lung ultrasonography is helpful in diagnosing pulmonary embolism. Although the application of transthoracic lung ultrasound may change some patients’ diagnostic processes, it is inappropriate to generally use transthoracic ultrasonography in diagnosing pulmonary embolism currently.

Transthoracic Lung Ultrasonography as a Tool of Alpha-1-Antitripsine Deficiency Assessment

A case refers to a patient with a diagnosis of alpha 1 antitrypsin deficiency and chronic obstructive pulmonary disease. Performed Transthoracic Lung Ultrasound (TLU) examination revealed the presence of artifacts Am lines that are the result of bullae, confirmed by computed tomography of the chest. This is the first case in which first revealed the presence of the Am.

Accuracy of Transthoracic Lung Ultrasound for Diagnosing Anesthesia-induced Atelectasis in Children

The aim of this study was to test the accuracy of lung sonography (LUS) to diagnose anesthesia-induced atelectasis in children undergoing magnetic resonance imaging (MRI). Fifteen children with American Society of Anesthesiology's physical status classification I and aged 1 to 7 yr old were studied. Sevoflurane anesthesia was performed with the patients breathing spontaneously during the study period. After taking the reference lung MRI images, LUS was carried out using a linear probe of 6 to 12 MHz. Atelectasis was documented in MRI and LUS segmenting the chest into 12 similar anatomical regions. Images were analyzed by four blinded radiologists, two for LUS and two for MRI. The level of agreement for the diagnosis of atelectasis among observers was tested using the κ reliability index. Fourteen patients developed atelectasis mainly in the most dependent parts of the lungs. LUS showed 88% of sensitivity (95% CI, 74 to 96%), 89% of specificity (95% CI, 83 to 94%), and 88% of accuracy (95% CI, 83 to 92%) for the diagnosis of atelectasis taking MRI as reference. The agreement between the two radiologists for diagnosing atelectasis by MRI was very good (κ, 0.87; 95% CI, 0.72 to 1; P < 0.0001) as was the agreement between the two radiologists for detecting atelectasis by LUS (κ, 0.90; 95% CI, 0.75 to 1; P < 0.0001). MRI and LUS also showed good agreement when data from the four radiologists were pooled and examined together (κ, 0.75; 95% CI, 0.69 to 0.81; P < 0.0001). LUS is an accurate, safe, and simple bedside method for diagnosing anesthesia-induced atelectasis in children.