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 SpO2<94% on room air) and severe COVID-19 (respiratory rate >30/min OR SpO2<90% on room air) at the time of enrolment. The lungs were systematically assessed with ultrasound after division into 14 zones (4 anteriorly, 4 axillary and 6 posteriorly). Clinical and laboratory parameters including arterial blood gas analysis at the time of evaluation were recorded. Patients were followed till death or discharge. The primary objective was to determine the correlation between clinical severity and lung ultrasound profiles (no. of A, B and C profiles, and the total number of areas involved). Secondary objectives included assessment of the correlation between lung ultrasound profiles and clinical outcomes and development of a statistical model incorporating ultrasound and clinical parameters to allow prediction of COVID-19 related severity and outcomes. 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, p<0.0001) and SpO2/FiO2 ratio (ρ= -0.6866, p<0.0001), and differed significantly between mild and moderate vs severe cases (p=0.0026 mild vs moderate, p<0.0001 mild vs severe, p=0.0175 moderate vs severe). The total number of B lines were predictors of mortality (p=0.0188, OR 1.03, 95% CI 1.003-1.060). Statistical models that incorporated total number of B-lines, CRP and anticoagulation use could predict mortality (p=0.0124, pseudo R2=0.1740) with an AUC= 0.7682 (95% CI=0.6176-0.9188), and the total number of involved areas and LDH levels could distinguish severe disease from mild/moderate disease (p<0.0001, Pseudo R2=0.3822), AUC = 0.8743 (95% CI=0.7752-0.9733). A simplified cut off of ≥6 involved areas (of the 14 assessed) was 100% sensitive and 52% specific for differentiating severe disease from mild and moderate ones. Interpretation: 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.

Download Full-text

90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat

Paediatrics & Child Health ◽

10.1093/pch/pxab061.072 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e65-e66

Author(s):

Noah Marzook ◽

Alexander Dubrovsky

Keyword(s):

Pediatric Patients ◽

Lung Ultrasound ◽

Demographic Data ◽

Tertiary Care ◽

Challenge Test ◽

Primary Objective ◽

Upper Respiratory Tract ◽

The Past ◽

Asthma Patients ◽

B Lines

Abstract Primary Subject area Emergency Medicine - Paediatric Background Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient. Objectives The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic. Design/Methods Eligible patients >6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (<1cm or >1cm), absent lung slide, and/or presence of pleural fluid. Results Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value. Conclusion In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.

Download Full-text

Intubation prognosis in COVID-19 patients and associated factors: a cross-sectional study

10.21203/rs.3.rs-115894/v1 ◽

2020 ◽

Author(s):

Mostafa Mohammadi ◽

Hesam Aldin Varpaei ◽

Majid Amini

Keyword(s):

Clinical Signs ◽

Respiratory Acidosis ◽

Absolute Lymphocyte Count ◽

Clinical Severity ◽

Common Finding ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Laboratory Parameters ◽

Arterial Blood ◽

Wide Range

Abstract Background: In December 2019, a new pathogen, HCoV, or New Corona Virus 2019 (2019-nCoV), was recognized in Wuhan, China, causing a pandemic. COVID-19 has a wide range of clinical severity. Approximately 3.2% of patients within some periods of the disease require intubation and invasive ventilation. Methods: This study was descriptive-analytical and was conducted in the Imam Khomeini Hospital. Patients with Covid-19 who required endotracheal intubation were identified and their clinical signs and laboratory parameters were recorded. SPSS23 software was used for statistical analysis. Results: 120 patients with coronavirus with different conditions were evaluated. The mean age was 55±14. 30 patients had cardiovascular disease (hypertension) and 20 endocrine disease(diabetes). Respiratory acidosis, decreased oxygen saturation, lymphopenia, and increased CRP were the most common finding before intubation. 31 patients had no comorbidity conditions. However, 27 patients had more than one comorbidity condition, and 23 experienced acute respiratory distress syndrome. The mortality rate was 49.2%. Discussion: Although all laboratory parameters and patients symptoms can affect the treatment outcome, it was found that WBC and absolute lymphocyte count, BUN, SOFA and APACHE scores, inflammatory index ratio CRP / LDH % CRP / ESR% and ESR / LDH%, arterial blood gas indices, pulse rate, and patient temperature before intubation are among the parameters that can affect the patient's 14-day prognosis. Conclusion: Except for the mentioned items, CRP / LDH% ratio seems to be a good indicator for checking the prognosis of discharge or death of patients within 14 days, However, CRP / ESR% and ESR / LDH% are appropriate criteria for determining the prognosis for discharge or stay in the ICU for more than 14 days.

Download Full-text

Genetic Mutation of Hb E/beta Thalassemia Patient in Bangladesh and Its Relation With Clinical Severity

10.21203/rs.3.rs-927268/v1 ◽

2021 ◽

Author(s):

Nishat Mahzabin ◽

Md. Abdul Aziz ◽

Md. Akhlak-Ul Islam ◽

Nusrat Jahan ◽

Md. Kamrul Hasan Sajib ◽

...

Keyword(s):

High Performance ◽

Mutational Analysis ◽

Severe Disease ◽

Genetic Mutation ◽

Clinical Severity ◽

Beta Thalassemia ◽

Thalassemia Patient ◽

Cross Sectional ◽

Hemoglobin E ◽

Hb E

Abstract Background: Hemoglobin E/β-thalassemia is a common inherited hemoglobin disorder among South Asian countries. The phenotypically diverse presentation of the disease is often attributed to coinheritance of β-globin (HBB) gene mutations. The current study described the phenotype and genetic basis of Hb E/β-thalassemia patients and assessed its relation with clinical severity.Methods: A total of 32 patients were included in this cross-sectional study. Cases were confirmed by using capillary hemoglobin electrophoresis or high-performance liquid chromatography. Those with positive findings were further analyzed with clinical information and ancestral data either from the interview or medical records. Data collection was confined to May 2019 and July 2020. Gene sequencing was performed using Sanger’s sequencing method for mutational analysis, and Mahidol scoring was used to grade clinical severity.Result: A total of 13 heterozygous mutations were identified in the HBB gene. Of all, IVS-1-5 (G>C) (n=17, 53.1%) was the most common, and codon 30 (G>C) (n=4, 12.5%) was the second most common mutations. According to the Mahidol scoring system, 37.5% (n=12) were classified as phenotypically mild, 43.8% (n=14) as moderate and 18.8% (n=6) as severe. The IVS-1-5(G>C) mutation was found to be frequently associated with severe disease and showed no mild form.Conclusion: The present study described the clinical severity and its association with genetic mutations in hemoglobin E/β-thalassemia patients. This finding could guide individually tailored management strategies for this particular group of patients.

Download Full-text

Bedside lung ultrasonography by emergency department residents as an aid for identifying heart failure in patients with acute dyspnea after a 2-h training course

The Ultrasound Journal ◽

10.1186/s13089-021-00207-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Mohamed Amine Msolli ◽

◽

Adel Sekma ◽

Maryem Ben Marzouk ◽

Wael Chaabane ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Predictive Value ◽

Lung Ultrasound ◽

Characteristic Curve ◽

Trial Registration ◽

Ordinal Scale ◽

Acute Dyspnea ◽

Cross Sectional ◽

B Lines

Abstract Background Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea. Patients and methods This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18 years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients’ clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leading diagnosis was assessed by two expert sonographers, who were blinded to the residents’ interpretations, based on clinical findings, chest X-ray, brain natriuretic peptide, cardiac and lung ultrasound testing. Accuracy and agreement of B-lines score and B-profile pattern were calculated. Results We included 700 patients with a mean age of 68 ± 12.6 years and a sex ratio (M/F) of 1.43. The diagnosis of CHF was recorded in 371 patients (53%). The diagnostic performance of B-lines score at a cut-off 15 and B-profile pattern was, respectively, 88% and 82.5% for sensitivity, 75% and 84% for specificity, 80% and 85% for positive predictive value, 84% and 81% for negative predictive value. The area under receiver operating characteristic curve was 0.86 [0.83–0.89] and 0.83 [0.80–0.86], respectively, for B-lines score and B-profile pattern. There was an excellent agreement between residents for the diagnosis of CHF using both scores (kappa = 0.81 and 0.85, respectively, for ordinal scale B-lines score and B-profile pattern). Conclusion Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry: clinicaltrials.gov; Trial registration number: NCT03717779; Date of registration: October 24, 2018 ‘Retrospectively registered’; URL of trial registry record: clinicaltrials.gov

Download Full-text

Bay 81-8973 in the Real World: Clinical Effectiveness and Safety in Patients with Hemophilia Α across the US and Europe

Blood ◽

10.1182/blood-2018-99-116814 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5044-5044

Author(s):

Jamie O'Hara ◽

Ceri Hirst ◽

Stephan Rauchensteiner ◽

Tom Burke

Keyword(s):

Real World ◽

Hemophilia A ◽

Severe Disease ◽

Primary Objective ◽

Severe Hemophilia ◽

Cross Sectional ◽

Psychological Burden ◽

The Real ◽

Patient Reported ◽

The Us

Abstract Background: BAY 81-8973 (Kovaltry®, Bayer) is an unmodified full-length recombinant FVIII launched in 2016 in Europe and the US for the prophylaxis and treatment of bleeds in patients with hemophilia A. BAY 81-8973 has been extensively studied in clinical trials, which have demonstrated consistent efficacy and safety in both children and adults in the LEOPOLD trials, and since launch, 6750 patient-years of experience have been accumulated. Pharmacokinetic analyses have demonstrated an increased half-life for BAY 81-8973 compared with standard factor VIII products (rFVIII-FS and rFVIII [rAHF-PFM]). Real world evidence demonstrating the effectiveness and safety of BAY 81-8973 across age groups is being collected, though aggregated international data have yet to be published. The primary objective of this analysis was to describe the effectiveness of BAY 81-8973 in the real world setting in children and adults from Europe and the US, as captured in the Cost of Haemophilia: a Socioeconomic Survey (CHESS) study. Methods: The CHESS 2018 program investigated the economic and psychological burden of moderate and severe hemophilia (FVIII < 5%) in Europe and the USA. The pediatric cohort (CHESS Pediatric) included 1050 males aged 1-17 years, with moderate or severe hemophilia, while CHESS US included 568 adults with severe hemophilia aged > 18 years. Clinical and patient reported data were obtained via medical chart abstraction and cross-sectional surveys sent to both physicians and patients. Data were collected between December 2017 and April 2018, and captured 12 months of clinical retrospective data. The current study is a descriptive analysis of patients treated with BAY 81-8973 from the CHESS pediatric and adult cohorts. Results: At the data cut off (May 2018), 49 patients were being treated with BAY 81-8973. The majority of pediatric patients were aged 6-11 years (51.7%, n=15), while 17.2% (n=5) were aged 0-5 years and 31% (n=9) were aged 12-17 years. In the adult US cohort, most (60%, n=12) were aged 18-35 years, 35% (n=7) were aged 36-59 years, and 5% (n=1) were aged > 60 years. The vast majority of patients across cohorts had severe disease (93.1% of children and 100% of adults); however, 89.7% (26/29) of children and 80% (16/20) of adults had no target joints. In this population, 75.9% (22/29) of children and 55.0% (11/20) of adults were receiving regular prophylaxis with BAY 81-8973. Children and adults on prophylaxis both had a mean (± SD) of 2 (± 1) infusions/week, with median (Q1; Q3) weekly doses of 84 (67; 110) and 62 (29; 144) IU/kg, respectively. Overall, 20.7% (6/29) of children and 35% (7/20) of adults treated with BAY 81-8973 had zero bleeds and mean annualized bleed rate (ABR) was 2.66 (± 2.06) in children and 1.45 (± 1) in adults; 68.9% (20/29) of children and 95.0% (19/20) of adults had experienced ≤ 3 bleeds in the previous year. There were no reports of inhibitor development in either the pediatric or adult cohorts while on BAY 81-8973. Conclusions: These observations suggest that BAY 81-8973 is an effective and well-tolerated treatment for adults and children with moderate and severe hemophilia A, with ABR < 3 in children and < 2 in adults and with many patients free from bleeds despite only 67% of patients studied receiving regular prophylaxis. These data confirm the observations from the LEOPOLD trials, suggest BAY 81-8973 provides good protection from bleeding across a range of patient types in routine clinical practice and illustrate how the established pharmacokinetic profile of BAY 81-8973 translates to clinical benefits for patients with hemophilia A. Study supported by Bayer Disclosures Hirst: Bayer: Employment. Rauchensteiner:Bayer: Employment.

Download Full-text

Lung Ultrasound to Quantitatively Evaluate Extravascular Lung Water Content and its Clinical Significance

10.21203/rs.3.rs-19227/v1 ◽

2020 ◽

Author(s):

Guo Guo ◽

Xue-Feng Zhang ◽

Jing Liu ◽

Hai-Feng Zong

Keyword(s):

Extravascular Lung Water ◽

Lung Ultrasound ◽

Rabbit Model ◽

Dry Weight ◽

Type I ◽

Lung Water ◽

Arterial Blood Gas ◽

Injection Volume ◽

Arterial Blood ◽

B Lines

Abstract Background:B-line assessment with lung ultrasound (LUS) has recently been proposed as a reliable, noninvasive semiquantitative tool for evaluating extravascular lung water (EVLW). Currently, there has been no easy quantitative method to evaluate EVLW by LUS. To establish a simple, accurate and clinically operable method for quantitative assessment of EVLW using LUS. Methods:Forty-five New Zealand rabbits were randomized into 9 groups (n=5). After anesthesia, each group of rabbits was injected with different amounts of warm sterile NS (0 ml/kg, 2 ml/kg, 4 ml/kg, 6 ml/kg, 8 ml/kg, 10 ml/kg, 15 ml/kg, 20 ml/kg, 30 ml/kg) via the endotracheal tube. Each rabbit was examined by LUS before and after NS injection. At the same time, the spontaneous respiratory rate (RR, breaths per minute), heart rate (HR, bpm) and arterial blood gas (ABG) of the rabbits were recorded. Then, both lungs were dissected to obtain the wet and dry weight and conduct a complete histological examination.Results:Injecting NS into the lungs through a tracheal tube can successfully establish a rabbit model with increased EVLW. When theNS injection volume is 2~6 ml/kg, comet-tail artifacts and B-lines are the main patterns found on LUS; as additional NS is injected into the lungs, the rabbits' RR gradually increases, while their HR gradually decreases. Confluent B-lines grow gradually but significantly, reaching a dominant position when the NS injection volume reaches 6~8 ml/kg and predominating almost entirely when the NS injection volume is 8~15 ml/kg; at that time, rabbits' RRs and HRs decrease sharply, and the ABG indicated type I respiratory failure (RF). Compact B-lines occur and predominate almost entirely when the NS injection volume reaches 10 ml/kg and 15~20 ml/kg, respectively. At that time, rabbits begin to enter cardiac and respiratory arrest, and ABG shows type II RF and metabolic acidosis (MA).Conclusion: LUS can estimate EVLW content based on the type of B-line.We can give clinical treatment depending on the type of LUS B-line.

Download Full-text

Milky Lungs: Ultrasonographic Findings in Pediatric Acute Respiratory Distress Syndrome

Central European Annals of Clinical Research ◽

10.35995/ceacr2010005 ◽

2020 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Naumovski Filip ◽

Toleska Marija ◽

Kuzmanovska Biljana ◽

Kartalov Andrijan ◽

Trposka Angela

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Gas Exchange ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Lung Ultrasound ◽

Surgical Intensive Care Unit ◽

Non Invasive ◽

Arterial Blood ◽

B Lines

Diagnosis and following up the dynamics of Pediatric Acute Respiratory Distress Syndrome demand a more feasible, non-invasive and bedside tool, such as lung ultrasound, for monitoring the damaged lungs. We report on a 6-month-old child admitted in our Pediatric Surgical Intensive Care Unit with a clinical presentation of ileus and concomitant community acquired pneumonia. Lung ultrasound (LUS) examinations according to the BLUE Protocol were done several times during the hospital stay. A-lines were seen at admission in the upper segments, but 2–3 B-lines were present in the posterolateral segments bilaterally. Later on, separated and coalescent B-lines were seen. White lung parenchyma or milky lungs with a thickened pleural line were seen, while the worst gas exchange according to the results of Arterial Blood Gases (ABGs) has been detected. According to the findings, as many B-lines will be detected, as the severeness of lung damage and gas exchange impairement. The improvement of the gas exchange with the disappearance of the coalescent B-lines was seen later on, after ventilating the child in a prone position. Bedsides, LUS is a feasible and non-invasive point of care method that could be used for diagnosing Pediatric Acute Respiratory Distress Syndrome (PARDS) but in guiding therapy of the damaged lungs, also. The finding of diffuse, coalescent and homogenous B-lines interpreted as “Milky lungs” is consistent with the diagnosis of PARDS.

Download Full-text

Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants Under 2 months of Age

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v31i3.5359 ◽

1970 ◽

Vol 31 (3) ◽

pp. 202-208

Author(s):

K Agrawal ◽

C Mahaseth ◽

A Rayamajhi

Keyword(s):

Respiratory Rate ◽

Clinical Signs ◽

High Specificity ◽

Signs And Symptoms ◽

Acute Illness ◽

Gas Analysis ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Head Nodding

Introduction: Hypoxemia is the most serious manifestation of any acute illness in infants less than two months and has shown to be a risk factor for mortality. Hypoxia can be detected using a pulse oxymeter or arterial blood gas analysis. However this facility is not available in most centers of Nepal. This study has correlated different signs and symptoms to predict hypoxia. Methodology: This hospital based prospective cross sectional study included 160 infant < 2 months, presenting to OPD or Emergency department with any acute illness A complete history was taken and weight, temperature, respiratory rate, heart rate and oxygen saturation was recorded. Presence or absence of nasal flaring, cyanosis, chest indrawing, head nodding, grunting, wheezing and crepitations on auscultation was recorded subsequently. Clinical signs of hypoxemic and non hypoxemic infants were compared and then analyzed. Results: 160 infants, 95 (59.4%) were male and 65 (40.6%) were female. Of the total population, 56(35%) were hypoxic where as 104(65%) were non hypoxic. Infants who presented with more than 3 symptoms, were lethargic, tachypneic or had chest indrawing had higher sensitivity(92.8%, 75%, 75% and 89.3 % respectively) where as infants with nasal flaring, grunting, head nodding or central cyanosis had high specificity (91.3%, 87.5%, 98% and 100%) respectively. Conclusion: Infants presenting with ≥ 3 symptoms, lethargy, respiratory rate of ≥ 70/minute or chest indrawing can be used for screening purpose to detect hypoxia and infants showing signs like grunting, head nodding, nasal flaring or central cyanosis should be considered hypoxic and treated with supplemental oxygen. Key words: Hypoxia; Respiratory rate; Chest indrawing; Nasal flaring DOI: http://dx.doi.org/10.3126/jnps.v31i3.5359 J Nep Paedtr Soc 2011;31(3): 202-208

Download Full-text

Lung Ultrasound in Pediatric Asthma - Characterizing Baseline Findings Outside of Acute Exacerbations

10.22541/au.163961764.45673724/v1 ◽

2021 ◽

Author(s):

Noah Marzook ◽

Francois Gagnon ◽

Alexandre Deragon ◽

David Zielinski ◽

Adam Shapiro ◽

...

Keyword(s):

Pediatric Patients ◽

Lung Ultrasound ◽

Pediatric Asthma ◽

Primary Objective ◽

Asthmatic Children ◽

Pleural Line ◽

Acute Exacerbations ◽

The Right ◽

B Lines ◽

Lung Zone

Background: Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress in the emergency department. However, very little is known about LUS findings in pediatric asthma outside of acute exacerbations. Objectives: The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. Methods: Eligible patients, aged 6 to 17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. A positive LUS was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation and/or pleural anomaly. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. Results: 52 patients were included. 10/52 patients had a positive LUS (19.2%, 95CI 8.3-30.1%). Of those with positive LUS findings, 8 had B lines, 7 had consolidations <1cm, 1 had a pleural line abnormality and 1 had a consolidation >1cm. Positive findings were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal spaces within one lung zone in 100% of participants. Conclusion: To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. Positive LUS findings in asthmatic children can be seen outside of acute exacerbations. Such findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.

Download Full-text

CAT correlates positively with respiratory rate and is a significant predictor of the impact of COPD on daily life of patients: a cross sectional study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2014.382 ◽

2014 ◽

Vol 9 ◽

Author(s):

Cíntia Becker ◽

Janaína Schäfer ◽

Lisiane L. Carvalho ◽

Isabel P. Vitiello ◽

Andréa L.G. Da Silva

Keyword(s):

Health Status ◽

Respiratory Rate ◽

Severe Disease ◽

Cross Sectional Study ◽

Rehabilitation Program ◽

Borg Scale ◽

Cross Sectional ◽

Brazilian Sample ◽

Copd Patients ◽

The Impact

Background: The pathophysiological changes of COPD tend to worsen with progression, triggering limiting symptoms and implying the decrease in the activities of daily living and quality of life. The COPD Assessment Test (CAT) is a questionnaire designed to measure the impact of COPD on the health status. The aim of this study was to evaluate the impact of the disease through the CAT in a Brazilian sample of COPD patients and to correlate symptoms at rest with the CAT score in these patients. Methods: Study of cases with COPD patients was conducted by pulmonary rehabilitation program (RP). Respiratory rate (RR) and symptoms (dyspnea by Modified Borg Scale Dyspnea Index; symptoms by CAT) were analyzed at the beginning of the RP. Results: The study analyzed 28 COPD patients, both genders, age 65.93 ± 7.84 years and many patients ranging from severe and very severe disease. The majority of patients were rated by CAT with low impact-disease (n = 13/46, 4%); medium (n = 11/39, 3%) and the high impact-diseases were observed in a few subjects (n = 4/14.3%). The difference between all CAT scores was significant, p = 0.000. There was a positive correlation between respiratory rate and CAT scores impact-level (r = 0.585, p = 0.001). The results obtained by the Borg Scale revealed a high presence of symptoms in these COPD patients but no association with CAT. Conclusion: The CAT is a sensitive tool to assess the current health status of COPD patients, and in Southern Brazil it is positively correlated with respiratory rate.

Download Full-text