scholarly journals Lung ultrasound findings in patients with novel SARS-CoV-2

2020 ◽  
Vol 6 (4) ◽  
pp. 00238-2020
Author(s):  
Mark E. Haaksma ◽  
Micah L.A. Heldeweg ◽  
Jorge E. Lopez Matta ◽  
Jasper M. Smit ◽  
Jessica D. van Trigt ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Time Course ◽  
Lung Ultrasound ◽  
Arterial Oxygen Tension ◽  
Dynamic Compliance ◽  
Arterial Oxygen ◽  
Clinical Parameters ◽  
Duration Of Symptoms ◽  
Ultrasound Findings ◽  
B Lines

BackgroundOver 2 million people worldwide have been infected with severe acute respiratory distress syndrome-coronavirus-2 (SARS CoV-2). Lung ultrasound has been proposed to diagnose and monitor it, despite the fact that little is known about the ultrasound appearance due to the novelty of the illness. The aim of this manuscript is to characterise the lung ultrasonographic appearance of critically ill patients with SARS-CoV-2 pneumonia, with particular emphasis on its relationship with the time course of the illness and clinical parameters.MethodsAdult patients from the intensive care unit of two academic hospitals who tested positive for SARS-CoV-2 were included. Images were analysed using internationally recognised techniques which included assessment of the pleura, number of B-lines, pathology in the PLAPS (posterolateral alveolar and/or pleural syndrome) point, bedside lung ultrasound in emergency profiles, and the lung ultrasound score. The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) durations of symptoms and their correlation with clinical parameters.ResultsIn this pilot observational study, 61 patients were included with 76 examinations available for analysis. 26% of patients had no anterior lung abnormalities, while the most prevalent pathological ultrasound findings were thickening of the pleura (42%), ≥3 B-lines per view (38%) and presence of PLAPS (74%). Patients with “long” duration of symptoms presented more frequently with a thickened and irregular pleura (32 (21%) versus 11 (9%)), C-profile (18 (47%) versus 8 (25%)) and pleural effusion (14 (19%) versus 3 (5%)), compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with arterial oxygen tension/inspiratory oxygen fraction ratio, fluid balance or dynamic compliance.ConclusionSARS-CoV-2 results in significant, but not specific, ultrasound changes, with decreased lung sliding, thickening of the pleura and a B-profile being the most commonly observed. With time, a thickened and irregular pleura, C-profile and pleural effusion become more common findings. When screening patients, a comprehensive ultrasound protocol might be necessary.

scholarly journals Lung ultrasound findings in patients with novel SARS-CoV2

2020 ◽  
Author(s):  
Mark Evert Haaksma ◽  
Micah L.A. Heldeweg ◽  
Jorge E. Lopez Matta ◽  
Jasper Martijn Smit ◽  
Jessica D. van Trigt ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Dynamic Compliance ◽  
Clinical Parameters ◽  
Duration Of Symptoms ◽  
Pleural Line ◽  
Long Duration ◽  
Academic Hospitals ◽  
Ultrasound Findings ◽  
Lung Sliding

Background: Over 2 million people worldwide have been infected with Severe Acute Respiratory Distress Syndrome Corona Virus 2 (SARS CoV2). Lung ultrasound has been proposed to diagnose and it. However, little is known about ultrasound findings in these patients. Our aim is to present an overview of lung ultrasound characteristics in critically ill patients with SARS CoV2 pneumonia overall and in relation to the duration of symptoms and clinical parameters. Methods: On the Intensive Care Unit of two academic hospitals, adult patients who tested positive for SARS-CoV2 were included. Images were analyzed for pleural line characteristics, number and appearance of B-lines, BLUE-profiles (Bedside Lung Ultrasound in Emergency), pathology in the PLAPS (Postero Lateral Alveolar and Pleural Syndrome) point and a LUS-score (lung ultrasound). The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) duration of symptoms and their correlation with clinical parameters. Results: In this pilot observational study, 61 patients were included with 75 examinations for analysis. The most prevalent ultrasound findings were decreased lung sliding (36%), thickening of the pleural line (42%) and a C-profile per view (37%). Patients with ″long″ duration of symptoms presented more frequently with a thickened and irregular pleural line (21% (32) vs 9% (11), p=.01), C-profile per patient (47% (18) vs. 25% (8),p=.01) and pleural effusion (19% (14) vs 5% (3),p=.02) compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with P/F ratio, fluid balance or dynamic compliance, with the exception of the LUS-score and dynamic compliance (R2=0.27, p=.02). Conclusion: SARS CoV2 results in significant ultrasound changes, with decreased lung sliding, thickening of the pleural line and a C-profile being the most observed. With time, a thickened and irregular pleural line, C-profile and pleural effusion become more common findings.

Comparison of lung bedside ultrasound and BNP in the diagnosis of acute heart failure in the emergency department

2020 ◽  
Vol 8 (1) ◽  
pp. 50-50
Author(s):  
Seyed Hossein Ojaghi Haghighi ◽  
Neda Hamed ◽  
Shiva Ebrahimi ◽  
Jafar Ghobadi ◽  
Hoorolnesa Ameli
Keyword(s):  
Heart Failure ◽  
Emergency Room ◽  
Pulmonary Edema ◽  
Acute Heart Failure ◽  
Lung Ultrasound ◽  
P Value ◽  
Ultrasound Evaluation ◽  
Ultrasound Findings ◽  
Medical Advances ◽  
B Lines

Introduction: Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP. Methods: This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure. Results: Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001). Conclusion: The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.

scholarly journals Interobserver Agreement of Lung Ultrasound Findings of COVID-19

2020 ◽  
Author(s):  
Andre Kumar ◽  
Yingjie Weng ◽  
Sally Graglia ◽  
Sukyung Chung ◽  
Youyou Duanmu ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Lung Ultrasound ◽  
Research Question ◽  
Portable Devices ◽  
Rt Pcr ◽  
Portable Ultrasound ◽  
Pleural Thickening ◽  
Increased Risk ◽  
Ultrasound Findings ◽  
B Lines

Background: Lung ultrasound (LUS) may be used in the diagnostic evaluation of patients with COVID-19. An abnormal LUS is associated with increased risk for ICU admission in COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown. Research Question: What is the interrater reliability of lung ultrasound findings in patients with RT-PCR confirmed COVID-19? Study Design and Methods: This study was conducted at conducted at two academic medical centers between 03/2020-06/2020. Nine physicians (hospitalists: n=4; emergency medicine: n=5) independently evaluated n=20 LUS scans (n=180 independent observations) collected from RT-PCR confirmed COVID-19 patients. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values were used to calculate IRR. Results: There was substantial IRR on the following items: normal LUS scan (K=0.79 [95% CI: 0.72-0.87]), presence of B-lines (K=0.79 [95% CI: 0.72-0.87]), >=3 B-lines observed (K=0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (K=0.57 [95% CI: 0.50-0.64]), subpleural consolidation (K=0.49 [95% CI: 0.42-0.56]), and presence of effusion (K=0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (K=0.23 [95% CI: 0.15-0.30]). Interpretation: Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.

scholarly journals Lung Ultrasound Findings in Patients Hospitalized with Covid-19

2020 ◽  
Author(s):  
Andre Kumar ◽  
Sukyung Chung ◽  
Youyou Duanmu ◽  
Sally Graglia ◽  
Farhan Lalani ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Lung Ultrasound ◽  
The United States ◽  
Clinical Deterioration ◽  
Point Of Care Ultrasound ◽  
X Rays ◽  
Disease Course ◽  
Pleural Thickening ◽  
Ultrasound Findings ◽  
B Lines

IntroductionPoint-of-care ultrasound (POCUS) has the potential to transform healthcare delivery in the era of COVID-19 with its diagnostic and therapeutic expediency. It can be performed by clinicians already at the bedside, which permits an immediate and augmented assessment of a patient. Although lung ultrasound can be used to accurately diagnose a variety of disease states such as pneumothorax, pleural effusions, pneumonia and interstitial lung disease2, there are limited reports on the sonographic manifestations of COVID-19. There is an urgent need to identify alternative diagnostic modalities that can be immediately employed at the bedside of COVID-19 patients.MethodsThis study was conducted at two medical centers in the United States from 3/21/2020-6/01/2020. Any adult who was hospitalized with COVID-19 (based on symptomatology and a confirmatory RT-PCR for SARS-CoV-2) and received a pulmonary POCUS examination was included. Providers were instructed to use a 12-zone scanning protocol for pulmonary views and save 6 second clips of each lung zone. This study utilized several POCUS devices, including Butterfly IQ, Vave, Lumify, and Sonosite. The collected images were interpreted by the study researchers based on a consensus document developed by the study authors and previously accepted definitions of lung POCUS findings.ResultsA total of 22 eligible patients who received 36 lung scans were included in our study. Eleven (50%) patients experienced clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death within 28 days from the initial symptom onset). Among the 36 lung scans collected, only 3 (8%) were classified as normal. The remaining scans had the following abnormalities: presence of B-lines (n=32, 89%), consolidations (n=20, 56%), pleural thickening (n=17, 47%), and pleural effusion (n=4, 11%). Out of 20 scans with consolidations, 14 (70%) were subpleural and 5 (25%) were translobar. A-lines were present in 26 (72%) of patients, although they were only observed in the majority of the collected lung zones in 5 (14%) of patients. Ultrasound findings were stratified by time from symptom onset to the scan based on the following time periods: early (0-6 days), middle (7-13 days), and late (14-28 days). B-lines appeared early after symptom onset and persisted well into the late disease course. In contrast, pleural thickening increased in frequency over time (early: 25%, middle: 47%, late: 67%). Subpleural consolidations also appeared in higher frequency later in the disease course (early: 13%, middle 42%, late: 56%).Discussioncertain lung ultrasound findings may be common in Covid-19, while others may appear later in the disease course or only occur in patients who experience clinical deterioration. Future efforts should investigate the predictive utility of consolidations, pleural thickening and B-lines for clinical deterioration and compare them to traditional radiological studies such as X-rays or CTs.

Acute Lung Injury after Instillation of Human Breast Milk into Rabbits' Lungs 

1999 ◽  
Vol 90 (4) ◽  
pp. 1112-1118 ◽  
Author(s):  
Brendan O'Hare ◽  
Christopher Chin ◽  
Jerrold Lerman ◽  
Junko Endo
Keyword(s):  
Breast Milk ◽  
Lung Injury ◽  
Gastric Juice ◽  
Neutrophil Count ◽  
Arterial Oxygen Tension ◽  
Dynamic Compliance ◽  
Arterial Oxygen ◽  
Human Breast Milk ◽  
Human Breast ◽  
Ph Values

Background The authors compared the lung injury in rabbits that occurred after tracheal instillation of human breast milk (HBM) acidified to pH 1.8 with hydrochloric acid (HCl), HBM at its native pH (7.0), and HBM acidified with gastric juice to pH 1.8 and 3.0. Methods The alveolar-to-arterial oxygen tension gradient and dynamic compliance were recorded before and hourly for 4 h after intratracheal instillation of 0.8 ml/kg HBM acidified with HCI (pH 1.8), HBM at its native pH (7.0), HBM acidified with gastric juice (pH 1.8 or 3.0), or 5% dextrose solution acidified with gastric juice (pH 1.8) as a control in 30 adult rabbits. The circulating neutrophil count and phagocyte oxidant activity were determined before and 1 and 4 h after instillation. Results The alveolar-to-arterial oxygen tension gradient increased and dynamic compliance decreased significantly in all groups after instillation of HBM compared with baseline values and those in the control group. The severity of the lung injury after instillation of HBM at all pH values (1.8, 3.0, and 7.0) and after acidification with gastric juice or HCl was similar. The circulating neutrophil count increased steadily for 4 h after instillation (P &lt; 0.013), whereas spontaneous phagocyte oxidant burst activity peaked at 1 h (P &lt; 0.007) and returned to baseline by 4 h after instillation. Conclusions The severity of the lung injury after tracheal instillation of 0.8 ml/kg HBM in rabbits is similar at pH values between 1.8 and 7.0 after acidification with HCl or gastric juice. Tracheal instillation of HBM increases the circulating neutrophil count and phagocyte oxidant burst activity.

scholarly journals ROLE OF LUNG ULTRASOUND FOR THE ETIOLOGICAL DIAGNOSIS OF COMMUNITY- ACQUIRED PNEUMONIA IN CHILDREN: A PROSPECTIVE STUDY

2020 ◽  
Author(s):  
Danilo Buonsenso ◽  
Annamaria Musolino ◽  
Valentina Ferro ◽  
Cristina De Rose ◽  
Rosa Morello ◽  
...  
Keyword(s):  
Prospective Study ◽  
Lung Ultrasound ◽  
Community Acquired Pneumonia ◽  
Clinical Parameters ◽  
Etiological Diagnosis ◽  
Size Number ◽  
Ultrasound Findings ◽  
Personalized Approach ◽  
A Prospective Study

ABSTRACTObjective and designOur prospective study is one of the largest prospective study assessing the role of detailed lung ultrasound features to discriminate the etiological diagnosis of Community acquired pneumonia (CAP) in children.MethodologyWe prospectively analysed patients aged from 1 month to 17 years admitted between March 2018 and April 2020 who were hospitalized for CAP. For all patients included in the study, history, clinical parameters, microbiological data, and lung ultrasound data were collected.Patients were stratified into three main groups (“bacterial”, “viral”, “atypical”) according to the presumed microbial aetiology and lung ultrasound findings evaluated according to the aetiological group.ResultsWe found that some ultrasound findings as size, number and distribution of consolidations, the position and motion of air bronchograms, pleural effusions and distribution of vertical artifacts significantly differ (p < 0.05) in children with bacterial, viral and atypical CAP. Conversely, clinical parameters and laboratory were not able to significantly distinguish between these groups. Chest x-ray, despite being still widely used, was the less useful tool in this discrimination.ConclusionOur study provides a detailed analysis of LUS features able to predict the etiology CAP in children. These findings may help the physicians to better manage a child with CAP and to offer personalized approach, from diagnosis to treatment and follow-up.

scholarly journals Lung Ultrasound to detect cardiopulmonary interactions in acutely ill children

2021 ◽  
Author(s):  
Danilo Buonsenso ◽  
Cristina De Rose ◽  
Valentina Ferro ◽  
Rosa Morello ◽  
Anna Maria Musolino ◽  
...  
Keyword(s):  
Inflammatory Disease ◽  
Cardiac Disease ◽  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Cardiopulmonary Interactions ◽  
Systemic Inflammatory Disease ◽  
Ultrasound Findings ◽  
Tract Infections ◽  
Ultrasound Parameters ◽  
B Lines

Objective and design: Our prospective observational study is the first study that evaluates the LUS findings of cardiopulmonary interactions in acutely ill children with elevated pro-BNP levels,with the aim of establishing the specific LUS pattern in this category of patients without primary lung diseases.Methodology:We prospectively analyzed epidemiological, clinical, laboratory, instrumental and lung ultrasound parameters in acutely ill children aged 1 month to 18 years admitted to the Department of Pediatrics between March 2020 to August 2020.Among the acutely ill patients evaluated, only patients with pro-BNP> 300 pg / ml and who underwent LUS before the start of any treatment were included. They were stratified into three sub-categories based on the diagnosis A) cardiac disease, B) systemic inflammatory disease / sepsis without functional and / or organic alterations of the myocardium and C) systemic inflammatory disease / sepsis and cardiac disease, and were classified into two groups based on the level of pro-BNP.We also enrolled patients belonging to two other categories (patients with primary infectious lung disease and completely healthy patients) analyzing their epidemiological, clinical, laboratory, instrumental parameters and lung ultrasound findings and comparing them with those of acutely ill children.Results and Conclusion: We found that LUS findings in these acutely ill children are different from the ultrasound pattern of other categories of children and in particular 1) children with acute lower respiratory tract infections and 2) healthy infants.The finding in a child of a sonographic interstitial syndrome with multiple, bright, long, separate and non-confluent B-lines / long vertical artefacts deriving from a normal and regular pleural line, in the absence of subpleural consolidations, is strongly predictive of cardiogenic pulmonary edema or pulmonary congestion in the course of systemic inflammatory disease / sepsis.

Alveolar-arterial oxygen tension gradient due to diffusion

1963 ◽  
Vol 18 (4) ◽  
pp. 673-680 ◽  
Author(s):  
Norman C. Staub
Keyword(s):  
Time Course ◽  
Arterial Oxygen Tension ◽  
Normal Subjects ◽  
Arterial Oxygen ◽  
Diffusion Resistance ◽  
Pulmonary Capillaries ◽  
Pulmonary Capillary ◽  
Capillary Membrane ◽  
Capillary Blood Volume ◽  
Pulmonary Capillary Blood

This is a theoretical paper in which the absolute time course of O2 uptake by the red blood cells during their passage through the pulmonary capillaries is calculated from recently obtained values of thetaO2 (the rate of O2 uptake by human red cells per milliliter of blood as a function of O2Hb saturation), the components of diffusion resistance (alveolar-capillary membrane and instantaneous pulmonary capillary blood volume), and the pulmonary blood flow. One result of these calculations is the alveolar-arterial Po2 difference due to diffusion. Five situations of varying degrees of diffusion stress are examined. The diffusion gradient for O2 is generally smaller than that computed by older techniques. Most of the diffusion resistance lies in the blood in normal subjects at rest breathing air. If the membrane and blood components of the diffusion resistance are unevenly distributed in the lung, the diffusion gradient will be greater than the ideal values. Regional variations in capillary transit time for any reason are more serious than membrane variation because of higher diffusion resistance of the blood normally. Submitted on November 19, 1962

scholarly journals Evolution of the Inflammatory and Fibroproliferative Responses during Resolution and Repair after Ventilator-induced Lung Injury in the Rat

2011 ◽  
Vol 115 (5) ◽  
pp. 1022-1032 ◽  
Author(s):  
Gerard F. Curley ◽  
Maya Contreras ◽  
Brendan Higgins ◽  
Cecilia O'Kane ◽  
Daniel F. McAuley ◽  
...  
Keyword(s):  
Lung Injury ◽  
Time Course ◽  
Transforming Growth Factor ◽  
Arterial Oxygen Tension ◽  
Interleukin 10 ◽  
Transforming Growth Factor Β1 ◽  
Arterial Oxygen ◽  
Normal Lung ◽  
Factor Α ◽  
Severe Lung

Background The time course and mechanisms of resolution and repair, and the potential for fibrosis following ventilation-induced lung injury (VILI), are unclear. We sought to examine the pattern of inflammation, injury, repair, and fibrosis following VILI. Methods Sixty anesthetized rats were subject to high-stretch; low-stretch, or sham ventilation, and randomly allocated to undergo periods of recovery of 6, 24, 48, and 96 h, and 7 and 14 days. Animals were then reanesthetized, and the extent of lung injury, inflammation, and repair determined. Results No injury was seen following low-stretch or sham ventilation. VILI caused severe lung injury, maximal at 24 h, but largely resolved by 96 h. Arterial oxygen tension decreased from a mean (SD) of 144.8 (4.1) mmHg to 96.2 (10.3) mmHg 6 h after VILI, before gradually recovering to 131.2 (14.3) mmHg at 96 h. VILI induced an early neutrophilic alveolitis and a later lymphocytic alveolitis, followed by a monocyte/macrophage infiltration. Alveolar tumor necrosis factor-α, interleukin-1β, and transforming growth factor-β1 concentrations peaked at 6 h and returned to baseline within 24 h, while interleukin-10 remained increased for 48 h. VILI generated a marked but transient fibroproliferative response, which restored normal lung architecture. There was no evidence of fibrosis at 7 and 14 days. Conclusions High-stretch ventilation caused severe lung injury, activating a transient inflammatory and fibroproliferative repair response, which restored normal lung architecture without evidence of fibrosis.

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