scholarly journals Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO2 retention

2020 ◽  
pp. 1-11
Author(s):  
G. Peschel ◽  
E.M. Jung ◽  
C. Fisser ◽  
F.J. Putz ◽  
T. Wertheimer ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Arithmetic Mean ◽  
Moderate Correlation ◽  
Single Centre ◽  
Laboratory Markers ◽  
Lung Aeration ◽  
Right Lobe ◽  
B Lines ◽  
Paco2 Level

BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress Syndrome (ARDS). OBJECTIVE: This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS). METHODS: A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-Line (1 point), coalescent B-Lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1–5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers. RESULTS: LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r = 0.467; p = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r = 0.632; p = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz-Index, CRP, LDH and IL-6 did not. CONCUSIONS: The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS.

scholarly journals Lung ultrasound predicts acute respiratory distress syndrome in patients with paraquat intoxication

2017 ◽  
Vol 24 (6) ◽  
pp. 275-281 ◽  
Author(s):  
Xiao Lu ◽  
DingQian Wu ◽  
YuZhi Gao ◽  
Mao Zhang
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Organ Failure ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Lung Aeration ◽  
Failure Assessment ◽  
Ultrasound Score ◽  
The Impact

Objective: We assessed the evolution of lung aeration by “Lung Ultrasound Score” to predict the acute respiratory distress syndrome in patients with paraquat intoxication. Methods: Patients with paraquat intoxication treated in the intensive care unit were reviewed. Patients who had been assessed by transthoracic lung ultrasound at 3 time points as day 1, day 3, and day 7 after the treatment were analyzed. Lung aeration was represented by the lung ultrasound score. The relationship of the score with the development of acute respiratory distress syndrome was evaluated. Results: There were 50 patients included. On day 7, 18 patients developed the acute respiratory distress syndrome. The acute respiratory distress syndrome patients demonstrated a higher mortality rate than that for the non-acute respiratory distress syndrome patients (88.9% vs 31.5%, p < 0.001). In addition, the acute respiratory distress syndrome patients not only had a higher creatinine level (p < 0.001), and Sepsis-related Organ Failure Assessment 48-h scores (p < 0.001), and a longer time to gastric lavage but also suffered from a lower PaO2/FiO2 (p < 0.001) and a higher lung ultrasound score (p < 0.001) compared to those in the non-acute respiratory distress syndrome patients. The decrease in PaO2/FiO2 between day 3 and day 7 correlated with the increase in lung ultrasound score between day 3 and day 7. There was also a significant correlation between the Sepsis-related Organ Failure Assessment score and lung ultrasound score in acute respiratory distress syndrome patient on day 7. Conclusion: The transthoracic lung ultrasound may be a useful tool for lung aeration assessment on patients with paraquat intoxication receiving treatment. Further studies are needed to evaluate the impact of this screening strategy on predicting acute respiratory distress syndrome.

scholarly journals Evaluation of the Efficacy of Budesonide Combined with Pulmonary Surfactants on the Neonatal Respiratory Distress Syndrome by Pulmonary Ultrasonography

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Chuanlong Zhang
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Premature Infants ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Control Group ◽  
Ultrasound Images ◽  
Neonatal Respiratory Distress ◽  
Experimental Group ◽  
Paco2 Level

Objective. This study aimed to investigate the value of lung ultrasound images in evaluating the efficacy of budesonide combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS) in premature infants. Methods. 76 NRDS premature infants admitted to the hospital were randomly divided into experimental group and control group, with 38 children in each group. The premature infants in control group underwent PS, and those in experimental group underwent budesonide combined with PS. After treatment, lung ultrasound imaging was used to evaluate the curative effect, and X-ray results were used as a reference. The changes in clinical signs of two groups were detected, and the pulmonary ultrasound was used to evaluate the clinical efficacy of two groups. The changes in the lung ultrasound score (LUS) and arterial blood gas (ABG) indexes of two groups were compared before and after treatment. Results. LUS and improvement of patients of experimental group were obviously higher than those of the control group after treatment. LUS of experimental group was 12.1 ± 3.7, and that of control group was 18.2 ± 2.3, respectively. The differences were statistically significant ( P  < 0.05). The arterial partial oxygen pressure (PaO2) and oxygenation index (PaO2/FiO2) levels of two groups of patients increased dramatically after treatment. PaO2 and PaO2/FiO2 levels of experimental group were 65.59 ± 12.46 mmHg and 112.57 ± 19.3 mmHg, and those of control group were 45.12 ± 11.21 mmHg and 101.28 ± 21.36 mmHg, respectively. However, arterial partial pressure of carbon dioxide (PaCO2) level was significantly decreased in two groups after treatment. PaCO2 level of experimental group was 40.24 ± 8.92 mmHg, and that of control group was 41.22 ± 9.24 mmHg, respectively ( P  < 0.05). The diagnostic accuracy of lung ultrasound images in two groups was 95.3% and 96.2%, respectively. Conclusion. Pulmonary ultrasonography showed a high diagnostic accuracy in evaluating the efficacy of budesonide combined with PS in the treatment of NRDS in premature infants. It can evaluate the cardiopulmonary function of premature infants with NRDS and effectively improve the respiratory status of premature infants. In conclusion, this study provided some reference value for upgrading the clinical treatment of NRDS in premature infants.

scholarly journals Milky Lungs: Ultrasonographic Findings in Pediatric Acute Respiratory Distress Syndrome

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.

scholarly journals Lung ultrasound and BNP to detect hidden pulmonary congestion in euvolemic hemodialysis patients: a single centre experience

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Domenico Giannese ◽  
Alessandro Puntoni ◽  
Adamasco Cupisti ◽  
Riccardo Morganti ◽  
Enrico Varricchio ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Lung Ultrasound ◽  
Dry Weight ◽  
Serum Levels ◽  
Hemodialysis Patients ◽  
Pulmonary Congestion ◽  
Single Centre ◽  
Single Centre Experience ◽  
B Lines

Abstract Background Dry weight assessment in hemodialysis (HD) remains a challenge. The aim of the study was to investigate the prevalence of subclinical pulmonary congestion using lung ultrasound (LUS) in maintenance HD patients with no clinical or bioimpedance signs of hyperhydration. The correlation between B-lines Score (BLS) and brain natriuretic peptide (BNP) was also evaluated. Methods Twenty-four HD patients underwent LUS and BNP dosage at the end of the mid-week HD session, monthly for 6 months . LUS was considered as positive when BLS was >15. Hospitalizations and cardiovascular events were also evaluated in relation to the BLS. Results LUS+ patients at baseline were 16 (67%), whereas 11 (46%) showed LUS + in at least 50% of the measurements (rLUS+ patients). Only the rLUS+ patients had a higher number of cardiovascular events [p=0.019, OR: 7.4 (CI 95%. 1.32-39.8)] and hospitalizations [p=0.034, OR 5.5 (CI 95% 1.22- 24.89)]. A BNP level of 165 pg/ml was identified as cut-off value for predicting pulmonary congestion, defined by BLS >15. Conclusion Prevalence of pulmonary congestion as assessed by LUS and persistent or recurrent BLS >15 were quite prevalent findings in euvolemic HD patients. In the patients defined as rLUS+, a higher rate of cardiovascular events and hospital admissions was registered. BNP serum levels > 165 pg/ml resulted predictive of pulmonary congestion at LUS. In the dialysis care, regular LUS examination should be reasonably included among the methods useful to detect subclinical lung congestion and to adjust patients’ dry weight.

Modified Lung Ultrasound Score for Assessing and Monitoring Pulmonary Aeration

2017 ◽  
Vol 38 (05) ◽  
pp. 530-537 ◽  
Author(s):  
Silvia Mongodi ◽  
Bélaïd Bouhemad ◽  
Anita Orlando ◽  
Andrea Stella ◽  
Guido Tavazzi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Intercostal Space ◽  
Icu Patients ◽  
Severe Loss ◽  
Constant Variance ◽  
Lung Aeration ◽  
Ultrasound Score ◽  
Space Width ◽  
B Lines ◽  
Pleural Involvement

Abstract Purpose Lung Ultrasound Score (LUSS) is a useful tool for lung aeration assessment but presents two theoretical limitations. First, standard LUSS is based on longitudinal scan and detection of number/coalescence of B lines. In the longitudinal scan pleura visualization is limited by intercostal space width. Moreover, coalescence of B lines to define severe loss of aeration is not suitable for non-homogeneous lung pathologies where focal coalescence is possible. We therefore compared longitudinal vs. transversal scan and also cLUSS (standard coalescence-based LUSS) vs. qLUSS (quantitative LUSS based on % of involved pleura). Materials and methods 38 ICU patients were examined in 12 thoracic areas in longitudinal and transversal scan. B lines (number, coalescence), subpleural consolidations (SP), pleural length and pleural involvement (> or ≤ 50 %) were assessed. cLUSS and qLUSS were computed in longitudinal and transversal scan. Results Transversal scan visualized wider (3.9 [IQR 3.8 – 3.9] vs 2.0 [1.6 – 2.5] cm, p < 0.0001) and more constant (variance 0.02 vs 0.34 cm, p < 0.0001) pleural length, more B lines (70 vs 59 % of scans, p < 0.0001), coalescence (39 vs 28 %, p < 0.0001) and SP (22 vs 14 %, p < 0.0001) compared to longitudinal scan. Pleural involvement > 50 % was observed in 17 % and coalescence in 33 % of cases. Focal coalescence accounted for 52 % of cases of coalescence. qLUSS-transv generated a different distribution of aeration scores compared to cLUSS-long (p < 0.0001). Conclusion In unselected ICU patients, variability of pleural length in longitudinal scans is high and focal coalescence is frequent. Transversal scan and quantification of pleural involvement are simple measures to overcome these limitations of LUSS.

Lung ultrasound and the role of lung aeration score in patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation

2021 ◽  
pp. 039139882110513
Author(s):  
Stefanie Curry ◽  
Aileen Tan ◽  
Luna Gargani ◽  
Oriana Ng ◽  
Andrew Roscoe ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Pleural Effusions ◽  
Membrane Oxygenation ◽  
Lung Aeration ◽  
Vv Ecmo

Objective: This was a pilot study to determine the utility of daily lung ultrasound (LUS) in patients requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). Design: This was a prospective, observational study. Setting: The study took place in the intensive care unit at Royal Papworth Hospital in Cambridge, UK. Participants: We recruited adult patients receiving VV-ECMO for ARDS. Interventions: All patients received a lung computed tomography (CT) scan and LUS on admission. Bedside chest radiography (CXR) and LUS were done on a daily basis until patients were decannulated. Measurements and main results: Daily LUS aeration scores were calculated according to the appearance of four defined patterns. An independent radiologist calculated corresponding scores for CT and CXR, retrospectively. These were checked for correlation with LUS aeration scores. There were statistically significant correlations between LUS versus CT ( r = 0.868, p = 0.002) and LUS versus CXR ( r = 0.498, p = 0.018) with good agreement and no evidence of proportional bias. LUS was able to detect 13.5% of pleural effusions and 54.2% of pneumothorax that were not picked up on CXR. In most of the patients who were weaned off VV-ECMO, a progressive reduction of LUS aeration scores corresponding to lung re-aeration was observed. Conclusions: LUS correlated with findings on CT and CXR for quantifying lung aeration and the clinical presentation of patients. LUS also picked up more pleural effusions and pneumothorax than CXR. Together with traditional imaging techniques, the routine use of LUS should be considered for this patient group.

scholarly journals Use of lung ultrasound in neonates during the COVID-19 pandemic

2020 ◽  
Vol 53 (6) ◽  
pp. 401-404
Author(s):  
Marcia Wang Matsuoka ◽  
Silvia Maria Sucena da Rocha ◽  
Maria Augusta Bento Cicaroni Gibelli ◽  
Carla Marques Nicolau ◽  
Werther Brunow de Carvalho ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Ultrasound Examination ◽  
Neonatal Period ◽  
Ultrasound Images ◽  
Normal Pattern ◽  
Pleural Thickening ◽  
Pleural Line ◽  
B Lines

Abstract In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2, ultrasound has played a fundamental role in patients who develop the resulting disease, designated coronavirus disease 2019 (COVID-19). In this study we present ultrasound images of the lungs of neonates with a suspected or confirmed diagnosis of COVID-19, distinguishing between the changes related to COVID-19 and those unrelated to the disease. Ultrasound examinations were performed by a pediatric sonographer. A total of 27 neonates were evaluated. Among those who presented no respiratory symptoms, some tested negative for COVID-19 and others tested positive. All of those who were pulmonary symptomatic, negative for COVID-19 presented transient tachypnea of the newborn and respiratory distress syndrome. Lung ultrasound images obtained in COVID-19-negative neonates showed, in some cases, a normal pattern (with A lines, few B lines, a thin, linear pleural line, and no pleural effusion), whereas in others showed coalescent B lines and areas of opacity. In two of the COVID-19-positive neonates, lung ultrasound examination showed several coalescent B lines, pleural thickening, and areas of opacity. Lung ultrasound in the neonatal period appears to be applicable within the context of the current pandemic, allowing efficient evaluation of COVID-19-related changes in neonates, as well as of pathologies inherent to the neonatal period.

scholarly journals POS0842 LUNG ULTRASOUND TO ASSESS THE SEVERITY OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 675.1-675
Author(s):  
C. Bruni ◽  
L. Mattolini ◽  
L. Tofani ◽  
L. Gargani ◽  
N. Landini ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Quantitative Methods ◽  
Lung Ultrasound ◽  
Significant Negative Correlation ◽  
High Resolution Computed Tomography ◽  
Quantitative Score ◽  
Quantitative Scoring ◽  
B Lines

Background:Interstitial lung disease (ILD) is one of the most common complications and one of the main causes of morbidity and mortality in Systemic Sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for the diagnosis of ILD and it allows its quantification. Among semi-quantitative methods, Goh et al proposed a semi-quantitative scoring system to visually quantify ILD extent, with categorical cut-off of 20% to distinguish limited and extensive parenchymal involvement with prognostic implications. More recently, the use of radiomics has allowed the objective quantification of ILD through the use of dedicated software, which calculate different parameters of lung density.Given the exposure to ionizing radiation that the procedure entails, other methods of ILD evaluation are being studied, among which lung ultrasound (LUS) identifies the B-lines as a main feature of ILD. So far, different evidences have proposed the use of LUS for the screening of ILD, even in the early phases of the disease and in subclinical lung involvement.Objectives:the aim of this study is to test the role of LUS in quantifying the severity of SSc-ILD, evaluated with both semi-quantitative visual radiological and quantitative radiomic scores.Methods:Adult SSc patients classified according to the ACR/EULAR 2013 criteria patients were assessed with pulmonary function test (PFTs), lung ultrasound and HRCT over 60 days. CT images were analysed qualitatively (by presence/absence of ILD), semi-quantitatively (categorical Goh score <20% vs> 20% of extent and the continuous extent Goh score made from 5 levels’ assessment– 0 to 100%) and quantitatively [with the densitometric radiomic data obtained through the Horos software - Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume (LV)]. LUS was used to quantify the B-lines detected in each patient by scanning a total of 13 intercostal spaces, on both anterior and posterior chest wall.Results:Among 59 SSc patients (81% women, mean age 48±14 years, 45% anti-Scl70 positive), 23 (39%) presented ILD on HRCT, of which 14 limited and 9 extensive. The mean visual semi-quantitative score was 6%, ranging from 0 to 66%. Our data showed a significantly different number of B-Lines in ILD vs non-ILD patients (median 38 vs 9, p <.005), a result which was further confirmed among non-ILD vs ILD> 20% (median 47 vs 9, p=.001) and ILD <20% (median 36 vs 9, p=.001) patients. Conversely, the number of B-lines was not statistically different between patients with ILD <20% and >20% (median 47 vs 36, p=.78). We observed a significant negative correlation between the number of B-lines and FVC (r=-.472, p<.05) TLC (r=-.436, p=.003), DLco (r=-.515, p<.001), DLCO/VA (r=.-306, p=.03). Finally, the number of B-lines showed a statistically significant correlation with the Goh score on 5 levels (r=.437, p=.001), MLA (r=.571, p<.001), kurtosis (r=-.285, p=.028), skewness (r=-.370, p = .004) and LV (r=-.277, p=.033). All data were confirmed analysing anterior and posterior B-Lines separately.Conclusion:Our study confirms that LUS represents a useful tool for the identification of SSc-ILD. In addition, we showed that LUS may be useful also for the quantification of the severity of SSc-ILD, by correlating with PFT parameters, radiomics parameters and visual radiological evaluation. Together with the PFTs, LUS could be used to increase the accuracy of the screening and, potentially, of the follow-up of SSc-ILD patients.Disclosure of Interests:Cosimo Bruni: None declared, Lavinia Mattolini: None declared, Lorenzo Tofani: None declared, Luna Gargani Consultant of: GE Healthcare, Philips Healthcare and Caption Health, Nicholas Landini: None declared, Gemma Lepri: None declared, Martina Orlandi: None declared, Serena Guiducci: None declared, Silvia Bellando Randone: None declared, Marco Matucci-Cerinic: None declared

Sign in / Sign up

Export Citation Format

Share Document