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Hassan M, Griffiths S, Probyn B, Sadaka AS, Touman AA, Trevelyan G, Breen D, Daneshvar C. Thoracic ultrasound in guiding management of respiratory disease. Expert Rev Respir Med 2024:1-20. [PMID: 39096207 DOI: 10.1080/17476348.2024.2387785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/06/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION The use of ultrasound in respiratory disease has evolved substantially over the past two decades. From a test done to confirm the safe site of pleural fluid drainage, thoracic ultrasound has become a point-of-care test that guides the management of patients on respiratory wards, in clinics and endoscopy. AREAS COVERED This review overviews the process of ultrasound examination in the chest. It then delves into specific disease areas (pleural disease, lung disease, diaphragm disease, and invasive procedures) to highlight how thoracic ultrasound is being used to refine management. The review concludes with discussion on the training curricula and assessment tools for competency in thoracic ultrasound. Being a scoping review, literature searches were conducted on PubMed using relevant search terms. EXPERT OPINION In addition to its current uses, there are many avenues where thoracic ultrasound will soon be beneficial. Recent studies show promising roles in areas such as patient-tailored guidance of pleurodesis and non-invasively predicting lung re-expansion after pleural fluid drainage. In addition, auxiliary tools such as contrast-enhanced ultrasound and elastography are proving useful in identifying the etiology and directing the successful sampling of pleural and lung lesions. Studies are also exploring the utility of sonographic biomarkers such as echogenicity and septations to predict outcomes in pleural disease.
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Affiliation(s)
- Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sally Griffiths
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Ben Probyn
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Ahmed S Sadaka
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Gareth Trevelyan
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Cyrus Daneshvar
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Plymouth Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
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Lo Cricchio A, Storelli A, Bertoletti I, Ciuti G, Fabbri A, Martinelli E, De Santis MC, Mercatelli P, El Aoufy K, Bellando Randone S, Moggi Pignone A, Accogli E, Bandini G. Accuracy of lung ultrasound performed with handheld ultrasound device in internal medicine: an observational study. J Ultrasound 2024:10.1007/s40477-024-00941-5. [PMID: 39097546 DOI: 10.1007/s40477-024-00941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/27/2024] [Indexed: 08/05/2024] Open
Abstract
AIMS Lung ultrasound (LUS) is increasingly used in Internal Medicine to complement medical examination, documenting pleural and lung conditions. This study aimed to compare the accuracy of handheld ultrasound device (HHUSD) with high-end ultrasound device (HEUSD) in patients with heart failure or pneumonia, also including the assessment of costs and time-savings. METHODS In this observational study 72 patients (aged ≥ 18) admitted to Internal Medicine Unit for heart failure or pneumonia underwent LUS plus evaluation of inferior cava vein (ICV) when indicated, using both HHUSD and HEUSD. Each evaluation, independently performed by 2 different experienced operators, included B-lines number, pleural effusion, lung consolidations, ICV ectasia and its respiratory excursions. RESULTS Concordance between HHUSD and HEUSD findings was 79.3% ± 17.7 (mean ± SD) for B-lines, 88.6% for pleural effusion, 82.3% for consolidations and 88.7% and 84.9% for ICV ectasia and its respiratory excursions respectively. BMI didn't significantly influence concordance between the two methods. Moreover, examination time (as mean ± SD) was shorter with HHUSD (8 ± 1.5 min) compared to HEUSD (10 ± 2.5 min). CONCLUSIONS HHUSD demonstrated high accuracy in detecting B-lines, pleural effusions, lung consolidations and ICV evaluation when compared to HEUSD. Thus, HHUSD, not only is characterized by accessibility, portability, and easy handling due to its small size, but it also offers advantages in terms of saving costs and time, ultimately contributing to faster patient assessment compared to HEUSD.
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Affiliation(s)
- Anna Lo Cricchio
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy.
| | - Andrea Storelli
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Iacopo Bertoletti
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Gabriele Ciuti
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Alessia Fabbri
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Elisa Martinelli
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Maria Cristina De Santis
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Paolo Mercatelli
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Khadija El Aoufy
- Department of Health Science, University of Florence, Florence, Italy
| | - Silvia Bellando Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Alberto Moggi Pignone
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
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3
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Corvino A, Basile L, Boccatonda A, Varelli C, Tafuri D, Cocco G, Catalano O. Breast ultrasound: An opportunity to detect unsuspected pleural and pulmonary abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:542-547. [PMID: 38488274 DOI: 10.1002/jcu.23663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/01/2024] [Accepted: 02/10/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE While scanning women for breast US, is possible to observe changes in the appearance of the pleural line or in the most superficial portion of the lung. The objective of this single-center, prospective study was to determine the prevalence of a variety of pleural and pulmonary US findings during routine breast US. METHODS In this study, there were 200 women undergoing standard breast US examination. The presence of pleural and pulmonary abnormalities in these cases was recorded. Two off-site reviewers confirmed the presence of pleura and lung changes. RESULTS There was no abnormal finding in 168 out of 200 cases (84%) while there were one or more abnormal findings in 32 cases (16%). Pleural effusion was observed in 0.5% of cases, thickening of the pleural line 5% of cases, irregularity of the pleural line in 6% of cases, increased number of vertical artifacts in 9% of cases, subpleural nodulations in 2% of cases, and lung consolidation in 0.5%. CONCLUSION Pleural and lung changes are not uncommon during breast US. Operators performing breast US examinations should be aware of the possibility to identify unsuspected pleuro-pulmonary abnormalities.
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Affiliation(s)
- Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Naples, Italy
| | - Luigi Basile
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bologna, Italy
| | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
| | - Domenico Tafuri
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Naples, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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Shehata SM, Almalki YE, Basha MAA, Hendy RM, Mahmoud EM, Abd Elhamed ME, Alduraibi SK, Aboualkheir M, Almushayti ZA, Alduraibi AK, Basha AMA, Alsadik ME. Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study. Diagnostics (Basel) 2024; 14:1041. [PMID: 38786339 PMCID: PMC11120087 DOI: 10.3390/diagnostics14101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.
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Affiliation(s)
- Samah M. Shehata
- Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (S.M.S.); (M.E.A.)
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.A.A.B.); (M.E.A.E.)
| | - Rasha Mohamed Hendy
- Department of Chest Disease, Faculty of Human Medicine, Benha University, Benha 13511, Egypt;
| | - Eman M. Mahmoud
- Department of Chest Disease, Faculty of Human Medicine, Port Said University, Port Said 42511, Egypt;
| | - Marwa Elsayed Abd Elhamed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (M.A.A.B.); (M.E.A.E.)
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | - Mervat Aboualkheir
- Department of Internal Medicine, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Ziyad A. Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | - Alaa K. Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia; (S.K.A.); (Z.A.A.); (A.K.A.)
| | | | - Maha E. Alsadik
- Department of Chest Disease, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt; (S.M.S.); (M.E.A.)
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Cheon EJ, Yoon JM. Reliability of renal point-of-care ultrasound (POCUS) performed by pediatric postgraduates to diagnose hydronephrosis in infants. Front Pediatr 2024; 12:1361223. [PMID: 38655276 PMCID: PMC11035807 DOI: 10.3389/fped.2024.1361223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose Point-of-care ultrasound (POCUS) has gained prominence in a variety of medical specialties due to advances in ultrasound technology. POCUS has not been fully integrated into pediatric residency training programs despite its widespread use and proven benefits. At our institution, renal POCUS is performed by pediatric residents for the evaluation of hydronephrosis, which is the main pathology for which ultrasound is used in the clinical practice of pediatric nephrology. This study was conducted to evaluate the quality of renal POCUS performed by pediatric residents in infants. Methods Four pediatric residents, comprising two first-year and two second-year residents at Konyang University Hospital, participated in the study conducted from May 2021 to May 2022. All participants had completed our Point-of-Care Ultrasound (POCUS) training program. The study focused on infants admitted to the pediatric inpatient unit, identified by attending physicians as requiring renal ultrasound. All infants underwent their initial kidney ultrasound examination. Temporal alignment between renal Point-of-Care Ultrasound (POCUS) performed by pediatric residents and conventional ultrasound (USG) conducted by radiologists was asynchronous. Pediatric residents conducted POCUS sessions during scheduled radiologist appointments throughout the day, occurring either before or after the radiologist's examination. There was no mutual awareness of each other's results. Inter-observer agreement between radiologists and pediatric residents was compared for the presence or absence of hydronephrosis and its grade, which are primary considerations in pediatric renal ultrasound. Results Our study found that 53 infants (68.8%) were diagnosed with hydronephrosis using point-of-care ultrasound (POCUS), compared to 48 infants (62.3%) diagnosed with conventional ultrasound (USG). Among the POCUS examinations conducted by pediatric residents, hydronephrosis of SFU grades 1, 2, 3, and 4 were observed in 56.6%, 35.8%, 7.5%, and 0%, respectively. Inter-observer reliability between POCUS and conventional USG showed good agreement, with Cohen's kappa coefficients exceeding 0.8 for sensitivity and 0.6 for grading. Conclusions Renal POCUS performed well in diagnosing and grading hydronephrosis in infants when performed by pediatric residents who had completed a two-phase training program.
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Affiliation(s)
- Eun Jung Cheon
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University Hospital, Daejeon, Republic of Korea
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Inchingolo R, Zanforlin A, Buonsenso D, Perrone T, Torri E, Limoli G, Mossolani EE, Tursi F, Soldati G, Marchetti G, Carlucci P, Radovanovic D, Lohmeyer FM, Smargiassi A. Lung Ultrasound Signs: The Beginning. Part 3-An Accademia di Ecografia Toracica Comprehensive Review on Ultrasonographic Signs and Real Needs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:629-641. [PMID: 38168739 DOI: 10.1002/jum.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed-anatomical and artifactual-pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Service of Pulmonology, Health District of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziano Perrone
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Elena Torri
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | | | - Paolo Carlucci
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | | | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Perez-Sanchez A, Jensen TP, Soni NJ. Clinical progress note: 5 Essential point-of-care ultrasound skills for hospitalists. J Hosp Med 2024; 19:304-311. [PMID: 38230881 DOI: 10.1002/jhm.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/09/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Ariadna Perez-Sanchez
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Trevor P Jensen
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nilam J Soni
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Medicine Service, Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Medicine, Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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8
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MATSUMOTO N, ITOH M, TOYOTOME T, HAGINO K, NEO S, YAMADA K. Usefulness of combining computed tomography and air sac fluid examination to rule out aspergillosis: case study in two gentoo penguins (Pygoscelis papua) with respiratory clinical signs. J Vet Med Sci 2024; 86:285-289. [PMID: 38233131 PMCID: PMC10963096 DOI: 10.1292/jvms.23-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024] Open
Abstract
Pulmonary aspergillosis occurring in captive penguins living in zoos and aquariums is a fatal disease owing to its high mortality rate. On conducting computed tomography, two gentoo penguins (Pygoscelis papua) with respiratory clinical signs that were housed at an aquarium in Hokkaido, Japan were found to have a certain amount of fluid in their air sacs. This fluid was collected and cultured for bacteria and fungi, the results of which both came back negative. These results enabled us to rule out bacterial infection or aspergillosis and supported our decision not to administer antibacterial and antifungal drugs. Overall, the combination of computed tomography and air sac fluid examination was useful for ruling out bacterial infection or aspergillosis in penguins with respiratory clinical signs.
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Affiliation(s)
| | - Megumi ITOH
- Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Takahito TOYOTOME
- Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
- Medical Mycology Research Center, Chiba University, Chiba, Japan
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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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10
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Bruck O, Naofal A, Senussi MH. Lung, Pleura, and Diaphragm Point-of-Care Ultrasound. Semin Ultrasound CT MR 2024; 45:120-131. [PMID: 38244897 DOI: 10.1053/j.sult.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Thoracic Ultrasonography involves the ultrasonographic examination of the lungs, pleura, and diaphragm. This provides a plethora of clinical information during the point of care assessment of patients. The air filled lungs create consistent artifacts and careful examination and understanding of these artefactual signs can provide useful information on underlying clinicopathologic states. This review aims to provide a review of the ultrasound signs and features that can be seen in horacic ultrasonography and summarize the clinical evidence to support its use.
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Affiliation(s)
- Or Bruck
- Baylor College of Medicine, Houston, TX
| | | | - Mourad H Senussi
- Baylor College of Medicine, Houston, TX; Texas Heart Institute, Houston, TX.
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Yang Y, Wu Y, Zhao W. Comparison of lung ultrasound and chest radiography for detecting pneumonia in children: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:12. [PMID: 38263086 PMCID: PMC10804756 DOI: 10.1186/s13052-024-01583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is recommended as a reliable diagnostic alternative to chest X-ray (CXR) for detecting pneumonia in children. METHODS PubMed, Embase, and Cochrane Library databases were used to identify eligible studies from their inception until April 2023. The investigated diagnostic parameters included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC). RESULTS Twenty-six studies involving 3,401 children were selected for meta-analysis. The sensitivity, specificity, PLR, NLR, DOR, and AUC of LUS for detecting pneumonia in children were 0.95, 0.92, 12.31, 0.05, 108.53, and 0.98, respectively, while the sensitivity, specificity, PLR, NLR, DOR, and AUC of CXR were 0.92, 0.93, 24.63, 0.08, 488.54, and 0.99, respectively. The sensitivity of LUS was higher than that of CXR for detecting pneumonia in children (ratio: 1.03; 95% CI: 1.01-1.06; P = 0.018), whereas the DOR of LUS was significantly lower than that of CXR (ratio: 0.22; 95% CI: 0.06-0.85; P = 0.028). CONCLUSIONS This study found that the diagnostic performance of LUS was comparable to that of CXR for detecting pneumonia, and the sensitivity of LUS was superior to that of CXR.
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Affiliation(s)
- Yalong Yang
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China.
| | - Yuexuan Wu
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China
| | - Wen Zhao
- Ningxia Medical University, Yinchuan, 750004, China
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12
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Zaki HA, Albaroudi B, Shaban EE, Shaban A, Elgassim M, Almarri ND, Basharat K, Azad AM. Advancement in pleura effusion diagnosis: a systematic review and meta-analysis of point-of-care ultrasound versus radiographic thoracic imaging. Ultrasound J 2024; 16:3. [PMID: 38261109 PMCID: PMC10805747 DOI: 10.1186/s13089-023-00356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pleural effusion is a fluid buildup in the pleural space that mostly result from congestive heart failure, bacterial pneumonia, malignancy, and pulmonary embolism. The diagnosis of this condition can be challenging as it presents symptoms that may overlap with other conditions; therefore, imaging diagnostic tools such as chest x-ray/radiograph (CXR), point-of-care ultrasound (POCUS), and computed tomography (CT) have been employed to make an accurate diagnosis. Although POCUS has high diagnostic accuracy, it is yet to be considered a first-line diagnostic tool as most physicians use radiography. Therefore, the current meta-analysis was designed to compare POCUS to chest radiography. METHODS n extended search for studies related to our topic was done on five electronic databases, including PubMed, Medline, Embase, Scopus, and Google Scholar. A quality assessment using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was performed on all eligible articles obtained from the databases. Moreover, the diagnostic accuracy of POCUS and CXR was performed using STATA 16 software. RESULTS Our search yielded 1642 articles, of which only 18 were eligible for inclusion and analysis. The pooled analysis showed that POCUS had a higher diagnostic accuracy compared to CXR (94.54% (95% CI 91.74-97.34) vs. 67.68% (95% CI 58.29-77.08) and 97.88% (95% CI 95.77-99.99) vs. 85.30% (95% CI 80.06-90.54) sensitivity and specificity, respectively). A subgroup analysis based on the position of patients during examinations showed that POCUS carried out in supine and upright positions had higher specificity than other POCUS positions (99%). In comparison, lateral decubitus CXR had higher sensitivity (96%) and specificity (99%) than the other CXR positions. Further subgroup analyses demonstrated that CXR had higher specificity in studies that included more than 100 patients (92.74% (95% CI 85.41-100). Moreover, CXR tends to have a higher diagnostic accuracy when other CXR positions are used as reference tests (93.38% (95% CI 86.30-100) and 98.51% (95% CI 94.65-100) sensitivity and specificity, respectively). CONCLUSION POCUS as an imaging modality has higher diagnostic accuracy than CXR in detecting pleural effusion. Moreover, the accuracy is still high even when performed by physicians with less POCUS training. Therefore, we suggest it is considered a first-line imaging tool for diagnosing pleural effusion at the patients' bedside.
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Affiliation(s)
- Hany A Zaki
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bilal Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Eman E Shaban
- Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Doha, Qatar
| | - Ahmed Shaban
- Department of Internal Medicine, Mansoura General Hospital, Mansoura, Egypt
| | - Mohamed Elgassim
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nood Dhafi Almarri
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Kaleem Basharat
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Mohammad Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Hamad Medical Corporation, Collège of Medicine QU and Weil Cornell Medical College, Doha, Qatar
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13
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Gualtierotti R, Solimeno LP, Peyvandi F. Ultrasound evaluation of hemophilic arthropathy: a proposal of definitions in a changing landscape. Res Pract Thromb Haemost 2024; 8:102314. [PMID: 38322151 PMCID: PMC10844857 DOI: 10.1016/j.rpth.2023.102314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024] Open
Abstract
The advent of novel effective treatments and the identification of the need to achieve a higher trough level for persons with hemophilia A and B have changed the landscape of management of these patients, allowing to change the target from survival and prevention of life-threatening complications to prevention of musculoskeletal complications and improvement of quality of life. Point-of-care musculoskeletal ultrasound imaging has also improved the early recognition of joint bleeding and the differential diagnosis of acute joint pain. In addition, joint ultrasound allows the evaluation of the severity of hemophilic arthropathy in terms of synovitis and cartilage and bone damage. However, a lack of standardization in the definition of ultrasound elementary lesions of hemophilic arthropathy may lead to confusion and an incorrect evaluation of the presence and progression of joint damage. Here, we propose to start a standardization and validation process for ultrasound definitions of hemophilic arthropathy that has been planned to become a project within the Factor VIII/IX Standardization Subcommittee of the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee.
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Affiliation(s)
- Roberta Gualtierotti
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luigi Piero Solimeno
- Division of Orthopaedic Surgery and Traumatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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14
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Bhattacharjee S, Prasanna M, Maitra S, Ray BR. Lung Ultrasound Findings in a Patient with Lymphangitic Carcinomatosis. Indian J Crit Care Med 2024; 28:82-83. [PMID: 38510761 PMCID: PMC10949285 DOI: 10.5005/jp-journals-10071-24597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
How to cite this article: Bhattacharjee S, Prasanna M, Maitra S, Ray BR. Lung Ultrasound Findings in a Patient with Lymphangitic Carcinomatosis. Indian J Crit Care Med 2024;28(1):82-83.
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Affiliation(s)
- Sulagna Bhattacharjee
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mrudula Prasanna
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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15
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Asharaf A, Gayle J, Patel N, Austin A, Alzghoul B. A 33-Year-Old Woman With Refractory Hypotension in the ICU: Thoracic and Mediastinal Ultrasound Images for Identifying the Etiology of Shock. Chest 2023; 164:e151-e154. [PMID: 37945198 DOI: 10.1016/j.chest.2022.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/13/2022] [Indexed: 11/12/2023] Open
Affiliation(s)
- Afsana Asharaf
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL.
| | - Jovan Gayle
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
| | - Nishil Patel
- Department of Emergency Medicine, University of Florida, Gainesville, FL
| | - Adam Austin
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
| | - Bashar Alzghoul
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
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16
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Huang S, de Jong D, Das JP, Widemon RS, Braumuller B, Paily J, Deng A, Liou C, Roa T, Huang A, Ma H, D'Souza B, Leb J, L'Hereaux J, Nguyen P, Luk L, Francescone M, Yeh R, Maccarrone V, Dercle L, Salvatore MM, Capaccione KM. Imaging the Side Effects of CAR T Cell Therapy: A Primer for the Practicing Radiologist. Acad Radiol 2023; 30:2712-2727. [PMID: 37394411 DOI: 10.1016/j.acra.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 07/04/2023]
Abstract
Chimeric antigen receptor (CAR) T cell therapy is a revolutionary form of immunotherapy that has proven to be efficacious in the treatment of many hematologic cancers. CARs are modified T lymphocytes that express an artificial receptor specific to a tumor-associated antigen. These engineered cells are then reintroduced to upregulate the host immune responses and eradicate malignant cells. While the use of CAR T cell therapy is rapidly expanding, little is known about how common side effects such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) present radiographically. Here we provide a comprehensive review of how side effects present in different organ systems and how they can be optimally imaged. Early and accurate recognition of the radiographic presentation of these side effects is critical to the practicing radiologist and their patients so that these side effects can be promptly identified and treated.
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Affiliation(s)
- Sophia Huang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Dorine de Jong
- Department of Immunology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (D.J.)
| | - Jeeban P Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (J.D., R.Y.)
| | - Reginald Scott Widemon
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Brian Braumuller
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Jacienta Paily
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Aileen Deng
- Department of Hematology and Oncology, Novant Health, 170 Medical Park Road, Mooresville, North Carolina 28117 (A.D.)
| | - Connie Liou
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Tina Roa
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Alice Huang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Belinda D'Souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Jade L'Hereaux
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Pamela Nguyen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Lyndon Luk
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Mark Francescone
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Randy Yeh
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (J.D., R.Y.)
| | - Valerie Maccarrone
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Laurent Dercle
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.)
| | - Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.).
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Ozkaya-Parlakay A, Polat M, Kanik-Yuksek S, Gulhan B. Treatment of Parapneumonic Effusion in Children. Pediatr Infect Dis J 2023; 42:e359-e360. [PMID: 37257113 DOI: 10.1097/inf.0000000000003978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Aslinur Ozkaya-Parlakay
- Pediatric Infectious Diseases Department, Yildirim Beyazit University Ankara City Hospital, Ankara, Turkey
| | - Meltem Polat
- Pediatric Infectious Diseases Department, Gazi University, Ankara, Turkey
| | - Saliha Kanik-Yuksek
- Pediatric Infectious Diseases Department, Ankara City Hospital, Ankara, Turkey
| | - Belgin Gulhan
- Pediatric Infectious Diseases Department, Ankara City Hospital, Ankara, Turkey
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18
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Clark A, Lampley P, Tran VH. Point-of-care Ultrasound Identification of Tension Hydrothorax in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2023; 7:127-131. [PMID: 37595302 PMCID: PMC10438948 DOI: 10.5811/cpcem.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Tension hydrothorax is an uncommon emergent condition in which hemodynamic instability and respiratory compromise may occur. Emergency physicians may diagnose tension hydrothorax by point-of-care ultrasound. CASE SERIES We discuss the key sonographic features assisting in identification. Four patients with history of malignancy who were found to have tension hydrothorax exhibited the following common ultrasound findings: massive, left-sided pleural effusion; complete, compressive atelectasis; and shift of cardiac structures into the right hemithorax, resulting in right-sided probe placement to obtain cardiac views. CONCLUSION This is the first instance to our knowledge of point-of-care ultrasound findings in tension hydrothorax to be described in the literature.
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Affiliation(s)
- Allison Clark
- Aventura Hospital and Medical Center, Emergency Medicine Residency Program, Aventura, Florida
| | - Peyton Lampley
- Aventura Hospital and Medical Center, Emergency Medicine Residency Program, Aventura, Florida
| | - Vu Huy Tran
- Aventura Hospital and Medical Center, Emergency Medicine Residency Program, Aventura, Florida
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19
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Polyzogopoulou E, Velliou M, Verras C, Ventoulis I, Parissis J, Osterwalder J, Hoffmann B. Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1180. [PMID: 37374384 DOI: 10.3390/medicina59061180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
- National Centre of Emergency Care (EKAB), 11527 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | | | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd, WCC2, Boston, MA 02215, USA
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20
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Sefic Pasic I, Riera Soler L, Vazquez Mendez E, Castillo Salinas F. Comparison between lung ultrasonography and chest X-ray in the evaluation of neonatal respiratory distress syndrome. J Ultrasound 2023; 26:435-448. [PMID: 36301438 PMCID: PMC10247622 DOI: 10.1007/s40477-022-00728-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Respiratory distress syndrome (RDS), also known as hyaline membrane disease, is the most common clinical syndrome encountered among preterm infants, and the complications of the disease account for substantial mortality. Diagnosis of RDS is based on the clinical status of patients in correlation with laboratory parameters and chest X-ray. Lung ultrasound despite its wide use still is not incorporated into diagnostic algorithms. The aim of the study was to evaluate the diagnostic ability of lung ultrasound in diagnosing respiratory distress syndrome as well as in the monitoring of the response to treatment. A secondary aim was to propose a modified ultrasound grading scale. METHODS The prospective study included 150 neonates with clinical and radiographic signs of neonatal respiratory distress syndrome within the first 24 h of life, with different gestational age (≤ 35 weeks). Lung ultrasound was performed by two radiologists and correlated with a chest X-ray. Two gradation scales (ultrasound and X-ray) were compared and each scale was correlated with the patient's clinical data. RESULTS In comparison between ultrasound findings and X-ray results showed a statistically significant difference in a favor of ultrasound. Based on the presence of subpleural consolidations, further differentiation of ultrasound profiles were made into subgroups and new ultrasound classification have been proposed. CONCLUSION Our study showed that lung ultrasound enables the diagnosing of respiratory distress syndrome in premature neonates and also shows a significant correlation with chest X-ray, which is considered as a radiological method of choice for the diagnosis of RDS.
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Affiliation(s)
- Irmina Sefic Pasic
- Radiology Clinic, Clinical Center University of Sarajevo, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - L. Riera Soler
- Pediatric Radiology, Vall d’Hebron Hospital, Hospital Infantil, Passeig Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - E. Vazquez Mendez
- Pediatric Radiology, Vall d’Hebron Hospital, Hospital Infantil, Passeig Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - F. Castillo Salinas
- Neonatology, Hospital Universitario Materno-Infantil Vall d’Hebrón, Universidad Autónoma de Barcelona, Passeig Vall d’Hebron, 119-129, 08035 Barcelona, Spain
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Bloise S, Marcellino A, Sanseviero M, Martucci V, Testa A, Leone R, Del Giudice E, Frasacco B, Gizzone P, Proietti Ciolli C, Ventriglia F, Lubrano R. Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting. Diagnostics (Basel) 2023; 13:diagnostics13101765. [PMID: 37238249 DOI: 10.3390/diagnostics13101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Point-of-care thoracic ultrasound at the patient's bedside has increased significantly recently, especially in pediatric settings. Its low cost, rapidity, simplicity, and repeatability make it a practical examination to guide diagnosis and treatment choices, especially in pediatric emergency departments. The fields of application of this innovative imaging method are many and include primarily the study of lungs but also that of the heart, diaphragm, and vessels. This manuscript aims to describe the most important evidence for using thoracic ultrasound in the pediatric emergency setting.
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Affiliation(s)
- Silvia Bloise
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Alessia Marcellino
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Mariateresa Sanseviero
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Vanessa Martucci
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Alessia Testa
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Rita Leone
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Emanuela Del Giudice
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Beatrice Frasacco
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Pietro Gizzone
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Claudia Proietti Ciolli
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Flavia Ventriglia
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Riccardo Lubrano
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
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22
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Szekely Y, Dawit TC. The "Fish Tank". Chest 2023; 163:e183-e185. [PMID: 37031991 PMCID: PMC10080199 DOI: 10.1016/j.chest.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/15/2022] [Accepted: 03/10/2022] [Indexed: 04/11/2023] Open
Affiliation(s)
- Yishay Szekely
- University Health Network, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada; Division of Cardiology, Tel Aviv University Sackler School of Medicine, Sourasky Medical Center, Tel Aviv, Israel.
| | - Tsega Cherkos Dawit
- Division of Critical Care Medicine, University of Toronto Faculty of Medicine, Toronto, ON, Canada; Ayder Comprehensive Specialized Hospital, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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23
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Padrez KA, Graglia S. Lung point-of-care ultrasound in the assessment of pleural effusions. Emerg Med J 2023; 40:228-231. [PMID: 36609442 DOI: 10.1136/emermed-2021-211886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kevin Andrew Padrez
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sally Graglia
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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24
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Bediwy AS, Al-Biltagi M, Saeed NK, Bediwy HA, Elbeltagi R. Pleural effusion in critically ill patients and intensive care setting. World J Clin Cases 2023; 11:989-999. [PMID: 36874438 PMCID: PMC9979285 DOI: 10.12998/wjcc.v11.i5.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/14/2023] Open
Abstract
Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses. Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients, with a wide range of variable prevalence rates of up to 50%-60% in some studies. This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit (ICU). The original disease that caused pleural effusion can be the exact cause of ICU admission. There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients. There are also many difficulties in diagnosing pleural effusion in the ICU, including clinical, radiological, and even laboratory difficulties. These difficulties are due to unusual presentation, inability to undergo some diagnostic procedures, and heterogenous results of some of the performed tests. Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients, who usually have frequent comorbidities. Similarly, pleural effusion drainage can modify the ICU-admitted patient’s outcome. Finally, pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.
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Affiliation(s)
- Adel Salah Bediwy
- Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Chest Diseases, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Mohammed Al-Biltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Chairperson of the Pathology Department, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26671, Bahrain
- Microbiology Section, Pathology Department, Royal College of Surgeons in Ireland - Bahrain, Busiateen 15503, Muharraq, Bahrain
| | | | - Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
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25
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Schwarz S. Pulmonary Sonography - Neonatal Diagnosis Part 1. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:14-35. [PMID: 36075237 DOI: 10.1055/a-1885-5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diseases of the respiratory system are among the main problems of premature patients in the neonatal intensive care unit. Radiography of the thorax is the gold standard of imaging. This results in high cumulative radiation exposure with potential negative long-term consequences. Ultrasound examination of thoracic structures represents a promising radiation-free and ubiquitously available alternative.A healthy, ventilated lung can only be imaged via artifacts, since total reflection of the sound waves occurs due to the high impedance difference between tissue and air-filled lung. Pathologies of pleura and subpleural lung tissue lead to changes in the acoustic properties of the tissue and thus to variations in the artifacts that can be imaged. The main sonographic characteristics of pulmonary pathology are: pleural line abnormalities, increased B-lines and comet-tail artifacts, lung consolidations, a visible pulmonary pulse, pleural sliding abnormalities, and visualization of effusions. Deviations from normal sonographic findings can be assigned to specific underlying pathophysiologies, so that conclusions about the disease can be drawn in conjunction with the clinical symptoms.
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Affiliation(s)
- Simone Schwarz
- Clinic for Pediatrics and Adolescent Medicine, Sana Kliniken Duisburg GmbH, Duisburg, Germany
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26
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Kazi S, Hernstadt H, Abo YN, Graham H, Palmer M, Graham SM. The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review. J Glob Health 2022; 12:10013. [PMID: 36560909 PMCID: PMC9789364 DOI: 10.7189/jogh.12.10013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Chest x-ray (CXR) is commonly used (when available) to support clinical management decisions for child pneumonia and provide a reference standard for diagnosis in research studies. However, its diagnostic and technical limitations for both purposes are well recognised. Recent evidence suggests that lung ultrasound (LUS) may have diagnostic utility in pneumonia. This systematic scoping review of research on the utility of CXR and LUS in the management of severe childhood pneumonia aims to inform pragmatic guidelines for low- and middle-income countries (LMICs) and identify gaps in knowledge. Methods We included peer-reviewed studies published between 2000 and 2020 in infants and children aged from one month to nine years, presenting with severe pneumonia. CXR studies were limited to those from LMICs, while LUS studies included any geographic region. LUS and CXR articles were mapped into the following themes: indications, role in diagnosis, role in management, impact on outcomes, and practical considerations for LMIC settings. Results 85 articles met all eligibility criteria, including 27 CXR studies and 58 LUS studies. CXR studies were primarily observational and examined associations between radiographic abnormalities and pneumonia aetiology or outcomes. The most consistent finding was an association between CXR consolidation and risk of mortality. Difficulty obtaining quality CXR images and inter-reader variability in interpretation were commonly reported challenges. Research evaluating indications for CXR, role in management, and impact on patient outcomes was very limited. LUS studies primarily focused on diagnostic accuracy. LUS had higher sensitivity for identification of consolidation than CXR. There are gaps in knowledge regarding diagnostic criteria, as well as the practical utility of LUS in the diagnosis and management of pneumonia. Most LUS studies were conducted in HIC settings with experienced operators; however, small feasibility studies indicate that good inter-operator reliability may be achieved by training of novice clinicians in LMIC settings. Conclusions The available evidence does not support the routine use of CXR or LUS as essential tools in the diagnosis and initial management of severe pneumonia. Further evaluation is required to determine the clinical utility and feasibility of both imaging modalities in low-resource settings.
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Affiliation(s)
- Saniya Kazi
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia
| | | | - Yara-Natalie Abo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Megan Palmer
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
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27
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Doran J, Hanna R, Nyagura-Mangori T, Mahotra N, Das SK, Borok M, Musani A, Maw AM. Stakeholder perspectives on current determinants of ultrasound-guided thoracentesis in resource limited settings: a qualitative study. BMJ Open 2022; 12:e064638. [PMID: 36523247 PMCID: PMC9748956 DOI: 10.1136/bmjopen-2022-064638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Preprocedure pleural fluid localization using bedside ultrasound has been shown to reduce complications related to thoracentesis and is now considered the standard of care. However, ultrasound-guided thoracentesis (USGT) has not been broadly adopted in many low-resource settings. With increasing affordability and portability of ultrasound equipment, barriers to USGT are changing. The aim of this multisite qualitative study is to understand the current barriers to USGT in two resource-limited settings. SETTING We studied two geographically diverse settings, Harare, Zimbabwe, and Kathmandu, Nepal. PARTICIPANTS 19 multilevel stakeholders including clinical trainees, attendings, clinical educators and hospital administrators were interviewed. There were no exclusion criteria. PRIMARY OUTCOME To understand the current determinants of USGT adoption in these settings. RESULTS Three main themes emerged from these interviews: (1) stakeholders perceived multiple advantages of USGT, (2) access to equipment and training were perceived as limited and (3) while an online training approach is feasible, stakeholders expressed scepticism that this was an appropriate modality for procedural training. CONCLUSION Our data suggests that USGT implementation is desired by local stakeholders and that the development of an educational intervention, cocreated with local stakeholders, should be explored to ensure optimal contextual fit.
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Affiliation(s)
- Jennifer Doran
- Department of Medicine, University of Colorado Hospital, Aurora, Colorado, USA
| | - Reem Hanna
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Narayan Mahotra
- Division of Physiology, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | - Santa Kumar Das
- Division of Pulmonary and Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Magaret Borok
- Unit of Internal Medicine, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Ali Musani
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
| | - Anna M Maw
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
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28
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Martocchia A, Bentivegna E, Sergi D, Luciani M, Barlattani M, Notarangelo MF, Piccoli C, Sesti G, Martelletti P. The Point-of-Care Ultrasound (POCUS) by the Handheld Ultrasound Devices (HUDs) in the COVID-19 Scenario: a Review of the Literature. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:1. [PMID: 36407770 PMCID: PMC9665043 DOI: 10.1007/s42399-022-01316-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/10/2023]
Abstract
The use of portable ultrasound (US) devices is increasing, due to its accessibility, versatility, non-invasiveness, and its significant support in the patient management, extending the traditional physical examination through the POCUS (point-of-care ultrasound). The pocket-size or handheld ultrasound devices (HUDs) can easily perform focused exams, not aiming to substitute for the high-end US systems (gold standard), since the HUDs usually have more limited functions. The HUDs are promising tools for the diagnosis, prognosis, and monitoring of the COVID-19 infection and its related disorders. In conclusion, the routine use of HUDs may ameliorate the management of COVID-19 pandemic, according to the guidelines for the POCUS approach and the procedures for the protection of the patients and the professionals.
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Affiliation(s)
- Antonio Martocchia
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Enrico Bentivegna
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Daniela Sergi
- Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michelangelo Luciani
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Michela Barlattani
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Fortunato Notarangelo
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Cinzia Piccoli
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
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29
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Moutard N, Richard P, de Blay F, Kessler R, Ohana M. Échogénicité des pleurésies : facteur prédictif d’amélioration de la dyspnée ? Étude pilote concernant les pleurésies métastatiques. Rev Mal Respir 2022; 39:805-813. [DOI: 10.1016/j.rmr.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
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30
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Istrail L. Instant Heart Failure Diagnosis Using Point-of-Care Ultrasound (POCUS) in a Patient Incorrectly Diagnosed With Asthma. Cureus 2022; 14:e27456. [PMID: 36060372 PMCID: PMC9420528 DOI: 10.7759/cureus.27456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
Abstract
Congestive heart failure is one of the most common causes of hospitalization in the United States, yet it often goes undetected due to the poor sensitivity of chest X-rays for detecting pulmonary edema. In this case, a patient presented with one year of shortness of breath and a diagnosis of asthma; however, a three-minute point-of-care ultrasound (POCUS) exam revealed that the correct diagnosis was in fact congestive heart failure. This highlights the importance of incorporating POCUS into the physical exam of any patient presenting with cardiopulmonary symptoms.
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31
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Henning RJ. Handheld ultrasound is an adjunct to the physical examination in the diagnosis of cardiopulmonary disease. Future Cardiol 2022; 18:585-600. [PMID: 35543226 DOI: 10.2217/fca-2021-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Handheld 2D ultrasound devices (HUDs) have become available as an adjunct to physical examinations, visualizing the heart and lungs in real time and facilitating prompt patient diagnosis and treatment of cardiopulmonar.y disorders. These devices provide simple and rapid bedside alternatives to repetitive chest x-rays, standard ultrasound examinations and thoracic CT scans. Two currently available HUDs are described. This paper discusses the use of HUDs in the diagnosis of patients with pericardial effusion and tamponade, ventricular dilation, aortic and mitral regurgitation, cardiogenic pulmonary edema, viral and bacterial pneumonia, pleural effusion and pneumothorax. The use of a HUD by physicians increases clinical diagnostic accuracy, adds quantitative information about cardiopulmonary disease severity and guides the use of medications and interventions.
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32
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Update on the diagnosis and management of malignant pleural effusions. Respir Med 2022; 196:106802. [DOI: 10.1016/j.rmed.2022.106802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022]
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33
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Montero Montero D, Ginest D, Hoelle R. Reprint of: Bilateral pleural effusion and pulmonary edema diagnosed by emergency department point-of-care ultrasound (POCUS) in a patient with severe undifferentiated dyspnea. Dis Mon 2022; 68:101376. [PMID: 35450592 DOI: 10.1016/j.disamonth.2022.101376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Diana Montero Montero
- North Florida Regional Medical Center, Department of Graduate Medical Education, United States; UCF/HCA Healthcare GME Consortium of North Florida, United States.
| | - Donavan Ginest
- North Florida Regional Medical Center, Department of Graduate Medical Education, United States; UCF/HCA Healthcare GME Consortium of North Florida, United States; Samaritan Albany General Hospital, United States
| | - Robyn Hoelle
- North Florida Regional Medical Center, Department of Graduate Medical Education, United States; UCF/HCA Healthcare GME Consortium of North Florida, United States
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34
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The “Black Pattern”, a Simplified Ultrasound Approach to Non-Traumatic Abdominal Emergencies. Tomography 2022; 8:798-814. [PMID: 35314643 PMCID: PMC8938823 DOI: 10.3390/tomography8020066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: A key issue in abdominal US is the assessment of fluid, which is usually anechoic, thus appearing “black”. Our approach focuses on searching for fluid in non-traumatic patients, providing a new, simplified method for point-of-care US (POCUS). Objective: Fluid assessment is based on a three-step analysis that we can thus summarize. 1. Look for black where it should not be. This means searching for effusions or collections. 2. Check if black is too much. This means evaluating anatomical landmarks where fluid should normally be present but may be abnormally abundant. 3. Look for black that is not clearly black. This means evaluating fluid aspects, whether wholly anechoic or not (suggesting heterogeneous or corpusculated fluid). Discussion: Using this simple method focused on US fluid presence and appearance should help clinicians to make a timely diagnosis. Although our simplified, systematic algorithm of POCUS may identify abnormalities; this usually entails a second-level imaging. An accurate knowledge of the physio–pathological and anatomical ultrasound bases remains essential in applying this algorithm. Conclusion: The black pattern approach in non -traumatic emergencies may be applied to a broad spectrum of abnormalities. It may represent a valuable aid for emergency physicians, especially if inexperienced, involved in a variety of non-traumatic scenarios. It may also be a simple and effective teaching aid for US beginners.
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35
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Janjigian M, Dembitzer A, Srisarajivakul-Klein C, Mednick A, Hardower K, Cooke D, Zabar S, Sauthoff H. Design and comparison of a hybrid to a traditional in-person point-of-care ultrasound course. Ultrasound J 2022; 14:12. [PMID: 35278145 PMCID: PMC8917361 DOI: 10.1186/s13089-022-00261-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Traditional introductory point-of-care ultrasound (POCUS) courses are resource intensive, typically requiring 2–3 days at a remote site, consisting of lectures and hands-on components. Social distancing requirements resulting from the COVID-19 pandemic led us to create a novel hybrid course curriculum consisting of virtual and in-person components. Methods Faculty, chief residents, fellows and advanced practice providers (APPs) in the Department of Medicine were invited to participate in the hybrid curriculum. The course structure included 4 modules of recorded lectures, quizzes, online image interpretation sessions, online case discussions, and hands-on sessions at the bedside of course participant’s patients. The components of the course were delivered over approximately 8 months. Those participants who completed a minimum of 3 modules over the year were invited for final assessments. Results from the hybrid curriculum cohort were compared to the year-end data from a prior traditional in-person cohort. Results Participant knowledge scores were not different between traditional (n = 19) and hybrid (n = 24) groups (81% and 84%, respectively, P = 0.9). There was no change in POCUS skills as measured by the hands-on test from both groups at end-of-course (76% and 76%, respectively, P = 0.93). Confidence ratings were similar across groups from 2.73 traditional to 3.0 hybrid (out of possible 4, P = 0.46). Participants rated the course highly, with an average overall rating of 4.6 out 5. Conclusions A hybrid virtual and in-person POCUS course was highly rated and as successful as a traditional course in improving learner knowledge, hands-on skill and confidence at 8 months after course initiation. These results support expanding virtual elements of POCUS educational curricula. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00261-x.
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Affiliation(s)
- Michael Janjigian
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, Bellevue Hospital Center, New York, USA.
| | - Anne Dembitzer
- Department of Medicine, New York University Grossman School of Medicine, NY Harbor Healthcare System, New York, USA
| | - Caroline Srisarajivakul-Klein
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, Bellevue Hospital Center, New York, USA
| | - Aron Mednick
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Khemraj Hardower
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Deborah Cooke
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Harald Sauthoff
- Department of Medicine, New York University Grossman School of Medicine, NY Harbor Healthcare System, New York, USA
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36
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Martocchia A, Ialungo S, Dulcetti A, Malena D, Proietta M, Del Porto F, Landolfi F, Sesti G, Sergi D, Martelletti P. The evaluation of the intracavitary effusions by a beside ultrasound examination. Clin Hemorheol Microcirc 2022; 81:233-240. [DOI: 10.3233/ch-221402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: This study aims to evaluate the bedside use of the pocket-sized ultrasound (US) device for the detection of the intracavitary effusions. METHODS: We randomly enrolled 40 patients admitted to S. Andrea Hospital of Rome. Every patient received a clinical and biochemical evaluation and a bedside US examination to detect and estimate the intracavitary (pleural, pericardial and intra-abdominal) effusions; the US measurements have been compared to the computed tomography (CT) scans (as gold standard). RESULTS: The patients presented a high prevalence of effusions: right pleural 16/40 = 40% (esteemed volume 236.3±500.7 ml, mean±standard deviation m±SD), left pleural 8/40 = 20% (127.0±377.4 ml), pericardial 12/40 = 30% (47.5±72.8 ml) and intra-abdominal effusions 5/40 = 12.5% of cases (110.9±600.6 ml). Linear regression analysis showed a significant correlation between US and CT measurements: pleural r = 0.973 p < 1×10–38, pericardial r = 0.927 p < 1×10–39, intra-abdominal space r = 0.921 p < 1×10–59. The accuracy of the bedside US at the pleural, pericardial and abdominal level was respectively 98%, 93% and 96% (Cohen’s kappa coefficient 0.966, 0.841 and 0.833). CONCLUSIONS: The present study showed a high prevalence of the intracavitary effusions and a high accuracy of the bedside US. The bedside US by a pocket-sized device is promising tool for its advantages of reproducibility and non-invasiveness of the device.
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Affiliation(s)
- A. Martocchia
- Emergency Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - S. Ialungo
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - A. Dulcetti
- Emergency Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - D.M. Malena
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - M. Proietta
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - F. Del Porto
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - F. Landolfi
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - G. Sesti
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - D. Sergi
- Internal Medicine and Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - P. Martelletti
- Emergency Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy
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37
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Bediwy AS, Al-Biltagi M, Nazeer JA, Saeed NK. Chest ultrasound in neonates: What neonatologists should know. Artif Intell Med Imaging 2022; 3:8-20. [DOI: 10.35711/aimi.v3.i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
For many years, ultrasound was thought to have no indications in pulmonary imaging because lungs are filled with air, creating no acoustic mismatch, as encountered by ultrasound wave beam. Lung ultrasound (LUS) was started in adult critical care settings to detect pleural effusion and acquired more indications over time. In the neonatal intensive care unit (NICU), the use of chest ultrasound has gained more attention during the last two decades. Being a radiation-free, bedside, rapid, and handy tool, LUS started to replace chest X-rays in NICU. Using LUS depends upon understanding the nature of normal lungs and the changes induced by different diseases. With the help of LUS, an experienced neonatologist can detect many of the respiratory problems so fast that interventional therapy can be introduced as early as possible. LUS can diagnose pleural effusion, pneumothorax, pneumonia, transient tachypnoea of the newborn, respiratory distress syndrome, pulmonary atelectasis, meconium aspiration syndrome, bronchopulmonary dysplasia, and some other disorders with very high accuracy. LUS will be helpful in initial diagnosis, follow-up, and predicting the need for further procedures such as mechanical ventilation, diuretic therapy, surfactant therapy, etc. There are some limitations to using LUS in some respiratory disorders such as bullae, interstitial emphysema, and other conditions. This review will highlight the importance of LUS, its uses, and limitations.
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Affiliation(s)
- Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Jameel Ahmed Nazeer
- Department of Radiology, University Medical center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex , Ministry of Health, Kingdom of Bahrain , Manama 12, Manama, Bahrain
- Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
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Wang S, Xia D, Zhang Z, Zhang J, Meng W, Zhang Y, Xu S. Mapping Trends and Hotspots Regarding the Use of Ultrasound in Emergency Medicine: A Bibliometric Analysis of Global Research. Front Public Health 2022; 9:764642. [PMID: 35004578 PMCID: PMC8739757 DOI: 10.3389/fpubh.2021.764642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Diagnostic tools in emergency medicine have been widely studied. As a non-invasive and quick tool, ultrasound plays a role in the field of emergency medicine. Thus, it is significant to understand the global scientific output of this topic. An analysis of publications on the use of ultrasound in emergency medicine over the past decade was performed and summarized to track the current hotspots and highlight future directions. Methods: Globally relevant publications on ultrasound in emergency medicine from 2009 to 2020 were extracted from the Web of Science collection database. VOSviewer software and CiteSpace were employed to visualize and predict the trends in the research on the topic. Results: The overall volume of global publications is on the rise; furthermore, the United States published the most publications in this field and had the most citations and H-index. University of California at San Francisco in the United States has most publications in terms of institutions. The American Journal of Emergency Medicine published the most papers related to ultrasound in emergency medicine in terms of journals. Pulmonary embolism was once the main research direction, and importantly, “point-of-care ultrasound” was determined to be a new research hotspot. Conclusion: Altogether, the number of publications on ultrasound in emergency medicine will rise in the future. In addition, the findings reported here shed new light on the major progress on ultrasound in emergency medicine, which may be mutually cooperative in various fields. Moreover, this bibliometric study provides further indications for the topic of “point-of-care ultrasound”.
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Affiliation(s)
- Sheng Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Demeng Xia
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Health Clinic, People's Liberation Army Unit 91666, Zhoushan, China
| | - Zhentao Zhang
- Department of Clinical Medicine, Naval Medical University, Shanghai, China
| | - Jingli Zhang
- Department of Neurology Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Wenhao Meng
- Department of Clinical Medicine, Wei Fang Medical University, Wei Fang, China
| | - Yanping Zhang
- Nanjing Comprehensive Stroke Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Shuogui Xu
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
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Leidi A, Saudan A, Soret G, Rouyer F, Marti C, Stirnemann J, Reny JL, Grosgurin O. Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey. Intern Emerg Med 2022; 17:113-122. [PMID: 34148178 PMCID: PMC8214715 DOI: 10.1007/s11739-021-02781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors' ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians' confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with > 15 years of experience and POCUS-naïve doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%, p < 0.001) and pleural effusion (80% vs 34%, p < 0.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.
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Affiliation(s)
- Antonio Leidi
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Saudan
- grid.8591.50000 0001 2322 4988Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Guillaume Soret
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Rouyer
- grid.150338.c0000 0001 0721 9812Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Stirnemann
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- grid.150338.c0000 0001 0721 9812Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
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Rice JA, Brewer J, Speaks T, Choi C, Lahsaei P, Romito BT. The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making. Int J Gen Med 2021; 14:9789-9806. [PMID: 34938102 PMCID: PMC8685447 DOI: 10.2147/ijgm.s339476] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jake A Rice
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Brewer
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler Speaks
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Lahsaei
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Correspondence: Bryan T Romito Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9068, USATel +1 214 648 7674Fax +1 214 648 5461 Email
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Altersberger M, Schneider M, Schiller M, Binder-Rodriguez C, Genger M, Khafaga M, Binder T, Prosch H. Point of care echocardiography and lung ultrasound in critically ill patients with COVID-19. Wien Klin Wochenschr 2021; 133:1298-1309. [PMID: 34714384 PMCID: PMC8553894 DOI: 10.1007/s00508-021-01968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/25/2021] [Indexed: 01/08/2023]
Abstract
Hundreds of millions got infected, and millions have died worldwide and still the number of cases is rising.Chest radiographs and computed tomography (CT) are useful for imaging the lung but their use in infectious diseases is limited due to hygiene and availability.Lung ultrasound has been shown to be useful in the context of the pandemic, providing clinicians with valuable insights and helping identify complications such as pleural effusion in heart failure or bacterial superinfections. Moreover, lung ultrasound is useful for identifying possible complications of procedures, in particular, pneumothorax.Associations between coronavirus disease 2019 (COVID-19) and cardiac complications, such as acute myocardial infarction and myocarditis, have been reported. As such, point of care echocardiography as well as a comprehensive approach in later stages of the disease provide important information for optimally diagnosing and treating complications of COVID-19.In our experience, lung ultrasound in combination with echocardiography, has a great impact on treatment decisions. In the acute state as well as in the follow-up setting after a severe or critical state of COVID-19, ultrasound can be of great impact to monitor the progression and regression of disease.
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Affiliation(s)
- Martin Altersberger
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory Diseases, Friedrich Hillegeist Straße 2, 2840 Grimmenstein, Austria
- Department of Cardiology, Nephrology and Intensive Care Medicine, State Hospital Steyr, Steyr, Austria
| | - Matthias Schneider
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria Waehringer Guertel 18–20, 1090
| | - Martina Schiller
- Department of Radiology, State hospital Neunkirchen, Neunkirchen, Austria
| | - Christina Binder-Rodriguez
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria Waehringer Guertel 18–20, 1090
| | - Martin Genger
- Department of Cardiology, Nephrology and Intensive Care Medicine, State Hospital Steyr, Steyr, Austria
| | - Mounir Khafaga
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory Diseases, Friedrich Hillegeist Straße 2, 2840 Grimmenstein, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria Waehringer Guertel 18–20, 1090
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Ruoss JL, Bazacliu C, Cacho N, De Luca D. Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care? CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121098. [PMID: 34943297 PMCID: PMC8700415 DOI: 10.3390/children8121098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.
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Affiliation(s)
- J. Lauren Ruoss
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
- Correspondence:
| | - Catalina Bazacliu
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Nicole Cacho
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, 94270 Paris, France;
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Laya BF, Concepcion NDP, Garcia-Peña P, Naidoo J, Kritsaneepaiboon S, Lee EY. Pediatric Lower Respiratory Tract Infections: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:15-40. [PMID: 34836562 DOI: 10.1016/j.rcl.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lower respiratory tract infection (LRTI) remains a major cause of morbidity and mortality in children. Various organisms cause LRTI, including viruses, bacteria, fungi, and parasites, among others. Infections caused by 2 or more organisms also occur, sometimes enhancing the severity of the infection. Medical imaging helps confirm a diagnosis but also plays a role in the evaluation of acute and chronic sequelae. Medical imaging tests help evaluate underlying pathology in pediatric patients with recurrent or long-standing symptoms as well as the immunocompromised.
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Affiliation(s)
- Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines.
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines
| | - Pilar Garcia-Peña
- Autonomous University of Barcelona (AUB), University Hospital Materno-Infantil Vall d'Hebron, Pso. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jaishree Naidoo
- Paeds Diagnostic Imaging and Envisionit Deep AI, 2nd Floor, One-on Jameson Building, 1 Jameson Avenue, Melrose Estate, Johannesburg, 2196, South Africa
| | - Supika Kritsaneepaiboon
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Road, Hat Yai, 90110, Thailand
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Optimizing the management of complicated pleural effusion: From intrapleural agents to surgery. Respir Med 2021; 191:106706. [PMID: 34896966 DOI: 10.1016/j.rmed.2021.106706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/11/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
Pleural effusion is a frequent complication of acute pulmonary infection and can affect its morbidity and mortality. The possible evolution of a parapneumonic pleural effusion includes 3 stages: exudative (simple accumulation of pleural fluid), fibropurulent (bacterial invasion of the pleural cavity), and organized stage (scar tissue formation). Such a progression is favored by inadequate treatment or imbalance between microbial virulence and immune defenses. Biochemical features of a fibrinopurulent collection include a low pH (<7.20), low glucose level (<60 mg/dl), and high lactate dehydrogenase (LDH). A parapneumonic effusion in the fibropurulent stage is usually defined "complicated" since antibiotic therapy alone is not enough for its resolution and an invasive procedure (pleural drainage or surgery) is required. Chest ultrasound is one of the most useful imaging tests to assess the presence of a complicated pleural effusion. Simple parapneumonic effusions are usually anechoic, whereas complicated effusions often have a complex appearance (non-anechoic, loculated, or septated). When simple chest tube placement fails and/or patients are not suitable for more invasive techniques (i.e. surgery), intra-pleural instillation of fibrinolytic/enzymatic therapy (IPET) might represent a valuable treatment option to obtain the lysis of fibrin septa. IPET can be used as either initial or subsequent therapy. Further studies are ongoing or are required to help fill some gaps on the optimal management of parapneumonic pleural effusion. These include the duration of antibiotic therapy, the risk/benefit ratio of medical thoracoscopy and surgery, and new intrapleural treatments such as antibiotic-eluting chest tubes and pleural irrigation with antiseptic agents.
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Bastos MG. Lung ultrasound: an opportunity to increase the accuracy of the physical examination by the nephrologist. Rev Assoc Med Bras (1992) 2021; 67:1729-1734. [DOI: 10.1590/1806-9282.20210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022] Open
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Kumar A, Weng Y, Graglia S, Chung S, Duanmu Y, Lalani F, Gandhi K, Lobo V, Jensen T, Nahn J, Kugler J. Interobserver Agreement of Lung Ultrasound Findings of COVID-19. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2369-2376. [PMID: 33426734 PMCID: PMC8013417 DOI: 10.1002/jum.15620] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with 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. METHODS This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans (n = 180 independent observations) collected from patients with COVID-19, diagnosed via RT-PCR. 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 (κ) were used to calculate IRR. RESULTS There was substantial IRR on the following items: normal LUS scan (κ = 0.79 [95% CI: 0.72-0.87]), presence of B-lines (κ = 0.79 [95% CI: 0.72-0.87]), ≥3 B-lines observed (κ = 0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (κ = 0.57 [95% CI: 0.50-0.64]), subpleural consolidation (κ = 0.49 [95% CI: 0.42-0.56]), and presence of effusion (κ = 0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (κ = 0.23 [95% CI: 0.15-0.30]). DISCUSSION 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.
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Affiliation(s)
- Andre Kumar
- Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Yingjie Weng
- Quantitative Sciences UnitStanford UniversityStanfordCaliforniaUSA
| | - Sally Graglia
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sukyung Chung
- Quantitative Sciences UnitStanford UniversityStanfordCaliforniaUSA
| | - Youyou Duanmu
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Farhan Lalani
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kavita Gandhi
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Viveta Lobo
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Trevor Jensen
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jeffrey Nahn
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - John Kugler
- Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Point-of-Care Lung Ultrasonography: A Clinical Update for the Emergency Nurse Practitioner. Adv Emerg Nurs J 2021; 43:279-292. [PMID: 34699417 DOI: 10.1097/tme.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the introduction of ultrasonography, clinicians have discovered different uses for embedding this technology in the clinical setting. The use of point-of-care ultrasonography has gained a lot of interest in the emergency department. It is a procedure that a clinician can rapidly utilize to triage, risk stratify, evaluate, and monitor the patient's condition. The COVID-19 pandemic has highlighted the significance and application of ultrasonography in identifying and managing patients presenting with lung pathology in the emergency setting.
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Sweeney DA, Wiley BM. Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock. Semin Respir Crit Care Med 2021; 42:641-649. [PMID: 34544181 DOI: 10.1055/s-0041-1733896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite decades of research, the mortality rate of sepsis and septic shock remains unacceptably high. Delays in diagnosis, identification of an infectious source, and the challenge of providing patient-tailored resuscitation measures routinely result in suboptimal patient outcomes. Bedside ultrasound improves a clinician's ability to both diagnose and manage the patient with sepsis. Indeed, multiple point-of-care ultrasound (POCUS) protocols have been developed to evaluate and treat various subsets of critically ill patients. These protocols mostly target patients with undifferentiated shock and have been shown to improve clinical outcomes. Other studies have shown that POCUS can improve a clinician's ability to identify a source of infection. Once a diagnosis of septic shock has been made, serial POCUS exams can be used to continuously guide resuscitative efforts. In this review, we advocate that the patient with suspected sepsis or septic shock undergo a comprehensive POCUS exam in which sonographic information across organ systems is synthesized and used in conjunction with traditional data gleaned from the patient's history, physical exam, and laboratory studies. This harmonization of information will hasten an accurate diagnosis and assist with hemodynamic management.
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Affiliation(s)
- Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Ma IWY, Hussain A, Wagner M, Walker B, Chee A, Arishenkoff S, Buchanan B, Liu RB, Mints G, Wong T, Noble V, Tonelli AC, Dumoulin E, Miller DJ, Hergott CA, Liteplo AS. Canadian Internal Medicine Ultrasound (CIMUS) Expert Consensus Statement on the Use of Lung Ultrasound for the Assessment of Medical Inpatients With Known or Suspected Coronavirus Disease 2019. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1879-1892. [PMID: 33274782 PMCID: PMC8451849 DOI: 10.1002/jum.15571] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID-19). METHODS Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered. RESULTS Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus. CONCLUSIONS In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.
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Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Arif Hussain
- Division of Cardiac Critical Care, Department of Cardiac SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
| | - Michael Wagner
- Division of Hospital Medicine, Department of MedicinePrisma Health–UpstateGreenvilleSouth CarolinaUSA
| | - Brandie Walker
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Alex Chee
- Division of Thoracic Surgery and Interventional PulmonologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Shane Arishenkoff
- Division of General Internal Medicine, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Brian Buchanan
- Department of Critical CareUniversity of AlbertaEdmontonAlbertaCanada
| | - Rachel B. Liu
- Section of Emergency Ultrasound, Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Gregory Mints
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Tanping Wong
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Vicki Noble
- Department of Emergency Medicine, University Hospitals, Cleveland Medical CenterCase Western Reserve School of MedicineClevelandOhioUSA
| | - Ana Claudia Tonelli
- Department of General Internal Medicine, Hospital de Clinicas de Porto Alegre and Department of MedicineUnisinos UniversitySão LeopoldoBrazil
| | - Elaine Dumoulin
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Daniel J. Miller
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Christopher A. Hergott
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrew S. Liteplo
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Schrift D, Barron K, Arya R, Choe C. The Use of POCUS to Manage ICU Patients With COVID-19. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1749-1761. [PMID: 33174650 DOI: 10.1002/jum.15566] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
Since the advent of SARS-CoV-2, the virus that causes COVID-19, clinicians have had to modify how they provide high-value care while mitigating the risk of viral spread. Routine imaging studies have been discouraged due to elevated transmission risk. Patients who have been diagnosed with COVID-19 often have a protracted hospital course with progression of disease. Given the need for close follow-up of patients, we recommend the use of ultrasonography, particularly point-of-care ultrasound (POCUS), to manage patients with COVID-19 through their entire ICU course. POCUS will allow a clinician to evaluate and monitor cardiac and pulmonary function, as well as evaluate for thromboembolic disease, place an endotracheal tube, confirm central venous catheter placement, and rule out a pneumothorax. If a patient improves sufficiently to perform weaning trials, POCUS can also help evaluate readiness for ventilator liberation.
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Affiliation(s)
- David Schrift
- Division of Pulmonary, Critical Care, and Sleep Medicine, Prisma Health USC Medical Group, Columbia, South Carolina, USA
| | - Keith Barron
- Department of Internal Medicine, Prisma Health USC Medical Group, Columbia, South Carolina, USA
| | - Rohan Arya
- Division of Pulmonary, Critical Care, and Sleep Medicine, Prisma Health USC Medical Group, Columbia, South Carolina, USA
| | - Carol Choe
- Department of Critical Care Medicine, Lexington Medical Center, West Columbia, South Carolina, USA
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