Lung Ultrasound in the Critically Ill

Comparison between lung ultrasonography and chest X-ray in the evaluation of neonatal respiratory distress syndrome

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.

B-Line Artifact as a Diagnostic Tool in Various Conditions at the Emergency Department

BACKGROUND: B-line artifacts (BLAs) play an important role in identifying lung pathology. They may indicate different diseases. However, the diagnostic study of BLA as applied to emergency patients has not been well studied. AIM: The aim of this study was to determine the diagnostic accuracy of BLA in various conditions. METHODS: This was a retrospective observational study of emergency patients who had received lung ultrasound at Srinagarind Hospital’s Emergency Department throughout January 2020–December 2020. Ultrasound artifacts were recorded. Ultrasonography findings were correlated with final diagnosis. Sensitivity and specificity were also calculated. RESULTS: A total of 105 patients were evaluated. The most prevalent condition which BLA found in this study was pulmonary edema (44.12%) with 88.24% sensitivity and 46.48% specificity. BLA also indicated pneumonia with 66.67% sensitivity and 35.71% specificity. Diffuse BLA indicated pulmonary edema with 70% sensitivity and 70.42% specificity. Focal BLA indicated pneumonia with 28.57% sensitivity and 76.19% specificity. CONCLUSIONS: The sensitivity of BLA for pulmonary edema and pneumonia diagnosis in this study was of moderate to good sensitivity, but low specificity. BLA may become crucial in the diagnosis of lung pathology in the emergency department.

Ultrasonography in the Critical Care Unit

Purpose of Review

This article summarizes the utility and evidence supporting the use of ultrasound exams in the intensive care unit.

Recent Findings

Point-of-care ultrasonography (POCUS) is widely used by intensivists managing critically ill patients whereby they can accurately and rapidly assess for many pathologies such as pneumothorax, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis among others. Basic and advanced critical care echocardiography, including transesophageal echocardiography, are routinely performed to determine the etiology of hemodynamic instability in undifferentiated shock and to guide subsequent therapy. The use of POCUS in the assessment of volume status is controversial with studies demonstrating that respiratory variation of the IVC is not reliable and with analysis of aortic blood flow velocity after passive leg raising maneuvers being the most promising.

Summary

Point-of-care ultrasonography allows frontline clinicians to make real-time diagnoses and treatment decisions. This article will provide the reader with a broad overview of this important topic.

Electronic supplementary material

The online version of this article (10.1007/s11886-020-01393-z) contains supplementary material, which is available to authorized users.

Utility of bedside lung ultrasound for assessment of lung recruitment in a case of acute respiratory distress syndrome

Lung recruitment maneuvers are rescue measures commonly used to improve oxygenation in severely hypoxemic patients with acute respiratory distress syndrome (ARDS), who fail to improve on standard treatment. After recruitment, appropriate level of positive end-expiratory pressure (PEEP) is applied to prevent alveolar de-recruitment during expiration. Computed tomography scan of thorax and quasi-static pressure-volume curves have played a pivotal role are important in the assessment of recruitment, but they have several limitations. Lung ultrasound (LUS), which is now easily available in nearly every Intensive Care Unit, could be an attractive alternative method for assessing lung recruitment. It is noninvasive, easily repeatable and is devoid of radiation hazards. We are presenting a case of 24-year-old female patient with moderate ARDS in whom bedside LUS was successfully used into assessing lung recruitment as well as into determining the appropriate level of PEEP.

Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.