Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

Lung ultrasound for the early diagnosis of acute lung injury:A case report

BACKGROUND The extensive availability of ultrasound(US)technology has increased its use for point-of-care applications in many health care settings.During anaesthesia and surgery,acute respiratory failure or pulmonary oedema are common lifethreatening events that,if not recognized and treated appropriately,result in a high mortality rate.CASE SUMMARY We report a patient under anaesthesia whose lung US examination showed multiple vertical artefacts(B-lines)in the lung tissue,indicating pulmonary oedema.The respiratory state improved with the resolution of the pulmonary oedema after our treatment.CONCLUSION We believe that US of the lungs may be a useful tool for dynamic respiratory monitoring at the bedside during anaesthesia.

Role of Lung Ultrasound in the Assessment of Hydration Status of Chronic Haemodialysis Patients

Background: Fluid overload is frequent in Haemodialysis (HD) and is one of the major factors of cardiovascular morbidity and mortality for chronic HD patients. The main challenge with chronic haemodialysis patients is indeed the maintenance of a normal extracellular volume through dry weight determination. Our study aimed at assessing the role of lung ultrasound in the detection of B-lines for the determination of hydration status in chronic HD patients. Methods: We conducted a cross-sectional study including 31 patients undergoing chronic HD treatment for at least 3 months, in the Yaounde University Teaching Hospital dialysis unit. Lung ultrasonography and clinical examinations were performed immediately before dialysis, and 30 minutes after dialysis. Differences between clinical and ultrasound variables before and after dialysis were measured to assess the effects of dialysis. Association between categorical variables was assessed with the Chi-squared test or Fischer test, and Rho’s Spearman coefficient for quantitative variables. Results: There was a reduction in the median of B-lines score after dialysis [12 (7 - 26) versus 8 (5 - 13)], clinical score [2 (1 - 3) versus 0 (-1 - 2)], mean of systolic blood pressure (164.74 ± 26.50 versus 158.48 ± 27.89), frequency of dyspnoea in patients (32.3% versus 6.5%);and raising of the frequency of cramps in patients (0% versus 19.4%) and all statistically significant (p ≤ 0.031). B-lines score before and after dialysis was associated with dyspnoea and raised jugular venous pressure (p Conclusion: Lung ultrasound for the detection of B-lines reflects the variation of extracellular volume during dialysis and can even capture pulmonary oedema at a pre-clinical stage. It is then a reliable and sensible method for assessing extravascular lung water and thus hydration status of haemodialysis patients. It could constitute a better alternative for an objective and accurate definition of dry weight, specifically in the African and Cameroonian context, with its assets being low cost, availability, and easiness to perform in a large population of HD patients. We, therefore, recommend further multicentric studies in order to design a standardized protocol of ultrasound follow-up for all chronic HD patients’ hydration status assessments.

High-flow nasal cannula oxygen therapy and noninvasive ventilation for preventing extubation failure during weaning from mechanical ventilation assessed by lung ultrasound score: A single-center randomized study

BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.

Ultrasonic Characteristics and Severity Assessment of Lung Ultrasound in COVID-19 Pneumonia:A Retrospective,Observational Study

The clinical application of lung ultrasound(LS)in the assessment of coronavirus disease 2019(COVID-19)pneumonia severity remains limited,Herein,we investigated the role of LUS imaging in CoVID-19pneumonia patients and the relationship between LUS findings and disease severity.This was a retro-spective,observational study at Tongji Hospital,on 48 recruited patients with COVID-19 pneu-monia,including 32 non-critically ill patients and 16critically ill patients.LUS was performed and the respiratory rate oxygenation(ROX)index,disease severity,and confusion,blood urea nitrogen,respira-tory rate,blood pressure,and age(CURB-65)score were recorded on days 0-7,8-14,and 15-21 after symptomonset.Lung images were divided into 12 regions,and the luS score(0-36 points)was calcu-lated.hestcomputed tomography(CT)scores(0-20 points)were also recorded on days O-7.Coelations between the LUS score,ROX index,and CURB-65 scores were examined.LUS detected COVID-19 pneumonia in 38patients.LUS signs included B lines(34/38,89.5%),consolidations(6/38,15.8%),and pleural effusions(2/38,5.3%).Most cases showed more than one lesion(32/38,84.2%)and involved both lungs(28/38,73.7%).Compared with non-critically ill patients,the LUS scores of critically ill patients were higher(12(10-18)vs 2(0-5),p<0.001).The LUS score showed significant negative cor-relations with the ROX indexon days O-7(r=-0.85,p<0.001),days 8-14(r=-0.71,p<0.001),and days 15-21(r=-0.76,p<0.001)after symptom onset.However,the LUS score was positively correlated with the CT score(r=0.82,p<0.001).The number of patients with LUS-detected lesions decreased from 27 cases(81.8%)to 20 cases(46.5%),and the lus scores significantly decreased from 4(2-10)to 0(0-5),(p<0.001) from days O-7 to 17-21.We conclude that LUS can detect lunglesions in COVID-19 pneumo-nia patients in a portable,real-time,and safe manner.Thus,LUS is helpful in assessing COVID-19 pneu-monia severity in critically ill patients.

Study the Role of Lung Ultrasound in Assessment of Subclinical Fluid Overload in Maintenance Hemodialysis Patients with Intra-Dialytic Hypertension

Objectives: To elucidate the role of lung ultrasound in assessment of subclinical fluid overload in hemodialysis (HD) patients. Background: Volume overload has a significant role in HD patients with difficult blood pressure control. The clinical evaluation of fluid status is challenging and has poor diagnostic accuracy. Extravascular lung water (ELW) represents an important element of body fluid volume. Lung ultrasound (LUS) is increasingly used for ELW assessment through the analysis of B-lines artifacts. Methods: Eighty-eight HD patients were followed up prospectively. Patients were divided into 3 groups according to the changes of systolic blood pressure (SBP) during HD sessions. Group (1): patients with intra-dialytic hypertension (n = 12), group (2): patients with intra-dialytic hypotension (n = 28) and group (3): patients with no significant blood pressure variabilities (n = 48). Numbers of B-lines were measured by LUS and IVC diameters were measured pre and post-dialysis. In addition, Endothelin-1 (ET-1) and other routine laboratory tests were done. Results: There were significant increases in the number of B-lines and IVC diameter pre and post-dialysis in group (1) compared to the other two groups. There was significant decrease in post dialysis IVC diameter but not the number of B-lines in group (2) compared with the other two groups. ET-1 level was significantly increased in group 1 compared to the other two groups. There was a statistically significant positive correlation between the pre-dialysis number of B-lines and ET-1. Conclusion: Lung ultrasound can be considered a sensitive and specific modality for volume assessment in HD patients especially with intra-dialytic hypertension. We recommend serial LUS as a part of management in this group of patients.

Applications of artificial intelligence in lung ultrasound:Review of deep learning methods for COVID-19 fighting

BACKGROUND The pandemic outbreak of the novel coronavirus disease(COVID-19)has highlighted the need to combine rapid,non-invasive and widely accessible techniques with the least risk of patient’s cross-infection to achieve a successful early detection and surveillance of the disease.In this regard,the lung ultrasound(LUS)technique has been proved invaluable in both the differential diagnosis and the follow-up of COVID-19 patients,and its potential may be destined to evolve.Recently,indeed,LUS has been empowered through the development of automated image processing techniques.AIM To provide a systematic review of the application of artificial intelligence(AI)technology in medical LUS analysis of COVID-19 patients using the preferred reporting items of systematic reviews and meta-analysis(PRISMA)guidelines.METHODS A literature search was performed for relevant studies published from March 2020-outbreak of the pandemic-to 30 September 2021.Seventeen articles were included in the result synthesis of this paper.RESULTS As part of the review,we presented the main characteristics related to AI techniques,in particular deep learning(DL),adopted in the selected articles.A survey was carried out on the type of architectures used,availability of the source code,network weights and open access datasets,use of data augmentation,use of the transfer learning strategy,type of input data and training/test datasets,and explainability.CONCLUSION Finally,this review highlighted the existing challenges,including the lack of large datasets of reliable COVID-19-based LUS images to test the effectiveness of DL methods and the ethical/regulatory issues associated with the adoption of automated systems in real clinical scenarios.

Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit

Background:No convenient,inexpensive,and non-invasive screening tools exist to identify pulmonary hypertension(PH)-left heart disease(LHD)patients during the early stages of the disease course.This study investigated whether different methods of lung ultrasound(LUS)could be used for the initial investigation of PH-LHD.Methods:This was a single-center prospective observational study which was performed in the Zigong Fourth People’s Hospital.We consecutively enrolled patients with heart failure(HF)admitted to the emergency intensive care unit from January 2018 to May 2020.Transthoracic echocardiography and LUS were performed within 24 h before discharge.We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure(PASP).Bland-Altman plots were generated to inspect possible bias,and receiver operating characteristic(ROC)curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD.Results:Seventy-one patients were enrolled in this study,with an overall median age of 79(interquartile range:71.5–84.0)years.Among the 71 patients,36(50.7%)cases were male,and 26(36.6%)had an intermediate and high echocardiographic probability of PH.All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH(P<0.05).The correlation coefficient(r)between different LUS scoring methods and PASP was moderate for the 6-zone(r=0.455,P<0.001),8-zone(r=0.385,P=0.001),12-zone(r=0.587,P<0.001),and 28-zone(r=0.535,P<0.001)methods.In Bland-Altman plots,each of the four LUS scoring methods had a good agreement with PASP(P<0.001).The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH(P<0.05).

Innovative integration of lung ultrasound and wearable monitoring for predicting pulmonary complications in colorectal surgery:A prospective study

BACKGROUND Postoperative pulmonary complications(PPCs)are common in patients who undergo colorectal surgery.Studies have focused on how to accurately diagnose and reduce the incidence of PPCs.Lung ultrasound has been proven to be useful in preoperative monitoring and postoperative care after cardiopulmonary surgery.However,lung ultrasound has not been studied in abdominal surgeries and has not been used with wearable devices to evaluate the influence of postoperative ambulation on the incidence of PPCs.AIM To investigate the relationship between lung ultrasound scores,PPCs,and postoperative physical activity levels in patients who underwent colorectal surgery.METHODS In this prospective observational study conducted from November 1,2019 to August 1,2020,patients who underwent colorectal surgery underwent daily bedside ultrasonography from the day before surgery to postoperative day(POD)5.Lung ultrasound scores and PPCs were recorded and analyzed to investigate their relationship.Pedometer bracelets measured the daily movement distance for 5 days post-surgery,and the correlation between postoperative activity levels and lung ultrasound scores was examined.RESULTS Thirteen cases of PPCs was observed in the cohort of 101 patients.The mean(standard deviation)peak lung ultrasound score was 5.32(2.52).Patients with a lung ultrasound score of≥6 constituted the high-risk group.High-risk lung ultrasound scores were associated with an increased incidence of PPCs after colorectal surgery(logistic regression coefficient,1.715;odds ratio,5.556).Postoperative movement distance was negatively associated with the lung ultrasound scores[Spearman’s rank correlation coefficient(r),-0.356,P<0.05].CONCLUSION Lung ultrasound effectively evaluates pulmonary condition post-colorectal surgery.Early ambulation and respiratory exercises in the initial two PODs will reduce PPCs and optimize postoperative care in patients undergoing colorectal surgery.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Simplified lung ultrasound method to predict the respiratory support needs of neonates whose mothers had pregnancy complications: a diagnostic accuracy study

Objective:Some pregnancy complications are associated with respiratory problems in infants.Early identification and implementation of respiratory support are needed for these infants.This study aimed to(1)use lung ultrasound(LU)for predicting the respiratory support requirements of infants and(2)simplify the examination method to facilitate its clinical application.Methods:Neonates underwent LU examinations within 1 hour of birth.The infants were divided into a pregnancy complication(PC)group and a control group according to their mothers'clinical data.The primary outcome measure was the need for respiratory support.Predictive models were established based on the differences in LU patterns between the two groups.The predictive value of the models was compared with that of the LU score(LUS)system,which has been widely used in other studies.Simplified models were established by analyzing the predictive effects of LU patterns in different parts of the lungs.Predictive reliability was tested using the receiver operating characteristic curve analysis.Results:PC and control groups had 29 and 117 neonates,respectively;a total of 22 neonates required respiratory support.The PC and control groups showed differences in respiratory support requirements,A-lines,and coalesced B-lines.The percentages of A-lines and coalesced B-lines were associated with respiratory support requirements.The optimal cutoff values for the percentages of the A-lines and coalesced B-lines were 55.7%and 24.5%,respectively.Similar effects were obtained by calculating the percentage of coalesced B-lines in four areas(R3,R4,L3,and L4).These methods were judged as more visual and convenient than LUS assessment.conclusion:The percentages of A-line and coalesced B-lines on LU images can be used to predict the respiratory support needs of neonates whose mothers had pregnancy complications.Only four areas(R3,R4,L3,and L4)had similar predictive values.

Evaluation value of lung ultrasound combined with CRP and PCT on the efficacy and prognosis of HAP

Objective To investigate the efficacy of lung ultrasound combined with serum C-reactive protein(CRP)and procalcitonin(PCT)in evaluating the efficacy and prognosis of hospital-acquired pneumonia(HAP).Methods A total of 308 HAP patients admitted to the emergency department and intensive care unit(ICU)of First Affiliated Hospital of Tsinghua University from January 2018 to December 2021 were selected and divided into effective group(n=276)and ineffective group(n=32)according to different treatment effects.The baseline data and the dynamic changes of lung ultrasound score(LUS),CRP and PCT were compared between the two groups before treatment,3 days and 7 days after treatment.Pearson correlation analysis was used to evaluate the correlation between LUS,CRP,PCT and Clinical Pulmonary Infection Score(CPIS)after 3 days and 7 days of treatment.Logistic regression equation was used to analyze the related influencing factors of curative effect.Receiver operating characteristic(ROC)curve and area under ROC(AUC)were used to analyze the efficacy of LUS,CPR,PCT and the combination of the three in predicting curative effect.Kaplan-Meier(K-M)survival curve was used to analyze the survival rate of patients with high-risk and low-risk LUS,CPR and PCT.Results In the effective group,the LUS,CPR and PCT after 3 days and 7 days of treatment were lower than those of the ineffective group.Pearson linear correlation analysis showed that LUS,CPR and PCT after 7 days of treatment were positively correlated with CPIS score(P<0.05),among which LUS after 7 days of treatment had the strongest correlation with CPIS(r=0.635).Logistic regression analysis showed that LUS,CPR and PCT were correlated with the efficacy of HAP after 3 days and 7 days of treatment(P<0.05).ROC curve analysis showed that the AUC of LUS,CPR and PCT predicting invalid HAP after 7 days of treatment was higher than that after 3 days of treatment.The AUC of LUS combined with CPR and PCT after 7 days of treatment to predict the efficacy is the largest(AUC=0.947).K-M curve analysis showed that there were statistically significant differences in LUS,CPR and PCT survival rates between high-risk and low-risk patients after 7 days of treatment(P<0.05).Conclusions There is a certain reference value for the dynamic monitoring of lung ultrasound combined with CPR and PCT in the evaluation of the efficacy and prognosis of HAP.

Role of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in isolated pancreatic metastasis from lung cancer

A case is reported of a 50-year-old woman with a history of small-cell lung cancer admitted with pancreatic head lesions, discovered during investigation for obstructive jaundice. Endoscopic ultrasound assisted fine needle aspiration of the pancreatic mass was consistent with small cell carcinoma, presenting as an isolated metastasis from the previously diagnosed lung cancer. Endoscopic retrograde cholangiopancrea- tography (ERCP) showed extrinsic compression and a bile duct stricture, requiring sphincterotomy and stent insertion. This case highlights that acute pancreatitis and biliary obstruction can occur as a manifestation of small cell lung cancer metastasizing to the pancreas. EUS is a safe, low risk and rapid diagnostic tool in such cases, and ERCP with stenting offers a safe and effective treatment option.

Diagnostic Accuracy and Complication Rates of Fusion Images Created Using Real-Time Ultrasound with CT for Identification of Peripheral Lung Lesions in Patients Undergoing Biopsy

Background: Fusion image improves lesion detectability and can be an effective tool for percutaneous ultrasound (US)-guide procedure. We describe the clinical benefit of US-guided lung biopsy using fusion image. Purpose: To retrospectively compare the diagnostic accuracy and complication rates of US-guided lung biopsy with B-mode alone and those of a fusion image created using real-time US and computed tomography (CT). Materials and Methods: Between September, 2013 and September, 2016, 50 peripheral lung lesions in 50 patients (40 males, 10 females;median, 74 years old) were performed by US-guided percutaneous cutting needle biopsy using the B-mode alone or fusion image. Final diagnoses were based on surgical outcomes or clinical follow-up results for at least 12 months after biopsy. To assess prebiopsy characteristics, all lesions were divided into two groups: group 1 (identification on B-mode) and group 2 (identification on fusion image). Results: Of 50 peripheral lesions, 40 lesions (80%) were detected by means of B-mode alone (group 1), and 10 lesions (20%) were identified by fusion image (group 2). The diagnostic accuracy of group 1 was 90% (36/40 lesions), and the diagnostic accuracy of group 2 was 100% (10/10 lesions). Nodule type and the size of the lesions showed significant group wise differences (p Conclusion: Fusion images created using real-time US and CT may be useful for identification of the minimal size of potential target lung lesions and may be more suitable for improved yields with US-guided lung biopsy.

Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

Purpose: Antenatal diagnosis of congenital cystic adenomatoid lung malformation (CCAM) is vital for disease surveillance and postnatal care. Ultrasonography (US) has been the imaging gold standard for antenatal CCAM assessment. However, one of the limitations of US is the “vanishing phenomenon” caused by isoechogenicity of CCAM tissue and adjacent normal lung parenchyma. Methods: Antenatal serial US were concurrently used with magnetic resonance imaging (MRI) to monitor macro- and microcystic lesions. Results: In both pregnant women, antenatal US and MRI confirmed the presence, in the fetus, of cystic lesions and predicted disease regression/progression as well as the need for postnatal surgical intervention. Several advantages were detected by using both—serial US and MRI (over serial US alone)—including improved signal intensity, exact volume size measurements, precise CCAM location in particular for patients with adverse ultrasound conditions. Both neonates underwent surgical resection and had an uneventful post-operative course. Conclusions: Antenatal use of MRI as well as serial US improved information regarding tissue resolution and delineation of CCAM. The information from two imaging modalities was complementary. Our literature review confirmed the emerging role of prenatal MRI for postnatal monitoring and management of CCAM.

The Observation on Risk of Ventilator Failure Weaning by Ultrasound bedside Monitoring of Inferior Vena Cava and Lung B Line

Objective: This study was designed to investigate risk of ventilator weaning by ultrasound bedside monitoring of the width of inferior vena cava (IVC) and the number of lung B-lines (B-lines). Methods: This study was conducted on 106 patients from January 2019 to January 2020 who had mechanical ventilation for more than 48 hours in an emergency care unit. They were clinically stable and had the criteria for weaning from the ventilator. Before Spontaneous Breathing Test (SBT) and 30 min or 120 min after SBT, the width of IVC and the number of B-lines in patients were monitored via bedside ultrasound. There were 87 cases of successful weaning as a control group and 19 cases of ventilator failure weaning as a study group. Changes of the width of IVC and the number of B-lines were compared in the different stages of SBT. Results: A total of 106 patients were included in this study. There were 87 cases of ventilator successful weaning and 19 cases failure weaning. The weaning success rate was 82.08%. The width of IVC and the number of B-lines in the study group were higher than those in the control group in same stage of SBT, the difference was statistically significant (P < 0.05), and which increased significantly with time. There was no significant difference in the width of IVC and the number of B-lines on the different stage of SBT in the control group (P > 0.05), and significant difference in the study group. Conclusion: The width of IVC and the number of B-lines monitored by bedside ultrasound can assess the risk of ventilator weaning, it may be caused by cardiopulmonary interaction.

机械通气脓毒症患者肺部超声重力依赖失充气表型与不良预后的相关性

目的分析脓毒症机械通气患者不同肺部超声表型的临床特征,探讨肺部超声重力依赖肺失充气表型对脓毒症机械通气患者不良预后的相关性。方法回顾性分析2019年4月至2020年10月四川大学华西医院重症医学科收治的机械通气脓毒症患者155例,按照28 d预后情况分为生存组(n=124)和死亡组(n=31),通过单因素和多因素Cox回顾分析肺部超声重力依赖失充气表型对患者28 d预后结局的影响。绘制Kaplan-Meier曲线分析重力依赖性和非重力依赖失充气表型与28 d预后生存的关系。结果单因素Cox回归分析发现,白细胞介素-6、SOFA评分、机械通气时间(h)、间质性失充气、实变性失充气、不张性失充气、存在重力依赖性失充气改变与患者28 d预后结局相关(P<0.05),进一步通过多因素Cox分析校正后发现存在间质性失充气肺部超声模式、机械通气时间和存在重力依赖性失充气改变与患者不良预后结局相关(P<0.05),重力依赖肺失充气表型的死亡风险是非重力依赖肺失充气表型的的2.003倍(HR=2.003,P=0.028,95%CI=1.112-6.387)。结论重力依赖肺失充气肺部超声表型可作为脓毒症机械通气患者不良预后的预测指标。

基于肺部超声的预测模型在急性呼吸窘迫综合征中的应用价值研究

目的建立并验证用于急性呼吸窘迫综合征(ARDS)诊断的肺部超声(LUS)-ARDS评分模型,并将其性能与胸部CT比较。方法回顾性将2019年3月至2023年3月马鞍山市人民医院急诊或ICU收治的325例接受有创呼吸机治疗的患者按照3∶1的比例分别纳入训练集243例和验证集82例,以专家团队诊断结果为“参考”,将患者分为ARDS组(训练集63例,验证集37例)和非ARDS组(训练集180例,验证集45例),患者均接受LUS检查,检查方法为肺部12分区法,然后采用Logistic回归模型构建LUS-ARDS评分系统,采用受试者工作特征(ROC)曲线分析LUS-ARDS评分对ARDS的诊断效能,获得诊断截断值,并计算曲线下面积(AUC)。结果243例(26.03%)ARDS和82例(45.12%)ARDS患者分别被纳入训练集和验证集;将肺左侧LUS通气评分、肺右侧LUS通气评分和前外侧胸膜线异常数构建LUS-ARDS评分为LUS-ARDS评分=LUS-ARDS评分=2.6×左侧LUS通气评分+1×右侧LUS通气评分+3.4×前外侧区域胸膜线异常数,该评分系统在训练集中的ROC曲线下面积(AUC)为0.90(95%CI:0.85~0.95),验证集中的ROC的AUC为0.85(95%CI:0.77~0.93);在有胸部CT的患者中,LUS-ARDS评分的ROC的AUC为0.85(95%CI:0.78~0.90)。结论LUS-ARDS评分可用于准确诊断ARDS,其可能是诊断ARDS的一个有用的辅助工具。其诊断性能与胸部CT(金标准)相当。

肺部超声检查在血液透析合并新型冠状病毒感染中的临床研究

目的探讨肺部超声检查在血液透析合并新型冠状病毒感染中的诊断及治疗策略,以期为临床同行提供参考依据。方法分析1例成功治愈的维持性血液透析合并重型新型冠状病毒感染患者的诊断、治疗等基本临床资料,采用“新型冠状病毒感染”“血液透析”“肺部超声检查”作为关键词对中国知网、PubMed数据库2020-2023年发表的文献进行检索。结果维持性血液透析合并新型冠状病毒感染患者经氧气治疗、抗病毒、抗炎、血液净化(利用肺部超声评估肺部B线变化)、抗感染、抗凝等治疗后痊愈出院,白细胞介素-6、淋巴细胞计数、C反应蛋白、降钙素原、红细胞沉降率、D-二聚体水平均正常,咽拭子新型冠状病毒核酸抗原检测阴性,床旁肺部超声检查提示双肺未见明显B线,肺部CT检查提示肺部渗出明显吸收。文献检索结果:共检索到文献35篇,排除16篇,最终保留可用文献19篇。结合病例分析及文献复习,对肺部超声检查在维持性血液透析合并新型冠状病毒感染中的临床诊断及治疗方法进行分析总结。结论床旁肺部超声检查在识别和分层维持性血液透析合并重型新型冠状病毒感染患者方面非常有效,可即时、准确评估患者的容量状态,保证患者透析的充分性。

超声监测下管理肺疾病:或使早产儿支气管肺发育不良成为可避免的疾病

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是早产儿最常见的慢性肺部疾病,虽然对其病因、机制、预防和治疗的研究取得了重要进展,但预后并没有明显改善。BPD患儿不仅病死率高,对存活者也造成呼吸、神经、心脏等多方面的持久性损害。作者团队在肺脏超声监测下管理新生儿肺疾病,在过去近7年的时间里避免了BPD的发生,为BPD的预防开辟了新途径。该文对此予以简介,以期加强相关研究,为预防或最大程度减少BPD的发生提供更加科学的管理方案。