Clinical and echocardiographic determinants of ultrasound lung comets☆

Frassi, Francesca; Gargani, Luna; Gligorova, Suzana; Ciampi, Quirino; Mottola, Gaetano; Picaño, Eugenio

doi:10.1016/j.euje.2006.09.004

Cited by 129 publications

(111 citation statements)

References 26 publications

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“…Pulmonary congestion may be semiquantified using lung ultrasound [22,25,27,[51][52][53][54][55]. In the clinical arena, lung ultrasound can therefore be employed as a bedside, easy-to-use, alternative tool for monitoring pulmonary congestion changes in heart failure patients, as they disappear or clear upon adequate medical treatment [27,[56][57][58][59][60].…”

Section: P-d3-s2 (Strong: Level A)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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Background: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. Methods: A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Results: Seventythree proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/ conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. Conclusions: This document reflects the overall results of the first consensus conference on ''point-of-care'' lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

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Section: P-d3-s2 (Strong: Level A)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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“…8,18 Ring-down artifact-Ultrasound artifact that appears as a series of bands or solid narrowbased spreading streaks radiating from a gas collection to the edge of the screen. Analysis of this artifact shows an acoustic signal with electronic processing converting this sound wave into a series of bands ( Figure 1).…”

Section: Definitionsmentioning

confidence: 99%

“…The setup consisted of metal syringe needles (21,18, and 14 gauge in succession) positioned vertically at the bottom of a 20 × 7-cm tube filled with 180 mL of a 3.5% polygeline solution (Emagel; Pierrel Medical Care, Potenza, Italy). Air was manually forced through the needles, forming a series of evenly spaced millimeter-sized air bubbles.…”

Section: Single Dynamic Bubblesmentioning

confidence: 99%

Sonographic Interstitial Syndrome

Soldati¹,

Copetti

Sher

2009

Journal of Ultrasound in Medicine

221

172

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Objective. Ultrasound lung comets (ULCs) now have an acknowledged correlation with extravascular lung water, but they present in different orders and numbers in different pathologic pulmonary entities. How these artifacts are created is not yet known, and the literature gives discordant hypotheses. Understanding their formation is the first step in understanding lung disease. The purpose of this study was to show the morphologic and genetic variability of interstitial lung disease studied with echography and thus to propose a unitary mechanism for the formation of ULCs. Methods. This study included 3 parts: (1) a retrospective analysis of echographic lung images of patients with interstitial syndrome; (2) an analysis of the literature for definitions of the size of the pulmonary lobule; and (3) an experimental model of different air-water interfaces scanned with varying ultrasonic frequencies.Results. The retrospective analysis of echographic lung images included 176 patients with diffuse ULCs: 118 patients had acute pulmonary edema; 18 had acute lung injury/acute respiratory distress syndrome; and 40 were premature neonates with respiratory distress syndrome. Experimental models permitted us to discover that ring-down artifacts are produced only by single and double layers of bubbles in specific structural settings. Conclusions. Reverberation between bubbles with a critical radius seems to be at the origin of ring-down artifacts. Echographic manifestations of interstitial lung disease, whose genesis lies in the partial air loss of lobes and segments, are acoustic phenomena originating from variations in the tissue-fluid relationship of the lung. A correlation between anatomopathologic characteristics and structures of sonographic artifacts could allow more rapid and noninvasive diagnoses.

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“…Early research was conducted on very sick inpatients, using microconvex or cardiac probes, interrogating many lung regions 4 20 , 21 Lung ultrasound has become a precision tool in the hands of physicians and intensivists 14 15 , 22 Interested emergency physicians subsequently simplified and transferred the technique to selected emergency presentations, using the more ubiquitous curved abdominal (3–5MHz) probe 2 …”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol

Baker

Mitchell

Thompson

et al. 2013

Australas J Ultrason Med

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Introduction: Emergency department differentiation of pulmonary oedema from chronic obstructive airways disease causing acute breathlessness is inaccurate 25% of the time despite clinical acumen, clinician‐reported chest x‐ray and ECG. This research investigates whether a basic lung ultrasound protocol (LUS) could improve identification of pulmonary oedema in breathless elderly patients. Method: Researchers prospectively sampled patients over 60 years, describing any breathlessness on presentation to a suburban emergency department. LUS studies were acquired by experienced or novice sonologists, interpreted by a blinded reviewer and compared with cardiologist chart audit for diagnosis at admission (gold standard). The admitting doctor's diagnosis, blinded to LUS, was compared with the chart audit result. Results: 204 LUS were collected, 145 by experienced sonologist and 59 by inexperienced. Diagnostic accuracy compared to cardiologist audit was 86.2% (95% CI 80.9 to 90.3), significantly higher than 70.2%, diagnostic accuracy for admission diagnosis, difference in proportion of 16% (95%CI 7.7 to 24.4%). Conclusion: A simple lung scanning protocol can help exclude pulmonary oedema in any breathless elderly patient.

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Clinical and echocardiographic determinants of ultrasound lung comets☆

Cited by 129 publications

References 26 publications

International evidence-based recommendations for point-of-care lung ultrasound

International evidence-based recommendations for point-of-care lung ultrasound

Sonographic Interstitial Syndrome

Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol

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