Evaluation of pulmonary B lines by different intensive care physicians using
            bedside ultrasonography: a reliability study

Vieira, Juliana; Castro, M.; Guimarães, Thaís de Paula; Pinheiro, Aldo José Tavarez; Figueiredo, Ana Clara Tiso Costa; Martins, Bruna Jacomini; Carmo, Daniel Reis do; Oliveira, Wesley Academes

doi:10.5935/0103-507x.20190058

Cited by 15 publications

(16 citation statements)

References 17 publications

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“…Results of the present study revealed that, hypertension, diabetes, COPD and hypothyroidism were reported in 63.3%, 66.7%, 16.7% and 40.0% respectively. These results are comparable to those reported by Vieira et al [23] who reported that, the main comorbidity was systemic arterial hypertension [50.7%]; congestive heart failure [28.4%]; and COPD [8.9%]. In line with the current study, an analysis of the LUNG-SAFE [Large study to UNderstand the Global impact of Severe Acute respiratory FailurE] study found that 13% of 2377 patients [13.3% in the current study] treated for ARDS underwent tracheostomy [24] .…”

Section: Discussionsupporting

confidence: 92%

Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP

Abdelhameed

Alrifai

Abdelhay

2020

International Journal of Medical Arts

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Background: Acute respiratory distress syndrome [ARDS] is usually associated with significant morbidities, and may need admission to intensive care unit [ICU]. Mechanical ventilation when indicated needs continuous monitoring. Aim of the work: To assess clinical value of ultrasonic monitoring in pulmonary recruitment and optimal positive end-expiratory pressure [PEEP] in cases of ARD. Methods: It included thirty patients with ARDS. All were subjected to clinical evaluation, X-ray chest, lung ultrasound and laboratory investigations. All patients underwent mechanical ventilation by increasing PEEP, starting at 5 mmHg then [6, 9, 12, and 15 mmHg] according to patient response with documentation of good response. At each PEEP, chest ultrasound was completed and results were correlated with respiratory functions. Results: Hypertension, diabetes, COPD and hypothyroidism were reported in 63.3%, 66.7%, 16.7% and 40.0% respectively. The rate of primary weaning success was 36.7%, and 30.0% achieved weaning success in the third trail; tracheostomy indicated for 13.3%, pneumothorax 10.0%, pleural effusion 6.7% and mortality rate was 33.3%. Increased PEEP was concomitant by progressive improvement of respiratory functions. In addition, there was progressive significant decrease of B-lines at different areas from right and left lungs. All effects were significant at PEEP 9. Conclusions: Gradual increments of PEEP helps to tailor the patient response on an individual basis. The use of readily available, portable ultrasound, permits the daily monitoring and could guide the treatment protocol.

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Section: Discussionsupporting

confidence: 92%

Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP

Abdelhameed

Alrifai

Abdelhay

2020

International Journal of Medical Arts

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“…How do these findings compare to the interrater reliability literature for LUS outside of COVID-19? Previous investigations have demonstrated moderate to substantial agreement for B-lines [22][23][24][25] . In contrast, there is only moderate to fair agreement for consolidation 11,12,22 , pleural irregularity 22 , and effusions.…”

Section: Discussionmentioning

confidence: 92%

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Kumar

Weng

Graglia

et al. 2020

Preprint

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Background: Lung ultrasound (LUS) may be used in the diagnostic evaluation of patients with COVID-19. An abnormal LUS is associated with increased risk for ICU admission in 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. Research Question: What is the interrater reliability of lung ultrasound findings in patients with RT-PCR confirmed COVID-19? Study Design and Methods: This study was conducted at conducted at two academic medical centers between 03/2020-06/2020. Nine physicians (hospitalists: n=4; emergency medicine: n=5) independently evaluated n=20 LUS scans (n=180 independent observations) collected from RT-PCR confirmed COVID-19 patients. 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 were used to calculate IRR. Results: There was substantial IRR on the following items: normal LUS scan (K=0.79 [95% CI: 0.72-0.87]), presence of B-lines (K=0.79 [95% CI: 0.72-0.87]), >=3 B-lines observed (K=0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (K=0.57 [95% CI: 0.50-0.64]), subpleural consolidation (K=0.49 [95% CI: 0.42-0.56]), and presence of effusion (K=0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (K=0.23 [95% CI: 0.15-0.30]). Interpretation: 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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“…It was replaced by neighbourhood socioeconomic deprivation, as previously described 24 , in one of our sensitivity analyses. Finally, we included self-declared immunodeficiency in the model, as this variable could potentially influence antibodies development, risk of infection and prolonged viral shedding 25 .…”

Section: Methodsmentioning

confidence: 99%

“…Finally, we included self-declared immunodeficiency in the model, as this variable could potentially influence antibodies development, risk of infection and prolonged viral shedding 25 .…”

Section: Study Design and Participantsmentioning

confidence: 99%

Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study

Leidi

Koegler

Dumont

et al. 2021

Preprint

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Importance: Serological assays detecting specific IgG antibodies generated against the Spike protein following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are being widely deployed in research studies and clinical practice. However, the duration and the effectiveness of the protection conferred by the immune response against future infection remains to be assessed in a large population. Objective: To estimate the incidence of newly acquired SARS-CoV-2 infections in seropositive individuals from a population-based sample as compared to seronegative controls. Design: Retrospective longitudinal propensity-score matched cohort study. Setting: A seroprevalence survey including a population-based representative sample of the population from the canton of Geneva (Switzerland) was conducted between April and June 2020, immediately after the first pandemic wave. Each individual included in the seroprevalence survey was linked to a state centralized registry compiling virologically confirmed SARS-CoV-2 infections since the beginning of the pandemic. Participants: Participants aged twelve years old and over, who developed anti-spike IgG antibodies were matched one-to-two to seronegative controls, using a propensity-score including age, gender, immunodeficiency, body mass index, smoking status and education level. Exposure: SARS-CoV-2 seropositivity. Main outcomes and measures: Our primary outcome was virologically confirmed SARS-CoV-2 infections which occurred from serological status assessment in April-June 2020 to the end of the second pandemic wave (January 2021). Additionally, incidence of infections, rate of testing and proportion of positive tests were analysed. Results: Among 8344 serosurvey participants, 498 seropositive individuals were selected and matched with 996 seronegative controls. After a mean follow-up of 35.6 (Standard Deviation, SD: 3.2) weeks, 7 out of 498 (1.4%) seropositive subjects had a positive SARS-CoV-2 test, of which 5 (1.0%) were considered as reinfections. By contrast, infection rate was significantly higher in seronegative individuals (15.5%, 154/996) during a similar mean follow-up of 34.7 (SD 3.2) weeks, corresponding to a 94% (95%CI 86% to 98%, P<0.001) reduction in the hazard of having a positive SARS-CoV-2 test for seropositive subjects. Conclusions and relevance: Seroconversion after SARS-CoV-2 infection confers protection to successive viral contamination lasting at least 8 months. These findings could help global health authorities establishing priority for vaccine allocation.

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Evaluation of pulmonary B lines by different intensive care physicians using bedside ultrasonography: a reliability study

Cited by 15 publications

References 17 publications

Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP

Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study

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