Is Bigger Really Better? Comparison of Ultraportable Handheld Ultrasound with Standard Point-of-Care Ultrasound for Evaluating Safe Site Identification and Image Quality prior to Pleurocentesis

Abstract

<b><i>Background:</i></b> Pleural effusions remain a common medical problem which often requires diagnostic pleurocentesis to determine the underlying cause. Pleurocentesis is a frequently performed procedure worldwide with improved safety using ultrasound (US) technology. <b><i>Objectives:</i></b> This prospective, single-center study evaluated the use of an ultraportable handheld (UPHH) US compared with standard point-of-care (SPOC) US in determining a safe site for pleurocentesis. In addition, US image quality and factors impacting on image quality were assessed using both UPHH and SPOC US. <b><i>Methods:</i></b> Paired US assessments were performed by thoracic physicians using UPHH and SPOC US on patients with unilateral pleural effusions to determine a safe site for pleurocentesis (defined as >2 cm of pleural fluid, >2 cm from a solid organ/diaphragm, and <7 cm chest wall depth). Distance measurements for key structures and image quality scores (using a 5-point Likert rating scale) were obtained at the time of US assessment. Factors affecting image quality were analyzed using univariate analysis. <b><i>Results:</i></b> In 52 of the 54 included patients (96.3%), UPHH US was able to identify a safe site for pleurocentesis. Distance measurements between UPHH and SPOC US were not statistically different (all <0.5 cm with values of <i>p</i> > 0.05), but image quality was reduced in UPHH compared with SPOC US by 1 point on a 5-point Likert rating scale (<i>p</i> < 0.002). Increasing body mass index was associated with a reduction in image quality in both UPHH and SPOC US (all <i>p</i> < 0.01). <b><i>Conclusions:</i></b> Although image quality was lower in UPHH than SPOC US, a safe site was found in 96.3% of patients, which suggests that UPHH US may be a useful tool for diagnostic pleuro­centesis when SPOC US is not available (http://www.anzctr.org.au/, Australia New Zealand Clinical Trials Registry, No. ACTRN12618001592235).

Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

“…Recent data also suggest that early LUS evaluation of patients with respiratory symptoms in the emergency department can result in significant changes in patient management [23], and this could be particularly useful in the COVID-19 pandemic, where misdiagnoses may have relevant consequences in terms of infection spread. The use of ultraportable handheld devices could be of particular interest in this emergency setting, as recently demonstrated for interventional applications [24]. The correlation between LUS and CT visual scores in COVID-19 supports the implementation of this technique and the design of larger, prospective studies evaluating the importance of LUS in different settings of COVID-19 care.…”

Hand-Held Ultrasound of the Lung: A Systematic Review

“…Four hundred and fifty-three articles were retrieved from all search bibliographic databases and 15 studies were evaluated (Figure 1): Bedetti et al [18], Kajimoto et al [19], Lisi et al [20], Cogliati et al [21], Filopei et al [22], Platz et al [23], Sforza et al [24], Phillips and Manning [25], Bobbia et al [26], Bensted et al [27], Lima et al [28], Newhouse et al [29], Jalil et al [30] Dini et al [31], Bennett et al [32].…”

“…Five out of the 15 studies were conducted in Italy [15,17,18,25,32,33] and in most cases, eligible subjects on a specific period of time [23][24][25][26]28,[30][31][32] were evaluated with a hand-held US device (Table 1). In the majority of cases, the role of the index test (namely HHUS, hand-held ultrasound) was diagnostic [19][20][21][22][23][24]26,27,30,32,33] followed by screening [28,29,32] and only one study as triage [24]. One of the included studies was a pilot study (Bobbia et al [26]).…”

“…One of the included studies was a pilot study (Bobbia et al [26]). The number of eligible participants were reported by four studies and were equal with 39 (Cogliati et al 2014 [21]), 37 (Platz et al, 2015 [23]), 198 (Bensted et al, 2018 [27]) and 54 (Newhouse et al 2020 [29]). The evaluated sample ranged from 18 (Bennett et al 2021 [32]) to 165 (Bensted et al, 2018 [27]) (Table 2).…”

Automatic Measurement of the Carotid Blood Flow for Wearable Sensors: A Pilot Study

“…They integrate, for example, the receiver front end and the beamformer [ 7 ], the transmitter and the piezoelectric transducers array [ 8 ], and the complete transmission–reception transceiver [ 9 ]. The availability of these devices fosters the development of compact and economical ultrasound systems [ 10 , 11 , 12 , 13 , 14 ], even based on smartphones [ 15 ], and can change the ultrasound paradigm, opening new scenarios for their employment. These apparatuses represent an important contribution, but they alone do not completely solve the problem, since, as noted before, the presence of an expert operator is still required.…”