Lung ultrasound in acute respiratory distress syndrome and beyond

Baston, Cameron; West, T. Eoin

doi:10.21037/jtd.2016.12.74

Cited by 25 publications

(31 citation statements)

References 32 publications

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“…Out of the 106 patients included in our study, 36 had ‘critical’ illness who presented to emergency in acute respiratory distress. Acute respiratory distress syndrome (ARDS) is characterized by heterogeneous B lines, with or without lung sliding and subpleural consolidations [ 25 ]. Early detection of these finding on a lung ultrasound can help predict the disease severity of the patient.…”

Section: Discussionmentioning

confidence: 99%

Lung sonographic findings in COVID-19 patients

Sahu

Mathew

Bhoi

et al. 2021

The American Journal of Emergency Medicine

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Objective The objective of this study was to describe the lung sonographic findings of COVID-19 patients prospectively and investigate its association with disease severity. Methods This study was conducted in an emergency department and included consecutively enrolled laboratory confirmed COVID-19 patients. Lung sonography findings were described in all the included patients and analysed with respect to the clinical severity of the patients. Results 106 patients were included in the study. Common sonographic findings in COVID-19 patients were pleural line irregularity or shredding (70% of patients), followed by B – profile (59%), pleural line thickening (33%), occasional B – lines (26%), sub-pleural consolidations (35%), deep consolidations (6%), spared areas (13%), confluent B – lines or waterfall sign (14%) and pleural effusion (9%). These findings tended to be present more bilaterally and in lower lung zones. Sonographic characteristics like bilateral lung involvement, B – profile, spared areas and confluent B – lines or waterfall sign were significantly associated ( p < 0.01) with clinical severity (more frequent with increasing disease severity). Conclusion The lung sonographic findings of COVID-19 were found more bilaterally and in lower lung zones, and specific findings like B – profile, pleural thickening, spared areas and confluent B – lines or waterfall sign were associated with severe COVID-19.

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Section: Discussionmentioning

confidence: 99%

Lung sonographic findings in COVID-19 patients

Sahu

Mathew

Bhoi

et al. 2021

The American Journal of Emergency Medicine

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“…Another reason for the limited concordance between chest radiography and lung ultrasound is that lung ultrasound could only detect abnormalities in contact with the visceral pleura, while chest radiography could detect parenchymal abnormalities away from the pleura (i.e., the sensitivity of lung ultrasound is limited by false negatives) [ 4 ]. Additionally, lung ultrasound may lack sensitivity compared with chest radiography since ARDS is generally a posterior-predominant disease and it may be difficult to scan the posterior regions of the lung due to obstruction of ultrasound by the scapula bone and the difficulty in rolling patients who are ventilated.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, chest radiography has poor sensitivity for the detection of pulmonary infiltrates compared with other imaging modalities such as computed tomography [ 3 ]. Secondly, chest radiography has poor specificity for the determination of acute lung injury [ 4 ]. Thirdly, chest radiography may not be available in resource-limited settings, or in austere environments, and requires the use of radiation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…It has been established as an important tool for the evaluation of critically ill patients, with higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia, using computed tomography as the reference standard [ 6 , 7 ]. It has also been shown to be useful in diagnosing specific pathological features such as interstitial edema, consolidation, and pleural effusion [ 4 , 8 , 9 ]. Using transpulmonary thermodilution measurement as the reference standard for pulmonary edema, lung ultrasound predicted extravascular lung water in ventilated intensive care patients better than chest radiography [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

et al. 2018

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BackgroundLung ultrasound may be a reasonable alternative to chest radiography for the identification of acute respiratory distress syndrome (ARDS), but the diagnostic performance of lung ultrasound for ARDS is uncertain. We therefore analyzed the clinical outcomes of ARDS diagnosed according to the Berlin Definition, using either chest radiography (Berlin-CXR) or lung ultrasound (Berlin-LUS) as an alternative imaging method.MethodsThis was a retrospective observational study in a 20-bed medical intensive care unit (ICU). Patients who required noninvasive ventilation or invasive ventilation for hypoxemic respiratory failure on ICU admission from August 2014 to March 2017 were included. Both chest radiography and lung ultrasound were performed routinely upon ICU admission. Comparisons were made using either the Berlin-CXR or Berlin-LUS definitions to diagnose ARDS with respect to the patient characteristics and clinical outcomes for each definition. ICU and hospital mortality were the main outcome measures for both definitions.ResultsThe first admissions of 456 distinct patients were analyzed. Compared with the 216 patients who met the Berlin-CXR definition (ICU mortality 19.4%, hospital mortality 36.1%), 229 patients who met the Berlin-LUS definition (ICU mortality 22.7%, hospital mortality 34.5%) and 79 patients who met the Berlin-LUS but not the Berlin-CXR definition (ICU mortality 21.5%, hospital mortality 29.1%) had similar outcomes. In contrast, the 295 patients who met either definition had higher mortality than the 161 patients who did not meet either definition (ICU mortality 20.0% versus 12.4%, P = 0.041; hospital mortality 34.2% versus 24.2%, P = 0.027). Compared with Berlin-CXR, Berlin-LUS had a positive predictive value of 0.66 (95% confidence interval 0.59–0.72) and a negative predictive value of 0.71 (0.65–0.77). Among the 216 Berlin-CXR ARDS patients, 150 patients (69.4%) also fulfilled Berlin-LUS definition.ConclusionsFor the identification of ARDS using the Berlin definition, both chest radiography and lung ultrasound were equally related to mortality. The Berlin definition using lung ultrasound helped identify patients at higher risk of death, even if these patients did not fulfill the conventional Berlin definition using chest radiography. However, the moderate overlap of patients when chest imaging modalities differed suggests that chest radiography and lung ultrasound should be complementary rather than used interchangeably.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2105-y) contains supplementary material, which is available to authorized users.

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“…36,37 Chest ultrasound to detect pericardial effusion, pleural effusion, interstitial edema, pneumothorax and consolidation has been reported to have a diagnostic accuracy as high as 90% -100% for emergent lung findings. 38,39 While the data is still maturing in the field, chest ultrasound may be more sensitive and specific than chest radiography, and less so than chest CT, for the detection of pulmonary complications in ventilated patients with acute respiratory failure 40 .…”

Section: Role Of Ultrasound For Imaging Covid-19 Infectionmentioning

confidence: 99%

The Role of Imaging in the Management of Suspected or Known COVID-19 Pneumonia: A Multidisciplinary Perspective

et al. 2020

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COVID-19 is an illness caused by a novel coronavirus that has rapidly escalated into a global pandemic leading to an urgent medical effort to better characterize this disease biologically, clinically and by imaging. In this review, we present the current approach to imaging of COVID-19 pneumonia. We focus on the appropriate utilization of thoracic imaging modalities to guide clinical management. We also describe radiologic findings that are considered typical, atypical and generally not compatible with COVID-19. Further, we review imaging examples of COVID-19 imaging mimics, such as organizing pneumonia, eosinophilic pneumonia and other viral infections.

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Lung ultrasound in acute respiratory distress syndrome and beyond

Cited by 25 publications

References 32 publications

Lung sonographic findings in COVID-19 patients

Lung sonographic findings in COVID-19 patients

Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

The Role of Imaging in the Management of Suspected or Known COVID-19 Pneumonia: A Multidisciplinary Perspective

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