Safely Inserting Neonatal Chest Drains

Goelz, Rangmar; Krumrey, Sabrina; Dietz, Klaus; Esser, Michael; Poets, Christian F.

doi:10.1159/000520041

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…However, LUS in neonatal patients may have similar exposimetric conditions as rats, with a 2-8 mm range of CWT. 20 A prudent safety recommendation for neonatal LUS is to limit the B mode MI OS ≤0.3, 7 which could be facilitated by the creation and use of safe neonatal imaging presets. The PCH adjusted for the frame rate emphasizes the puzzling decrease of PCH with increase in frame number.…”

Section: Discussionmentioning

confidence: 99%

“…The use of the rat model of LUS seems removed from adult human use, due to the reduced transmission through the thicker CWTs. However, LUS in neonatal patients may have similar exposimetric conditions as rats, with a 2–8 mm range of CWT 20 . A prudent safety recommendation for neonatal LUS is to limit the B mode MI OS ≤0.3, 7 which could be facilitated by the creation and use of safe neonatal imaging presets.…”

Section: Discussionmentioning

confidence: 99%

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Frame Rate Exposimetry for Pulmonary Capillary Hemorrhage During Lung Ultrasound

Miller

Dou

Dong

2023

J of Ultrasound Medicine

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Objectives-Lung ultrasound (LUS) is a powerful and accessible clinical tool for pulmonary diagnosis, but risk of pulmonary capillary hemorrhage (PCH) presents a safety issue. The dependence of PCH in a rat model of LUS was evaluated for image frames-per-second (fps) and associated on-screen Mechanical Index (MI OS ) and Thermal Index (TI).Methods-A Philips iE33 machine with L15-7io probe was used to scan anesthetized rats in a warmed water bath. B mode was applied at 9 MHz with settings of 34, 61 and 118 fps. After 2 minutes of exposure at an MI OS setting, samples were obtained for assessment of PCH areas on the lung surface. Ultrasound parameters were measured to determine the in situ MI IS at the lung surface.Results-The PCH trend counter-intuitively decreased with increasing fps, with areas of 19.5 mm 2 for 34 fps (MI OS = 1.0, TI = 0.8, 4080 images), 9.6 mm 2 at 61 fps (MI OS = 1.0, TI = 0.5, 7320 images) and 7.5 mm 2 at 118 fps (MI OS = 1.1, TI = 0.4, 14,160 images). The PCH was not significantly different for 34 fps (TI = 0.5, MI OS = 0.8) (10.7 mm 2 ), compared to 61 and 118 fps, above, indicating some value for the TI as a predictive indicator of PCH. MI IS thresholds were 0.42, 0.46, and 0.49 for 34, 61 and 118 fps, respectively.Conclusions-The increase in PCH at low fps was associated with delivering more relatively high amplitude grazing pulse exposures during slower image scans. No significant PCH was found for the MI OS setting of 0.5, corresponding to in MI IS values of 0.35-0.39.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frame Rate Exposimetry for Pulmonary Capillary Hemorrhage During Lung Ultrasound

Miller

Dou

Dong

2023

J of Ultrasound Medicine

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“…Neonatal patients have CWTs in the range of 0.2–0.8 cm 34 . For a neonatal intercostal space of T = 0.3 cm and f = 10 MHz, assuming adult attenuation coefficient, MI CWC (Equation ()) would be 0.68MI, affording little safety margin (ie, 1.3 for an MI = 1.9).…”

mentioning

confidence: 99%

“…Neonatal patients have CWTs in the range of 0.2-0.8 cm. 34 For a neonatal intercostal space of T = 0.3 cm and f = 10 MHz, assuming adult attenuation coefficient, MI CWC (Equation ( 1)) would be 0.68MI, affording little safety margin (ie, 1.3 for an MI = 1.9). As this most vulnerable patient population appears to be most at risk of PCH lung injury, problematic adjustment of settings would be needed to achieve MI CWC ≤ 0.3.…”

mentioning

confidence: 99%

AIUM Official Statement: Statement and Recommendations for Safety Assurance in Lung Ultrasound

2023

J of Ultrasound Medicine

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iagnostic ultrasound has made great strides since performance standards and recommended maximum exposure levels were set up in the 1980s and 1990s. Lung ultrasound (LUS) has advanced to become an important clinical tool. The pleura appears in the image as a hyperechoic line, and defects in the line shown by image artifacts, such as B lines, are used to facilitate a variety of diagnoses in patients from neonates to high-BMI adults. In addition to the older methods for pulmonary effusion and thoracentesis, LUS has been found to be valuable in the diagnosis of pneumonia, pulmonary edema, pulmonary embolism, atelectasis, diffuse parenchymal disease, respiratory distress syndrome, COVID-19, and lung cancer. [1][2][3][4] Lung ultrasound is particularly valuable in neonates at the point-of-care (POC) for diagnosis of respiratory distress syndrome, 5 assessing surfactant treatment, 6 pulmonary hemorrhage, 7 and the number of B lines correlates with computed tomography findings, 8 while avoiding any ionizing radiation exposure. An international review provides guidelines and 20 consensus statements on the use of LUS. 9 Neonatal POC LUS has been found to be valuable in many patient settings, and is often routinely performed daily to follow patient progress. 5,6 Neonatal exam guidelines noted the use of 10-15 MHz linear arrays at 10-12 positions on the neonatal chest, at birth and each week (ie, totaling 40-48 individual exams for scoring). 10 Use of presets was recommended if available with adjustment of parameters to recommended settings. 11 The concomitant evolution of ultrasound technology has provided simplified and handy devices that have revolutionized the practice of POC LUS, a major positive development in patient care.The development of diagnostic ultrasound performance standards to clear diagnostic ultrasound machines for marketing in the United States began with the 1976 Medical Device Amendments to the 1938 Food, Drug, and Cosmetic Act. These standards aimed to ensure that new machines entering the market would be substantially equivalent in terms of safety and effectiveness to machines on the market before enactment of the 1976 Medical Device Amendments. The possibility of bioeffects of ultrasound was accepted, and a means to communicate ultrasound exposure levels to the practitioner was deemed essential. The National Equipment Manufacturers Association developed an Output Display Standard (ODS), 12 with the aid of the American Institute of Ultrasound in Medicine, the US Food and Drug Administration, and the National Council on Radiation Protection and Measurements, among others, based on possible physical mechanisms for ultrasound bioeffects. The ODS is now maintained by the International Electrotechnical Commission. 13 Two exposure indices were created to provide the

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Lung Ultrasound Induction of Pulmonary Capillary Hemorrhage in Rats With Consideration of Exposimetric Relationships to Previous Similar Observations in Neonatal Swine

Miller

Dou

Dong

2023

Ultrasound in Medicine & Biology

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Safely Inserting Neonatal Chest Drains

Cited by 3 publications

References 15 publications

Frame Rate Exposimetry for Pulmonary Capillary Hemorrhage During Lung Ultrasound

Frame Rate Exposimetry for Pulmonary Capillary Hemorrhage During Lung Ultrasound

AIUM Official Statement: Statement and Recommendations for Safety Assurance in Lung Ultrasound

Lung Ultrasound Induction of Pulmonary Capillary Hemorrhage in Rats With Consideration of Exposimetric Relationships to Previous Similar Observations in Neonatal Swine

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