Training for Lung Ultrasound Score Measurement in Critically Ill Patients

Rouby, Jean-Jacques; Arbelot, Charlotte; Gao, Ya; Zhang, Mao; Lv, Jie; An, Youzhong; Wang, Chun-Yao; Du, Bin; Barbas, Carmen Sílvia Valente; Neto, Felippe Leopoldo Dexheimer; Caltabeloti, Fabiola Prior; Lima, Emidio J. S.; Cebey, Andres; Parratte, Sébastien; Constantin, Jean-Michel

doi:10.1164/rccm.201802-0227le

Cited by 162 publications

(182 citation statements)

References 11 publications

(8 reference statements)

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“…However, the protocol did not include the posterior chest, and only the anterior and lateral chest walls were considered. In the 12 regions protocol, anterior, lateral, and posterior areas were included, but in each region, only the intercostal space with the worst ultrasound pattern was calculated . In neonates, linear transducers have been commonly used, and the posterior area is mostly considered .…”

Section: Discussionmentioning

confidence: 99%

“…In the 12 regions protocol, anterior, lateral, and posterior areas were included, but in each region, only the intercostal space with the worst ultrasound pattern was calculated. 11,15,34 In neonates, linear transducers have been commonly used, and the posterior area is mostly considered. 4,5 For this reason, the protocol used in this experiment also included the posterior chest.…”

Section: Evlw Measurements Determined By Transpulmonary Thermodilutionmentioning

confidence: 99%

“…LUS scoring systems have been developed to meet the need for standardization and have been shown to correlate with various metrics in adults and neonates . These scoring systems are used to assess the severity, course, and prognosis of the disease and then guide the treatment . Nevertheless, it remains unclear about the degree of lung water content that can cause pulmonary dysfunction, and how to quantitatively assess lung water content by ultrasound.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] These scoring systems are used to assess the severity, course, and prognosis of the disease and then guide the treatment. [14][15][16][17] Nevertheless, it remains unclear about the degree of lung water content that can cause pulmonary dysfunction, and how to quantitatively assess lung water content by ultrasound. And the correlation between B-line score (BLS) and the EVLW content is still not clear.…”

Section: Introductionmentioning

confidence: 99%

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Using lung ultrasound to quantitatively evaluate pulmonary water content

Zong

Guo

Liu

et al. 2020

Pediatric Pulmonology

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Background Increases in extravascular lung water (EVLW) can lead to respiratory failure. This study aimed to investigate whether the B‐line score (BLS) was correlated with the EVLW content determined by the lung wet/dry ratio in a rabbit model. Methods A total of 45 New Zealand rabbits were randomly assigned to nine groups. Among the animals, models of various lung water content levels were induced by the infusion of different volumes of warm sterile normal saline (NS) via the endotracheal tube. The arterial blood gas, spontaneous respiratory rate, and PaO2/FiO2 ratio were detected before and after infusion. In addition, the B‐lines were determined before and immediately after infusion in each group. Finally, both lungs were resected to determine the wet/dry ratio. In addition, all lung specimens were analyzed histologically, and EVLW was quantified using the BLS based on the number and confluence of B‐lines in the intercostal space. Results The BLS increased with increasing infusion volume. The BLS was statistically correlated with the wet/dry ratio (r2= .946) and with the PaO2/FiO2 ratio (r2= .916). Furthermore, a repeatability study was performed for the lung ultrasound (LUS) technology (Bland‐Altman plots), and the results suggest that LUS had favorable intraobserver and interobserver reproducibility. Conclusions This study is the first to suggest that the BLS can serve as a sensitive, quantitative, noninvasive, and real‐time indicator of EVLW in a rabbit model of lung water accumulation. Notably, the BLS displayed an obvious correlation with the experimental gravimetry results and could also be used to predict the pulmonary oxygenation status.

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Section: Discussionmentioning

confidence: 99%

Section: Evlw Measurements Determined By Transpulmonary Thermodilutionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Using lung ultrasound to quantitatively evaluate pulmonary water content

Zong

Guo

Liu

et al. 2020

Pediatric Pulmonology

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“…[2]. Furthermore, TUS expertise is easily attained following a concise training course for physicians and non-physicians alike [3]. In women with preeclampsia, pulmonary edema is associated with the appearance of B-lines, i.e., interstitial syndrome [4,5].…”

Section: Introductionmentioning

confidence: 99%

Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia

et al. 2020

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Background: Pregnancy-induced changes in cardiovascular status make women more susceptible to pulmonary edema. During cesarean section, to counterbalance the effect of hypotension caused by spinal anesthesia, anesthesiologists must choose between two fundamental approaches to maintain the hemodynamic state-intravenous fluids or vasopressors-and this choice will depend upon their particular opinions and experience. We aim to assess for any correlations between thoracic ultrasound A-and B-line artifacts, brain natriuretic peptide (BNP) levels, and the amount of intraoperative fluids administered.Results: From December 2016 to August 2018, at the University-Hospital of Udine, we enrolled 80 consecutive pregnant women undergoing cesarean section. We observed a statistically significant difference in the volume of fluids administered in the first 24 h (p = 0.035) between the patients presenting B-lines in at least one basal area of their thoracic ultrasound and patients with no evident B-lines (AUC 66.4%; IC 0.49-0.83). Dividing the population on whether their BNP levels were higher or less than 20 pg/mL, no statistically significant difference was revealed with regard to fluids administered in the first 24 h (p = 0.537). Conclusions:Thoracic ultrasound is a non-invasive and easy-to-use tool for detecting fluid intolerance in pregnant women undergoing cesarean section. BNP levels were slow to rise following the cesarean section and did not show any clear correlation with fluid volumes administered.

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The Lung Ultrasound Score Cannot Accurately Evaluate the Severity of Neonatal Lung Disease

Liu

2019

J of Ultrasound Medicine

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F or nearly a decade, lung ultrasound (LUS) has been extensively used in the diagnosis and differential diagnosis of neonatal lung diseases because of its increased accuracy and effectiveness compared with traditional chest radiography, and LUS has replaced radiography in the diagnosis of neonatal lung diseases in some neonatal intensive care units. [1][2][3][4] However, during the development of LUS, it was expected that LUS could quantitatively evaluate the severity of lung diseases, with a so-called LUS scoring system. 5-7 On the basis of my accumulated experience with more than 10 years of research in this field, I found that the LUS score not only cannot be used to accurately assess the severity of neonatal lung disease but also may result in substantial discrepancies.The LUS score has the following major defects and shortcomings:1. A score of 1 is assigned for pulmonary interstitial syndrome according to the presence of "multiple isolated B-lines". However, the term "multiple B-lines" is not clearly defined in the scoring system. For instance, the LUS score would be 1 according to the system, regardless of the presence of 3 or 4 B-lines or more than 10 B-lines. This scoring criterion is obviously inappropriate because the number of B-lines is associated with the severity of edema.2. A score of 1 is assigned for focal lung edema, and a score of 2 is assigned for alveolar edema. For focal lung edema, coalescent B-lines should occupy less than 50% of the intercostal space in the whole lung field. However, for alveolar edema, coalescent B-lines should occupy 100% of the intercostal space in the whole lung field. The question is how the edema should be scored when coalescent B-lines occupy between 50% and 100% of the intercostal space in the field, which is a very common condition in clinical practice. 3. The system ignores the influence of the distribution zones of coalescent B-lines. Lung US commonly displays different patterns of coalescent B-lines in different lung zones. Coalescent B-lines are present in some intercostal spaces, whereas other spaces may be normal or abnormal, reflecting different degrees of

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Training for Lung Ultrasound Score Measurement in Critically Ill Patients

Cited by 162 publications

References 11 publications

Using lung ultrasound to quantitatively evaluate pulmonary water content

Using lung ultrasound to quantitatively evaluate pulmonary water content

Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia

The Lung Ultrasound Score Cannot Accurately Evaluate the Severity of Neonatal Lung Disease

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