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Ultrasound Technology in Intensive Care: Current and Emerging Treatment
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Ultrasound Technology in Intensive Care: Current and Emerging Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 16953

Special Issue Editors

Prof. Dr. Cosima Schiavone

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Guest Editor
Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University of Chieti-Pescara, 65122 Chieti, Italy
Interests: internal Medicine; ultrasound; gastrenterology
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Gianpaolo Vidili

E-Mail Website
Guest Editor
Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
Interests: hepatocellular carcinoma; cholangiocellular carcinoma; mini invasive interventional oncology treatments
Special Issues, Collections and Topics in MDPI journals
Dr. Andrea Boccatonda

E-Mail Website
Guest Editor
Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bologna, Italy
Interests: ultrasound; lung disease; hemostasis and thrombosis; cardiovascular disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Ultrasound is currently considered as the “fifth pillar” of the patient's clinical evaluation. In particular, there is a growing interest on the concept of "clinical" ultrasound (bed-side or point of care ultrasound), that is an examination performed by the physician at the bed of the patient, that is able to provide relevant information in a short time, to make diagnoses and therefore to set more and more specific therapies, thus reducing the probability of failure. That diagnostic method was born and developed mainly in the field of intensive care medicine due to its characteristics, currently extending to most of the medical-surgical fields. The Sars-CoV-2 pandemic has underlined the role of ultrasound, by enhancing its benefits such as simplicity and reproducibility in every care setting. New software and technologies open new interesting fields of development for this method.

The present Special Issue “Ultrasound Technology in Intensive Care: Current and Emerging Treatment  Options” welcomes submissions in this field, addressing how an ultrasound-based approach can improve patient management and outcome.

Beyond specialists from intensive care medicine, researchers of all affiliated disciplines with a focus on basic research or patient care are invited to submit original articles or reviews in their area of expertise in order to enhance the awareness of interdisciplinarity in modern intensive care medicine.

Prof. Dr. Cosima Schiavone
Prof. Dr. Gianpaolo Vidili
Dr. Andrea Boccatonda
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung
  • ultrasound
  • pneumonia
  • trauma
  • intensive care
  • cancer
  • heart failure
  • CEUS (Contrast-enhanced Ultrasonography)
  • ventilation
  • diaphragm

Published Papers (7 papers)

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Editorial

Jump to: Research, Review

3 pages, 181 KiB  
Editorial
Emergency Ultrasound: Is It Time for Artificial Intelligence?
by Andrea Boccatonda
J. Clin. Med. 2022, 11(13), 3823; https://doi.org/10.3390/jcm11133823 - 01 Jul 2022
Cited by 5 | Viewed by 1198
Abstract
Ultrasound is a fundamental and indispensable diagnostic method in the field of emergency medicine [...] Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)

Research

Jump to: Editorial, Review

15 pages, 3590 KiB  
Article
Deep Learning for Improving the Effectiveness of Routine Prenatal Screening for Major Congenital Heart Diseases
by Siti Nurmaini, Radiyati Umi Partan, Nuswil Bernolian, Ade Iriani Sapitri, Bambang Tutuko, Muhammad Naufal Rachmatullah, Annisa Darmawahyuni, Firdaus Firdaus and Johanes C. Mose
J. Clin. Med. 2022, 11(21), 6454; https://doi.org/10.3390/jcm11216454 - 31 Oct 2022
Cited by 9 | Viewed by 2961
Abstract
Early prenatal screening with an ultrasound (US) can significantly lower newborn mortality caused by congenital heart diseases (CHDs). However, the need for expertise in fetal cardiologists and the high volume of screening cases limit the practically achievable detection rates. Hence, automated prenatal screening [...] Read more.
Early prenatal screening with an ultrasound (US) can significantly lower newborn mortality caused by congenital heart diseases (CHDs). However, the need for expertise in fetal cardiologists and the high volume of screening cases limit the practically achievable detection rates. Hence, automated prenatal screening to support clinicians is desirable. This paper presents and analyses potential deep learning (DL) techniques to diagnose CHDs in fetal USs. Four convolutional neural network architectures were compared to select the best classifier with satisfactory results. Hence, dense convolutional network (DenseNet) 201 architecture was selected for the classification of seven CHDs, such as ventricular septal defect, atrial septal defect, atrioventricular septal defect, Ebstein’s anomaly, tetralogy of Fallot, transposition of great arteries, hypoplastic left heart syndrome, and a normal control. The sensitivity, specificity, and accuracy of the DenseNet201 model were 100%, 100%, and 100%, respectively, for the intra-patient scenario and 99%, 97%, and 98%, respectively, for the inter-patient scenario. We used the intra-patient DL prediction model to validate our proposed model against the prediction results of three expert fetal cardiologists. The proposed model produces a satisfactory result, which means that our model can support expert fetal cardiologists to interpret the decision to improve CHD diagnostics. This work represents a step toward the goal of assisting front-line sonographers with CHD diagnoses at the population level. Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)
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12 pages, 1420 KiB  
Article
Association between Wait Time for Transthoracic Echocardiography and 28-Day Mortality in Patients with Septic Shock: A Cohort Study
by Jiezhao Zheng, Qilin Yang, Tianyu Kong, Xiaohua Chen, Rundong Wang, Jiaxian Huo, Weichao Huang, Deliang Wen, Xuming Xiong and Zhenhui Zhang
J. Clin. Med. 2022, 11(14), 4131; https://doi.org/10.3390/jcm11144131 - 16 Jul 2022
Cited by 2 | Viewed by 1643
Abstract
Background: the optimal timing of Transthoracic echocardiography (TTE) performance for patients with septic shock remains unexplored. Methods: a retrospective cohort study included patients with septic shock in the MIMIC-Ⅲ database. Risk-adjusted restricted cubic splines modeled the 28-day mortality according to time elapsed from [...] Read more.
Background: the optimal timing of Transthoracic echocardiography (TTE) performance for patients with septic shock remains unexplored. Methods: a retrospective cohort study included patients with septic shock in the MIMIC-Ⅲ database. Risk-adjusted restricted cubic splines modeled the 28-day mortality according to time elapsed from ICU admission to receive TTE. The cut point when a smooth curve inflected was selected to define early and delayed group. We applied propensity score matching (PSM) to ensure our findings were reliable. Causal mediation analysis was used to assess the intermediate effect of fluid balance within 72 h after ICU admission. Results: 3264 participants were enrolled and the risk of 28-day mortality increased until the wait time was around 10 h (Early group) and then was relatively flat afterwards (Delayed group). A beneficial effect of early TTE in terms of the 28-day mortality was observed (HRs 0.73–0.78, all p < 0.05) in the PSM. The indirect effect brought by the fluid balance on day 2 and 3 was significant (both p = 0.006). Conclusion: early TTE performance might be associated with lower risk-adjusted 28-day mortality in patients with septic shock. Better fluid balance may have mediated this effect. A wait time within 10 h after ICU may represent a threshold defining progressively increasing risk. Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)
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12 pages, 914 KiB  
Article
The Role of Lung Ultrasound Monitoring in Early Detection of Ventilator-Associated Pneumonia in COVID-19 Patients: A Retrospective Observational Study
by Silvia Mongodi, Nello De Vita, Giulia Salve, Silvia Bonaiti, Francesco Daverio, Margherita Cavagnino, Gilda Siano, Alessandro Amatu, Giuseppe Maggio, Valeria Musella, Catherine Klersy, Rosanna Vaschetto, Belaid Bouhemad and Francesco Mojoli
J. Clin. Med. 2022, 11(11), 3001; https://doi.org/10.3390/jcm11113001 - 26 May 2022
Cited by 6 | Viewed by 1745
Abstract
Specific lung ultrasound signs combined with clinical parameters allow for early diagnosis of ventilator-associated pneumonia in the general ICU population. This retrospective cohort study aimed to determine the accuracy of lung ultrasound monitoring for ventilator-associated pneumonia diagnosis in COVID-19 patients. Clinical (i.e., clinical [...] Read more.
Specific lung ultrasound signs combined with clinical parameters allow for early diagnosis of ventilator-associated pneumonia in the general ICU population. This retrospective cohort study aimed to determine the accuracy of lung ultrasound monitoring for ventilator-associated pneumonia diagnosis in COVID-19 patients. Clinical (i.e., clinical pulmonary infection score) and ultrasound (i.e., presence of consolidation and a dynamic linear–arborescent air bronchogram, lung ultrasound score, ventilator-associated lung ultrasound score) data were collected on the day of the microbiological sample (pneumonia-day) and 48 h before (baseline) on 55 bronchoalveolar lavages of 33 mechanically-ventilated COVID-19 patients who were monitored daily with lung ultrasounds. A total of 26 samples in 23 patients were positive for ventilator-associated pneumonia (pneumonia cases). The onset of a dynamic linear–arborescent air bronchogram was 100% specific for ventilator-associated pneumonia. The ventilator-associated lung ultrasound score was higher in pneumonia-cases (2.5 (IQR 1.0 to 4.0) vs. 1.0 (IQR 1.0 to 1.0); p < 0.001); the lung ultrasound score increased from baseline in pneumonia-cases only (3.5 (IQR 2.0 to 6.0) vs. −1.0 (IQR −2.0 to 1.0); p = 0.0001). The area under the curve for clinical parameters, ventilator-associated pneumonia lung ultrasound score, and lung ultrasound score variations were 0.472, 0.716, and 0.800, respectively. A newly appeared dynamic linear–arborescent air bronchogram is highly specific for ventilator-associated pneumonia in COVID-19 patients. A high ventilator-associated pneumonia lung ultrasound score (or an increase in the lung ultrasound score) orients to ventilator-associated pneumonia. Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)
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11 pages, 1563 KiB  
Article
Role of Lung Ultrasound in the Management of Patients with Suspected SARS-CoV-2 Infection in the Emergency Department
by Andrea Boccatonda, Alice Grignaschi, Antonella Maria Grazia Lanotte, Giulio Cocco, Gianpaolo Vidili, Fabrizio Giostra and Cosima Schiavone
J. Clin. Med. 2022, 11(8), 2067; https://doi.org/10.3390/jcm11082067 - 07 Apr 2022
Cited by 9 | Viewed by 3202
Abstract
Background: The lung ultrasound (LUS) score has been proposed as an optimal scheme for the ultrasound study of patients with suspected/confirmed COVID-19 pneumonia. The aims of our study were to evaluate the use of lung ultrasound as a diagnostic tool for diagnosing SARS-CoV-2 [...] Read more.
Background: The lung ultrasound (LUS) score has been proposed as an optimal scheme for the ultrasound study of patients with suspected/confirmed COVID-19 pneumonia. The aims of our study were to evaluate the use of lung ultrasound as a diagnostic tool for diagnosing SARS-CoV-2 pneumonia, to examine the validity of the LUS score for the diagnosis of COVID-19 pneumonia, and to correlate this score with hospitalization rate and 30-day mortality. Materials and Methods: A retrospective analysis was performed on 1460 patients who were referred to the General Emergency Department of the S. Orsola-Malpighi Hospital from April 2020 to May 2020 for symptoms suspected to indicate SARS-CoV-2 infection. The ultrasound examination was based on a common execution scheme called the LUS score, as previously described. Results and Conclusions: The LUS score was found to correlate with the degree of clinical severity and respiratory failure (paO2/FiO2 ratio and the alveolar–arterial gradient increase than expected for age). It was shown that COVID-19 patients with an LUS score of >7 require the use of oxygen support, and a value of >10 is associated with an increased risk of oro-tracheal intubation. The LUS score was found to present higher values in hospitalized patients, increasing according to the degree of care intensity. Patients who died from COVID-19 were characterized by a mean LUS score of 11 at presentation to the emergency department. An LUS score of >7.5 was found to indicate a sensitivity of 83% and a specificity of 89% for 30-day mortality in COVID-19 patients. The use of LUS seems to be an optimal first level method for pneumonia detection and risk stratification in patients with suspected SARS-CoV-2 infection. Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)
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Review

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11 pages, 279 KiB  
Review
Ultrasound in Sepsis and Septic Shock—From Diagnosis to Treatment
by Gianluca Tullo, Marcello Candelli, Irene Gasparrini, Sara Micci and Francesco Franceschi
J. Clin. Med. 2023, 12(3), 1185; https://doi.org/10.3390/jcm12031185 - 02 Feb 2023
Cited by 4 | Viewed by 3924
Abstract
Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, [...] Read more.
Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, appropriate source control as well as adequate hemodynamic resuscitation. For years now, both emergency department (ED) doctors and intensivists have used ultrasound as an adjunctive tool for the correct diagnosis and treatment of these patients. Our aim was to better understand the state-of-the art role of ultrasound in the diagnosis and treatment of sepsis and septic shock. Methods: We conducted an extensive literature search about the topic and reported on the data from the most significant papers over the last 20 years. Results: We divided each article by topic and exposed the results accordingly, identifying four main aspects: sepsis diagnosis, source control and procedure, fluid resuscitation and hemodynamic optimization, and echocardiography in septic cardiomyopathy. Conclusion: The use of ultrasound throughout the process of the diagnosis and treatment of sepsis and septic shock provides the clinician with an adjunctive tool to better characterize patients and ensure early, aggressive, as well as individualized therapy, when needed. More data are needed to conclude that the use of ultrasound might improve survival in this subset of patients. Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)
12 pages, 2677 KiB  
Review
Ultrasound-Guided Dynamic Needle-Tip Positioning Method Is Superior to Conventional Palpation and Ultrasound Method in Arterial Catheterization
by Guannan Wu, Chen Chen, Xiaoling Gu, Yanwen Yao, Dongmei Yuan, Jiawen Lv, Beilei Zhao and Qin Wang
J. Clin. Med. 2022, 11(21), 6539; https://doi.org/10.3390/jcm11216539 - 03 Nov 2022
Cited by 3 | Viewed by 1465
Abstract
Background: Dynamic needle-tip positioning (DNTP) was shown to improve arterial cannulation efficiency with fewer complications than conventional palpation and ultrasound methods by some studies. However, this is still controversial, and we performed this meta-analysis to comprehensively assess its value in arterial cannulation. Methods: [...] Read more.
Background: Dynamic needle-tip positioning (DNTP) was shown to improve arterial cannulation efficiency with fewer complications than conventional palpation and ultrasound methods by some studies. However, this is still controversial, and we performed this meta-analysis to comprehensively assess its value in arterial cannulation. Methods: A literature search of randomized controlled trials was conducted, and 11 studies were finally included. Efficiency outcomes (first-attempt success, overall success, and total cannulation time) and complications (hematoma, thrombosis, posterior wall puncture, and vasospasm) were separately analyzed. Subgroup analyses in different populations under cannulation were also performed. Results: DNTP was associated with increased first-attempt success (pooled RR = 1.792, p < 0.001), overall success (pooled RR = 1.368, p = 0.001), and decreased cannulation time (pooled SMD = −1.758, p = 0.001) than palpation. DNTP gained even more advantage in small children and infants. No significant difference in these outcomes between DNTP and conventional ultrasound method was detected. Fewer hematoma occurred in DNTP than palpation (pooled RR = 0.265, p < 0.001) or traditional ultrasound (pooled RR = 0.348, p < 0.001). DNPT was also associated with fewer posterior wall punctures (pooled RR = 0.495, p = 0.001) and vasospasm (pooled RR = 0.267, p = 0.007) than traditional ultrasound. Conclusions: DNTP was a better choice in artery cannulation than conventional palpation and ultrasound method, especially in small children and infants. Full article
(This article belongs to the Special Issue Ultrasound Technology in Intensive Care: Current and Emerging Treatment)
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