Search Results (49)

There is limited research on the impact of a physiotherapy-guided rehabilitation program (PGRP) on lung structure in systemic sclerosis (SSc). Lung ultrasound (LUS) has been used for over a decade to identify interstitial lung disease associated with SSc (SSc-ILD). This study aims to evaluate the impact of a PGRP on LUS signals in women with SSc-ILD and women without ILD (SSc-wILD). This is a longitudinal quasi-experimental study that included 33 women with SSc. The results show that changes in LUS were observed in 22 participants, especially B-lines > two. Before the PGRP the median of B-lines > two was three (0–7), while after the PGRP it was three (0–6) (p = 0.020). The aeration score was eight (0–16.5) pre-PGRP and three (0–16) post-PGRP (p = 0.013). Analyzing the impact of the PGRP on LUS signals in SSc-ILD and SSc-wILD groups, the main change observed was a reduction in B-lines > two between pre-PGRP and post-PGRP in the SSc-ILD group (p = 0.0004). The SSc-ILD group had a higher aeration score than the SSc-wILD group both pre-PGRP (p < 0.0001) and post-PGRP (p = 0.0001)]. In conclusion, LUS may be a complementary tool for assessing pre- and post-PGRP changes in people with SSc-ILD and SSc-wILD. Our data also suggest that the PGRP can elicit measurable changes in LUS findings in SSc, particularly in SSc-ILD. These findings support the inclusion of LUS in the routine monitoring of SSc and the use of a PGRP as a non-pharmacologic adjunctive strategy in SSc. Full article

Rabbits are commonly affected by subclinical lung diseases. Computed tomography (CT) is the gold standard for diagnosing rabbit lung diseases but is not widely available and requires anesthesia, delaying diagnosis. Lung ultrasound (LUS) has emerged as a radiation-free, bedside diagnostic tool in human and veterinary medicine, though its use in rabbit medicine is not routine. This study aimed to evaluate LUS for detecting subclinical lung lesions in rabbits. Thirty healthy, five-month-old male New Zealand white rabbits underwent lung ultrasound, exploring four regions in each hemithorax, followed by thoracic CT under sedation with midazolam and butorphanol. The ultrasound images were scored as positive or negative, and the CT exams were assessed for aeration using threshold masks. The results showed that 63% of rabbits had one or more affected regions in the ultrasound images, and 19% of the regions were positive. CT identified 54% of the regions as positive for poorly aerated tissue, with 26/30 rabbits showing at least one positive region. The sensitivity and specificity of LUS were 33.33% and 93.48%, respectively, with an accuracy of 67.92% for detecting subclinical lesions. While LUS demonstrated a high specificity, its sensitivity was low compared to CT, highlighting the need for further refinement in its use for rabbit respiratory disease diagnosis. Full article

Background: Acute lower respiratory tract conditions are highly prevalent in paediatrics. Many of these conditions present as consolidations on imaging studies. One of the most common causes is bacterial pneumonia (BP), which requires an accurate diagnosis to implement the best treatment plan. Despite the fact that major guidelines constrain the use of invasive tests, chest X-ray (CXR) or blood tests are still routinely used for the diagnosis. In this regard, the introduction of lung ultrasound (LUS) signified an advancement in reducing the invasiveness of diagnosis. However, there are still situations where distinguishing between different aetiologies remains challenging, especially in the case of atelectasis. Methods: This is a prospective cohort study to assess the diagnostic accuracy of new non-invasive, quantifiable, and reproducible imaging biomarkers (lung elastance and microvascularization ratio) for differentiating BP from another major entity that causes the appearance of consolidation in imaging tests, atelectasis. It will be conducted at Sant Joan de Déu Hospital in Spain from June 2025 to June 2027. Firstly, imaging biomarkers will be measured in well-aerated lung tissue without consolidation to establish their values in healthy lung tissue, according to a predefined imaging acquisition protocol. Subsequently, the imaging biomarkers will be assessed in patients with confirmed lung consolidation by LUS (Group 1: BP; Group 2: atelectasis). Results: The study aims to determine whether there are statistically significant differences in the biomarker values in relation to the normal values and between the different etiological groups. Conclusions: The demonstration of the reliable diagnostic accuracy of these biomarkers could significantly reduce the need for invasive techniques and improve the therapeutic management of many patients with BP and other pulmonary conditions presenting with consolidation in imaging tests. Full article

Lung ultrasound (LUS) has become a crucial part of the investigative tools available in the management of critically ill patients, both within the intensive care unit setting and in prehospital medicine. The increase in its application, in part driven by the COVID-19 pandemic, along with the easy access and use of mobile and handheld devices, allows for immediate access to information, reducing the need for other radiological investigations. LUS allows for the rapid and accurate diagnosis and grading of respiratory pathology, optimisation of ventilation, assessment of weaning, and monitoring of the efficacy of surfactant therapies. This, however, must occur within the framework of accreditation to ensure patient safety and prevent misinterpretation and misdiagnosis. This narrative review aims to outline the current uses of LUS within the context of published protocols, associated pathologies, LUS scoring systems, and their applications, whilst exploring more novel uses. Full article

Objectives: The intensity of respiratory treatment in acute respiratory distress syndrome (ARDS) is traditionally adjusted based on oxygenation severity, as defined by the mild, moderate, and severe Berlin classifications. However, ventilator-induced lung injury (VILI) is primarily determined by ventilator settings, namely tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP). All these variables, along with respiratory elastance, are included in the concept of mechanical power. The aim of this study is to investigate whether applied mechanical power is proportional to oxygenation severity. Methods: We analyzed 291 ARDS patients (71 mild, 155 moderate, and 65 severe). We defined low, middle, and high mechanical power by dividing the entire population into tertiles with a similar number of patients. In each oxygenation class, we measured computed tomography (CT) anatomy, gas exchange, respiratory mechanics, mechanical power, and mortality rate. Results: ARDS severity was proportional to lung anatomy impairment, as defined by quantitative CT scans (i.e., lung volume and well-aerated tissue decreased across the ARDS classes, while respiratory elastance increased, as did mortality). Mechanical power, however, was similarly distributed across the severity classes, as the decrease in tidal volume in severe ARDS was offset by an increase in respiratory rate. Within each ARDS class, mortality increased from low to high mechanical power (roughly 1% for each J/min increase). Conclusions: Both lung severity and mechanical power independently impact mortality rates. It is tempting to speculate that ARDS severity primarily reflects the natural course of the disease, while mechanical power primarily reflects the risk of VILI. Full article

Background/Objective: A-lines and B-lines are key ultrasound markers that differentiate normal from abnormal lung conditions. A-lines are horizontal lines usually seen in normal aerated lungs, while B-lines are linear vertical artifacts associated with lung abnormalities such as pulmonary edema, infection, and COVID-19, where a higher number of B-lines indicates more severe pathology. This paper aimed to evaluate the effectiveness of a newly released lung ultrasound AI tool (ExoLungAI) in the detection of A-lines and quantification/detection of B-lines to help clinicians in assessing pulmonary conditions. Methods: The algorithm is evaluated on 692 lung ultrasound scans collected from 48 patients (65% males, aged: 55 ± 12.9) following their admission to an Intensive Care Unit (ICU) for COVID-19 symptoms, including respiratory failure, pneumonia, and other complications. Results: ExoLungAI achieved a sensitivity of 91% and specificity of 81% for A-line detection. For B-line detection, it attained a sensitivity of 84% and specificity of 86%. In quantifying B-lines, the algorithm achieved a weighted kappa score of 0.77 (95% CI 0.74 to 0.80) and an ICC of 0.87 (95% CI 0.85 to 0.89), showing substantial agreement between the ground truth and predicted B-line counts. Conclusions: ExoLungAI demonstrates a reliable performance in A-line detection and B-line detection/quantification. This automated tool has greater objectivity, consistency, and efficiency compared to manual methods. Many healthcare professionals including intensivists, radiologists, sonographers, medical trainers, and nurse practitioners can benefit from such a tool, as it assists the diagnostic capabilities of lung ultrasound and delivers rapid responses. Full article

Background: Fluoroscopy-guided PTNB for fluoroscopy-identifiable lung lesions has been suggested as a useful method for the pathological diagnosis of lung lesions; however, it is lacking in accuracy and safety compared to CT-guided PTNB. Thus, we aimed to investigate the diagnostic accuracy and complications of fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) with the aid of pre-procedural planning cone-beam computed tomography (CBCT) in order to take advantage of their respective strengths. Methods: A total of 255 fluoroscopy-guided PTNBs with the aid of planning CBCT were performed. Pre-procedural planning CBCT was conducted to calculate the shortest length from the skin puncture site to the margin of the target lesion for the needle trajectory. No intra-procedural CBCT was performed. The diagnostic performance of fluoroscopy-guided PTNB with the aid of planning CBCT was calculated. The prognostic factors for diagnostic failures and complications were evaluated using logistic regression analysis. Results: The accuracy, sensitivity, specificity, PPV, and NPV were 97.3%, 88.0%, 90.9%, 100%, and 62.5%, respectively. There were 29 diagnostic failures (11.8%), and the multivariable analysis showed that a longer lesion depth on CBCT and a shorter specimen length were each associated with diagnostic failure (p = 0.010 and 0.012, respectively). Complications occurred in 34 PTNBs (13.3%). The multivariable analysis showed that an increased total number of biopsies per lesion, a longer length of lung aeration via needle insertion, a smaller lesion size on CT imaging (≤20 mm), and the presence of an air bronchogram were associated with the occurrence of complications (p = 0.027, <0.001, 0.003, and 0.020, respectively). Conclusions: Excellent diagnostic accuracy was obtained by fluoroscopy-guided PTNB with the aid of planning CBCT. Compared to that of CT- or CBCT-guided PTNB, the procedure-related complication rate was acceptably low, but the radiation dose to patients could be potentially reduced. Full article

Objective: The aim of this study was to evaluate high-frequency percussive ventilation (HFPV) as a rescue strategy for extremely low gestational age neonates (ELGANs) with severe lung disease. Methods: This is a retrospective review of 16 ELGANs with severe lung disease who were placed on HFPV following a lack of improvement on other modes of conventional and high-frequency ventilation. Results: The gestational age of these 16 infants was 25 (24, 26) weeks and their birth weight was 640 (535, 773) grams [median (IQR)], with the survivors being more immature compared to those who died [24 (23, 26) and 26 (25, 28) weeks, respectively; (p = 0.04)]; and with an overall mortality of 31% (N = 5). Of those who died, 60% were SGA (p = 0.02). Following placement on HFPV, the survivors had a statistically significant decrease in their respiratory severity scores (RSSs) [11 (9, 14) to 6 (5, 13), p = 0.03] compared to those who did not survive [15 (11, 16) to 11 (6.8, 14.5), p = 0.32] due to an improvement in their oxygenation [FiO₂: 0.95 (0.85, 1) to 0.6 (0.4, 0.9), p = 0.01; compared to 1 (1, 1) to 1 (0.7, 1); survivors and non-survivors, respectively; p = 0.32]. Chest X-rays also showed significantly improved aeration due to decreased areas of atelectasis in those who survived. Conclusions: HFPV may be an appropriate rescue mode of high-frequency ventilation in the ELGAN population with severe lung disease, particularly for patients with impaired oxygenation and ventilation difficulties due to shifting atelectasis and mucous plugging. Full article

Aim: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. Materials and methods: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. Results: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001—delivery room; r = 4.0443, p < 0.001—one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). Conclusions: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support. Full article

Background/Objectives: During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO₂)/fractional inspired oxygen (FiO₂) ratio as a reference standard to define the best cut-off for predicting adverse outcomes. Methods: We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO₂/FiO₂ ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO₂/FiO₂ ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13). Conclusions: Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care. Full article

Advanced respiratory monitoring encompasses a diverse range of mini- or noninvasive tools used to evaluate various aspects of respiratory function in patients experiencing acute respiratory failure, including those requiring extracorporeal membrane oxygenation (ECMO) support. Among these techniques, key modalities include esophageal pressure measurement (including derived pressures), lung and respiratory muscle ultrasounds, electrical impedance tomography, the monitoring of diaphragm electrical activity, and assessment of flow index. These tools play a critical role in assessing essential parameters such as lung recruitment and overdistention, lung aeration and morphology, ventilation/perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient–ventilator synchrony. In contrast to conventional methods, advanced respiratory monitoring offers a deeper understanding of pathological changes in lung aeration caused by underlying diseases. Moreover, it allows for meticulous tracking of responses to therapeutic interventions, aiding in the development of personalized respiratory support strategies aimed at preserving lung function and respiratory muscle integrity. The integration of advanced respiratory monitoring represents a significant advancement in the clinical management of acute respiratory failure. It serves as a cornerstone in scenarios where treatment strategies rely on tailored approaches, empowering clinicians to make informed decisions about intervention selection and adjustment. By enabling real-time assessment and modification of respiratory support, advanced monitoring not only optimizes care for patients with acute respiratory distress syndrome but also contributes to improved outcomes and enhanced patient safety. Full article

Background: Oscillometry allows for the non-invasive measurements of lung mechanics. In COVID-19 ARDS patients treated with Non-Invasive Oxygen Support (NI-OS), we aimed to (1) observe lung mechanics at the patients’ admission and their subsequent changes, (2) compare lung mechanics with clinical and imaging data, and (3) evaluate whether lung mechanics helps to predict clinical outcomes. Methods: We retrospectively analyzed the data from 37 consecutive patients with moderate–severe COVID-19 ARDS. Oscillometry was performed on their 1st, 4th, and 7th day of hospitalization. Resistance (R5), reactance (X5), within-breath reactance changes (ΔX5), and the frequency dependence of the resistance (R5–R19) were considered. Twenty-seven patients underwent computed tomographic pulmonary angiography (CTPA): collapsed, poorly aerated, and normally inflated areas were quantified. Adverse outcomes were defined as intubation or death. Results: Thirty-two patients were included in this study. At the first measurement, only 44% of them had an abnormal R5 or X5. In total, 23 patients had measurements performed on their 3rd day and 7 on their 7th day of hospitalization. In general, their R5, R5–R19, and ΔX decreased with time, while their X5 increased. Collapsed areas on the CTPA correlated with the X5 z-score (ρ = −0.38; p = 0.046), while poorly aerated areas did not. Seven patients had adverse outcomes but did not present different oscillometry parameters on their 1st day of hospitalization. Conclusions: Our study confirms the feasibility of oscillometry in critically ill patients with COVID-19 pneumonia undergoing NI-OS. The X5 z-scores indicates collapsed but not poorly aerated lung areas in COVID-19 pneumonia. Our data, which show a severe impairment of gas exchange despite normal reactance in most patients with COVID-19 ARDS, support the hypothesis of a composite COVID-19 ARDS physiopathology. Full article

This article aims to detect lung cavitations using lung ultrasound (LUS) in a cohort of patients with pulmonary tuberculosis (TB) and correlate the findings with chest computed tomography (CT) and chest X-ray (CXR) to obtain LUS diagnostic sensitivity. Patients with suspected TB were enrolled after being evaluated with CXR and chest CT. A blinded radiologist performed LUS within 3 days after admission at the Infectious Diseases Department. Finally, 82 patients were enrolled in this study. Bronchoalveolar lavage (BAL) confirmed TB in 58/82 (71%). Chest CT showed pulmonary cavitations in 38/82 (43.6%; 32 TB patients and 6 non-TB ones), LUS in 15/82 (18.3%; 11 TB patients and 4 non-TB ones) and CXR in 27/82 (33%; 23 TB patients and 4 non-TB ones). Twelve patients with multiple cavitations were detected with CT and only one with LUS. LUS sensitivity was 39.5%, specificity 100%, PPV 100% and NPV 65.7%. CXR sensitivity was 68.4% and specificity 97.8%. No false positive cases were found. LUS sensitivity was rather low, as many cavitated consolidations did not reach the pleural surface. Aerated cavitations could be detected with LUS with relative confidence, highlighting a thin air crescent sign towards the pleural surface within a hypoechoic area of consolidation, easily distinguishable from a dynamic or static air bronchogram. Full article

Artificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is characterized by interstitial opacities, mostly in the dependent areas, decreased lung aeration with alveolar collapse, and inflammatory lung edema resulting in elevated lung weight. As a result, lung imaging is a crucial tool for evaluating the mechanical and morphological traits of ARDS patients. Compared to traditional chest radiography, sensitivity and specificity of lung computed tomography (CT) and ultrasound are higher. The state of the art in the application of AI is summarized in this narrative review which focuses on CT and ultrasound techniques in patients with ARDS. A total of eighteen items were retrieved. The primary goals of using AI for lung imaging were to evaluate the risk of developing ARDS, the measurement of alveolar recruitment, potential alternative diagnoses, and outcome. While the physician must still be present to guarantee a high standard of examination, AI could help the clinical team provide the best care possible. Full article

Background: The role of quantitative chest computed tomography (CT) is controversial in the follow-up of patients with COVID-19 pneumonia. The aim of this study was to test during the follow-up of COVID-19 pneumonia the association between pulmonary function tests (PFTs) and quantitative parameters extrapolated from follow-up (FU) CT scans performed at least 6 months after COVID-19 onset. Methods: The study included patients older than 18 years old, admitted to the emergency department of our institution between 29 February 2020 and 31 December 2020, with a diagnosis of COVID-19 pneumonia, who underwent chest CT at admission and FU CT at least 6 months later; PFTs were performed within 6 months of FU CT. At FU CT, quantitative parameters of well-aerated lung and pneumonia extent were identified both visually and by software using CT density thresholds. The association between PFTs and quantitative parameters was tested by the calculation of the Spearman’s coefficient of rank correlation (rho). Results: The study included 40 patients (38% females; median age 63 years old, IQR, 56–71 years old). A significant correlation was identified between low attenuation areas% (%LAAs) <950 Hounsfield units (HU) and both forced expiratory volume in 1s/forced vital capacity (FEV1/FVC) ratio (rho −0.410, 95% CIs −0.639–−0.112, p = 0.008) and %DLCO (rho −0.426, 95% CIs −0.678–−0.084, p = 0.017). The remaining quantitative parameters failed to demonstrate a significant association with PFTs (p > 0.05). Conclusions: At follow-up, CT scans performed at least 6 months after COVID-19 pneumonia onset showed %LAAs that were inversely associated with %DLCO and could be considered a marker of irreversible lung damage. Full article