暂无摘要。

BACKGROUND: Heart failure (HF) poses a major health problem, where frequent HF rehospitalizations (HFH) heavily burden national health systems. HFH are predominantly linked to inadequate decongestion before discharge. It is uncertain if systematic implementation of cardio-pulmonary ultra-sound imaging (CPUSI) to standard HF management can improve outcomes and reduce HFH.
RESULTS: This study recruited 50 patients admitted with acute decompensated heart failure (ADHF). Besides the conventional daily assessment, CPUSI was systematically performed to guide treatment decisions, focusing on ventricular filling pressure and 8-zone lung ultrasound (LUS) score. On-admission and predischarge LUS scores were correlated to clinical outcomes. The mean age of the study group was 55.7 ± 10.59 years, with predominance of male gender. Supplementing clinical judgment, CPUSI modified therapeutic strategy in 57 out of 241 assessments (24%), improving patients\' care. Besides its value in guiding therapeutic decisions, the LUS score on admission had a significant positive correlation to the length of ICU stay and the total hospitalization length. Also, LUS score > 12 at discharge predicted 90-day HFH with sensitivity and specificity of 100% and 98%, respectively.
CONCLUSIONS: Systematic CPUSI can improve HF management by complementing the often challenging judgment of pulmonary congestion. Adding periodic evaluation of ventricular filling pressures and LUS scores to clinical assessment can optimize treatment decisions and improve patient care. LUS score was a significant predictor for in-hospital and post-discharge clinical outcomes.

Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65-89%) and specificity (Sp) of 73% (95% CI 54-86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients.

Hyponatremia is a multifactorial disorder defined as a decrease in plasma sodium concentration. Its differential diagnosis requires an adequate evaluation of the extracellular volume (ECV). However, ECV determination, simply based on the clinical history, vital signs, physical examination, and laboratory findings can leads to misdiagnosis and inappropriate treatment. The use of Point-of-Care Ultrasound (POCUS), through the combination of Lung Ultrasound (LUS), Venous Excess UltraSound (VExUS) and Focused Cardiac Ultrasound (FoCUS), allows a much more accurate holistic assessment of the patient\'s ECV status in combination with the other parameters.

This review explores imaging\'s crucial role in acute Coronavirus Disease 2019 (COVID-19) assessment. High Resolution Computer Tomography is especially effective in detection of lung abnormalities. Chest radiography has limited utility in the initial stages of COVID-19 infection. Lung Ultrasound has emerged as a valuable, radiation-free tool in critical care, and Magnetic Resonance Imaging shows promise as a Computed Tomography alternative. Typical and atypical findings of COVID-19 by each of these modalities are discussed with emphasis on their prognostic value. Considerations for pediatric and immunocompromised cases are outlined. A comprehensive diagnostic approach is recommended, as radiological diagnosis remains challenging in the acute phase.

Acute respiratory distress syndrome (ARDS) is a significant cause of morbidity and mortality in critically ill patients, yet it is often underrecognized. Current imaging techniques, such as CT scan and X-ray, have several limitations, including inter-observer reliability, limited accessibility, radiation and the need for transportation. Ultrasound has become an essential bedside tool in the critical care setting and the emergency room, offering several advantages over traditional imaging techniques. It is nowadays widely used for diagnosis and early management of acute respiratory and circulatory failure. Lung ultrasound (LUS) provides non-invasively valuable information regarding lung aeration, ventilation distribution and respiratory complications in ARDS patients at the bedside. Moreover, a holistic ultrasound approach, combining LUS, echocardiography, and diaphragm ultrasound offers physiological information that could help the clinician to personalize ventilator settings and guide fluid resuscitation in these patients. Ultrasound techniques could also inform about possible causes of weaning failure in difficult-to-wean patients. However, it is uncertain whether clinical decisions based on ultrasound assessment can improve outcomes in ARDS patients and this clinical approach requires further investigation. In this article, we review the use of thoracic ultrasound, including lung and diaphragm examination, for the clinical assessment of patients with ARDS, and discuss its limitations and future perspectives.

BACKGROUND: With the recent developments in automated tools, smaller and cheaper machines for lung ultrasound (LUS) are leading us toward the potential to conduct POCUS tele-guidance for the early detection of pulmonary congestion. This study aims to evaluate the feasibility and accuracy of a self-lung ultrasound study conducted by hemodialysis (HD) patients to detect pulmonary congestion, with and without artificial intelligence (AI)-based automatic tools.
METHODS: This prospective pilot study was conducted between November 2020 and September 2021. Nineteen chronic HD patients were enrolled in the Soroka University Medical Center (SUMC) Dialysis Clinic. First, we examined the patient\'s ability to obtain a self-lung US. Then, we used interrater reliability (IRR) to compare the self-detection results reported by the patients to the observation of POCUS experts and an ultrasound (US) machine with an AI-based automatic B-line counting tool. All the videos were reviewed by a specialist blinded to the performer. We examined their agreement degree using the weighted Cohen\'s kappa (Kw) index.
RESULTS: A total of 19 patients were included in our analysis. We found moderate to substantial agreement between the POCUS expert review and the automatic counting both when the patient performed the LUS (Kw = 0.49 [95% CI: 0.05-0.93]) and when the researcher performed it (Kw = 0.67 [95% CI: 0.67-0.67]). Patients were able to place the probe in the correct position and present a lung image well even weeks from the teaching session, but did not show good abilities in correctly saving or counting B-lines compared to an expert or an automatic counting tool.
CONCLUSIONS: Our results suggest that LUS self-monitoring for pulmonary congestion can be a reliable option if the patient\'s count is combined with an AI application for the B-line count. This study provides insight into the possibility of utilizing home US devices to detect pulmonary congestion, enabling patients to have a more active role in their health care.

UNASSIGNED: Optimizing respiratory support after birth requires real-time feedback on lung aeration. We hypothesized that lung ultrasound (LUS) can accurately monitor the extent and progression of lung aeration after birth and is closely associated with oxygenation.
UNASSIGNED: Near-term (140 days gestation, term ∼147 days), spontaneously breathing lambs with normal (controls; n = 10) or elevated lung liquid levels (EL; n= 9) were delivered by Caesarean section and monitored for four hours after birth. LUS (Phillips CX50, L3-12 transducer) images and arterial blood gases were taken every 5-20 min. LUS images were analyzed both qualitatively (grading) and quantitatively (using the coefficient of variation of pixel intensity (CoV) to estimate the degree of lung aeration), which was correlated with the oxygen exchange capacity of the lungs (Alveolar-arterial difference in oxygen; AaDO2).
UNASSIGNED: Lung aeration, measured using LUS, and the AaDO2 improved over the first 4 h after birth. The increase in lung aeration measured using CoV of pixel intensity, but not LUS grade, was significantly reduced in EL lambs compared to controls (p = 0.02). The gradual decrease in AaDO2 after birth was significantly correlated with increased lung aeration in both control (grade, r2 = 0.60, p < 0.0001; CoV, r2 = 0.54, p < 0.0001) and EL lambs (grade, r2 = 0.51, p < 0.0001; CoV, r2 = 0.44, p < 0.0001).
UNASSIGNED: LUS can monitor lung aeration and liquid clearance after birth in spontaneously breathing near-term lambs. Image analysis techniques (CoV) may be able detect small to moderate differences in lung aeration in conditions with lung liquid retention which are not readily identified using qualitative LUS grading.

Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a very common disease in the intensive care unit (ICU), with rapid progression and high mortality. Infections caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can easily progress to ARDS in severely ill patients. Early and rapid diagnosis as well as screening for ARDS during treatment is very important. Owing to the particularity of patients with coronavirus disease 2019 (COVID-19), computed tomography (CT) examination is not always possible, and chest radiographs have a low sensitivity and specificity for the diagnosis of lung diseases. Therefore, bedside lung ultrasound (LUS) can be used as a new tool for the diagnosis of ARDS in patients with COVID-19. In the non-gravity-dependent pulmonary field, there are bilateral non-uniform B lines. In the dorsal pulmonary field, the B lines are denser and even appears as \"white lung\". Areas of consolidation are usually found in the dorsal pulmonary field, especially at the basilar part, with static or dynamic air bronchogram sign. In the fused B-line area, the \"lung slip\" usually decreases or disappears. The pleural line is irregular, thickened, and rough, with multiple small consolidations. The pulmonary ultrasound findings of primary and secondary ARDS were similar.
METHODS: In the abovementioned context, we share our experience with the treatment of one critical COVID-19 case and review the literature. An 81-year-old male patient with ARDS which is caused by COVID-19. The implementation of prone ventilation was guided by LUS, and we found that the pulmonary edema in the gravity-dependent area did improve over time. After 9 h of prone ventilation, the consolidation of the posterior area began to open. LUS shows the change from fragment sign to B line. After 16 h, the B-line was educed, indicating that pulmonary edema was improving. The oxygenation could be improved. Pulmonary ultrasound makes the monitoring of prone ventilation visualized. As the same time, the patient was accepted high-flow nasal oxygen, mechanical ventilation and treated with oseltamivir, lopinavir/ritonavir, abidol and cefoperazone-sulbactam.
CONCLUSIONS: LUS-guided treatment was the key factor in the successful treatment of this case.