Background: During the use of CPAP ( Continuos Positive Airway Pressure), with contained pressures, the excursion of the diaphragm tends to increase. Conversely during NIMV ( Non Invasive Mechanical Ventilation ), with the increase in pressure support, there is a decrease in work of breathing (WOB) and in diaphragm excursion. Aims: The purpose of the study was to evaluate whether diaphragm sonography could be a useful aid to promote adaptation during the ventilation of patients in CPAP or NIV who have difficulty on accepting this treatment. Methods: We studied the diaphragmatic excursion of 20 patients using a portable sonography with a convex probe from 1 to 5 MgHz. The patient9s position was generally supine at 45°. The probe was placed in the right subcostal position (the window of the liver is larger than that of the spleen). The patient breathes spontaneously and the machine record the excursion from the maximum inspiratory point to the lowest expiratory point. The monitor was turned towards the patient9s face so he can see what happens during each breath.Subsequently the patient was vented with nasal or oronasal mask and the measurement was remade during CPAP/NIMV ventilation. The modification, breath on breath, of the diaphragmatic excursions, seen by the patient live, facilitated the approach to the use of the ventilatory device. Results: All 20 patients evaluated with this method accepted more easily to use the ventilator device. Conclusion: The Diaphragm sonography can be an excellent, safe, fast, not expensive method to be performed, at the patient9s bed, to reinforce an respiratory educational program in patient9s with problem9s of adaptation to CPAP/NIMV ventilation.
{"title":"Diaphragm sonography as an educational aid in CPAP and NIMV treatment","authors":"Angelo Longoni, Carla Bassino, Tiziana Cappelletti, Francesca Frassanito, Lorenza Fusetti, Giacomo Concas, Mariele Vago, Antonio Paddeu","doi":"10.1183/13993003.congress-2023.pa1822","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1822","url":null,"abstract":"<b>Background:</b> During the use of CPAP ( Continuos Positive Airway Pressure), with contained pressures, the excursion of the diaphragm tends to increase. Conversely during NIMV ( Non Invasive Mechanical Ventilation ), with the increase in pressure support, there is a decrease in work of breathing (WOB) and in diaphragm excursion. <b>Aims:</b> The purpose of the study was to evaluate whether diaphragm sonography could be a useful aid to promote adaptation during the ventilation of patients in CPAP or NIV who have difficulty on accepting this treatment. <b>Methods:</b> We studied the diaphragmatic excursion of 20 patients using a portable sonography with a convex probe from 1 to 5 MgHz. The patient9s position was generally supine at 45°. The probe was placed in the right subcostal position (the window of the liver is larger than that of the spleen). The patient breathes spontaneously and the machine record the excursion from the maximum inspiratory point to the lowest expiratory point. The monitor was turned towards the patient9s face so he can see what happens during each breath.Subsequently the patient was vented with nasal or oronasal mask and the measurement was remade during CPAP/NIMV ventilation. The modification, breath on breath, of the diaphragmatic excursions, seen by the patient live, facilitated the approach to the use of the ventilatory device. <b>Results:</b> All 20 patients evaluated with this method accepted more easily to use the ventilator device. <b>Conclusion:</b> The Diaphragm sonography can be an excellent, safe, fast, not expensive method to be performed, at the patient9s bed, to reinforce an respiratory educational program in patient9s with problem9s of adaptation to CPAP/NIMV ventilation.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136195397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1833
Niamh Boyle, Jack Mccarthy, Caitlyn Paclibar, Colm Quigley
Appropriate use of thoracic ultrasound (TUS) reduces the risk of iatrogenic complications from pleural procedures in comparison with unguided intervention(1). The ERS has introduced a TUS certification programme in order to improve thoracic ultrasound competency. This retrospective review compared ultrasound-guided thoracocentesis with non-ultrasound guided thoracocentesis in a level 3 hospital with regards to diagnostic yield and complication rate. Ultrasound-guided procedures were defined as being performed by trainees with ERS TUS certification. Thoracocentesis performed after being marked by radiology were defined as non-ultrasound guided. Chest radiograph was reviewed to determine pneumothorax rate. Lights criteria and pleural cytology were reviewed to determine diagnostic yield. 20 patients were reviewed; 10 who underwent thoracocentesis with TUS and 10 patients without TUS guidance. Pneumothorax occurred in 5 patients without TUS guidance compared with no occurrence when TUS was used. There was no occurrence of bleeding in either group. In the ultrasound group, pleural fluid was sent for light’s criteria and cytology in all cases. In the non-ultrasound group, pleural fluid was sent for light’s criteria in 70% of cases and cytology in 60%. This review highlights the importance of ultrasound competency training for trainees in reducing the risk of pneumothorax and improving the diagnostic yield for our patients. 1. McCracken DJ, Laursen CB, Barker G, Gleeson FV, Cullen KM, Rahman NM. Thoracic ultrasound competence for ultrasound-guided pleural procedures. European Respiratory Review. 2019;28(154):190090.
{"title":"Comparison of diagnostic yield and complications in ultrasound-guided thoracocentesis versus non-ultrasound guided thoracocentesis in a Level 3 Hospital","authors":"Niamh Boyle, Jack Mccarthy, Caitlyn Paclibar, Colm Quigley","doi":"10.1183/13993003.congress-2023.pa1833","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1833","url":null,"abstract":"Appropriate use of thoracic ultrasound (TUS) reduces the risk of iatrogenic complications from pleural procedures in comparison with unguided intervention(1). The ERS has introduced a TUS certification programme in order to improve thoracic ultrasound competency. This retrospective review compared ultrasound-guided thoracocentesis with non-ultrasound guided thoracocentesis in a level 3 hospital with regards to diagnostic yield and complication rate. Ultrasound-guided procedures were defined as being performed by trainees with ERS TUS certification. Thoracocentesis performed after being marked by radiology were defined as non-ultrasound guided. Chest radiograph was reviewed to determine pneumothorax rate. Lights criteria and pleural cytology were reviewed to determine diagnostic yield. 20 patients were reviewed; 10 who underwent thoracocentesis with TUS and 10 patients without TUS guidance. Pneumothorax occurred in 5 patients without TUS guidance compared with no occurrence when TUS was used. There was no occurrence of bleeding in either group. In the ultrasound group, pleural fluid was sent for light’s criteria and cytology in all cases. In the non-ultrasound group, pleural fluid was sent for light’s criteria in 70% of cases and cytology in 60%. This review highlights the importance of ultrasound competency training for trainees in reducing the risk of pneumothorax and improving the diagnostic yield for our patients. 1. McCracken DJ, Laursen CB, Barker G, Gleeson FV, Cullen KM, Rahman NM. Thoracic ultrasound competence for ultrasound-guided pleural procedures. European Respiratory Review. 2019;28(154):190090.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1824
Rune Wiig, Casper Falster, Niels Jacobsen, Stefan Posth, August Emil Licht, Christian Laursen
Aims: Ultrasound is a valuable diagnostic tool in the diagnostic work-up of dyspnea and can identify even small pleural effusions. Incorporating Shear Wave Elastography (SWE) represents a possible tool in stratifying pleural effusions by risk of underlying malignancy. No previous studies have been conducted in an emergency department (ED), where it might have a clinical impact by hastening referral for diagnostic work-up of underlying malignancy. The aim of this study was to appraise the diagnostic accuracy of ultrasonographic findings associated with thoracic malignancy, as well as calculating optimal cut-off values for SWE in this regard. Methods: Patients with unilateral pleural effusion of unknown origin were included in the ED and subjected to a Focused Lung Ultrasound (FLUS) scan during their first 48 hours after admittance. Two index tests were applied: i) traditional 2D FLUS examination registering presence of diaphragmatic noduli, pleural thickenings and other findings associated with malignancy, and ii) a SWE examination of different Regions of Interest. Reference test was defined as subsequent diagnosis of malignant pleural effusion (MPE) in the three months following inclusion. Results: 39 patients were included. The 2D index test yielded a sensitivity of 28.57% (95%CI 3.67-70.96%) and a specificity of 90.62% (95%CI 74.98%-98.02%). The SWE max of intercostal space yielded a sensitivity of 100% (95%CI 47.82-100%) and a specificity of 59.09% (95%CI 36.35%-79.29%). Conclusion: FLUS with integrated SWE may aid in identifying MPE9s and improving referral to diagnostic work-up of underlying malignancy. Larger adequately powered studies are warranted.
{"title":"Diagnostic accuracy of lung ultrasound with elastography in predicting malignant origin of pleural effusions in an emergency department","authors":"Rune Wiig, Casper Falster, Niels Jacobsen, Stefan Posth, August Emil Licht, Christian Laursen","doi":"10.1183/13993003.congress-2023.pa1824","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1824","url":null,"abstract":"<b>Aims:</b> Ultrasound is a valuable diagnostic tool in the diagnostic work-up of dyspnea and can identify even small pleural effusions. Incorporating Shear Wave Elastography (SWE) represents a possible tool in stratifying pleural effusions by risk of underlying malignancy. No previous studies have been conducted in an emergency department (ED), where it might have a clinical impact by hastening referral for diagnostic work-up of underlying malignancy. The aim of this study was to appraise the diagnostic accuracy of ultrasonographic findings associated with thoracic malignancy, as well as calculating optimal cut-off values for SWE in this regard. <b>Methods:</b> Patients with unilateral pleural effusion of unknown origin were included in the ED and subjected to a Focused Lung Ultrasound (FLUS) scan during their first 48 hours after admittance. Two index tests were applied: i) traditional 2D FLUS examination registering presence of diaphragmatic noduli, pleural thickenings and other findings associated with malignancy, and ii) a SWE examination of different Regions of Interest. Reference test was defined as subsequent diagnosis of malignant pleural effusion (MPE) in the three months following inclusion. <b>Results:</b> 39 patients were included. The 2D index test yielded a sensitivity of 28.57% (95%CI 3.67-70.96%) and a specificity of 90.62% (95%CI 74.98%-98.02%). The SWE max of intercostal space yielded a sensitivity of 100% (95%CI 47.82-100%) and a specificity of 59.09% (95%CI 36.35%-79.29%). <b>Conclusion:</b> FLUS with integrated SWE may aid in identifying MPE9s and improving referral to diagnostic work-up of underlying malignancy. Larger adequately powered studies are warranted.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1830
Gang Hou, Jieru Lin, Mingming Deng
Background: Airway dimension measurements are an important component of treatment efficacy assessment and longitudinal follow-up in patients with subglottic stenosis (SGS) and tracheal stenosis. However, noninvasive, nonradioactive method is lack to assess the degree of stenosis. Methods: In this study, volunteers and patients with a diagnosis of SGS underwent point-of-care ultrasonography (POCUS), CT and flexible bronchoscopy. Radiologist determined the anteroposterior and transverse diameters of the trachea on the CT image and calculated the mean value (CT-mean). Air column width (ACW) and anterior tracheal wall thickness (ATWT) were obtained from POCUS, and the diameter of the subglottic and cervical trachea calculated using the radius of curvature (CR) formula. Results: A total of 123 volunteers without tracheal disease and 15 patients with SGS were enrolled. Both in control group and patients with SGS, there is a strong correlation between US-CR and CT-mean (r =0.96 and 0.98, P <0.001, respectively). The diameter of subglottic and cervical trachea assessed by US-CR is more accurate than the direct measurement of US-ACW. The intraobserver and interobserver repeatability of US-CR was excellent (all correlation coefficients > 0.95; P < 0.05). In patients with SGS, the degree of stenosis determined by US-ATWT correlate best with the CT-ATWT with coefficients of 0.98 (P<0.001), while a moderate correlation was observed between methods for ATWT (r = 0.65, P<0.001) in control group. Conclusion: The airway dimension measured using POCUS based on the radius of the curvature is a reliable tool for assessing the subglottic and cervical tracheal diameters.
{"title":"Point-of-care ultrasound for the assessment of subglottic and cervical tracheal stenosis: A Prospective, Multicenter, Exploratory Study","authors":"Gang Hou, Jieru Lin, Mingming Deng","doi":"10.1183/13993003.congress-2023.pa1830","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1830","url":null,"abstract":"<b>Background:</b> Airway dimension measurements are an important component of treatment efficacy assessment and longitudinal follow-up in patients with subglottic stenosis (SGS) and tracheal stenosis. However, noninvasive, nonradioactive method is lack to assess the degree of stenosis. <b>Methods:</b> In this study, volunteers and patients with a diagnosis of SGS underwent point-of-care ultrasonography (POCUS), CT and flexible bronchoscopy. Radiologist determined the anteroposterior and transverse diameters of the trachea on the CT image and calculated the mean value (CT-mean). Air column width (ACW) and anterior tracheal wall thickness (ATWT) were obtained from POCUS, and the diameter of the subglottic and cervical trachea calculated using the radius of curvature (CR) formula. <b>Results:</b> A total of 123 volunteers without tracheal disease and 15 patients with SGS were enrolled. Both in control group and patients with SGS, there is a strong correlation between US-CR and CT-mean (r =0.96 and 0.98, P <0.001, respectively). The diameter of subglottic and cervical trachea assessed by US-CR is more accurate than the direct measurement of US-ACW. The intraobserver and interobserver repeatability of US-CR was excellent (all correlation coefficients > 0.95; P < 0.05). In patients with SGS, the degree of stenosis determined by US-ATWT correlate best with the CT-ATWT with coefficients of 0.98 (P<0.001), while a moderate correlation was observed between methods for ATWT (r = 0.65, P<0.001) in control group. <b>Conclusion:</b> The airway dimension measured using POCUS based on the radius of the curvature is a reliable tool for assessing the subglottic and cervical tracheal diameters.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"175 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1831
Yao-Wen Kuo, Yen-Lin Chen, Huey-Dong Wu, Hao-Chien Wang
Purpose: This study used shear-wave ultrasound elastography to measure the stiffness of pleural lesions. The research hypothesis is that shear-wave elastography can add the elasticity information of the pleural lesions and help in the diagnosis of pleural diseases. Methods: This prospective observational study included one derivation cohort from May 2018 to Oct 2021 and one validation cohort from Nov 2021 to Aug 2022. The inclusion criterion was patients with radiographic evidence of pleural lesions or pleural effusion. We used the Toshiba Aplio 500 Platinum Ultrasound Machine to locate the pleural lesions and measure the elasticity of the pleural lesions. Diagnoses were made based on microbiological studies, pathology of pleural effusion or pleura, or following up the clinical course for at least 6 months. Results: A total of 210 patients with pleural lesions were included. The mean elasticity of the malignant pleural lesions was significantly higher than that of the benign pleural lesions (91.9 vs. 61.2 kPa, p< 0.001). Among the 103 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 60.2 kPa with an accuracy of 72.7% (sensitivity 81.3%, specificity 57.1%, and area under the ROC curve 0.69). Among the 107 patients in the validation cohort, the diagnostic performance was maintained with an accuracy of 73.8%. Conclusions: This study validated the use of shear-wave ultrasound elastography for assessing pleural malignancy. Additional studies using shear-wave elastography-guided pleural biopsy are warranted to further investigate the diagnostic yield.
目的:本研究采用剪切波超声弹性成像测量胸膜病变的刚度。研究假设横波弹性成像可以增加胸膜病变的弹性信息，有助于胸膜疾病的诊断。方法:本前瞻性观察研究包括2018年5月至2021年10月的一个衍生队列和2021年11月至2022年8月的一个验证队列。纳入标准是胸膜病变或胸膜积液的影像学证据。我们使用东芝Aplio 500白金超声机定位胸膜病变并测量胸膜病变的弹性。诊断依据微生物学检查、胸腔积液或胸膜病理，或随访临床病程至少6个月。结果:共纳入210例胸膜病变患者。恶性胸膜病变的平均弹性明显高于良性胸膜病变(91.9 vs 61.2 kPa, p<0.001)。在衍生队列的103例患者中，构建了接受者工作特征曲线，区分良恶性病变的截断点为60.2 kPa，准确率为72.7%(敏感性81.3%，特异性57.1%，ROC曲线下面积0.69)。在验证队列中的107例患者中，诊断性能保持在73.8%的准确率。结论:本研究证实了剪切波超声弹性成像在评估胸膜恶性肿瘤中的应用。使用剪切波弹性成像引导胸膜活检的进一步研究是有必要的，以进一步研究诊断率。
{"title":"Validation of transthoracic shear-wave ultrasound elastography in diagnosing pleural lesions","authors":"Yao-Wen Kuo, Yen-Lin Chen, Huey-Dong Wu, Hao-Chien Wang","doi":"10.1183/13993003.congress-2023.pa1831","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1831","url":null,"abstract":"<b>Purpose:</b> This study used shear-wave ultrasound elastography to measure the stiffness of pleural lesions. The research hypothesis is that shear-wave elastography can add the elasticity information of the pleural lesions and help in the diagnosis of pleural diseases. <b>Methods:</b> This prospective observational study included one derivation cohort from May 2018 to Oct 2021 and one validation cohort from Nov 2021 to Aug 2022. The inclusion criterion was patients with radiographic evidence of pleural lesions or pleural effusion. We used the Toshiba Aplio 500 Platinum Ultrasound Machine to locate the pleural lesions and measure the elasticity of the pleural lesions. Diagnoses were made based on microbiological studies, pathology of pleural effusion or pleura, or following up the clinical course for at least 6 months. <b>Results:</b> A total of 210 patients with pleural lesions were included. The mean elasticity of the malignant pleural lesions was significantly higher than that of the benign pleural lesions (91.9 vs. 61.2 kPa, p< 0.001). Among the 103 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 60.2 kPa with an accuracy of 72.7% (sensitivity 81.3%, specificity 57.1%, and area under the ROC curve 0.69). Among the 107 patients in the validation cohort, the diagnostic performance was maintained with an accuracy of 73.8%. <b>Conclusions:</b> This study validated the use of shear-wave ultrasound elastography for assessing pleural malignancy. Additional studies using shear-wave elastography-guided pleural biopsy are warranted to further investigate the diagnostic yield.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1814
Pia Iben Pietersen, Rahul Bhatnagar, Freja Andreasen, Lars Konge, Christian Laursen, Najib M. Rahman, Anders B. Nielsen
Background: Clinicians increasingly use thoracic ultrasound in several settings due to its high diagnostic accuracy for many common causes of respiratory failure and dyspnoea. However, ultrasound examinations are operator-dependent, and sufficient competences are needed to obtain high diagnostic accuracy and to attain the ability to interpret the images and integrate them into the patient history and other examinations. This study aims to explore and gather validity evidence for the 2022 ERS thoracic ultrasound objective structured clinical examination (OSCE). Methods: An expert panel created the test, which included two theoretical and three practical stations comprising cases with diagnoses which can be established by point-of-care thoracic ultrasound. Twenty-five participants with different levels of experience thoracic ultrasound completed the test. Data from the test scores and questionnaires on participants’ experiences were used for item analysis. Validation was done according to Messick’s framework. The contrasting groups9 standard-setting method was used to establish a pass/fail score. Results: The summarised internal consistency reliability was high with a Cronbach’s alpha=0.83. The novice group (n=4) had a mean test score of 26.9±10.0 points, the intermediate group (n=8) scored 55.2±5.8 points, and the experienced group (n=13) 62.0±6.1 points (one-way ANOVA, p<0.001). A pass/fail score of 48 points was thus derived (maximum score =75 points). Conslusion: We developed a test for the assessment thoracic ultrasound competences with solid validity evidence, and a pass/fail standard with no false positives or false negatives.
{"title":"Validity evidence of the 2022 ERS thoracic ultrasound Objective Structured Clinical Examination (OSCE)","authors":"Pia Iben Pietersen, Rahul Bhatnagar, Freja Andreasen, Lars Konge, Christian Laursen, Najib M. Rahman, Anders B. Nielsen","doi":"10.1183/13993003.congress-2023.pa1814","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1814","url":null,"abstract":"<b>Background:</b> Clinicians increasingly use thoracic ultrasound in several settings due to its high diagnostic accuracy for many common causes of respiratory failure and dyspnoea. However, ultrasound examinations are operator-dependent, and sufficient competences are needed to obtain high diagnostic accuracy and to attain the ability to interpret the images and integrate them into the patient history and other examinations. This study aims to explore and gather validity evidence for the 2022 ERS thoracic ultrasound objective structured clinical examination (OSCE). <b>Methods:</b> An expert panel created the test, which included two theoretical and three practical stations comprising cases with diagnoses which can be established by point-of-care thoracic ultrasound. Twenty-five participants with different levels of experience thoracic ultrasound completed the test. Data from the test scores and questionnaires on participants’ experiences were used for item analysis. Validation was done according to Messick’s framework. The contrasting groups9 standard-setting method was used to establish a pass/fail score. <b>Results:</b> The summarised internal consistency reliability was high with a Cronbach’s alpha=0.83. The novice group (n=4) had a mean test score of 26.9±10.0 points, the intermediate group (n=8) scored 55.2±5.8 points, and the experienced group (n=13) 62.0±6.1 points (one-way ANOVA, p<0.001). A pass/fail score of 48 points was thus derived (maximum score =75 points). <b>Conslusion:</b> We developed a test for the assessment thoracic ultrasound competences with solid validity evidence, and a pass/fail standard with no false positives or false negatives.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136193688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1817
Bruno S. Silva, Beatriz Ferraz, Filipa Correia, Maria Inês Costa, Maria Esteves Brandão, Nuno Cortesão
Introduction: Lung ultrasound (LUS) performed by non-radiologist doctors has evolved over the last few decades, placing it as a useful diagnostic, prognostic and monitoring bedside tool in patients with respiratory disease. Despite its proven clinical applications, LUS training has not been standardized in Portugal. Objetctives: To characterize LUS learning processes and clinical usage amongst portuguese pulmonologists as well as to assess future needs. Methods: From August to November 2022 an online survey was sent to all members of the Portuguese Pulmonology Society. Degrees of confidence were assessed through Likert scales. Pearson’s chi-squared test and non-parametric tests were used. Outcomes were considered statistically significant if the probability of error was below 5% (p < 0.05). Results: 114 valid answers were obtained. Most responders (81%) had LUS training and 22% had attended other ultrasound-related courses. The majority had an ultrasound machine available. However, only 17% performed LUS > 3 times per week. Overall confidence in LUS usage for diagnostic purpose (median: 7/10), disease monitoring (median: 7/10) and support of invasive procedures (median: 8/10) were high. There was a significant relation between higher levels of confidence and regularly attending LUS courses and performing LUS > 3 times per week. The main reasons preventing regular use of LUS were availability/cost of courses, availability/cost of equipment and lack of time. Conclusions: Physician`s confidence degree on ultrasound utility is related to regular LUS training as well as regular usage. Costs involved with LUS training hamper its wider use.
{"title":"Survey on lung ultrasound usage by portuguese pulmonologists","authors":"Bruno S. Silva, Beatriz Ferraz, Filipa Correia, Maria Inês Costa, Maria Esteves Brandão, Nuno Cortesão","doi":"10.1183/13993003.congress-2023.pa1817","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1817","url":null,"abstract":"<b>Introduction:</b> Lung ultrasound (LUS) performed by non-radiologist doctors has evolved over the last few decades, placing it as a useful diagnostic, prognostic and monitoring bedside tool in patients with respiratory disease. Despite its proven clinical applications, LUS training has not been standardized in Portugal. <b>Objetctives:</b> To characterize LUS learning processes and clinical usage amongst portuguese pulmonologists as well as to assess future needs. <b>Methods:</b> From August to November 2022 an online survey was sent to all members of the Portuguese Pulmonology Society. Degrees of confidence were assessed through Likert scales. Pearson’s chi-squared test and non-parametric tests were used. Outcomes were considered statistically significant if the probability of error was below 5% (p < 0.05). <b>Results:</b> 114 valid answers were obtained. Most responders (81%) had LUS training and 22% had attended other ultrasound-related courses. The majority had an ultrasound machine available. However, only 17% performed LUS > 3 times per week. Overall confidence in LUS usage for diagnostic purpose (median: 7/10), disease monitoring (median: 7/10) and support of invasive procedures (median: 8/10) were high. There was a significant relation between higher levels of confidence and regularly attending LUS courses and performing LUS > 3 times per week. The main reasons preventing regular use of LUS were availability/cost of courses, availability/cost of equipment and lack of time. <b>Conclusions:</b> Physician`s confidence degree on ultrasound utility is related to regular LUS training as well as regular usage. Costs involved with LUS training hamper its wider use.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1825
Mona El Hoshy, Alaa Amin, Maged Hassan
Background: The echo-texture of pleural effusion (PE) can be determined by ultrasound (US) which gives a clue about its etiology. Echogenic PEs are usually due to exudates while anaechoic PEs can be transudate or exudate. This study aims to determine if quantitative measurement of PE echogenicity can non-invasively differentiate exudative from transudative PEs and to explore its correlation with PE biochemical and cellular content. Methods: The study prospectively recruited patients with PE US greyscale images were transferred to a computer to be analysed by an image analysis software. To control the sonographic window difference between patients, liver echogenicity was measured (using the same US settings image depth, gain, and focus position) and compared to that of PE. Pleural fluid relative echogenicity (PFRE) was calculated as the ratio of the PE echogenicity: liver echogenicity. Results: 54 patients were examined, 25males (46.3%) with mean age 52+15.7, exudates were (59%)). PE was due to malignancy in 17 cases, heart failure 9, liver cirrhosis 8, TB 7, empyema 6, Renal disease 5, inflammation 2. Exudates’ median LDH was 499 [298- 1388], Protein 4.2 [3.9- 4.8], and PFRE 0.51 [0.25 – 0.82].Transudates had a median LDH 74 [69-164], Protein 1.9 [1.5 – 2.8] and PFRE 0.24 [.09-.35]. PFRE significantly correlated with LDH (R 0.392, P=0.004) and serum protein (R 0.316, P=0.021). PFRE predicted PE nature with area under the curve for PFRE of 0.77[95%CI 0.64 -00.89]. A PFRE > 0.32 had a sensitivity of 70% and specificity of 74% to predict an exudate. Conclusion: PFRE can predict the nature of Pleural effusion (Exudates VS Transudates) non-invasively with moderate degree of accuracy.
{"title":"Quantitative US echogenicity to differentiate exudate from transudate pleural effusion","authors":"Mona El Hoshy, Alaa Amin, Maged Hassan","doi":"10.1183/13993003.congress-2023.pa1825","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1825","url":null,"abstract":"<b>Background:</b> The echo-texture of pleural effusion (PE) can be determined by ultrasound (US) which gives a clue about its etiology. Echogenic PEs are usually due to exudates while anaechoic PEs can be transudate or exudate. This study aims to determine if quantitative measurement of PE echogenicity can non-invasively differentiate exudative from transudative PEs and to explore its correlation with PE biochemical and cellular content. <b>Methods:</b> The study prospectively recruited patients with PE US greyscale images were transferred to a computer to be analysed by an image analysis software. To control the sonographic window difference between patients, liver echogenicity was measured (using the same US settings image depth, gain, and focus position) and compared to that of PE. Pleural fluid relative echogenicity (PFRE) was calculated as the ratio of the PE echogenicity: liver echogenicity. <b>Results:</b> 54 patients were examined, 25males (46.3%) with mean age 52+15.7, exudates were (59%)). PE was due to malignancy in 17 cases, heart failure 9, liver cirrhosis 8, TB 7, empyema 6, Renal disease 5, inflammation 2. Exudates’ median LDH was 499 [298- 1388], Protein 4.2 [3.9- 4.8], and PFRE 0.51 [0.25 – 0.82].Transudates had a median LDH 74 [69-164], Protein 1.9 [1.5 – 2.8] and PFRE 0.24 [.09-.35]. PFRE significantly correlated with LDH (R 0.392, P=0.004) and serum protein (R 0.316, P=0.021). PFRE predicted PE nature with area under the curve for PFRE of 0.77[95%CI 0.64 -00.89]. A PFRE > 0.32 had a sensitivity of 70% and specificity of 74% to predict an exudate. <b>Conclusion:</b> PFRE can predict the nature of Pleural effusion (Exudates VS Transudates) non-invasively with moderate degree of accuracy.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1815
Santos Ferrer Espinosa, Antonio Quezada Reynoso, Jesus Sancho Chinesta, Juan Carbonell Asins, Jaime Signes-Costa Miñana
Myasthenic crisis (MC) is the most life-threatening complication of myasthenia gravis (MG). Our hypothesis is that repeated measures of the rate of diaphragmatic contraction (((v10-v1)/(v1))x100) after performing snip maneuvers using ultrasound can predict the need for mechanical ventilation in patients admitted for MG. 1 year duration prospective observational study. Patients who met admission criteria according to the Neurology Department with a diagnosis of MG and were evaluated by Pulmonology in the first 24 hours of admission were included. Demographic data, pulmonary function variables, and ultrasound data were collected. The percentage change between the first and tenth measurement of diaphragmatic contraction velocity were determined by this formula: (((v10-v1)/v1))x100). Statistical analysis: Wilcoxon test. 18 patients were included in the study. 52.9% were male with a mean age of 57.94 +/- 21.01 years. Demographic and clinical data are shown in Table 133.3% had a MC. The correlation between percentage change in diaphragmatic contraction velocity and snip and PImax were -0.593 (p=0.020) and -0.552 (p=0.041) respectively. After statistical analysis, we observed differences in (((v10-v1)/v1))x100) between the group of patients who required mechanical ventilation (and were classified as myasthenic crisis) vs the group of patients who did not require NIV (p= 0.0018). (figure 2) The percentage of change in diaphragmatic contraction velocity after repeated snip maneuvers may be an indicator of diaphragm fatigability in patients with MG and may be useful in determining the need for ventilation in these patients.
{"title":"Diaphragmatic contraction speed at follow-up of patients admitted for myasthenia gravis","authors":"Santos Ferrer Espinosa, Antonio Quezada Reynoso, Jesus Sancho Chinesta, Juan Carbonell Asins, Jaime Signes-Costa Miñana","doi":"10.1183/13993003.congress-2023.pa1815","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1815","url":null,"abstract":"Myasthenic crisis (MC) is the most life-threatening complication of myasthenia gravis (MG). Our hypothesis is that repeated measures of the rate of diaphragmatic contraction (((v10-v1)/(v1))x100) after performing snip maneuvers using ultrasound can predict the need for mechanical ventilation in patients admitted for MG. 1 year duration prospective observational study. Patients who met admission criteria according to the Neurology Department with a diagnosis of MG and were evaluated by Pulmonology in the first 24 hours of admission were included. Demographic data, pulmonary function variables, and ultrasound data were collected. The percentage change between the first and tenth measurement of diaphragmatic contraction velocity were determined by this formula: (((v10-v1)/v1))x100). Statistical analysis: Wilcoxon test. 18 patients were included in the study. 52.9% were male with a mean age of 57.94 +/- 21.01 years. Demographic and clinical data are shown in Table 133.3% had a MC. The correlation between percentage change in diaphragmatic contraction velocity and snip and PImax were -0.593 (p=0.020) and -0.552 (p=0.041) respectively. After statistical analysis, we observed differences in (((v10-v1)/v1))x100) between the group of patients who required mechanical ventilation (and were classified as myasthenic crisis) vs the group of patients who did not require NIV (p= 0.0018). (figure 2) The percentage of change in diaphragmatic contraction velocity after repeated snip maneuvers may be an indicator of diaphragm fatigability in patients with MG and may be useful in determining the need for ventilation in these patients.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"368 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136195188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa1818
Anja Ljilja Posavec, Boris Karanović, Ivana Ježić, Renata Huzjan Korunić, Nevenka Piskač Živković, Josip Tečer, Stela Hrkač, Joško Mitrović
Background: Pleural irregularity visualized by ultrasound has a higher specificity for interstitial lung disease (ILD) than B lines. It is manifested as a loss of the normal hyperechoic pleural contour. Diaphragm mobility has not been studied so far in patients with systemic sclerosis (SSc). Patients may have reduced diaphragm function due to ILD, disuse atrophy, malnutrition, corticosteroid therapy, etc. Aims and objectives: To investigate whether pleural irregularity is associated with diaphragm mobility in patients with SSc. Methods: In this cross sectional multicentric research participated 50 patients with systemic sclerosis. The patients underwent an ultrasound of the pleura. The mobility of the right diaphragm was measured in M mode with convex probe. We applied reference values for diaphragm mobility in deep breathing according to Boussuges et al. (1). Results: In patients with reduced mobility of the diaphragm in deep breathing, regression analysis pointed that irregular pleura on ultrasound was an independent factor predicting reduced diaphragm mobility (OR=40.0, 95% CI: 1.98 to 807.1). Conclusion: According to the results, irregular pleura on ultrasound is independent factor that predicts reduced mobility of the diaphragm in deep breathing among the patients with SSc. Literature: 1. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391-400.
背景:超声胸膜不规则性对间质性肺疾病(ILD)的特异性高于B线。它表现为正常高回声胸膜轮廓的丧失。到目前为止，还没有对系统性硬化症(SSc)患者的横膈膜活动度进行研究。患者可能由于ILD、废用性萎缩、营养不良、皮质类固醇治疗等原因导致膈肌功能降低。目的和目的:探讨SSc患者胸膜不规则是否与膈肌活动有关。方法:对50例系统性硬化症患者进行横断面多中心研究。病人接受了胸膜超声检查。用凸探头在M模式下测量右膈肌的可动性。我们参照Boussuges et al.(1)的方法采用了深呼吸时膈肌活动度的参考值。结果:在深呼吸时膈肌活动度降低的患者中，回归分析指出超声胸膜不规则是预测膈肌活动度降低的独立因素(OR=40.0, 95% CI: 1.98 ~ 807.1)。结论:超声显示胸膜不规则是预测SSc患者深呼吸时膈肌活动度降低的独立因素。文献:1。Boussuges A, goole Y, Blanc P.横膈膜运动的m型超声研究:方法，再现性和正常值。胸部135:391 2009;400年。
{"title":"Pleural irregularity and diaphragm mobility among patients with systemic sclerosis","authors":"Anja Ljilja Posavec, Boris Karanović, Ivana Ježić, Renata Huzjan Korunić, Nevenka Piskač Živković, Josip Tečer, Stela Hrkač, Joško Mitrović","doi":"10.1183/13993003.congress-2023.pa1818","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa1818","url":null,"abstract":"<b>Background:</b> Pleural irregularity visualized by ultrasound has a higher specificity for interstitial lung disease (ILD) than B lines. It is manifested as a loss of the normal hyperechoic pleural contour. Diaphragm mobility has not been studied so far in patients with systemic sclerosis (SSc). Patients may have reduced diaphragm function due to ILD, disuse atrophy, malnutrition, corticosteroid therapy, etc. <b>Aims and objectives:</b> To investigate whether pleural irregularity is associated with diaphragm mobility in patients with SSc. <b>Methods:</b> In this cross sectional multicentric research participated 50 patients with systemic sclerosis. The patients underwent an ultrasound of the pleura. The mobility of the right diaphragm was measured in M mode with convex probe. We applied reference values for diaphragm mobility in deep breathing according to Boussuges et al. (1). <b>Results:</b> In patients with reduced mobility of the diaphragm in deep breathing, regression analysis pointed that irregular pleura on ultrasound was an independent factor predicting reduced diaphragm mobility (OR=40.0, 95% CI: 1.98 to 807.1). <b>Conclusion:</b> According to the results, irregular pleura on ultrasound is independent factor that predicts reduced mobility of the diaphragm in deep breathing among the patients with SSc. Literature: 1. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391-400.","PeriodicalId":23440,"journal":{"name":"Ultrasound","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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