Ultrasound Journal最新文献

E-point septal separation (EPSS) and tricuspid annular plane systolic excursion (TAPSE) are M-mode measures of left and right ventricular systolic function, with limited pediatric point-of-care ultrasound (POCUS) research. We conducted a cross-sectional study in a pediatric emergency department, enrolling 12-17-year-olds without cardiopulmonary complaints. Exclusion criteria included abnormal vital signs, fever, altered mental status, or psychiatric illness. POCUS faculty performed the measurements, while blinded to pediatric echocardiography reference values. Data was analyzed using unpaired t-tests and Pearson's correlation. Correlations with age, height, weight, body mass index, and heart rate were examined. Twenty subjects were enrolled. The mean EPSS was 2.5 mm (SD 1.9 mm), and the mean TAPSE was 2.6 cm (SD 0.4 cm), aligning with pediatric echocardiography reference values. No significant correlations were found between EPSS or TAPSE and anthropometric data.

The duration of mechanical systole-also termed the flow time (FT) or left ventricular ejection time (LVET)-is measured by Doppler ultrasound and increasingly used as a stroke volume (SV) surrogate to guide patient care. Nevertheless, confusion exists as to the determinants of FT and a critical evaluation of this measure is needed. Using Doppler ultrasound of the left ventricular outflow tract velocity time integral (LVOT VTI) as well as strain and strain rate echocardiography as grounding principles, this brief commentary offers a model for the independent influences of FT. This framework establishes that systolic duration is directly proportional to the distance traversed by a single cardiac myocyte and indirectly proportional to its shortening velocity. Grossly, this translates to a direct relationship between FT and the LVOT VTI (i.e., SV) and an indirect relationship with mean ejection velocity. Thus, changes in the systolic time can infer SV change, so long as other cardiac parameters are considered.

Background: The adoption of diaphragm and lung ultrasound (DLUS) by physiotherapists, physical therapists, and respiratory therapists ("therapists") to examine and assess the diaphragm and lungs continues to grow. The aim of this updated scoping review is to re-explore and re-collate the evidence around the adoption of DLUS by therapists.

Methods: This scoping review followed the PRISMA-ScR guidelines. Data sources searched included AMED, EmCare, CINAHL, Embase, Medline, PubMed and Pedro. Grey literature sources were searched alongside communication with leading authors in the field. The Participants, Concept and Context (PCC) approach was employed to formulate the research question. A charting form was developed and piloted to extract: title, authors, year of publication, country of origin, professional group involved (population), lung or diaphragm ultrasound (concept), evaluation method, educational, clinical or research setting (context), subject/disease/patient group, sample size, study design and professional group performing DLUS.

Results: 133 studies met all inclusion criteria, an increase of 107 new studies compared to the original scoping review searches 7-years ago. Studies were included from 17 new countries and included 17 new participant populations. Lung ultrasound saw the largest increase in study number with education and implementation emerging as a new area of investigation. Full list of included studies is provided in Supplementary File 1.

Conclusion: The number of DLUS studies involving therapists continues to show international growth with studies investigating an increasing range of participant populations. Published studies now include research on DLUS adoption, implementation, and utility amongst all three of the therapy professions who use DLUS. The potential of DLUS and its direct impact on patient outcomes still needs to be explored further. However, DLUS remains a novel and innovative imaging technique in the hands of physiotherapists, physical therapists, and respiratory therapists as its utility continues to grow in various research, clinical and educational settings.

Background: Understanding venous congestion is critical to the management of many illnesses, but assessing volume status can be challenging. The current gold standard for volume status assessment of right heart catheterization (RHC) is invasive, costly, and often unavailable. Venous Excess Ultrasound Score (VExUS) is a novel ultrasound protocol for to assessment of venous congestion using the inferior vena cava, hepatic, portal and renal veins. Though there is a much interest in the technique, the renal component of the exam is challenging to acquire. For this reason we aimed to see if a modified VExUS (mVExUS) excluding the kidney component performs similarly to traditional VExUS (tVExUS) for detecting elevated right atrial pressure (RAP) as measured by RHC.

Methods: A consecutive cohort of 95 patients undergoing RHC had VExUS exams before the procedure. Researchers compared the performance of tVExUS, mVExUS, and inferior vena cava (IVC) diameter in predicting RAP > 12 mmHg.

Results: The area under the curve (AUC) for detecting elevated RAP was similar for tVExUS (0.87) and mVExUS (0.85). Both methods achieved high sensitivity and specificity. Agreement between tVExUS and mVExUS scores was near-perfect (Cohen's Kappa = 0.85).

Conclusion: mVExUS may be as effective as tVExUS in identifying elevated RAP. This abbreviated version could improve efficiency and adoption of VExUS for assessing venous congestion. Further studies are needed in diverse patient populations.

Background: Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Clinician diagnosis and management vary due to limited objective assessment tools. Point-of-care lung ultrasound (LUS) offers a promising diagnostic and prognostic tool in the emergency department (ED), however, the time to perform LUS is of concern in the emergency setting.

Methods: Infants ≤ 12 months diagnosed with AB in the emergency department were enrolled. Two LUS techniques were performed sequentially: a 12-segment "lawnmower" approach and a posterior paravertebral "waterfall" technique. LUS were scored (0-36 for lawnmower; 0-6 for waterfall). Respiratory support (RS) was categorized into three levels: no RS (room air), low RS (wall O2 or heated high flow nasal cannula < 1L/kg), and high RS (heated high flow nasal cannula ≥ 1L/kg or positive pressure). Clinical data, including RS at 12 and 24 h, maximum RS, disposition, and length of stay, were extracted via chart review and compared to mean LUS scores for each technique. Calculated areas under the curve (AUC) were compared using the Youden Index (J).

Results: 82 infants were enrolled. The mean waterfall scanning time was 1.65 min (SD 0.55) compared to the lawnmower's 7.65 min (SD 1.45). The difference between mean LUS scores for the waterfall technique was statistically significant for all disposition comparisons and nearly all RS comparisons. While the lawnmower AUC was greater than the waterfall AUC for all RS and disposition comparisons, the Youden Index (J) was statistically significantly different for only two of the eight comparisons.

Conclusion: The posterior-only LUS technique is faster than the lawnmower technique, provides comparable information for disposition, and has a stronger association with LOS, but is less associated with RS. The waterfall technique may be a suitable alternative to more time-intensive, thorough techniques.

Background: There are significant discrepancies in the optic nerve sheath diameter (ONSD) reported in the literature. We aimed to determine the ultrasonographic imaging features of ONSD and ophthalmic vessels in a healthy population, using a standardized protocol, and to estimate the effect of demographics and positioning changes on imaging measurements.

Methods: We measured the mean values of the ONSD in supine and sitting position and the Doppler imaging parameters of the ophthalmic, central retinal and short posterior ciliary arteries. Inter-observer reliability was assessed using intraclass correlation coefficient (ICC). Linear regression models were fitted to predict the effect of demographic and clinical determinants on the imaging features.

Results: A total of 50 measurements were obtained for each observer. The mean ONSD was 5.9 mm and there was a mean reduction of 0.2 mm when assessed in sitting position (p < 0.001). Doppler analysis showed higher peak-systolic velocity and resistive index in the ophthalmic artery (35.6 cm/s vs. 12.0 cm/s; 0.78 vs. 0.70) compared to the central retinal artery (p < 0.001). Age, sex, heart rate and systolic blood pressure were significant determinants of the imaging features, with ONSD being larger in males (p < 0.001) and increasing with heart rate (p = 0.001). ICC estimates indicated 'good' inter-observer reliability of the ONSD and the ophthalmic and central retinal arteries velocities and resistance.

Conclusions: Our findings suggest a significant impact of patient demographics and positioning during ultrasonography on the normal imaging features of the ONSD and ophthalmic vessels. The heterogeneity in methodology and clinical cohorts may justify previous discrepancies in the literature. These findings can assist in the interpretation of imaging features in clinical settings and in the standardization of point of care ONSD ultrasonography.

Background: The cannulation of the internal jugular vein (IJV) is a frequent procedure in critically ill patients. According to the guidelines, real-time ultrasound navigation is recommended. Traditional techniques pose several disadvantages, such as suboptimal needle visualization. Therefore, this non-inferiority trial aimed to describe the novel approach and compare the novel lateral in-plane short-axis approach for IJV access with the conventional short-axis out-of-plane approach.

Objectives: The primary objective of the trial was to prove that the first attempt success rate in the novel technique is non-inferior to the conventional technique. The secondary objectives were to demonstrate that the complication rate and the functional duration of the catheter in the novel technique are not inferior to those in the conventional technique.

Methods: Patients eligible for IJV cannulation were randomly assigned to either the novel technique (Group A) or the conventional one (Group B). The procedure duration, success rate and the number of attempts required were documented. The functionality of the catheter and complications were monitored from insertion until the catheter removal. Standard descriptive statistical methods were employed for the analysis.

Results: A total of 200 subjects were equally divided between Group A and Group B. For the primary outcome, there was no significant difference in first attempt success rate (Group A: 79, Group B: 77, p = 0.434). Secondary outcomes, including complications and catheter functional time, did not differ significantly between the groups. However, the novel technique demonstrated a significantly faster procedure time (Group A: 315 s, Group B: 330 s, p = 0.016). Notably, the novel approach was linked with significantly larger IJV diameter measured during the procedure (Group A: 18.2 mm, Group B: 12.1 mm, p < 0.001).

Conclusion: The novel lateral in-plane short-axis approach for IJV cannulation is a non-inferior alternative with a lower incidence of posterior vessel wall puncture compared to the conventional approach.

Background: Lung ultrasound (LUS) is increasingly utilized in veterinary medicine to assess pulmonary conditions. However, the characterization of pleural line and subpleural fields using different ultrasound transducers, specifically high-frequency linear ultrasound transducers (HFLUT) and curvilinear transducers (CUT), remains underexplored in canine patients. This study aimed to evaluate inter-rater agreement in the characterization of pleural line and subpleural fields using B- and M-mode ultrasonography in dogs with and without respiratory distress.

Results: Eighty-eight ultrasound clips from nine dogs were analyzed. HFLUT demonstrated strong inter-rater agreement in B-mode (κ = 0.89) and near-perfect agreement in M-mode (κ = 1.00) for pleural line homogeneity. In contrast, CUT showed minimal agreement in both B-mode (κ = 0.34) and M-mode (κ = 0.37). Homogeneous pleural lines were predominantly observed in control dogs or those with cardiogenic pulmonary edema (CPE), while non-homogeneous pleural lines were more common in dogs with non-cardiogenic alveolar-interstitial syndrome (NCAIS). Vertical subpleural fields identified in M-mode were associated with both CPE and NCAIS, whereas horizontal fields were more often observed in control dogs.

Conclusions: HFLUT offers superior inter-rater reliability for characterizing pleural and subpleural features in canine LUS compared to CUT, particularly in M-mode. These findings suggest HFLUT may enhance diagnostic accuracy for pulmonary conditions in dogs. Further studies are needed to explore the diagnostic potential of LUS in differentiating vertical artifact (e.g., B-lines) etiologies in veterinary patients.

Objective: There has been an increase in real-time ultrasonography use in central venous catheterisation. This systematic review and meta-analysis aimed to assess the role of real-time ultrasound use in umbilical venous catheterisation in neonates.

Data sources: PubMed, Embase, Web of Science and Cochrane Library were searched on July 11, 2024. We followed the Cochrane Handbook for Systematic Reviews of Interventions (for study conduct), GRADE methodology (for certainty of evidence), and PRISMA guidelines (for reporting).

Study selection: All randomised controlled trials/RCTs and non-randomised studies of interventions/NRSIs comparing real-time ultrasound with the conventional technique of umbilical venous catheterisation were included.

Data extraction: The outcomes of interest were malposition rates, procedure duration, mortality, sepsis, and cost. Data extraction and quality assessment were done in duplicate.

Data synthesis: Six studies (three RCTs and three NRSI), including 863 participants, were included. Data were analysed separately for RCTs and NRSIs. The RCTs were at low risk of bias, but NRSIs were at moderate to serious risk. The pooled estimates from RCTs showed a decrease in malposition rates (2 studies, 165 participants, risk ratio/RR 0.45, 95% confidence interval/CI 0.23, 0.90) and procedure duration (3 studies, 196 participants, mean difference -6.1 min, 95% CI -8.4, -3.8 min) with real-time ultrasound use. There was no reduction in sepsis. Mortality was not reported. The certainty of evidence was low for malposition rates and procedure duration. The data from NRSIs showed a reduction in malposition rates (3 studies, 667 participants, risk ratio/RR 0.10, 95% confidence interval/CI 0.07, 0.14) without an impact on procedure duration and sepsis. However, these findings did not improve the evidence.

Conclusions: Low certainty evidence suggests that using real-time ultrasound for umbilical venous catheterisation reduces malposition rates. There is a clinically insignificant reduction in procedure duration. There is no sufficient data to come to a conclusion on the critical outcomes of sepsis and mortality. PROSPERO registration number: CRD42024567895.

Background: Tele-robotic ultrasound (US) is a novel technique that might help overcome the current shortage of radiologists and poor access to radiologists and/or sonographers in remote or rural areas. Despite the promising results of this technology in the past two decades, there is still insufficient data about its advantages and limits, as well as the implementation in routine clinical practice and the learning curve for the user. The purpose of this prospective cohort-based study is to evaluate the performance of a 5G-based tele-robotic US system for abdominal and thyroid gland assessment in a cohort of healthy volunteers and outpatients, as well as assessing the learning curve and patient satisfaction.

Results: 64 participants (23 male, 41 female) were consecutively included during the recruitment period, for a total of 51 abdominal and 37 thyroid gland US studies. The mean age was 45.23 ± 18.90 years old, and the body mass index of the abdominal cohort was 22.97 ± 2.95 kg/m². The learning curve estimated a minimum of 20 patients for abdominal tele-robotic US training, being almost non-existent in the thyroid gland cohort. All the variables showed no-statistical differences between standard US and tele-robotic US in the abdominal post-trained cohort except the visualization of the left kidney short axis and its interpolar length. Thyroid gland variables showed no statistical differences. The mean time of exploration for the tele-robotic US for abdomen and thyroid gland examinations were 18.33 ± 6.26 min and 4.64 ± 0.97 min respectively. Most participants (> 70%) felt comfortable and safe while being examined by the tele-robotic US.

Conclusion: Tele-robotic US achieves equal performance in comparison with the standard US when evaluating abdominal structures in this cohort of patients, as well as a relatively fast learning curve and good patient satisfaction. The performance when assessing the thyroid gland is almost identical to the standard US, which makes it a strong first candidate for a future clinical implementation.