Ultrasound Journal最新文献

Background: Systemic venous congestion assessed by the venous excess ultrasound score (VExUS), has been associated with acute kidney injury (AKI) in patients undergoing cardiac surgery. However, there is a lack of evidence of this association in the general critically ill patients.

Study design and methods: PubMed, Embase, and Cochrane databases were searched for observational prospective studies that included critically ill patients and analyzed VExUS score on the first day of admission to the ICU. The main outcome was occurrence of AKI. Secondary outcome was all-cause mortality. Statistical analysis was performed using Review Manager 5.4.1. Odds ratios (OR) with 95% confidence interval were pooled using a random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Publication bias was assessed via funnel plot and heterogeneity was examined with I² statistics.

Results: Our analysis included 1036 patients from nine studies, of whom 17.4% presented venous congestion according to VExUS definition. In critically ill patients presenting with venous congestion (VExUS score ≥ 2), the incidence of AKI was significantly higher as compared with those without congestion (OR 2.63, 95% CI 1.06-6.54; p = 0.04; I² = 74%). The association was notably stronger in cardiac surgery patients (OR 3.86, 95% CI 2.32-6.42; p < 0.00001; i² = 0%). There was no significant association between venous congestion and all-cause mortality (OR 1.25, 95% CI 0.71-2.19; p = 0.44; i² = 8%).

Conclusions: These findings suggest that VExUS score may correlate with an elevation in the incidence AKI in critically ill patients, with a more pronounced effect observed within the subgroup of patients undergoing cardiac surgery. There was no statistically significant association between VExUS score and all-cause mortality.

Clinical trial registration: PROSPERO under protocol number CRD535513.

Background: Obstetric ultrasound (US) is a non-invasive imaging method that employs sound waves to explore the abdominal and pelvic areas of a pregnant woman. It is recommended to have at least two ultrasound scans during pregnancy, one in the first trimester and another in the second trimester, to identify potential complications and improve perinatal outcomes. While this practice is widely implemented in developed nations, its utilization in many African countries remains suboptimal. This systematic review and meta-analysis aims to examine the level of knowledge and utilization of obstetric ultrasound among pregnant women in Africa, providing insights into its awareness and utilization across the continent.

Method: A systematic review and meta-analysis were conducted following PRISMA guidelines. Extensive literature searches were carried out across various databases, including PubMed, Google Scholar, ScienceDirect, Web of Science, Scopus, and African Online Journal databases. The pooled prevalence was estimated using a weighted inverse variance random-effects model. Heterogeneity among studies was assessed using the Cochrane Q-test and I² statistics, while publication bias was evaluated through a funnel plot and Egger's test. Stata v17 software was employed to analyze factors associated with the utilization of obstetric ultrasound among pregnant women in Africa.

Result: A total of 622 articles were initially identified, with 23 ultimately meeting the inclusion criteria for this review, including five studies that addressed both knowledge and utilization of obstetric ultrasound. The overall knowledge level among pregnant women in Africa regarding obstetric ultrasound was estimated at 74.33% (95% CI 63.27-85.38%), while the pooled proportion of utilization was 63.3% (95% CI 51.59-75.02%). Subgroup analysis revealed that both knowledge and utilization levels were highest in Western Africa, whereas knowledge was lowest among pregnant women in Eastern Africa. Pregnant women with good knowledge of obstetric ultrasound were significantly more likely to utilize the service, with a pooled odds ratio (POR) of 8.41 (95% CI 4.66-12.16).

Conclusion: This systematic review and meta-analysis revealed a moderate utilization of obstetric ultrasound among pregnant mothers in Africa, with an increasing trend over time, particularly after 2020. The overall level of knowledge about obstetric ultrasound among mothers was 74.33%, and knowledge was identified as the key factor significantly associated with ultrasound utilization.

Background: A recent study suggested that point-of-care ultrasound (POCUS) venous congestion assessment poorly describes the changes in venous return during a fluid challenge. The aim of the present study was to explore the relationship between POCUS venous congestion assessment parameters and the determinants of venous return in steady state and during a fluid challenge.

Methods: This study is a post-hoc analysis of a single-centre prospective cohort study of patients presenting acute circulatory failure and venous congestion. The protocol consisted in a fluid administration of 4mL/kg over five minutes, just preceded and followed by the acquisition of haemodynamic data and POCUS venous congestion assessment parameters (VExUS score and portal pulsatility index, PPi). Venous return (dVR) was defined as the difference between mean systemic filling pressure analogue estimated by the mathematical approach of Parkin and Leaning (Pmsa) and central venous pressure (CVP). Relationships between Pmsa, CVP, dVR, and VExUS score and PPi were analysed using linear regression and Jonckheere-Terpstra test for trend.

Results: Thirty-two patients were included in the analysis. Fluid challenge induced a significant increase in CVP, Pmsa, dVR, and VExUS score. In steady state, there was a significant association of VExUS score and PPi with CVP (P-value = 0.006 and 0.002, respectively) and Pmsa (P-value = 0.004 and 0.003, respectively) but not with dVR (P-value = 0.943 and 0.408, respectively). The variations induced by fluid challenge in CVP, Pmsa and dVR were not associated with variations in PPi (P-value = 0.844, 0.912 and 0.716, respectively). Patients without VExUS score increase during the fluid challenge presented a higher increase in Pmsa than patients with an increase in VExUS score.

Conclusion: In steady state, POCUS venous congestion assessment parameters are associated with CVP and Pmsa but not with dVR. After fluid administration, changes in POCUS venous congestion assessment parameters were not associated with changes in CVP, Pmsa, and dVR.

Background: The assessment of right ventricular (RV) size is an important part of 2-dimensional transthoracic echocardiography. Current chamber quantification guidelines provide reference values as unindexed numbers, similar for men and women. We sought to evaluate normal ranges of RV dimensions based on age, sex, body surface area (BSA), and height. Consecutive patients with "normal echocardiogram" between January 2011 and August 2022 at our center were retrospectively included. RV dimensions including diameter at the base and mid-ventricle level, and base-to-apex length were measured.

Results: Of 1389 patients (median 43 years, 53% female) with all three measurements available, the median RV measurements, both unindexed and indexed to BSA, were: basal diameter 35.0 mm (31.0-39.0) and 18.4 mm/m² (16.5-20.3); mid diameter 28.0 mm and 14.8 mm/m² (13.1-16.6); RV length 73.0 mm (67.0-78.0) and 37.6 mm/m² (34.9-40.9). RV dimensions were larger in men than women across all age groups but similar when indexed to BSA (for basal and mid dimensions). RV length was best indexed to height. Our indexed normal values by age and sex were similar to World Alliance Societies of Echocardiography (WASE) cohort.

Conclusions: RV measurements should be indexed to BSA, considering sex and age, to determine RV size and enlargement.

Background and objectives: This study aimed to compare Total kidney volume (TKV) measurements using US-ellipsoid (US-EL) and MRI-ellipsoid (MRI-EL) in patients with autosomal-dominant-polycystic-kidney-disease (ADPKD). It also evaluated whether the agreement between right (RKV) and left (LKV) kidney volume measurements differed.

Methods: Retrospective analysis of a prospective data-base that included consecutive patients diagnosed with ADPKD. Total kidney volumes by 3D-US-EL were compared with those by MRI-EL. Bland-Altman-plots, Passing-Bablok-regression, and the concordance-correlation-coefficient (CCC) were used to compare right (RKV), left (LKV), and TKV measurements.

Results: Thirty-two ADPKD patients, 14(43.7%) women, were included. Mean measured (mGFR) and estimated (eGFR) glomerular-filtration-rate (GFR) were 86.5 ± 23.9 mL/min and 78.9 ± 23.6 mL/min, respectively. Compared with MRI-EL, TKV (Mean difference: - 85.9 ± 825.6 mL; 95%CI - 498.5 to 326.7 mL; p = 0.6787), RKV (Mean difference: - 58.5 ± 507.7 mL; 95%CI - 312.2 to 195.2 mL; p = 0.6466), and LKV (Mean difference: - 27.4 ± 413.5 mL; 95%CI - 234.1 to 179.2 mL; p = 0.7918) were lower with US-EL than with MRI-EL, although without significant differences. According to Passing and Bablok-regression analysis, the Spearman correlation-coefficient was 0.96 (95%CI 0.92 to 0.98); 0.91 (95%CI 0.82 to 0.96), and 0.94 (95%CI 0.87 to 0.97) in the RKV, LKV, and TKV, respectively; p < 0.0001 each, respectively. CCC of RKV, LKV, and TKV measurements were 0.95, 0.89, and 0.94, respectively. The mGFR and eGFR showed statistically significant negative correlations with TKV measured by both MRI-EL (p = 0.0281 and p = 0.0054, respectively) and US-EL (p = p = 0.0332 and p = 0.0040, respectively).

Conclusions: This study found that ultrasound-based ellipsoid kidney volume measurements strongly correlated with MRI-based measurements, suggesting that ultrasound is a reliable, accessible alternative for assessing kidney volume, particularly when MRI is unavailable.

Background: The prevalence of dengue fever (DF), a mosquito-borne viral disease, is rising worldwide. Its severe manifestations like thrombocytopenia and plasma leakage are associated with increased mortality. Ultrasound-detected gallbladder wall thickening (GBWT) has been suggested as a potential indicator of the severity of the disease.

Aims: This systematic review and meta-analysis evaluated the predictive value of GBWT in identifying patients at risk for severe dengue.

Methods: Following the PRISMA 2020 guidelines, we conducted a systematic search of Web of Science, PubMed, Embase, and Scopus. Among the inclusion criteria were original studies that assessed GBWT across various dengue severity categories. Then, we performed a meta-analysis using a random effects model and subgroup analyses based on severity criteria to determine the relationship between GBWT and severe dengue.

Results: For the meta-analysis, 19 studies qualified for the inclusion criteria. There was a significant association between GBWT and severe dengue, according to the odds ratio (OR) of 2.35 (95% CI 1.88-2.82, p < 0.001). The subgroup analysis revealed consistent results for thrombocytopenia (OR: 2.65) and plasma leakage (OR: 2.26), among other severity criteria.

Conclusions: A reliable ultrasound indicator, GBWT can help identify patients at risk for severe dengue early on, improving clinical decision-making and patient outcomes. However, the possibility of differential diagnosis requires cautious interpretation.

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: 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.