Use of Cardio-Pulmonary Ultrasound in the Neonatal Intensive Care Unit.

Cardiopulmonary ultrasound (CPUS), the combination of lung ultrasound (LUS) and targeted neonatal echocardiography (TnECHO)AA, may offer a more appropriate approach to the challenging neonatal cardiovascular and respiratory disorders. This paper reviews the possible use of CPUS in the neonatal intensive care unit (NICU).

Cardiopulmonary Ultrasound-Guided Treatment of Premature Infants with Respiratory Failure and Patent Ductus Arteriosus: A Randomized, Controlled Trial.

OBJECTIVES: To evaluate the role of cardiopulmonary ultrasonography in the treatment of preterm infants with respiratory failure combined with patent ductus arteriosus (PDA). METHODS: A single-center, prospective, randomized, controlled trial of premature infants born in the authors' hospital with a birth weight ≤ 1500 g and respiratory failure combined with PDA was conducted from January 2020 to December 2021. The included infants were randomly assigned to the cardiopulmonary ultrasound-guided therapy group or the traditional therapy group. The primary outcome of this study was data on respiratory support and PDA. RESULTS: A total of 76 premature infants were included in the study. There were 39 patients in the cardiopulmonary ultrasound-guided therapy group and 37 patients in the traditional therapy group. There was no difference in the baseline data, and the cardiopulmonary ultrasound-guided therapy group had a higher initial positive end-expiratory pressure [difference in median = -1.5 cm H2O, 95% confidence interval (CI): -2.0 to -1.0, p < 0.0001], earlier use of ibuprofen to close the PDA (difference in median = 2.5 d, 95% CI: 1.0-4.0, p = 0.004), fewer patients requiring invasive respiratory support [risk ratio (RR) = 0.63, 95% CI: 0.41-0.99, p = 0.04], and a lower incidence of moderate to severe bronchopulmonary dysplasia (RR = 0.44, 95% CI: 0.44-0.96, p = 0.04). There was no difference in the incidence of adverse events. CONCLUSIONS: For premature infants with respiratory failure combined with PDA, cardiopulmonary ultrasonography can better guide respiratory support. The timely administration of drugs helps treat PDA, thereby decreasing the risk of intubation and BPD. TRIAL REGISTRATION: https://www.trialos.com/index/ , TRN: 20220420024607012, date of registration: 2022/03/28, retrospectively registered.

Role of cardiopulmonary ultrasound in predicting the occurrence of heart failure with preserved ejection fraction in patients with acute myocardial infarction / 中华超声影像学杂志

Objective:To evaluate the left ventricular diastolic function and pulmonary congestion in patients with acute myocardial infarction (AMI) with preserved left ventricular ejection fraction (LVEF) by cardiopulmonary ultrasound (CPUS), and to explore the value of CPUS in predicting the occurrence of heart failure with preserved ejection fraction (HFpEF) in AMI patients with preserved LVEF during hospitalization.Methods:A total of eighty-four patients with AMI with preserved LVEF (≥50%) who received optimal emergency reperfusion therapy on admission at Beijing Chaoyang Hospital Affiliated to Capital Medical University from August 2021 to March 2022 were enrolled. All patients completed comprehensive cardiopulmonary ultrasonography within 12 hours after reperfusion therapy and LVEF, left atrial maximum volume(LAV), peak flow velocity of tricuspid valve regurgitation (V TR), peak flow velocity of mitral valve in early diastole (E), peak velocity of mitral valve annulus on septal side and left ventricular lateral side in early diastole and other conventional echocardiography parameters were obtained, and then the left atrial volume index (LAVI), the mean peak velocity of the mitral valve annulus on the septal side and left ventricular lateral side in early diastole (e′) and E/e′ were calculated; lung ultrasound parameters(the number of B lines) were obtained; the left ventricular global long-axis strain (GLS) was obtained using speckle tracking imaging (STE). The predictive power of CPUS parameters for HFpEF during hospitalization in AMI patients with preserved LVEF were analyzed. Results:①The incidence of HFpEF during hospitalization was 40.4% (34/84). ②The number of B lines and LAVI were independently correlated with the occurrence of HFpEF during hospitalization( P<0.05). ③The ROC curve analysis showed that the area under the curve (AUC) of the number of B lines and LAVI for predicting the occurrence of HFpEF during hospitalization were 0.766 and 0.690, respectively. The number of B lines combined with LAVI had the best predictive performance in predicting the occurrence of HFpEF during hospitalization, with the largest AUC of 0.903, which was significantly better than the number of B lines and LAVI ( P<0.05). Conclusions:The number of B lines combined with LAVI can effectively predict the occurrence of HFpEF during hospitalization in AMI patients with preserved LVEF, which is helpful to further improve the clinical management of AMI patients at risk of HFpEF.

Diagnostic accuracy of cardiopulmonary ultrasound for pulmonary embolism: A systematic review and meta-analysis.

BACKGROUND: Cardiopulmonary ultrasound has shown varying results in the diagnosis of pulmonary embolism patients around the world. Hence, the current review was done to assess the diagnostic accuracy of cardiopulmonary ultrasound for diagnosis of pulmonary embolism among suspected patients. METHODS: We conducted a systematic search for all studies reporting the diagnostic accuracy of cardiopulmonary ultrasound for pulmonary embolism in the databases of MEDLINE, EMBASE, MEDLINE, SCOPUS, and Cochrane library from inception till May 2021. Meta-analysis was performed using STATA software "midas" package. RESULTS: Ten studies with 4216 patients were included. The pooled sensitivity was 77% (95% CI, 50-92%) and specificity was 99% (95% CI, 97-100%), respectively. The pooled DOR was 382 (95% CI, 77-1883). Pooled LRP was 90 (95% CI, 24-326) and pooled LRN was .23 (.09-.58). There was significant heterogeneity found with the outcome with significant chi-square test and I2 statistic > 75%. CONCLUSION: Cardiopulmonary ultrasound has the ability to be used as an adjunct to CTPA especially in resource constrained settings. Further reviews comparing multiple non-invasive imaging modalities are required to pick the best tool for diagnosis of pulmonary embolism.

Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study.

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants <12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients underwent clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 h of hospital admission. The existence of significant correlation between cardiac and respiratory parameters was the primary outcome. The association of different cardiopulmonary variables with the need of respiratory support higher than O2, the length of stay hospitalization, the PICU stay and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5-3) months; 62% males) hospitalized with acute bronchiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction (Tei index). Up to 36 (32%) infants required respiratory support during the hospitalization. This group presented with higher lung ultrasound score (p < 0.001) and increased values of NT-proBNP (p < 0.001), the Tei index (p < 0.001) and pulmonary artery pressures (p < 0.001). All the analyzed respiratory and cardiac variables showed moderate-to-strong correlations with the LOS of hospitalization and the time of respiratory support. Lung ultrasound and echocardiography showed a moderate-to-strong predictive accuracy for the need of respiratory support in the ROC analysis, with the AUC varying from 0.74 to 0.87. Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ultrasonography could be a useful tool to easily identify high-risk populations for complicated acute bronchiolitis hospitalization.

Risk assessment in interstitial lung disease: the incremental prognostic value of cardiopulmonary ultrasound.

BACKGROUND: The mortality risk of chronic interstitial lung disease (ILD) is currently assessed using the ILD-GAP score. The present study evaluates whether the addition of cardiopulmonary ultrasound parameters to the ILD-GAP score can further improve the predictive value of ILD-GAP. METHODS: Medical records from 91 patients with ILD hospitalized from June 2015 to March 2016 were retrospectively examined. The Lung ultrasound (LUS) score, right ventricular (RV) function, and mechanics were obtained from the cardiopulmonary ultrasound. The ILD-GAP score was calculated from demographic characteristics and pulmonary function parameters. Patients were followed up with until May 2020. The primary endpoint was all-cause death. RESULTS: After exclusions, 74 patients with ILD were included in the analysis. During the follow-up period, 36 patients with ILD survived (ILDs), and 38 patients died (ILDd). Compared to ILDs, the ILDd cases exhibited a higher number of B-lines, LUS score, and RV end-diastolic base dimension (RVD), but lower RV function. In multivariate analysis, the ILD-GAP score (hazard ratio, 2.88; 95% CI 1.38-5.99, P = 0.005), LUS score (hazard ratio 1.13; 95% CI 1.04-1.24, P = 0.006), and RVD (hazard ratio 1.09, 95% CI 1.03-1.16, P = 0.004) were significantly related to the risk of death. Adding the LUS score and RVD to the ILD-GAP score significantly improved the predictive value compared to the ILD-GAP score alone (C statistics 0.90 vs 0.76, P = 0.018). CONCLUSION: We investigated the utility of a new prognostic model for ILD that includes both cardiopulmonary ultrasound parameters (LUS score and RVD) and the ILD-GAP score. This model better reflects the severity of pulmonary fibrosis and cardiac involvement, and has incremental predictive value over the ILD-GAP score alone.

Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome.

BACKGROUND: Lung ultrasound and echocardiography are mainly applied in critical care and emergency medicine. However, the diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome (ARDS) is still unclear. METHODS: Consecutive patients admitted to ICU with the diagnosis of suspected ARDS based on clinical grounds were enrolled. Cardiopulmonary ultrasound was performed as part of monitoring on day 1, day 2 and day 3. On each day a bedside ultrasound was performed to examine the lungs and calculate the Left Ventricular Ejection Fraction (LVEF). On day 3, a thoracic CT was performed on each patient as gold standard for ARDS imaging diagnosis. According to the results from CT scan, patients were grouped into ARDS group or Non-ARDS group. The relation between the cardiopulmonary ultrasound results on each day and the results of CT scan was analyzed. RESULTS: Fifty one consecutive patients aged from 73 to 97 years old were enrolled. Based on CT criteria, 33 patients were classified into the ARDS group, while 18 patients were included in non-ARDS group. There was no significant difference between the two groups in baseline characteristics, including gender, age, underlying disease, comorbidities, APACHE II score, SOFA score, and PaO2/FiO2 ratio (P > 0.05). Lung ultrasound (LUS) examination results were consistent with the CT scan results in diagnosis of pulmonary lesions. The Kappa values were 0.55, 0.74 and 0.82 on day 1, day 2 and day 3, respectively. The ROC analysis showed that the sensitivity, specificity and area under curve of ROC (AUROC) for lung ultrasound in diagnose ARDS were 0.788,0.778,0.783;0.909,0.833,0.871;0.970,0.833,0.902 on day 1, day 2 and day 3, respectively. However, cardiopulmonary ultrasound performed better in diagnosing ARDS in elderly patients. The sensitivity, specificity and AUROC were 0.879,0.889,0.924;0.939,0.889,0.961;and 0.970,0.833,0.956 on day 1, day 2 and day 3, respectively. The combined performances of cardiopulmonary ultrasound, N-terminal pro-brain natriuretic peptide (NT-proBNP), and PaO2/FiO2 ratio improved the specificity of the diagnosis of ARDS in elderly patients. CONCLUSIONS: LUS examination results were consistent with the CT scan results in diagnosis of pulmonary lesions. Cardiopulmonary ultrasound has a greater diagnostic accuracy in elderly patients with ARDS, compared with LUS alone. The combined performances of cardiopulmonary ultrasound, NT-proBNP, and PaO2/FiO2 increased the specificity of the diagnosis of ARDS in elderly patients.

Sustainable Resuscitation Ultrasound Education in a Low-Resource Environment: The Kumasi Experience.

BACKGROUND: Point-of-care-ultrasound (POCUS) is an increasingly important tool for emergency physicians and has become a standard component of emergency medicine residency training in high-income countries. Cardiopulmonary ultrasound (CPUS) is emerging as an effective way to quickly and accurately assess patients who present to the emergency department with shock and dyspnea. Use of POCUS, including CPUS, is also becoming more prevalent in low- and middle-income countries (LMICs); however, formal ultrasound training for emergency medicine resident physicians in these settings is not widely available. OBJECTIVES: To evaluate the feasibility of integrating a high-intensity ultrasound training program into the formal curriculum for emergency medicine resident physicians in an LMIC. METHODS: We conducted a pilot ultrasound training program focusing on CPUS for 20 emergency medicine resident physicians in Kumasi, Ghana, which consisted of didactic sessions and hands-on practice. Competency was assessed by comparing pretest and posttest scores and with an Objective Structured Clinical Examination (OSCE) performed after the final training session. RESULTS: The mean score on the pretest was 61%, and after training, the posttest score was 96%. All residents obtained passing scores above 70% on the OSCE. CONCLUSION: A high-intensity ultrasound training program can be successfully integrated into an emergency medicine training curriculum in an LMIC.

Integrative Cardiopulmonary Ultrasound for Interstitial Lung Disease Assessment: Correlation between Lung Ultrasound Performance and Cardiac Involvement.

The aims of this study were to apply integrative cardiopulmonary ultrasound (thoracic ultrasound) to the evaluation of patients with interstitial lung disease (ILD) and to determine the relationship between lung ultrasound signs and echocardiographic parameters such as systolic pulmonary artery pressure (SPAP) and various right ventricular parameters. ILD patients and healthy controls underwent lung ultrasound (LUS) and echocardiographic tests. In addition to traditional echocardiographic parameters, right ventricular free wall longitudinal strain (RVLS_FW) was measured using 2-D speckle-tracking echocardiography. The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored with a semiquantitative scoring method, taking into account multiple LUS signs. Statistical analyses were performed to compare various parameters between ILD patients with and those without pulmonary hypertension. Correlations between the different parameters were then evaluated, and the LUS scores were used to predict pulmonary hypertension using a receiver operating characteristic curve analysis. Among the 90 patients who qualified for entry into this study, 30% (n = 27) had pulmonary hypertension. The patients with pulmonary hypertension had larger right ventricular dimensions, lower RVLS_FW and higher LUS scores. An effective correlation was found between ILD LUS scores and echocardiographic parameters, especially SPAP (r = 0.735, p < 0.001). The groups were comparable with respect to most echocardiographic parameters, with mild, moderate and severe pulmonary fibrosis, whereas SPAP was significantly higher in the moderate and severe groups. RVLS_FW was obviously reduced in the group with severe pulmonary fibrosis. Although RVLS_FW in the mild pulmonary fibrosis group was in the normal range, it was slightly reduced compared with that of the controls. A cutoff of more than 16 LUS points had 85.2% sensitivity and 80.3% specificity in predicting elevated SPAP (>36 mm Hg). Thoracic ultrasound is useful in the assessment of ILD. As ILD progresses, the structure or function of the right ventricle gradually deteriorates. LUS not only detects lung conditions in ILD, but also indirectly reflects SPAP and right ventricular function. Integrated use of LUS and echocardiography will provide an invaluable point-of-care imaging modality to facilitate the diagnosis, management and treatment of patients with ILD.

Assessment of the correlation between the severity of interstitial lung disease and clinical parameters by cardiopulmonary ultrasound performance / 中华超声影像学杂志

Objective To evaluate the application value of cardiopulmonary ultrasound(CPUS) in patients with interstitial lung diseases(ILD).Methods Ninety patients with clinically diagnosed interstitial lung diseases and 30 healthy subjects were included in this study.The conventional echocardiographic parameters and right ventricular free wall longitudinal strain (RVLS_FW) were measured in all patients and healthy subjects.The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored using a semi-quantitative scoring method.Patients’ pulmonary function parameters and clinical outcome score (GAP score) were recorded.Fourteen patients belong to other types of ILD and 19 patients with incomplete clinical data were unable to perform GAP scoring,finally 57 patients' clinical and ultrasonographic parameters were measured.On the basis of the pulmonary arterial systolic pressure (PASP) obtained by Doppler echocardiography,90 patients were divided into two groups:ILD patients with pulmonary hypertension(ILDpH,PASP ≥36 mmHg,1 mmHg =0.133 kPa) and ILD patients without PH (ILDNpH,PASP＜ 36 mmHg).Comparsion between ILDpH,ILDNpH and healthy subjects were then evaluated.According to the GAP score,all cases were divided into three groups:low risk,moderate risk and high risk.Statistical analysis was performed to examine the relationship between CPUS parameters and clinical parameters.Results ①Compared with ILDNpH patients,ILDpH patients had significantly lower right ventricular function,wider basal right ventricular diameter (RVD),proximal right ventricular outflow diameter (DRvor1) and right pulmonary artery diameter (DRPA).Compared with healthy subjects,ILDNpH patients had mildly lower right ventricular function and wider left pulmonary artery diameter (DLPA) and right ventricular outflow tract dimensions at the distal or pulmonic valve (DRvoT2).②A good correlation was found between lung ultrasound (LUS) scores and pulmonary function parameters,especially diffusion capacity for carbon monoxide of the lung(DLco)(r =-0.68,P ＜0.001).③With the increased risk of patients,the right ventricular function was gradually decreased,DRVOT2,DRPA,DLPA were gradually widened,and the lung ultrasound score was gradually increased.A weak correlation was found between GAP scores with RVLS_FW,LUS scores,DRpA(r =0.44,0.34,0.31,P ＜0.05).Conclusions CPUS parameters are useful in the assessment of interstitial lung disease and could reflect the prognosis of ILD patients to some extent.Therefore,on the basis of GAP scores,addition of RVLS_FW and LUS score will be more helpful to evaluate the prognosis ofILD patients.