Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD

Volpicelli, Giovanni; Cardinale, Luciano; Garofalo, G.; Veltri, Andrea

doi:10.1007/s10140-008-0701-x

Cited by 88 publications

(76 citation statements)

References 28 publications

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“…In the critically ill, a more rapid anterior two-region scan may be sufficient to rule out interstitial syndrome in cardiogenic acute pulmonary edema [12]. A positive examination for sonographic diffuse interstitial syndrome allows bedside distinction between a cardiogenic versus a respiratory cause of acute dyspnea [22][23][24]. For more precise quantification of interstitial syndrome, the 28-scanning-site technique can be useful, especially in cardiology and nephrology settings [25].…”

Section: B-d4-s5 (Strong: Level B)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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Background: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. Methods: A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Results: Seventythree proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/ conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. Conclusions: This document reflects the overall results of the first consensus conference on ''point-of-care'' lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

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Section: B-d4-s5 (Strong: Level B)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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“…However, lung ultrasound interpretation is based on the analysis of sonographic artefacts that arise from interactions of the ul-trasound beams with tissue media having different acoustic impedance. This has given rise to a new ultrasound language, including comet-tail reverberation artefacts, called B lines [13], the description of the interstitial syndrome [14] and the BLUE (bedside lung ultrasound in emergency) protocol [7]. This has changed the way we work in intensive care medicine, and even more importantly helped to improve patient outcome.…”

Section: One Of His First Surprises Was To See That No One Bothered Amentioning

confidence: 99%

Ten good reasons to practice ultrasound in critical care

Lichtenstein¹,

Hooland²,

Elbers³

et al. 2014

Anaesthesiol Intensive Ther

141

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Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a component of the physical exam, it has the potential to become the stethoscope of the 21 st century. Critical care ultrasound is a combination of simple protocols, with lung ultrasound being a basic application, allowing assessment of urgent diagnoses in combination with therapeutic decisions. The LUCI (Lung Ultrasound in the Critically Ill) consists of the identification of ten signs: the bat sign (pleural line); lung sliding (seashore sign); the A-lines (horizontal artefact); the quad sign and sinusoid sign indicating pleural effusion; the fractal and tissue-like sign indicating lung consolidation; the B-lines and lung rockets indicating interstitial syndromes; abolished lung sliding with the stratosphere sign suggesting pneumothorax; and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. The BLUE protocol (Bedside Lung Ultrasound in Emergency) is a fast protocol (< 3 minutes), also including a vascular (venous) analysis allowing differential diagnosis in patients with acute respiratory failure. With this protocol, it becomes possible to differentiate between pulmonary oedema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax, each showing specific ultrasound patterns and profiles. The FALLS protocol (Fluid Administration Limited by Lung Sonography) adapts the BLUE protocol to be used in patients with acute circulatory failure. It makes a sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography in combination with lung ultrasound, with the appearance of B-lines considered to be the endpoint for fluid therapy. An advantage of lung ultrasound is that the patient is not exposed to radiation, and so the LUCI-FLR project (LUCI favouring limitation of radiation) can be unfolded in trauma patients. Although it has been practiced for 25 years, critical care ultrasound is a relatively young but expanding discipline and can be seen as the stethoscope of the modern intensivist. In this review, the usefulness and advantages of ultrasound in the critical care setting are discussed in ten points. The emphasis is on a holistic approach, with a central role for lung ultrasound.

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“…[16][17][18] In the clinical setting of suspected AHF, pulmonary oedema is determined sonographically, using an eight-zone scanning technique, as greater than three B-lines in a rib space in at least two lung zones bilaterally. 19,20 This finding on LUS is highly sensitive for the diagnosis of AHF, can be used to differentiate AHF from chronic obstructive pulmonary disease (COPD) 14,16,18,[21][22][23][24]10,25,26 and has better diagnostic accuracy for AHF than chest X-ray. 15,27,28 In small studies, B-lines correlate well with natriuretic peptide levels 8 and wedge pressure, 28 though a more recent study shows only a modest correlation with filling pressures.…”

Section: Lung or Pulmonary Ultrasound: B-linesmentioning

confidence: 99%

Focused Ultrasound In The Emergency Department For Patients With Acute Heart Failure

Russell

Rutz

Pang

2015

Cardiac Failure Review

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The emergency department (ED) plays a key role in the initial diagnosis and management of acute heart failure (AHF). Despite the advent of novel biomarkers and traditional methods of assessment, such as history, examination, and chest X-ray, diagnosis of the dyspnoeic ED patient is, at times, very challenging. Focused cardiac and pulmonary ultrasound has emerged as a valid, facile and efficient method to aid in the initial diagnosis and management of AHF.

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Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD

Cited by 88 publications

References 28 publications

International evidence-based recommendations for point-of-care lung ultrasound

International evidence-based recommendations for point-of-care lung ultrasound

Ten good reasons to practice ultrasound in critical care

Focused Ultrasound In The Emergency Department For Patients With Acute Heart Failure

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