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Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia.Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

Introduction: The use of a reliable scoring system for quality assessment (QA) is imperative to limit inconsistencies in measuring ultrasound acquisition skills. The current grading scale used for QA endorsed by the American College of Emergency Physicians (ACEP) is non-specific, applies irrespective of the type of study performed, and has not been rigorously validated. Our goal in this study was to determine whether a succinct, organ-specific grading scale designed for lung-specific QA would be more precise with better interobserver agreement.Methods: This was a prospective validation study of an objective QA scale for lung ultrasound (LUS) in the emergency department. We identified the first 100 LUS performed in normal clinical practice in the year 2020. Four reviewers at an urban academic center who were either emergency ultrasound fellowship-trained or current fellows with at least six months of QA experience scored each study, resulting in a total of 400. The primary outcome was the level of agreement between the reviewers. Our secondary outcome was the variability of the scores given to the studies. For the agreement between reviewers, we computed the intraclass correlation coefficient (ICC) based on a two-way random-effect model with a single rater for each grading scale. We generated 10,000 bootstrapped ICCs to construct 95% confidence intervals (CI) for both grading systems. A two-sided one-sample t-test was used to determine whether there were differences in the bootstrapped ICCs between the two grading systems.Results: The ICC between reviewers was 0.552 (95% CI 0.40–0.68) for the ACEP grading scale and 0.703 (95% CI 0.59–0.79) for the novel grading scale (P < 0.001), indicating significantly more interobserver agreement using the novel scale compared to the ACEP scale. The variance of scores was similar (0.93 and 0.92 for the novel and ACEP scales, respectively).Conclusion: We found an increased interobserver agreement between reviewers when using the novel, organ-specific scale when compared with the ACEP grading scale. Increased consistency in feedback based on objective criteria directed to the specific, targeted organ provides an opportunity to enhance learner education and satisfaction with their ultrasound education.

Objectives Lung ultrasound (LUS) and high-resolution CT (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a 1 year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. Methods SSc-ILD patients who started NIN were enrolled and followed for 12 months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after 1 year and quantitatively analysed with CALIPER software. Results Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after 12 months (from 175.1 [66.7] to 120.8 [70.3] for BL, P  = 0.005; and from 50.6 [32.5] to 37.2 [22.4] for PLI, P  = 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction in both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (P  = 0.016 and P  = 0.04, respectively) and Saint George's Respiratory Questionnaire (P  = 0.006 and P  = 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after 12 months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. Conclusion We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed. [ABSTRACT FROM AUTHOR]

Long-term care facility (LTCF) residents are twice as likely to receive antibiotics compared with elderly living in the community, and studies have reported up to half of prescriptions in LTCFs as inappropriate. To identify factors contributing to general and inappropriate antibiotic prescription among LTCF residents with lower respiratory tract infections (LRTIs). In this prospective, multicentric, observational study, residents with LRTIs were recruited among 32 LTCFs in Western Switzerland during winter 2022–2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. Multivariate logistic regression and backward selection were used with P < 0.1 cut-off to identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription. A total of 114 residents were included, 63% female, median age 87 years. Fifty-nine (52%) residents underwent diagnostic tests: 50 (44%) polymerase chain reaction (PCR) for respiratory viruses and 16 (14%) blood test with C-reactive protein and/or blood count. Sixty-three (55%) residents received antibiotics. Factors associated with antibiotic prescriptions were Rockwood Clinical Frailty Scale score ≥7, oxygen saturation <92%, performing a blood test, rural LTCFs, and female physician. Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with performance of respiratory virus PCR test as the only protective factor. Whereas half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53–80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of individualized lung protective ventilation guided by lung ultrasound on postoperative diaphragm function in elderly patients. Methods A total of 80 elderly patients who underwent laparoscopic radical resection of colon cancer at Taizhou People's Hospital from January to December 2023 were selected as the research subjects. They were randomly divided into the traditional lung protective ventilation group (T-LP group) and the personalized lung protective ventilation group based on lung ultrasound (U-LP group) using a random number table method, with 40 cases in each group. The T-LP group implemented traditional mode lung protective ventilation strategy using low tidal volume (VT), sustained fixed positive end expiratory pressure (PEEP), and fixed lung recruitment maneuver (RM) pressure. The U-LP group implements personalized lung protective ventilation strategies based on lung ultrasound titration of individualized PEEP and RM pressure on the basis of the T-LP group. Before induction of general anesthesia. 15 minutes after extubation. 30 minutes after extubation, and preparation to leave the postanesthesia recovery unit (PACU),two sets of records diaphragmatic ultrasound monitoring indicators during quiet breathing (QB) and deep breathing (DB) include diaphragmtic excursion (DE) [quiet breathing diaphragm excursion (DEQ), deep breathing diaphragmtic excursion (DED), diaphragmtic thickness (DT) [quiet inspiratory diaphragm thickness (DTQi), calm expiratory diaphragm thickness (DTQe), deep inspiratory diaphragm thickness (DTDi), deep expiratory diaphragm thickness (DTDe)],and diaphragmtic thickening fraction (DTF) [calm breathing diaphragmtic thickening fraction (DTFQ), deep breathing diaphragm thickening fraction (DTFD)]. In addition, record the time it takes to stop using muscle relaxants when train of four ratio (TOFr) ≥90%, the time it takes to remove the tube until the Aldrete score is greater than 9 points, and the number of cases requiring the reversal of residual muscle relaxants with sugammadex. Results Compared with before induction of general anesthesia, the diaphragm ultrasound indicators such as DEQ,DED, DTQi.DTQe.DTFQ,DTD; and DTFD in the T-LP group were significantly reduced, thinned, or decreased upon leaving the PACU (P<0.05), while the DTD; indicator in the U-LP group was significantly thinned (P<0.05). Compared with the T-LP group, the DEQ in the U-LP group increased significantly upon leaving the PACU (P<0.05), and the DED, DTD; and DTFD increased or thickened significantly at 15 and 30 minutes after extubation and upon leaving the PACU (P<0.05). The DTQi, DTQe, and DTDe increased significantly at 30 minutes after extubation and upon leaving the PACU (P<0.05), and the time for extubation to achieve an Aldrete score of ≥ 9 was significantly shortened (P<0.05). Conclusion The implementation of individualized lung protective ventilation based on lung ultrasound has a slight impact on the postoperative diaphragm function in elderly patients with laparoscopic radical resection of colon cancer, which is more conducive to the recovery of postoperative diaphragm function, and shortens the retention time in PACU, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Background: Although the incidence of postoperative atelectasis could be reduced using lung recruitment manoeuvres, it remains high. We hypothesised that intraoperative visual lung recruitment guided by trans-oesophageal lung ultrasound would be more effective than the conventional method for managing postoperative atelectasis. Methods: In this randomised, controlled, prospective study, 84 patients undergoing thoracoscopic lobectomy were recruited from Affiliated Chengdu Fifth People's Hospital (teaching hospital) in China. Patients were grouped into trans-oesophageal lung ultrasound-guided (Group G, n = 42) and control (Group C, n = 42) groups. Methods: Lung recruitment was performed after anaesthesia induction, before chest closure and before the endotracheal tube extubation. In Group C, recruitment pressure was controlled at 30 cm H2O for 10 s (performed thrice); in Group G, the pressure was controlled at 30 cm H2O (performed thrice), and the tidal volume did not exceed 20 ml kg−1 until no atelectasis was detected by trans-oesophageal ultrasound. The primary outcome was lung ultrasound scores measured at the post anaesthesia care unit 30 min after extubation. The secondary outcomes included the oxygenation index (30 min after extubation) and the incidence of atelectasis (30 min after extubation and 3 days after surgery). Results: The final analysis included 79 patients. The lung ultrasound score was significantly higher in the control group than in the ultrasound-guided group 30 min after extubation (Group C vs. Group G, 8.6 ± 2.6 vs. 6.5 ± 2.0, P < 0.001). No significant difference in the oxygenation indexes 30 min after extubation was observed between the groups (P = 0.074); however, the incidence of atelectasis 30 min after extubation significantly differed between the two groups (Group C vs. Group G, 57% vs. 33%, P = 0.031). The incidence of atelectasis 3 days after surgery did not significantly differ between the two groups (Group C vs. Group G, 45% vs. 28%, P = 0.122). Conclusions: Lung recruitment guided by trans-oesophageal lung ultrasound can reduce lung ultrasound scores and the incidence of atelectasis at the post anaesthesia care unit 30 min after extubation. However, it does not significantly reduce the incidence of atelectasis 3 days after surgery. Trial registration: Registration number: ChiCTR2200062509. Registered on 10 /8/ 2022. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Lung transplantation is a vital option for patients with end-stage lung disease. However, it faces a significant challenge due to the shortage of compatible donors, which particularly affects individuals with small chest cavities and pediatric patients. The novel approach of cadaveric lobar lung transplantation is a promising solution to alleviate the donor shortage crisis. Both the mid-term and long-term outcomes of lobar lung transplantation are comparable to those of standard lung transplantation. However, patients undergoing lobar lung transplantation reported a significantly higher rate of primary graft dysfunction compared to patients undergoing standard lung transplantation. Therefore, careful donor selection is critical to improve outcomes after lobar transplantation. However, no established method exists to evaluate each lung lobar graft of deceased donors. This case report describes a case of cadaveric lobar lung transplantation to overcome size mismatch and donor shortage, with particular emphasis on lobar graft evaluation. Case presentation: A 39-year-old woman with scleroderma-related respiratory failure was listed for deceased donor lung transplantation due to a rapidly progressing disease. Faced with a long waiting list and impending mortality, she underwent bilateral living-donor lobar lung transplantation donated by her relatives. Post-transplant complications included progressive pulmonary vein obstruction and pleural effusion, which ultimately required retransplantation. An oversized donor with pneumonia in the bilateral lower lobes was allocated. Lung ultrasound was used to evaluate each lung lobar graft during procurement. The right upper and middle lobes and left upper lobe were confirmed to be transplantable, and lobar lung redo transplantation was performed. The patient's post-transplant course was uneventful, and she was discharged home and returned to her daily activities. Conclusions: This case highlights the clinical impact of cadaveric lobar lung transplantation as a feasible and effective strategy to overcome the shortage of donor lungs, especially in patients with small thoracic cavities. By establishing donor lung evaluation techniques and overcoming anatomical and logistical challenges, cadaveric lobar lung transplantation can significantly expand the donor pool and offer hope to those previously considered ineligible for transplantation. [ABSTRACT FROM AUTHOR]

Background: Extubation failure is a crucial issue for acute respiratory distress syndrome (ARDS). Ultrasound of the lung and diaphragm is individually valuable for predicting extubation outcomes. We aimed to determine whether combined lung and diaphragmatic ultrasound could improve the accuracy of predicting the extubation of ARDS patients. Methods: This was a prospective cohort study of ARDS patients who were ready for extubation. The lung ultrasound score (LUS), diaphragmatic displacement (DD), diaphragm thickening fraction (DTF), and diaphragmatic-rapid shallow breathing index (D-RSBI) were measured at the end of the spontaneous breathing trial. The primary outcome was extubation success. Logistic regression was used to combine these indicators, and the predictive performance of the single and combined indicators was evaluated through receiver operating characteristic (ROC) curves, the Hosmer–Lemeshow Ĉ‐test, and the Brier score. Multivariate logistic regression was used to determine the association between combined ultrasound indicators and extubation success. Results: This study enrolled 132 eligible patients from January 2019 to December 2022. A total of 71% (94/132) of patients were successfully extubated from mechanical ventilation. The combination of LUS and D-RSBI had the largest area under the ROC curves, the lowest Brier score, and the greatest calibration. After formula transformation, LUS + 2.43 × D-RSBI ≤ 14.273 was significantly associated with extubation success in ARDS patients. Conclusions: In ARDS patients receiving mechanical ventilation, the combination of LUS and D-RSBI was more accurate than a single parameter alone in predicting extubation outcomes. This combined approach could help refine extubation protocols in critical care. Clinical trial registration This study is registered online with the Chinese Clinical Trial Registry (ChiCTR), http://www.chictr.org.cn, ChiCTR1800019340 (Registration time: 2018/11/06). [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at risk for bronchopulmonary dysplasia (BPD) due to prolonged respiratory support. Studies have described differences in the regional distribution of lung ventilation (non-dependent (NDL) vs. dependent (DL)). The aim of this study was to use LUS to compare regional distribution of pulmonary edema and atelectasis in infants with evolving BPD. Methods: We prospectively performed LUS in premature infants with evolving BPD. On each side, three lung areas (NDL/anterior, lateral, and DL/posterior) were examined for the presence of pulmonary edema and atelectasis. Pulmonary edema scores were assigned based on the number of B-lines, and atelectasis scores were assigned based on the presence/absence of atelectasis. Results: 38 premature infants were enrolled. The NDL showed more pulmonary edema and atelectasis compared to the DL (p = 0.003, p = 0.049, respectively) and compared to the lateral lung (p =< 0.001, p = 0.004, respectively). There was no difference between the lateral and DL (p = 0.188, p = 0.156, respectively). There was no difference between the right and the left lung (p = 0.223, p = 0.656, respectively). Conclusions: In this cohort of preterm infants with evolving BPD, lung disease was unevenly distributed, with more pulmonary edema and atelectasis in the NDL regions compared to the DL or lateral regions. [ABSTRACT FROM AUTHOR]

Primary pulmonary sarcoma and mesothelioma are rare malignancies. The review article discusses the appearance of these tumors in B-mode ultrasound (US), color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). In particular, the article is intended to inspire the examination of thoracic wall tumors and pleural masses with the possibilities of ultrasonography and to obtain histologically evaluable material using US or CEUS-guided sampling. [ABSTRACT FROM AUTHOR]

Background: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices—maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns—with weaning failure. Methods: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Results: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01–1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86–0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98–1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Conclusions: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study. [ABSTRACT FROM AUTHOR]

Point of Care ultrasound (POCUS) of the lungs, also known as lung ultrasound (LUS), has emerged as a technique that allows for the diagnosis of many respiratory pathologies with greater accuracy and speed compared to conventional techniques such as chest x-ray and auscultation. The goal of this narrative review is to provide a simple and practical approach to LUS for critical care, pulmonary, and anesthesia providers, as well as respiratory therapists and other health care providers to be able to implement this technique into their clinical practice. In this review, we will discuss the basic physics of LUS, provide a hands-on scanning technique, describe LUS findings seen in normal and pathological conditions (such as mainstem intubation, pneumothorax, atelectasis, pneumonia, aspiration, COPD exacerbation, cardiogenic pulmonary edema, ARDS, and pleural effusion) and also review the training necessary to achieve competence in LUS. [ABSTRACT FROM AUTHOR]

Introduction: Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS). Methods: This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis. Results: Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21–8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis. Discussion: Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates. Trial registration: ClinicalTrials.gov identifier: NCT06069414. [ABSTRACT FROM AUTHOR]

Aims: Lung ultrasound (LUS) is a sensitive tool to assess pulmonary congestion (PC). Few data are available on LUS‐PC evaluation in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the prevalence and prognostic impact of LUS‐PC in patients with severe AS before and after TAVI. Methods and results: We designed a single‐centre prospective study in patients referred for TAVI for severe AS (ClinicalTrials.gov identification number: NCT05024942). All patients underwent echocardiography and LUS (according to a simplified 8‐zone scanning protocol) the day before and within 72 h after the procedure. The primary endpoint was the composite of all‐cause mortality, hospitalization for heart failure and urgent medical visits for worsening dyspnoea at 12‐month follow‐up. A total of 127 patients were enrolled (mean age 81.1 ± 5.8 years; 54.3% female). Pre‐TAVI LUS‐PC was documented in 65 patients (51%). After TAVI, the prevalence of LUS‐PC significantly decreased as compared to pre‐TAVI evaluation, being documented in only 28 patients (22% vs. 51%, p < 0.001) with a median B‐lines score of 4 (interquartile range [IQR] 0–11) versus 11 (IQR 6–19) pre‐TAVI (p < 0.001). During a median follow‐up of 12 (12–17) months, 25 patients (19.6%) met the composite endpoint. On multivariable Cox regression analysis, pre‐TAVI LUS‐PC was independently associated with cardiovascular events (hazard ratio 2.764, 95% confidence interval 1.114–6.857; p = 0.028). Conclusions: Lung ultrasonography reveals a high prevalence of PC in patients with severe AS undergoing TAVI, which is significantly reduced by the procedure. Pre‐TAVI PC, measured by LUS, is an independent predictor of 1‐year clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction: Optimization of ultrafiltration during hemodialysis is a critical parameter in achieving therapeutic efficacy and ensuring hemodynamic stability. While various modalities such as blood volume monitoring, inferior vena cava diameter assessment, natriuretic peptide levels, bioimpedance assay, and lung ultrasound have been widely explored in the context of maintenance hemodialysis, the concept of volume‐guided ultrafiltration in dialysis patients with acute kidney injury remains unexplored. Methods: Adult patients with acute kidney injury requiring dialysis, who were hemodynamically stable and not on ventilator support, without underlying lung pathology or cardiac failure, were randomized into two groups. All patients underwent 28‐zone lung ultrasound before dialysis. The ultrafiltration was decided based on the treating physician's clinical judgment in controls. In the intervention group, the ultrafiltration orders prescribed by the treating physician were modified, based on the Kerley B line scores obtained by lung ultrasound. The rest of the dialysis prescriptions were similar. A postdialysis lung ultrasound was done in both groups to assess the postdialysis volume status 30 min after the dialysis session. Results: A total of 74 patients undergoing hemodialysis for acute kidney injury were randomized. The baseline characteristics were comparable except for higher baseline B line score scores in the intervention arm. All patients received similar dialysis prescriptions. The lung ultrasound‐guided ultrafiltration arm had a higher change in B line scores (BLS) from baseline (4 [0–9.5] vs. 0 [0–4]; p value 0.004) during the first dialysis session. The predialysis BLS indexed to ultrafiltration (mL/kbw/h) were significantly lower in controls, reflecting a relatively higher rate of ultrafiltration in controls compared with intervention (p = 0.006). The total number of dialysis sessions done in the control and intervention arm were 61 and 59, respectively. Among controls, 23/61 sessions (37.7%) had intradialytic adverse events, whereas, in the intervention arm, only 4/59 sessions (6.7) had any adverse intradialytic events (p < 0.01). Conclusion: Lung ultrasound‐guided ultrafiltration was associated with a better safety profile, as demonstrated by reduced intradialytic events. [ABSTRACT FROM AUTHOR]

Background: Lower respiratory tract infections (LRTIs) are a significant cause of primary care consultations. Differentiating between viral and bacterial infections is critical for effective treatment and to minimize unnecessary antibiotic use. This study investigates the impact of combining lung ultrasound (LUS) with capillary blood C-reactive protein (CRP) rapid testing on clinical decision-making for patients with LRTIs. Objectives: The primary objective is to assess how the integration of CRP testing and LUS influences antibiotic prescription decisions. The study aims to quantify the percentage change in antibiotic prescriptions before and after performing LUS, following history taking, clinical examination, and CRP testing. Methods: This analytical observational study will be conducted in six primary care centers within the Health Region of Lleida, Catalonia, serving a mixed urban and rural population of approximately 105,000 residents. The study will recruit 196 patients aged 18 and over, presenting with LRTI symptoms and not treated with antibiotics in the preceding 14 days. Participants will undergo CRP testing followed by LUS during their consultation. Statistical analyses, including linear regression, bivariate analysis, Pearson or Spearman correlation, and logistic regression, will be used to evaluate the impact of LUS on clinical decisions and its predictive value in diagnosing bacterial infections. Results and Conclusions: This study will provide insights into the role of LUS combined with CRP testing in improving diagnostic accuracy and guiding antibiotic prescription decisions in primary care. The findings aim to enhance treatment protocols for LRTIs, reducing unnecessary antibiotic use and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigated how pulmonary metastases in the lungs can be assessed using a special imaging technique called contrast-enhanced ultrasound (CEUS). We analyzed data from 54 patients with confirmed cancer spread to the lungs. Our goal was to identify patterns of blood flow in the lung tumors and to compare these with the findings from tissue samples stained to highlight blood vessels. The results showed that most lung tumors had a blood supply from the bronchial arteries, with a few showing a supply from the pulmonary arteries. Additionally, most tumors showed a rapid reduction in contrast enhancement. This research helps improve the understanding of blood flow in lung tumors and could aid in developing better diagnostics strategies. Purpose: Description of the perfusion of pulmonary metastasis by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns represented by immunohistochemical CD34 endothelial staining. Patients and methods: The data of 54 patients with histologic proven peripheral pulmonary metastasis, investigated between 2004 and 2023 by CEUS. These CEUS parameters were evaluated: time to enhancement (TE), categorized as early pulmonary-arterial (PA) or delayed bronchial-arterial (BA) patterns; extent of enhancement (EE), either marked or reduced; homogeneity of enhancement (HE), homogeneous or inhomogeneous; and decrease of enhancement (DE), rapid washout (<120 s) or late washout (≥120 s). Additionally, tissue samples in 45 cases (83.3%) were stained with CD34 antibody for immunohistochemical analysis. Results: In total, 4 lesions (7.4 %) exhibited PA enhancement, and 50 lesions (92.6%) demonstrated BA enhancement. Furthermore, 37 lesions (68.5%) showed marked enhancement, while 17 lesions (31.5%) exhibited reduced enhancement. The enhancement was homogeneous in 28 lesions (51.86%) and inhomogeneous in 26 lesions (48.14%). Additionally, 53 lesions (98.1%) displayed a rapid washout. A chaotic vascular pattern indicative of a bronchial arterial blood supply was identified in all cases (45/45, 100%), including all 4 lesions with PA enhancement. Conclusion: Pulmonary metastases in CEUS predominantly reveal bronchial arterial enhancement and a rapid washout. Regarding EE and HE, pulmonary metastases show heterogeneous perfusion patterns. A PA enhancement in CEUS does not exclude BA neoangiogenesis. [ABSTRACT FROM AUTHOR]

Lung imaging techniques are crucial for managing ventilated patients in pediatric intensive care units (PICUs). Bedside chest x-ray has limitations such as low sensitivity and radiation exposure risks. Recently, lung ultrasound has emerged as a promising technology offering advantages such as real-time monitoring and radiation-free imaging. However, the integration of lung ultrasound into clinical practice raises questions about its impact on chest x-ray prescriptions. This study aims to assess whether implementing lung ultrasound reduces reliance on chest x-rays for ventilated pediatric patients in the PICU. This before-and-after uncontrolled quality improvement project was conducted from January 2022 to December 2023 in a referral PICU. The study included three phases: retrospective evaluation, learning phase, and prospective evaluation. Patients aged under 14 years, intubated, and ventilated for ≤ 30 days were included. Lung ultrasound was performed using a standardized protocol, and chest x-rays were conducted as per clinical indications. During the study period, 430 patients were admitted to the PICU, with 142 requiring mechanical ventilation. Implementation of routine bedside lung ultrasound led to a 39% reduction in chest x-ray requests (p < 0.001). Additionally, there was a significant decrease in irradiation exposure and a 27% reduction in costs associated with chest x-rays. Conclusion: Routine bedside lung ultrasound is a valuable tool in the modern PICU, it reduces the number of chest x-rays, with reduced radiation exposure and a potential cost savings. What is known: • Bedside chest x-ray is the main imaging study in ventilated pediatric patients • Chest x-ray is a valuable tool in pediatric critical care but it is associated with irradiation exposure What is new: • Implementation of bedside lung ultrasound in pediatric critical care unites reduces the chest x-rays requests and therefore patient-irradiation [ABSTRACT FROM AUTHOR]

Acute respiratory failure (ARF) is a sudden failure of the respiratory system to ensure adequate gas exchanges. Numerous clinical conditions may cause ARF, including pneumonia, obstructive lung diseases (e.g., asthma), restrictive diseases such as neuromuscular diseases (e.g., spinal muscular atrophy and muscular dystrophy), and albeit rarely, interstitial lung diseases. Children, especially infants, may be more vulnerable to ARF than adults due to anatomical and physiological features of the respiratory system. Assessing respiratory impairment in the pediatric population is particularly challenging as children frequently present difficulties in reporting symptoms and due to compliance and cooperation in diagnostic tests. The evaluation of clinical and anamnestic aspects represents the cornerstone of ARF diagnosis: first level exams (e.g., arterial blood gas analysis) confirm and evaluate the severity of the ARF and second level exams help to uncover the underlying cause. Prompt management is critical, with supplemental oxygen, mechanical ventilation, and the treatment of the underlying problem. The aim of this review is to provide a comprehensive summary of the current state of the art in diagnosing pediatric ARF, with a focus on pathophysiology, novel imaging applications, and new perspectives, such as biomarkers and artificial intelligence. [ABSTRACT FROM AUTHOR]

Background: Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value. Methods: Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm underwent validation and refinement with an additional 140 LUS images, leading to five iterative revisions and the generation of 1902 distinct LUS phenotypes. Subsequently, a validated machine learning algorithm was applied to these phenotypes. To assess the algorithm's effectiveness, experts manually verified 30% of the phenotypes, confirming its efficacy. Using K-means cluster analysis and expert image selection from the 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities. Results: A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II (APACHE II)score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses. Conclusions: Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness. [ABSTRACT FROM AUTHOR]

Objective To explore the application value of lung ultrasound B-line in the assessment of volume status in hemodialysis patients. Methods A total of 93 maintenance hemodialysis patients in the dialysis center of our hospital from January 2022 to June 2023 were selected. Ultrasound was used to measure the number of B-lines and inferior vena cava diameter（IVCD) before and after dialysis. The changes of the two before and after dialysis were compared, and the correlation between the number of B-lines and IVCD before and after dialysis was analyzed. At the same time, 62 patients with hypertension were selected, and the traditional clinical evaluation method and lung ultrasound B-line evaluation method were used to adjust the dry weight of dialysis. The number of B-lines, the degree of dry weight loss, blood pressure and the incidence of dialysis hypotension were compared between the two groups. Results The number of B-lines, IVCD and body weight after dialysis were lower than those before dialysis, and the differences were statistically significant（P＜0. 05). The number of B-lines before dialysis was positively correlated with IVCD（r=0. 536, P＜0. 05). Compared with the traditional evaluation group, the degree of blood pressure decline and dry weight loss in the lung ultrasound B-line group were greater, and the incidence of dialysis hypotension was lower, the differences were statistically significant（P＜0. 05). Conclusion In hemodialysis patients, the application of lung ultrasound B-line detection for volume assessment has good clinical value. [ABSTRACT FROM AUTHOR]

Objective Administering surfactant timely and appropriately is important to minimize lung injury but remains challenging in preterm neonates with respiratory distress syndrome. The published literature supports that lung ultrasound (LUS) score can predict surfactant need. Neonatal LUS scanning specification and parameter setting guidelines have been recently published for standardization. However, variations in scanning protocols and machine settings hinder its clinical implementation widely. This observational study aims to internally validate the suggested LUS protocol in a neonatal intensive care unit to establish a correlation between LUS scores and surfactant need as the first step of integrating LUS in the clinical practice. Study Design LUS was performed on 40 eligible preterm neonates within 3 hours after birth or before surfactant administration between May 2020 and March 2021. The neonates were between 27 and 32 weeks' gestational age, and all had respiratory distress. Neonates with known congenital anomalies were excluded. A high-frequency linear probe was used to obtain LUS images from six lung zones which were scored using a 0 to 3 system, yielding a maximum of 18 points. Treating physicians were blinded to the LUS score. Receiver operating characteristic analysis determined the optimal LUS score cut-off for predicting surfactant need. Results Fifteen of the 40 neonates (38%) required higher oxygen fraction and received surfactant. In our cohort, an LUS score ≥10 was identified as the optimal cut-off for predicting surfactant need, with a sensitivity of 80% and specificity of 84%. The area under the curve was 0.8 (p = 0.0003). LUS predicted surfactant need at a median of 3.5 hours earlier than traditional clinical decision (p < 0.0037). Conclusion LUS is a helpful adjunct for predicting surfactant need in preterm neonates. This study describes an approach to implement the LUS protocol and score for clinical decision-making in the clinical practice. Key Points LUS is a helpful adjunct for predicting surfactant need in preterm neonates. Machine setting variation and probe selection may affect LUS image and score. LUS score should be validated at the local unit before clinical implementation. [ABSTRACT FROM AUTHOR]

Background: Ultrasound can detect fluid in the alveolar and interstitial spaces of the lung using the presence of artifacts known as B-lines. The aim of this study was to determine whether a deep learning algorithm generated B-line severity score correlated with pulmonary congestion and disease severity based on clinical assessment (as identified by composite congestion score and Rothman index) and to evaluate changes in the score with treatment. Patients suspected of congestive heart failure underwent daily ultrasonography. Eight lung zones (right and left anterior/lateral and superior/inferior) were scanned using a tablet ultrasound system with a phased-array probe. Mixed effects modeling explored the association between average B-line score and the composite congestion score, and average B-line score and Rothman index, respectively. Covariates tested included patient and exam level data (sex, age, presence of selected comorbidities, baseline sodium and hemoglobin, creatinine, vital signs, oxygen delivery amount and delivery method, diuretic dose). Results: Analysis included 110 unique subjects (3379 clips). B-line severity score was significantly associated with the composite congestion score, with a coefficient of 0.7 (95% CI 0.1–1.2 p = 0.02), but was not significantly associated with the Rothman index. Conclusions: Use of this technology may allow clinicians with limited ultrasound experience to determine an objective measure of B-line burden. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings. Methods: We developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians' proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire. Results: Fifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p < 0.001), and in identifying normal versus abnormal views, improving from 54 to 74% accuracy (p < 0.001). Ten weeks after training, primary care physicians reported greater comfort using lung ultrasound, rising from 10 to 54% (p < 0.001), and improved grasp of its potential and limits, increasing from 27.5% to 84% (p < 0.001). Weekly usage increased from none to 50%, and the number of primary care physicians not using at all decreased from 72 to 26% (p < 0.001). Conclusions: A two-day focused in-person and remote self-learning lung-POCUS training significantly improved primary care physicians' lung ultrasound skills, comfort, and implementation. [ABSTRACT FROM AUTHOR]

The interpretation of lung ultrasound is the result of the analysis of artifacts rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker and as an aid in monitoring of patients. The main elements in lung ultrasound interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography [high resolution computed tomography (HRCT)] of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung ultrasound, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung ultrasound regarding sensitivity to change needs further investigation with multicenter prospective studies. [ABSTRACT FROM AUTHOR]

The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26–36) and a specificity of 82% (95% CI 78–86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27–37) and specificity of 81% (95% CI 77–85). CXR had a sensitivity of 66% (95% CI 61–72) and a specificity of 76% (95% CI 71–81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63–74) and a specificity of 68% (95% CI 62–72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR (p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard (p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators. [ABSTRACT FROM AUTHOR]

This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives. Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine? We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels. A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM%5f240216/INFO). Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Bronchopulmonary dysplasia (BPD) is a respiratory morbidity related to prematurity. Early prediction of BPD allows the selection of patients who would benefit from new therapies. Lung ultrasound (LUS) is a non-invasive diagnostic tool that has proven to be reliable for many neonatal diseases recently. The study aimed to detect the role of LUS in predicting BPD at days 7 and 14 of life in preterm babies. Methods: This was a prospective cohort study that included 95 preterm babies ≤ 34 weeks. Lung ultrasounds were performed on days 7 and 14 of life. Results: The mean gestational age of the studied neonates was 30.25 ± 2.21 weeks. The mean birth weight was 1347.66 ± 432.14 gm. Patients who developed BPD had statistically significantly higher LUS scores on both days 7 and 14 of life. At first examination, a LUS score > 8 showed a sensitivity of 83.33% and a specificity of 60.87%, whereas at follow-up, a LUS score > 8 showed a sensitivity of 76.39% and a specificity of 82.61%. The multivariate logistic regression analysis shows that the most important factors associated with BPD were gestational age ≤ 30 weeks, LUS score at first examination > 8, platelets ≤ 245 × 109/L, segment neutrophils ≤ 42%, and CRP > 5 mg/l. Conclusions: The LUS score predicts BPD at 7 and 14 days of life. LUS scores increased with increasing BPD severity. LUS score > 8 was an independent factor in the prediction of BPD. [ABSTRACT FROM AUTHOR]

Aims Lung ultrasound (LUS) is often used to assess congestion in heart failure (HF). In this study, we assessed the prognostic role of LUS in patients with HF at admission and hospital discharge, and in an outpatient setting, and explored whether clinical factors [age, sex, left ventricular ejection fraction (LVEF), and atrial fibrillation] impact the prognostic value of LUS findings. Further, we assessed the incremental prognostic value of LUS on top of the following two clinical risk scores: (i) the atrial fibrillation, haemoglobin, elderly, abnormal renal parameters, diabetes mellitus (AHEAD) and (ii) the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) clinical risk scores. Methods and results We pooled data on patients hospitalized for HF or followed up in outpatient clinics from international cohorts. We enrolled 1947 patients at admission (n = 578), discharge (n = 389), and in outpatient clinics (n = 980). The total LUS B-line count was calculated for the eight-zone scanning protocol. The primary outcome was a composite of rehospitalization for HF and all-cause death. Compared with those in the lower tertiles of B lines, patients in the highest tertiles were older, more likely to have signs of HF and had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels. A higher number of B lines was associated with increased risk of primary outcome at discharge [Tertile 3 vs. Tertile 1: adjusted hazard ratio (HR): 5.74 (3.26–10.12), P < 0.0001] and in outpatients [Tertile 3 vs. Tertile 1: adjusted HR: 2.66 (1.08–6.54), P = 0.033]. Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to the MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings. Conclusion A higher number of B lines in patients with HF was associated with an increased risk of morbidity and mortality, regardless of the clinical setting. [ABSTRACT FROM AUTHOR]

Background and Objectives: PoCUS ultrasound applications are widely used in everyday work, especially in the field of emergency medicine. The main goal of this research was to create a diagnostic and therapeutic protocol that will integrate ultrasound examination of the lungs, ultrasound measurements of the inferior vena cava (assessment of central venous pressure) and BREST scores (risk stratification for heart failure), with the aim of establishing a more effective differential diagnostic approach for dyspneic patients. Materials and Methods: A cross-sectional study was conducted in the emergency medicine department with the educational center of the community health center of Banja Luka. Eighty patients of both sexes were included and divided into experimental and control groups based on the presence or absence of dyspnea as a dominant subjective complaint. Based on the abovementioned variables, the LUSBI protocol (lung ultrasound/BREST score/inferior vena cava) was created, including profiles to determine the nature of the origin of complaints. The biochemical marker of heart failure NT pro-BNP served as a laboratory confirmation of the cardiac origin of the complaints. Results: The distribution of NT pro BNP values in the experimental group showed statistically significant differences between individual profiles of the LUSBI protocol (p < 0.001). Patients assigned to group B PLAPS 2 had significantly higher average values of NT pro-BNP (20159.00 ± 3114.02 pg/mL) compared to other LUSBI profiles. Patients from the experimental group who had a high risk of heart failure according to their BREST scores also had a significantly higher average maximum expiratory diameter compared to those without heart failure (p = 0.004). A statistically significant difference (p = 0.001) in LUSBI profiles was observed between the groups of patients divided according to CVP categories. Conclusion: The integration of the LUSBI protocol into the differential diagnosis of dyspnea has been shown to be very effective in confirming or excluding a cardiac cause of the disease in patients. [ABSTRACT FROM AUTHOR]

Abstract Background Although the incidence of postoperative atelectasis could be reduced using lung recruitment manoeuvres, it remains high. We hypothesised that intraoperative visual lung recruitment guided by trans-oesophageal lung ultrasound would be more effective than the conventional method for managing postoperative atelectasis. Methods In this randomised, controlled, prospective study, 84 patients undergoing thoracoscopic lobectomy were recruited from Affiliated Chengdu Fifth People’s Hospital (teaching hospital) in China. Patients were grouped into trans-oesophageal lung ultrasound-guided (Group G, n = 42) and control (Group C, n = 42) groups. Methods Lung recruitment was performed after anaesthesia induction, before chest closure and before the endotracheal tube extubation. In Group C, recruitment pressure was controlled at 30 cm H2O for 10 s (performed thrice); in Group G, the pressure was controlled at 30 cm H2O (performed thrice), and the tidal volume did not exceed 20 ml kg−1 until no atelectasis was detected by trans-oesophageal ultrasound. The primary outcome was lung ultrasound scores measured at the post anaesthesia care unit 30 min after extubation. The secondary outcomes included the oxygenation index (30 min after extubation) and the incidence of atelectasis (30 min after extubation and 3 days after surgery). Results The final analysis included 79 patients. The lung ultrasound score was significantly higher in the control group than in the ultrasound-guided group 30 min after extubation (Group C vs. Group G, 8.6 ± 2.6 vs. 6.5 ± 2.0, P

Abstract Background Extubation failure is a crucial issue for acute respiratory distress syndrome (ARDS). Ultrasound of the lung and diaphragm is individually valuable for predicting extubation outcomes. We aimed to determine whether combined lung and diaphragmatic ultrasound could improve the accuracy of predicting the extubation of ARDS patients. Methods This was a prospective cohort study of ARDS patients who were ready for extubation. The lung ultrasound score (LUS), diaphragmatic displacement (DD), diaphragm thickening fraction (DTF), and diaphragmatic-rapid shallow breathing index (D-RSBI) were measured at the end of the spontaneous breathing trial. The primary outcome was extubation success. Logistic regression was used to combine these indicators, and the predictive performance of the single and combined indicators was evaluated through receiver operating characteristic (ROC) curves, the Hosmer–Lemeshow Ĉ‐test, and the Brier score. Multivariate logistic regression was used to determine the association between combined ultrasound indicators and extubation success. Results This study enrolled 132 eligible patients from January 2019 to December 2022. A total of 71% (94/132) of patients were successfully extubated from mechanical ventilation. The combination of LUS and D-RSBI had the largest area under the ROC curves, the lowest Brier score, and the greatest calibration. After formula transformation, LUS + 2.43 × D-RSBI ≤ 14.273 was significantly associated with extubation success in ARDS patients. Conclusions In ARDS patients receiving mechanical ventilation, the combination of LUS and D-RSBI was more accurate than a single parameter alone in predicting extubation outcomes. This combined approach could help refine extubation protocols in critical care. Clinical trial registration This study is registered online with the Chinese Clinical Trial Registry (ChiCTR), http://www.chictr.org.cn , ChiCTR1800019340 (Registration time: 2018/11/06).

Abstract Background Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value. Methods Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm underwent validation and refinement with an additional 140 LUS images, leading to five iterative revisions and the generation of 1902 distinct LUS phenotypes. Subsequently, a validated machine learning algorithm was applied to these phenotypes. To assess the algorithm’s effectiveness, experts manually verified 30% of the phenotypes, confirming its efficacy. Using K-means cluster analysis and expert image selection from the 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities. Results A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II (APACHE II)score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses. Conclusions Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.

Abstract Background PEEP optimization in acute respiratory distress syndrome (ARDS) is a controversial issue. Lung ultrasound (LUS) is a potential useful tool in PEEP optimization. Aim This study was intended to investigate the usefulness of LUS as a tool for PEEP optimization in ARDS patients. Methods Prospective randomized controlled trial conducted on ARDS patients that included 60 patients randomized in a 1:1 ratio to either PEEP/FiO2 table (group I) or lung ultrasound (group II). Results The baseline findings showed more severe ARDS in group I patients with significantly lower P/F ratio (P = 0.008) and static compliance (P = 0.02). The use of LUS for PEEP optimization did not result in better improvement in P/F ratio (P = 0.4), PaCO2 (P = 0.2), or static compliance (P = 0.8). The use of LUS was associated with a favorable effect on hemodynamics with significantly less decrease in CO (P

Abstract Introduction Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS). Methods This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis. Results Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p

Abstract Background Ultrasound can detect fluid in the alveolar and interstitial spaces of the lung using the presence of artifacts known as B-lines. The aim of this study was to determine whether a deep learning algorithm generated B-line severity score correlated with pulmonary congestion and disease severity based on clinical assessment (as identified by composite congestion score and Rothman index) and to evaluate changes in the score with treatment. Patients suspected of congestive heart failure underwent daily ultrasonography. Eight lung zones (right and left anterior/lateral and superior/inferior) were scanned using a tablet ultrasound system with a phased-array probe. Mixed effects modeling explored the association between average B-line score and the composite congestion score, and average B-line score and Rothman index, respectively. Covariates tested included patient and exam level data (sex, age, presence of selected comorbidities, baseline sodium and hemoglobin, creatinine, vital signs, oxygen delivery amount and delivery method, diuretic dose). Results Analysis included 110 unique subjects (3379 clips). B-line severity score was significantly associated with the composite congestion score, with a coefficient of 0.7 (95% CI 0.1–1.2 p = 0.02), but was not significantly associated with the Rothman index. Conclusions Use of this technology may allow clinicians with limited ultrasound experience to determine an objective measure of B-line burden.

Abstract Systemic autoimmune rheumatic diseases (SARDs) related pulmonary disease is highly prevalent, with variable clinical presentation and behavior, and thus is associated with poor outcomes and negatively impacts quality of life. Chest high resolution computed tomography (HRCT) is still considered a fundamental imaging tool in the screening, diagnosis, and follow-up of pulmonary disease in patients with SARDs. However, radiation exposure, economic burden, as well as lack of point-of-care CT equipment limits its application in some clinical situation. Ultrasound has found a place in numerous aspects of the rheumatic diseases, including the vasculature, skin, muscle, joints, kidneys and in screening for malignancies. Likewise it has found increasing use in the lungs. In the past two decades, lung ultrasound has started to be used for pulmonary parenchymal diseases such as pneumonia, pulmonary edema, lung fibrosis, pneumothorax, and pleural lesions, although the lung parenchymal was once considered off-limits to ultrasound. Lung ultrasound B-lines and irregularities of the pleural line are now regarded two important sonographic artefacts related to diffuse parenchymal lung disease and they could reflect the lesion extent and severity. However, its role in the management of SARDs related pulmonary involvement has not been fully investigated. This review article will focus on the potential applications of lung ultrasound in different pulmonary scenarios related with SARDs, such as interstitial lung disease, diffuse alveolar hemorrhage, diaphragmatic involvement, and pulmonary infection, in order to explore its value in clinical daily practice.

Abstract Background Point-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings. Methods We developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians’ proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire. Results Fifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p

Purpose: To determine whether pre- and postoperative follow-up based on lung ultrasound is associated with the respiratory and clinical evolution of patients undergoing cardiac surgery in the neonatal period. Methods: Prospective observational unicentric study from December 2020 to October 2023 in a neonatal intensive care unit, a referral center for congenital heart diseases (CHD). Neonates with CHD exposed to heart surgery or percutaneous catheterization in their first 28 days of life were included. LU follow-up was performed before surgery (LUSpre) and on days 1 (LUS_1), 3 (LUS_3), and 7 (LUS_7) afterwards by mean of a dedicated score (LUS) ranging from 0 to 3 points in 8 areas (total score 0–24). Results: Fifty-five neonates were included. Median gestational age was 39.1 weeks (37.8–40.1), birth weight 3088 g (IQR 2910–3400). Forty-nine received surgery and 6 only percutaneous catheterization. Median LUSpre score was associated with total respiratory support in the first 30 postoperative days (p = 0.034). Median postoperative LUS was significantly higher than LUSpre in the surgery cohort at all time points (p < 0.05). LUS_1 was associated with respiratory and several clinical outcomes: for each point increase in the ultrasound score, the days on invasive mechanical ventilation, the need for any respiratory support within the first 30 postoperative days, and the length of NICU stay increased significantly (p < 0.05). The presence of consolidations in any area in the postoperative lung ultrasounds was associated with worse respiratory outcomes: higher invasive mechanical ventilation duration (6.84 days), longer total respiratory support (6.07 days), and NICU admission (21.61 days). The presence of consolidations in LUS_7 was significantly associated with the occurrence of ipsilateral diaphragmatic paralysis (odds ratio of 10.25 (95% CI 2.05–51.26, p = 0.006). Conclusion: Performance of lung ultrasound follow-up in CHD in the NICU is feasible and predictive of the respiratory evolution of the patient. LUS_1 presented the highest predictive values. The presence of consolidations is associated with a worse respiratory evolution and if they persist for a week after the procedure, it may raise suspicion of ipsilateral diaphragmatic paralysis. What is known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in premature infants. What is new: • Follow-up based on lung ultrasound in congenital heart diseases postoperative period is associated with respiratory evolution and length of admission. [ABSTRACT FROM AUTHOR]

Abstract Background The development of heart failure is a turning point in the natural course of aortic stenosis (AS). Pulmonary oedema and elevated left ventricular pressure (LVP) are cardinal features of heart failure. Evaluating pulmonary oedema by lung ultrasound involves taking the upper hand with a bedside noninvasive tool that may reflect LVP. Aim We sought to assess the correlation between sonographic pulmonary congestion, invasive LV pre-A pressure, and echocardiographic LV end-diastolic pressure (LVEDP) in symptomatic AS patients receiving transcatheter aortic valve replacement. Methods Forty-eight consecutive patients with severe AS and planned transcatheter aortic valve implantation (TAVI) were enrolled. LVEDP was estimated to be normal or elevated using the ASE/EACVI algorithm and transmitral Doppler indices, the E/A ratio, the E/e′, and the left atrial volume index. Invasive LV pre-A pressure was used as a reference, with > 12 mm Hg defined as elevated. Results Forty-eight patients (25 women (52%), mean age 75 years, standard deviation (SD) ± 7.7 years) were enrolled in the study. We detected severe B-lines (≥ 30) in 13 (27%) patients and moderate B-lines (15–30) in 33 (68.6%) patients. The number of B-lines increased significantly with the severity of New York Heart Association (NYHA) functional classes (Fig. 1). The B-line count was 14 ± 13 in NYHA class I patients, 20 ± 20 in class II patients, and 44 ± 35 in class III patients (p 12, with a mean pressure of 26 mmHg, a minimum of 13 mmHg, and a maximum of 45 mmHg, with an SD of 7.85. Conclusion Assessing lung ultrasonic B-lines is a straightforward and practical approach to identifying pulmonary oedema in AS patients. The number of B-lines correlated with the E/E’ ratio and the functional status of patients but did not correlate with invasive LVEDP or LVEF. All patients had elevated LVEDP that correlated with E/E’.

Abstract Objective To develop and evaluate the predictive value of a simplified lung ultrasound (LUS) method for forecasting respiratory support in term infants. Methods This observational, prospective, diagnostic accuracy study was conducted in a tertiary academic hospital between June and December 2023. A total of 361 neonates underwent LUS examination within 1 h of birth. The proportion of each LUS sign was utilized to predict their respiratory outcomes and compared with the LUS score model. After identifying the best predictive LUS sign, simplified models were created based on different scan regions. The optimal simplified model was selected by comparing its accuracy with both the full model and the LUS score model. Results After three days of follow-up, 91 infants required respiratory support, while 270 remained healthy. The proportion of confluent B-lines demonstrated high predictive accuracy for respiratory support, with an area under the curve (AUC) of 89.1% (95% confidence interval [CI]: 84.5-93.7%). The optimal simplified model involved scanning the R/L 1–4 region, yielding an AUC of 87.5% (95% CI: 82.6-92.3%). Both the full model and the optimal simplified model exhibited higher predictive accuracy compared to the LUS score model. The optimal cut-off value for the simplified model was determined to be 15.9%, with a sensitivity of 76.9% and specificity of 91.9%. Conclusions The proportion of confluent B-lines in LUS can effectively predict the need for respiratory support in term infants shortly after birth and offers greater reliability than the LUS score model.

Abstract Background Respiratory functions may be impaired in cesarean section (C/S) delivery performed under spinal anesthesia (SA) and oxygen supplementation may be required. Therefore, we conducted a randomized controlled study aimed to evaluate the effects of different oxygen administrations in pregnant women on the lungs during C/S under SA using ultrasound and oxygen reserve index (ORI). Methods We conducted a randomized, controlled, single-center study from May 1, 2021, to March 31, 2022. A total of 90 patients scheduled for C/S under SA were randomly divided into 3 groups. Following the SA, patients in group 0 were treated with room air, in Group 3 were administered 3 L/min O₂ with a nasal cannula (NC), in Group 6 were administered 6 L/min O₂ with a simple face mask. In addition to routine monitoring, ORI values were measured. Lung aeration was evaluated through the modified lung ultrasound score (LUS) before the procedure (T0), at minute 0 (T1), 20 (T2), and hour 6 (T3) after the procedure, and ∆LUS values were recorded. Results After SA, the ORI values of Group 3 were higher than Group 0 at all times (p

Objective To evaluate the clinical application value of positional management guided by 12-zone lung ultrasound（LUS） in the treatment of neonatal infectious pneumonia. Methods A total of 76 neonates with a gestational age of >36 weeks and corrected gestational age of P < 0.05）. On 7th day after the intervention， the LUS scores of dorsal in the treatment group were significantly lower than those in the control group （P < 0.05）， and in both groups， the LUS scores of dorsal remained significantly higher than those of the anterior and lateral chest （all P < 0.001）. Additionally， the LUS scores of chest were significantly higher than those of the anterior chest （P < 0.001）. The total LUS score on 7th day after the intervention in the treatment group were significantly lower than that in the control group（P < 0.05）， and compared to pre-intervention and the 3rd day after the intervention， the total LUS score in the treatment group showed a significant decrease （both P < 0.001）. The length of hospital stay in the treatment group was significantly shorter than that in the control group （P < 0.05）. Conclusion Positional management guided by 12-zone LUS is beneficial in promoting the recovery from neonatal infectious pneumonia and shortening the length of hospital stay.

Introduction: Cardiothoracic surgery is a complex and highly specialized medical field requiring precise surgical techniques and meticulous patient management. One critical aspect of this type of surgery is the accurate placement of the endobronchial double-lumen tube (DLT), which facilitates lung isolation and one-lung ventilation (OLV) during the procedure. Proper positioning of the DLT is essential to ensure adequate oxygenation, prevent complications, and optimize surgical access. Objective: This study aimed to compare the accuracy of positioning of the left DLT by the auscultation method versus the lung ultrasound technique in patients undergoing cardiothoracic surgery in both supine and lateral positions. Material and methods: A prospective, observational, and cross-sectional study was conducted in a single group of 62 patients based on the eligibility criteria. After general anesthesia, a DLT was inserted and rotated until resistance. Placement was confirmed by auscultation, ultrasound, and fibreoptic bronchoscopy. The evaluation process was done initially in a supine position, followed by a lateral position. Results: After insertion of the left DLT, initially evaluated in the supine position, sensitivity and specificity for auscultation were found to be 65.2% and 37.5%, respectively, sensitivity and specificity for ultrasonography were 82.6% and 75%, respectively. The accuracy of lung ultrasound at 80.7% (69.2%-88.6%) was higher than the accuracy of auscultation at 58.1% (45.7%-69.5%). This was followed by evaluation in lateral position, where sensitivity and specificity for auscultation were found to be 76.1% and 25% respectively, sensitivity and specificity for ultrasonography were 95.7% and 62.5%, respectively. The accuracy of lung ultrasound at 87.1% (76.6%-93.3%) was higher than the accuracy of auscultation at 62.9% (50.5%- 73.8%). Conclusion: Lung ultrasound is a superior method for assessing lung isolation and determining Double Lumen Tube position as compared to auscultation.

Abstract Background Pulmonary embolism (PE) is a common and usually fatal condition that is commonly misdiagnosed and consequently ignored. Lung ultrasonography is quickly becoming a valuable tool in the ER and ICU for assisting in emergency decisions. Methods One hundred fourteen patients with moderate/high probability of PE in the Critical Care Department meeting the inclusion/exclusion criteria were enrolled in the study. A detailed medical history and a full physical examination involving vital signs, transthoracic ultrasound, CT pulmonary angiography (CTPA), and echocardiography were done for the eligible participants. The goal of this study was to evaluate the diagnostic role of transthoracic ultrasound (TUS) in PE and to compare its specificity and sensitivity with CT pulmonary angiography. Multivariate logistic regression analysis was performed. Results Within the 75 patients with confirmed PE based on CTPA, 30 had LUS findings of confirmed PE (40%), and 45 had LUS findings not consistent with confirmed PE (60%). Within the 39 patients with no PE based on CTPA, all patients had LUS findings of non-confirmed PE (100%), and no patients had LUS findings of confirmed PE (0%). The diagnosis of pulmonary embolism based on confirmed LUS signs had sensitivity and specificity of 40% and 100% respectively with 100% positive predictive value and 46.4% negative predictive value. Conclusion Positive TUS findings with moderate/high suspicion for PE may prove a valuable tool in the diagnosis of PE at the bedside, especially in the emergency setting, but a negative TUS study cannot rule out PE with certainty.

Abstract Background In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation. Methods This multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization. Discussion We aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients. Trial registration The Research Ethics Committee (CEIm) of the Fundació Unió Catalana d’Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials.gov in August 2023. Identifier: NCT05526053.

Abstract Background Lung ultrasound (LUS) in an emerging technique used in the intensive care unit (ICU). The derivative LUS aeration score has been shown to have associations with mortality in invasively ventilated patients. This study assessed the predictive value of baseline and early changes in LUS aeration scores in critically ill invasively ventilated patients with and without ARDS (Acute Respiratory Distress Syndrome) on 30- and 90-day mortality. Methods This is a post hoc analysis of a multicenter prospective observational cohort study, which included patients admitted to the ICU with an expected duration of ventilation for at least 24 h. We restricted participation to patients who underwent a 12-region LUS exam at baseline and had the primary endpoint (30-day mortality) available. Logistic regression was used to analyze the primary and secondary endpoints. The analysis was performed for the complete patient cohort and for predefined subgroups (ARDS and no ARDS). Results A total of 442 patients were included, of whom 245 had a second LUS exam. The baseline LUS aeration score was not associated with mortality (1.02 (95% CI: 0.99 – 1.06), p = 0.143). This finding was not different in patients with and in patients without ARDS. Early deterioration of the LUS score was associated with mortality (2.09 (95% CI: 1.01 – 4.3), p = 0.046) in patients without ARDS, but not in patients with ARDS or in the complete patient cohort. Conclusion In this cohort of critically ill invasively ventilated patients, the baseline LUS aeration score was not associated with 30- and 90-day mortality. An early change in the LUS aeration score was associated with mortality, but only in patients without ARDS. Trial registration ClinicalTrials.gov, ID NCT04482621.

Abstract Background Point-of-Care Ultrasound (POCUS) consists of a range of increasingly important imaging modalities across a variety of specialties. Despite a variety of accreditation pathways available in the UK, lung POCUS training remains difficult to deliver and accreditation rates remain suboptimal. We describe a multidisciplinary, multi-centre, and multi-pronged approach to lung POCUS education within a region. Methods A survey was conducted in a region. From these results, bottlenecks were identified for improvement. We utilised key stages in an established accreditation pathway, and the Action Learning process. Analysing participant feedback, consensus amongst the team, regional educational needs, and leveraging the expertise within the faculty, we implemented several solutions which were multidisciplinary, multi-centre, and multi-pronged. We also set up a database across several accreditation pathways to facilitate supervision and assessment of rotational trainees. Results Utilising the Action Learning process, we implemented several improvements at elements of the lung ultrasound accreditation pathways. An initial regional survey identified key barriers to accreditation: lack of courses (52%), lack of mentors (93%), and difficulty arranging directly supervised scans (73%). A multidisciplinary team of trainers was assembled. Regular courses were organised and altered based on feedback and anecdotal educational needs within the region. Courses were set up to also facilitate continuing professional development and exchange of knowledge and ideas amongst trainers. The barrier of supervision was removed through the organisation of regular supervision sessions, facilitating up to fifty scans per half day per trainer. We collected feedback from courses and optimised them. Remote mentoring platforms were utilised to encourage asynchronous supervision. A database of trainers was collated to facilitate triggered assessments. These approaches promoted a conducive environment and a commitment to learning. Repeat survey results support this. Conclusion Lung ultrasound accreditation remains a complex educational training pathway. Utilising an education framework, recruiting a multidisciplinary team, ensuring a multi-pronged approach, and fostering a commitment to learning can improve accreditation success.

Background: Pneumonia is a ubiquitous health condition with severe outcomes. The advancement of ultrasonography techniques allows its application in evaluating pulmonary diseases, providing safer and accessible bedside therapeutic decisions compared to chest X-ray and chest computed tomography (CT) scan. Because of its aforementioned benefits, we aimed to confirm the diagnostic accuracy of lung ultrasound (LUS) for pneumonia in adults. Methods: A systematic literature search was performed of Medline, Cochrane and Crossref, independently by two authors. The selection of studies proceeded based on specific inclusion and exclusion criteria without restrictions to particular study designs, language or publication dates and was followed by data extraction. The gold standard reference in the included studies was chest X-ray/CT scan or both. Results: Twenty-nine (29) studies containing 6702 participants were included in our meta-analysis. Pooled sensitivity, specificity and PPV were 92% (95% CI: 91–93%), 94% (95% CI: 94 to 95%) and 93% (95% CI: 89 to 96%), respectively. Pooled positive and negative likelihood ratios were 16 (95% CI: 14 to 19) and 0.08 (95% CI: 0.07 to 0.09). The area under the ROC curve of LUS was 0. 9712. Conclusions: LUS has high diagnostic accuracy in adult pneumonia. Its contribution could form an optimistic clue in future updates considering this condition.