SonoKids PULM

Pneumothorax is a frequent critical situation in the neonatal intensive care unit. Diagnosis relies on clinical judgement, transillumination and chest radiogram. We report the case of a very preterm infant suddenly developing significant and persistent desaturation and bradycardia. Re-intubation and cardiopulmonary resuscitation were performed. Clinical and cold light examination were not suggestive of pneumothorax according to two experienced neonatologists. A lung ultrasound scan showed evidence of right pneumothorax that was promptly aspirated...

Transient tachypnea of the newborn (TTN) is one of the most common causes of perinatal dyspnea and is traditionally diagnosed by chest x-ray. This study aimed to explore the diagnostic value of lung ultrasonography (LUS) for TTN as well as differentiate it from respiratory distress syndrome (RDS) by using LUS. From January 2013 to February 2014, 60 infants who were diagnosed with TTN based on medical history, clinical manifestations, arterial blood gas analysis, and chest radiography were recruited to the study group...

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 21st 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...

BACKGROUND: The senile lung undergoes physiologic changes that are well known but have not been investigated with ultrasound (US). Thus, the aim of our study was to compare the US appearances of the lungs in a group of healthy, nonsmoker elderly subjects with those in a group of young subjects. METHODS: One hundred elderly subjects older than 65 years of age (mean age ± SD, 79 ± 7 years) and 50 younger subjects less than 56 years of age (mean age ± SD, 33 ± 12) underwent US examination of the lungs...

The reversal of lung collapse is one of the challenges of lung injury prevention in pediatric acute respiratory distress syndrome. In this case, lung recruitment maneuver (RM) with positive end-expiratory pressure under computed tomography guidance is the procedure of choice, but cumulative ionizing radiation exposure is a major radiologic concern, especially in infants. Real-time guidance of lung recruitment under bedside lung ultrasound (US) assessment in adults has shown to be an effective procedure for performing RM that avoids ionizing radiation overexposure...

An increasingly amount of evidence suggests that lung ultrasonography constitutes a relevant complementary diagnostic tool for adults patient in acute respiratory failure. A comprehensive and standardized ultrasonographic semiology has been described, relying on accurate and reproducible data directly obtained at patient's bedside. Therefore, pleural effusion, pneumothorax, pulmonary consolidation and interstitial lung disease can be diagnosed in a critical care environment with a similar level of performance than when reference diagnosis methods such as thoracic CT-scan are employed...

Lung hemorrhage (LH) remains the only bioeffect of non-contrast, diagnostic ultrasound (DUS) proven to occur in mammals. While DUS for lung imaging is routine in critical care situations, a fundamental understanding of DUS-induced LH remains lacking. The objective of this study is to numerically simulate DUS-lung interaction to identify potential damage mechanisms, with an emphasis on shear. Experimentally relevant ultrasound waveforms of different frequencies and amplitudes propagate in tissue (modeled as water) and interact with the lung (modeled as air)...

Meconium aspiration syndrome (MAS) is a rare and life-threatening neonatal lung injury induced by meconium in the lung and airways. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly being used in critical care settings, also for newborns. In this paper we describe ultrasound findings in MAS. Six patients with MAS of variable severity were examined by LUS during the first hours of life. Chest X-rays were used as reference. The following dynamic LUS signs were seen in all patients: (1) B-pattern (interstitial) coalescent or sparse; (2) consolidations; (3) atelectasis; (4) bronchograms...

AIM: The purpose of this study was to compare lung ultrasound findings in both the supine and upright positions in heart failure patients presenting with dyspnea or chest pain. METHODS AND RESULTS: We performed lung ultrasonography on 50 heart failure patients in the emergency department. Each subject underwent eight-zone lung sonography in the seated upright position, followed by a repeat ultrasound in the supine position. Each ultrasound video clip was later assigned a score (0-2 B-lines=0 points, 3-7 B-lines=1 point, >7 B-lines=2 points) by a physician who was blinded to patient position, chest zone, and clinical information...

BACKGROUND: Noninvasive ventilation is the treatment of choice for neonatal moderate respiratory distress (RD). Predictors of nasal ventilation failure are helpful in preventing clinical deterioration. Work on neonatal lung ultrasound has shown that the persistence of a hyperechogenic, "white lung" image correlates with severe distress in the preterm infant. We investigate the persistent white lung ultrasound image as a marker of noninvasive ventilation failure. METHODS: Newborns admitted to the NICU with moderate RD and stabilized on nasal continuous positive airway pressure for 120 minutes were enrolled...

PURPOSE: Chest ultrasonography is currently a required element to achieve competence in general critical care ultrasound (GCCUS) which should be part of the training of every intensivist. We sought to assess the ability of resident novices in ultrasonography to identify and quantify unloculated pleural effusions in ICU patients after a limited training program. METHODS: A total of 147 patients (mean age, 62 ± 17 years; simplified acute physiology score II, 35 ± 15; 78 % ventilated) with a suspected pleural effusion underwent a thoracic ultrasonography performed successively by a recently trained resident novice in ultrasound and by an experienced intensivist with expertise in GCCUS, considered as reference...

Lung ultrasonography is a diagnostic tool increasingly used in critical care. Few data are available for the pediatric population. We describe our experience with lung ultrasonography for 5 pediatric patients with common post-cardiac surgery lung complications (pleural effusion, pneumothorax, atelectasis, pneumonia). Ultrasonography was useful also for lung recruitment. Such data were confirmed by chest radiographs or by computed tomography, or both. Lung ultrasonography can be considered as a useful, real-time, bedside tool to detect specific lung diseases, reliably implementing radiographic images and potentially decreasing the total number of radiographs in critically ill children with congenital heart diseases...

Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall...

No abstract text is available yet for this article.

Diagnosis of pulmonary tuberculosis (TB) remains a challenge in the pediatric population because of the lack of sputum production for laboratory analysis. Chest radiography is used in the diagnosis of pulmonary TB and the hallmark of diagnosis is the demonstration of hilar or mediastinal lymphadenopathy. Point-of-care sonography of the mediastinum is an alternative to chest radiography in detection of tuberculous lymph nodes. In the rural district health care setting US is often the most commonly available imaging modality and its mobility makes it possible to examine patients at the point of care, reducing the need for patients to travel to a regional hospital to acquire a chest radiograph...

INTRODUCTION: Performed for many years in clinical settings, pleural and lung ultrasound (PLUS) has emerged to be an invaluable tool to diagnose underlying conditions of respiratory failure, to monitor disease progression and to ensure appropriate therapeutic intervention. PLUS basically relies on the analysis of two prevalent ultrasound artefacts: A-lines and B-lines. A-lines are hyperechoic reverberation artefacts of the pleural line. A-lines combined with lung sliding show that lungs are well aerated...

There is controversy regarding needle aspiration for primary spontaneous pneumothorax (PSP), with contradictory recommendations between the American College of Chest Physicians consensus statement (2001), which suggests that needle aspiration has little place in the management of PSP, and the British Thoracic Society guidelines (2010), which recommend that needle aspiration be attempted first for all cases of PSP where drainage is deemed necessary. Studies have shown that there is no significant difference between needle aspiration and tube thoracostomy with regard to safety, rates of immediate success, and early failure and has the advantages of decreasing pain and reducing rates of hospital admission and duration of hospital stay compared with tube thoracostomy...

BACKGROUND: Lung ultrasound (LUS) has become more and more popular in the first decade of the 21(st) century, both in neonatal and in pediatric age groups. Several papers addressed the usefulness of this procedure mainly because of its possibility to be utilised at the bedside, without risk of irradiation along with simple and immediate interpretations of the images. AIMS: The purpose of this paper is to update the knowledge on LUS related to the most common neonatal respiratory diseases and some pediatric acute lung diseases...