Ultrasound versus Computed Tomography Assessment of Focal Lung Aeration in Invasively Ventilated ICU Patients

It is unknown whether and to what extent the penetration depth of lung ultrasound (LUS) influences the accuracy of LUS findings. The current study evaluated and compared the LUS aeration score and two frequently used B-line scores with focal lung aeration assessed by chest computed tomography (CT) at different levels of depth in invasively ventilated intensive care unit (ICU) patients. In this prospective observational study, patients with a clinical indication for chest CT underwent a 12-region LUS examination shortly before CT scanning. LUS images were compared with corresponding regions on the chest CT scan at different subpleural depths. For each LUS image, the LUS aeration score was calculated. LUS images with B-lines were scored as the number of separately spaced B-lines (B-line count score) and the percentage of the screen covered by B-lines divided by 10 (B-line percentage score). The fixed-effect correlation coefficient (β) was presented per 100 Hounsfield units. A total of 40 patients were included, and 372 regions were analyzed. The best association between the LUS aeration score and CT was found at a subpleural depth of 5 cm for all LUS patterns (β = 0.30, p < 0.001), 1 cm for A- and B1-patterns (β = 0.10, p < 0.001), 6 cm for B1- and B2-patterns (β = 0.11, p < 0.001) and 4 cm for B2- and C-patterns (β = 0.07, p = 0.001). The B-line percentage score was associated with CT (β = 0.46, p = 0.001), while the B-line count score was not (β = 0.07, p = 0.305). In conclusion, the subpleural penetration depth of ultrasound increased with decreased aeration reflected by the LUS pattern. The LUS aeration score and the B-line percentage score accurately reflect lung aeration in ICU patients, but should be interpreted while accounting for the subpleural penetration depth of ultrasound.     

Diagnostic Value of Ultrasound in Children with Discoid Lateral Meniscus Using Either an Intracavitary Convex Array Probe or a Linear Array Probe

This prospective study aimed to assess the usefulness of an intracavitary convex array probe (ICAP) in visualizing the lateral meniscus (LM) and improving the diagnostic utility of ultrasound (US) when diagnosing or screening for discoid lateral meniscus (DLM) in children. We included 105 knees (66 patients) that had symptomatic or asymptomatic DLM. We extracted and retrospectively reviewed data regarding patient demographics, medical records, magnetic resonance imaging (MRI), ultrasonographic features and arthroscopic findings. The inner edge of the LM visualized using an ICAP was significantly clearer than that visualized using a linear array probe, and the difference was significant (p < 0.01). The edges were better visualized in patients aged <8 y than in those aged >8 y, and the difference was significant (p < 0.001). The average widths of the LM body using an ICAP and MRI were 19.85 ± 3.63 and 24.46 ± 4.94 mm, respectively, and the wider the meniscal width, the greater was the deviation between the US and MRI measurements, which were positively correlated (r = 0.612, p < 0.001). With the use of MRI measurements and an ICAP, meniscal widths in poorly visualized LMs were greater than those in clearly visualized LMs, but this difference was not significant (p = 0.161). US scans using an ICAP and MRI were highly consistent in assessing the shape of the menisci (κ = 0.849, p < 0.001). US scan using an ICAP is a non-invasive, convenient and low-cost modality for diagnosing or screening for DLM in the pediatric population, especially in children aged <8 y.     

脑电双频指数在ICU机械通气患者临床应用的研究

目的：探讨ICU机械通气患者使用脑电双频指数（BIS）指导镇静的临床作用。方法：采用前瞻性完全随机对照研究。将53例患者分为2组,分别用BIS和主观评分进行镇静监测48h,设定SAS评分3～4分为镇静目标,评估临床指标如机械通气时间、ICU住院日、给药率和肢体制动率的组间差异,评价BIS监测在机械通气患者的临床应用价值。结果：两组患者均达镇静目标,BIS监测较常规镇静监测组机械通气时间（17.33±15.77dvs.39.83±56.33d）和ICU住院日（21.60±20.45dvs.41.67±55.81d）缩短,肢体制动率下降（40.70%vs.76.90%）（P〈0.05）,但给药率无统计学意义（P〉0.05）。结论：BIS监测可以缩短ICU患者的机械通气时间和GICU住院日,减少肢体制动率。     

Coronavirus Disease 2019 Phenotypes,Lung Ultrasound,Chest Computed Tomography and Clinical Features in Critically Ill Mechanically Ventilated Patients

Chest computed tomography (CT) may provide insights into the pathophysiology of coronavirus disease 2019 (COVID-19), although it is not suitable for a timely bedside dynamic assessment of patients admitted to intensive care unit (ICU); therefore, lung ultrasound (LUS) has been proposed as a complementary diagnostic tool. The aims of this study were to investigate different lungs phenotypes in patients with COVID-19 and to assess the differences in CT and LUS scores between ICU survivors and non-survivors. We also explored the association between CT and LUS, and oxygenation (arterial partial pressure of oxygen [PaO₂]/fraction of inspired oxygen [FiO_2]) and clinical parameters. The study included 39 patients with COVID-19. CT scans revealed types 1, 2 and 3 phenotypes in 62%, 28% and 10% of patients, respectively. Among survivors, pattern 1 was prevalent (p < 0.005). Chest CT and LUS scores differed between survivors and non-survivors both at ICU admission and 10 days after and were associated with ICU mortality. Chest CT score was positively correlated with LUS findings at ICU admission (r = 0.953, p < 0.0001) and was inversely correlated with PaO₂/FiO₂ (r = –0.375, p = 0.019) and C-reactive protein (r = 0.329, p = 0.041). LUS score was inversely correlated with PaO₂/FiO₂ (r = –0.345, p = 0.031). COVID-19 presents distinct phenotypes with differences between survivors and non-survivors. LUS is a valuable monitoring tool in an ICU setting because it may correlate with CT findings and mortality, although it cannot predict oxygenation changes.     

影响综合医院护士照护机械通气患者行为意向的因素分析

目的 探讨影响成都地区综合医院ICU与非ICU护士,对机械通气患者照护行为意向的因素,为相关的护士培训提供依据.方法 应用《护士对照护机械通气患者的行为态度、主观行为规范和行为意向》量表的中文修订版,对近3个月内照护过机械通气患者的ICU与非ICU护士进行测评,调查影响其行为意向的因素.结果 理性行为理论多个变量间呈正相关,行为态度和主观行为规范均对行为意向有显著预测作用,主观行为规范的预测作用更强.结论 学历、行为态度、主观行为规范、机械通气培训、工作年限和是否为ICU护士是影响综合医院护士照护机械通气患者行为意向的主要因素.     

自动乳腺全容积扫查与手持超声诊断乳腺病灶价值的对比研究

目的 探讨自动乳腺全容积扫查系统（automated breast volume scanner,ABVS）与手持超声（handheld ultrasound,HHUS）诊断乳腺病灶的价值.方法 回顾性分析191例接受ABVS及HHUS 2种检查方法患者的临床资料,比较2种方法的病灶检出率.然后筛选出2种检查方法对患者病灶数检查结果一致的83例患者（104个病灶）,以病理诊断为标准,对2种方法检查乳腺病灶的结果进行比较.结果 191例患者中ABVS的乳腺病灶阳性检出率为70.2％（134/191）,HHUS的乳腺病灶阳性检出率为59.2％（113/191）,ABVS的阳性检出率明显高于HHUS的阳性检出率（P＜0.05）.ABVS诊断乳腺恶性病灶的敏感度为82.1％,特异度为80.0％,准确性为80.8％;HHUS诊断乳腺恶性病灶的敏感度为74.4％,特异度为72.3％,准确性为73.1％,ABVS的敏感度、特异度及准确度均高于HHUS（均P＜0.05）.结论 ABVS在乳腺病灶阳性检出率方面及对乳腺恶性病灶诊断的敏感性、特异性以及准确性方面均要高于HHUS,适合在临床上广泛应用.     

ICU护士人工气道内吸痰护理相关知识与态度调查分析

目的:了解ICU护理人员对人工气道内吸痰护理知识、态度的情况,分析护理人员知识得分和态度得分之间的相关性。方法:以方便取样的方法选取北京市8所"三甲"医院ICU中为机械通气患者实施人工气道内吸痰护理的148名护理人员,对其进行问卷调查。结果:①调查对象的人工气道内吸痰护理知识平均得分为(51.55±18.21)分,73.7%的护理人员得分低于60分;方差分析结果显示,在ICU工作时间>5年的护士其知识水平高于在ICU工作时间<1年的护士(P<0.05)。②调查对象对人工气道内吸痰护理的态度整体较好,年龄>30岁、工作时间>10年的护理人员态度更好些(P<0.05)。③调查对象人工气道内吸痰护理的知识得分与态度得分无相关性(r=0.077,P=0.351)。结论:应注意引导护士积极的工作态度,为护士提供分层次、多样化的继续教育途径,丰富护士的人工气道内吸痰护理知识,提高临床护理质量。     

Multi-Focus Beamforming for Thermal Strain Imaging Using a Single Ultrasound Linear Array Transducer

Ultrasound-induced thermal strain imaging (TSI) has been used successfully to identify lipid- and water-based tissues in atherosclerotic plaques in some research settings. However, TSI faces several challenges to be realized in clinics. These challenges include motion artifacts and displacement tracking accuracy, as well as limited heating capability, which contributes to low thermal strain signal-to-noise ratio, and a limited field of view. Our goal was to address the challenge in heating tissue in TSI. Current TSI systems use separate heating and imaging transducers, which require physical alignment of the heating and imaging beams and result in a bulky setup that limits in vivo operation. We evaluated a new design for heating beams that can be implemented on a linear array imaging transducer and can provide improved heating area and efficiency as compared with previous implementations. The heating beams designed were implemented with a clinical linear array imaging transducer connected to a research ultrasound platform. In vitro experiments using tissue-mimicking phantoms with no blood flow revealed that the new design resulted in an effective heating area of approximately 0.85 cm² and a 0.3°C temperature rise in 2 s of heating, which compared well with in silico finite-element simulations. With the new heating beams, TSI was found to be able to detect a lipid-mimicking rubber inclusion with a diameter of 1 cm from the water-based gelatin background, with a strain contrast of 2.3 (+0.14% strain in the rubber inclusion and ?0.06% strain in the gelatin background). Lastly, lipid-based tissue in a 1-cm-diameter human carotid endarterectomy (CEA) sample was identified in good agreement with histology.     

Ultrasound Image Quality Comparison between an Inexpensive Handheld Emergency Department (ED) Ultrasound Machine and a Large Mobile ED Ultrasound System

Questions have been raised regarding image quality (IQ) provided by portable ultrasound (US) machines. OBJECTIVES: To determine if a difference exists between images obtained with a common portable US machine and those obtained with a more expensive, larger US machine when comparing typical views used by emergency physicians. METHODS: The authors performed a cross-sectional, blinded comparison of images from similar sonographic windows obtained on healthy models using a SonoSite 180 Plus and a General Electric (GE) 400 US machine. Both machines were optimized by company representatives. Images obtained included typical abdominal and vascular applications using the abdominal and linear transducers on each machine. All images were printed on identical high-resolution printers and then digitized using a bitmap format at 300 dots-per-inch resolution (RES). Images were then cropped, masked, and placed into random order comparing each view per model by a commercial Web design company (loracs.com). Three credentialed emergency physician sonologists, blinded to machine type, rated each image pair for RES, detail (DET), and total IQ as previously defined in the literature using a ten-point Likert scale; 10 was the best rating for each category. Paired t-test, 95% confidence intervals (95% CIs), and interobserver correlation were calculated. RESULTS: A total of 49 image pairs were evaluated. Mean GE 400 RES, DET, and IQ scores were 6.8, 6.8, and 6.6, respectively. Corresponding SonoSite means were 6.3, 6.3, and 6.0, respectively. The difference of 0.5 (95% CI = 0.13 to 1.1) for DET was not statistically significant (p = 0.06). The differences of 0.5 (95% CI = 0.1 to 1.1) and 0.6 (95% CI = 0.2 to 1.2) for RES and IQ were statistically significant, with p = 0.01 and 0.01. There was good interobserver agreement (kappa = 0.71; 95% CI = 0.67 to 0.78). CONCLUSIONS: A statistically significant difference was seen between GE 400 and SonoSite in IQ and RES, but not DET.     

Role of Lung Ultrasound in Adjusting Ultrafiltration Volume in Hemodialysis Patients

Chronic fluid over-hydration is common in dialysis patients. It is associated with mortality and cardiovascular events. Optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain. The purpose of this study was to evaluate the usefulness of ultrasound in quantifying body water. In 35 hemodialysis patients, we performed ultrasound of the chest, pre-tibial skin tissue thickness (TT), heart and inferior vena cava (IVC) before and after dialysis. We compared B-line scores of lungs, IVC diameters and cardiac functions in pre-dialysis and post-dialysis groups. We then estimated the correlations between ultrasound parameters and ultrafiltration volumes. Ultrafiltration parameters were adjusted prospectively for subsequent dialysis. As a result, both extravascular and intravascular water decreased during ultrafiltration. The median numbers of B-line scores (10 [0–42] vs. 4 [0–30]; p < 0.001); mitral valve blood flow velocities E (0.83 ± 0.23 m/s vs. 0.70 ± 0.20 m/s; p < 0.001), A (0.93 ± 0.28 vs. 0.89 ± 0.23 m/s; p < 0.001) and E/e' (12.47 ± 4.92 vs. 10.37 ± 4.0; p < 0.001); IVC diameters at end-expiration (17.51 ± 3.33 mm vs. 14.26 ± 3.45 mm; p < 0.001); and right pre-tibial TT (2.86 ± 1.36 mm vs. 2.43 ± 1.24 mm; p < 0.001) decreased during dialysis. Ultrafiltration volume was most associated with B-line score (adjusting for age and sex) (β?=?–3.340; p?=?0.003). In addition, the B-line score after dialysis was significantly associated with left ventricular ejection fraction (r?=?–0.393; p?=?0.019) and TT (r?=?–0.447; p?=?0.007). Ultrafiltration volume was prospectively increased then if the B-line score was >6 in the previous dialysis. All patients tolerated the protocol well without any symptoms. Ultrafiltration volume was most associated with lung water, reflected by variation in B-line score. It was not associated with cardiac function, IVC diameter, IVC collapse rate or TT. Lung ultrasound is a useful imaging tool for dialysis patients.     

Imaging of Gaps in Digital Joints by Measurement of Ultrasound Transmission Using a Linear Array

In orthodontic dentistry for young subjects, it is important to assess the degree of growth of the jaw bones to determine the optimum time for treatment. The structure of the digital joint changes with age, with such changes correlating to the degree of bone growth (including jaw bones). There are two gaps in the digital joint of a young subject, one of which disappears with aging. In the present study, a method for noninvasive assessment of such change in the structure of a digital joint was examined, in which continuous-wave ultrasound is radiated to a digital joint by a single-element ultrasonic transducer. This continuous ultrasound, which passes through the digital joint, is received by a linear array ultrasonic probe situated opposite the transducer. The probe simultaneously realizes pulse–echo imaging and imaging of transmission ultrasound, which passes through the joint. Using this experimental apparatus, the existence and position of a gap can be detected clearly by imaging the transmission ultrasound on a pulse–echo image. In basic experiments, continuous-wave ultrasound generated by a planar or focused transducer was radiated to a gap between two acrylic bars, which simulated that in a digital joint; transmission ultrasound, which passed through the gap, was measured with a linear array probe. The basic experimental results showed that a gap with a width >0.4 mm is detectable and that the width at half maximum of the amplitude profile of the received transmission ultrasound that passed through the gap correlated with the width of the gap. Furthermore, in the preliminary in vivo experiments, transmission ultrasound that passed through two gaps in the case of a child was clearly imaged by the proposed method, and that which passed through only one gap in the case of an adult was also imaged. These results show the possibility for the use of the proposed method to noninvasively assess the change in the structure of a joint as a result of aging. (E-mail: hasegawa@ecei.tohoku.ac.jp)     

超声检查在肺癌锁骨上淋巴结转移中的诊断价值

目的：探讨超声诊断肺癌锁骨上淋巴结转移的准确性。方法：对疑似或确诊肺癌并检出肿大锁骨上淋巴结的患者135例行彩色多普勒超声检查,并将判断结果和超声引导下细针穿刺细胞学检查（FNAC）的结果相比较,评价超声鉴别诊断肺癌锁骨上淋巴结转移的准确性。结果：135例中,共85例患者符合4项恶性转移性淋巴结的超声标准,其中62例经FNAC确诊为恶性（准确率为74.1%）,包括22例临床疑似肺癌并初次确诊的患者;符合3项标准的98例患者中64例确诊为恶性（准确率67.4%）。结论：超声是一种有效且可靠的判断锁骨上淋巴结转移的方法,可用于常规筛查。     

心功能不全患者肺部超声彗星尾征对心功能状态评估价值

目的分析心功能不全患者肺部超声彗星尾征（ultrasound lung comets,ULCs）与超声心动图参数问的关系,以评估其在临床的应用价值。方法对我院收治的100例心功能不全进行超声心动图和肺部超声检查,记录ULCs的数目,并分析ULCs与超声心动图参数间的关系。结果肺部ULCs数目与左房内径、左室舒张末期内径、肺动脉收缩压呈正相关（r=0．284,r=0．316,r=0．204;P均〈0．0001）,与左室射血分数呈负相关（r=-0．324,P〈0．0001）。结论肺部超声检测ULCs在评估心功能状态方面是一个较好的指标,临床可列入心功能不全和肺水肿患者的常规筛查。     

Portable Pocket-Sized Ultrasound Scanner for the Evaluation of Lung Involvement in Coronavirus Disease 2019 Patients

Ultrasound imaging of the lung (LUS) and associated tissues has demonstrated clinical utility in coronavirus disease 2019 (COVID-19) patients. The aim of the present study was to evaluate the possibilities of a portable pocket-sized ultrasound scanner in the evaluation of lung involvement in patients with COVID-19 pneumonia. We conducted 437 paired readings in 34 LUS evaluations of hospitalized individuals with COVID-19. The LUS scans were performed on the same day with a standard high-end ultrasound scanner (Venue GO, GE Healthcare, Chicago, IL, USA) and a pocket-sized ultrasound scanner (Butterfly iQ, Butterfly Network Inc., Guilford, CT, USA). Fourteen scans were performed on individuals with severe cases, 11 on individuals with moderate cases and nine on individuals with mild cases. No difference was observed between groups in days since onset of symptoms (23.29 ± 10.07, 22.91 ± 8.91 and 28.56 ± 11.13 d, respectively; p = 0.38). No significant differences were found between LUS scores obtained with the high-end and the portable pocket-sized ultrasound scanner. LUS scores in individuals with mild respiratory impairment were significantly lower than in those with moderate and severe cases. Our study confirms the possibilities of portable pocket-sized ultrasound imaging of the lung in COVID-19 patients. Portable pocket-sized ultrasound scanners are cheap, easy to handle and equivalent to standard scanners for non-invasive assessment of severity and dynamic observation of lung lesions in COVID-19 patients.     

Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID-19

Growing evidence is showing the usefulness of lung ultrasound in patients with the 2019 new coronavirus disease (COVID-19). Severe acute respiratory syndrome coronavirus 2 has now spread in almost every country in the world. In this study, we share our experience and propose a standardized approach to optimize the use of lung ultrasound in patients with COVID-19. We focus on equipment, procedure, classification, and data sharing.     

Quantitative Ultrasound Assessment of Early Osteoarthritis in Human Articular Cartilage Using a High-Frequency Linear Array Transducer

Quantitative ultrasound (QUS) assessment of osteoarthritis (OA) using high-frequency, research-grade single-element ultrasound systems has been reported. The objective of this ex vivo study was to assess the performance of QUS in detecting early OA using a high-frequency linear array transducer. Osteochondral plugs (n = 26) of human articular cartilage were scanned with ExactVu Micro-Ultrasound using an EV29L side-fire transducer. For comparison, the samples were also imaged with SAM200Ex, a custom 40-MHz scanning acoustic microscope with a single-element, focused transducer. Thirteen QUS parameters were derived from the ultrasound data. Magnetic resonance imaging (MRI) data, with T1 and T2 extracted as the quantitative parameters, were also acquired for comparison. Cartilage degeneration was graded from histology and correlated to all quantitative parameters. A maximum Spearman rank correlation coefficient (ρ) of 0.75 was achieved using a combination of ExactVu QUS parameters, while a maximum ρ of 0.62 was achieved using a combination of parameters from SAM200Ex. A maximum ρ of 0.75 was achieved using the T1 and T2 MRI parameters. This study illustrates the potential of a high-frequency linear array transducer to provide a convenient method for early OA screening with results comparable to those of research-grade single-element ultrasound and MRI.