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14.05.2019 | Original Research | Ausgabe 2/2020

Journal of Clinical Monitoring and Computing 2/2020

Optimizing B-lines on lung ultrasound: an in-vitro to in-vivo pilot study with clinical implications

Zeitschrift:
Journal of Clinical Monitoring and Computing > Ausgabe 2/2020
Autoren:
Christopher N. Schmickl, Aravind Ajakumar Menon, Rajanigandha Dhokarh, Bhavna Seth, Frank Schembri
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10877-019-00321-z) contains supplementary material, which is available to authorized users.
Part of this study was presented as a poster at the annual conference of the American Throracic Society (ATS) in May, 2017 in Washington, DC, USA.

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Abstract

B-lines on lung ultrasound (US) are the hallmark of pulmonary edema. It is unknown if ultrasound machine settings or probe type matter. We created an in-vitro gelatin model. Using lung presets as baseline, five blinded investigators assessed the impact of 32 distinct settings on B-line visibility based on a Likert-Scale (LS) from 0 to10 (< 5 worse, > 5 better) separately for two probes. The experiment was then repeated in-vivo in a patient with known pulmonary edema. Based on a multivariable regression LS-ratings were similar when comparing the in-vitro versus in-vivo experiment (P = 0.16; partial R2 = 0.2%) and when using the curvilinear versus linear probe (P = 0.69; partial R2 = 0.02%) but significantly different across machine settings (P < 0.0001; partial R2 = 34.4%). Limited by its pilot character, our study suggests that (1) certain US-machine settings heavily impact B-line visibility, with no clear difference between probes; (2) in-vitro models are a valid and practical alternative to more challenging patient-based research; (3) there is significant potential to improve B-line visibility and thus diagnostic yield in the clinical setting by using lung presets, centering the focal zone at the pleural line and increasing the distal time gain compensation, most of which are (in our experience) rarely done.

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