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Airway Ultrasonography in Critical Care
Abstracts
T3. Chest Ultrasound Symposium
T3-14-IN01 Ultrasound Guided Biopsy of Chest and Lung Lesions Michael G. Kawooya Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda Approach to biopsy of intrathoracic and mediastinal structures are often performed by CT scan or fluoroscopy. Ultrasound has been rarely used because of overlying aerated lung which obscures sonographic visualization of lung many lung lesions. This is especially so for central lung lesions. For more superficial lesions adjacent to the pleura and for lesions overlaid by pleural effusions, ultrasound is at times used to guide biopsy and aspiration with accuracy approaching 90% and complications of less than 5%. In developing countries where CT scan is not so widely available, accessible and affordable, ultrasound is often the only method to guide chest and mediastinal biopsies. We retrospectively reviewed 100 cases of ultrasound –guided chest procedures, the majority of which were lung biopsies, followed by pleural biopsy for complex pleural effusions. Histological analysis revealed adenocarcinoma of the lung as the commonest lesion followed by inflammatory pleural thickening. Lymphoma was the second commonest mediastinal and lung tumor. The accuracy of the procedure was 90%. Unsuccessful procedures were in areas overlaid by the scapula, the thick muscles of the posterior chest wall and proximity to vital mediastinal structures. Complications occurred in less than 2% of patients, and this was occasional hemoptysis and mild chest pain which all did not require admission. These findings are comparable to several other studies. Ultrasound guidance is advocated for pleural, lung and mediastinal lesions as a flexible, portable, safe, affordable and accurate alternative to other imaging technologies. T3-14-IN02 The Sound of Lung – Ultrasound of the Lung and Mediastinum Christoph F. Dietrich Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim The analysis of lung artefacts has gained increasing importance as markers of lung pathology. B-line artefact (BLA), caused by a reverberation phenomenon, is the most important lung artefact. In this presentation the current role of BLA in pneumology is discussed. The current literature about BLA is summarized in healthy subjects and patients with interstitial syndrome (pulmonary fibrosis and edema) including technical factors influencing BLA visualization. BLA imaging is influenced by more factors than recently assumed [(1, 2)]. When multiple BLA are visualized in the lung, they represent a sign of increased density due to the loss of aeration in the lung periphery. This condition may indicate different diseases including cardiogenic pulmonary edema, diffuse or focal
S29
interstitial lung diseases, infections and acute respiratory distress syndrome (ARDS). Correct interpretation of BLA in lung ultrasound is strongly influenced by associated sonographic signs and careful integration of all relevant clinical information. BLA are useful to monitor clinical response, and may become crucial in directing the diagnostic process [(3)]. T3-14-IN03 Transcutaneous Airway Ultrasonography Chin-Chung Shu Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University, Taiwan Airway plays an important role in respiration and once it becomes dysfunctional, many chest diseases develop. In fact, airway is not easily measured and the NTUH team successfully measured trachea disease and detect the extubation failure by tracheal and laryngeal ultrasound. In addition, obstructive sleep apnea is a frequent disease. MRI and CT have been previously used for measuring the collapse of pharyngeal airway during sleep apnea but the cost and radiation are not good for general application. We aimed to explore the association between obstructive sleep apnea severity and pharyngeal parameters using transcutaneous pharyngeal ultrasound. The diameters of the retro-glossal (RG) and retro-palatal (RP) regions were measured by pharyngeal ultrasound through submental approach. The procedure of M€uller maneuver was applied. Using the prediction model constructed with changes of RP diameters at M€uller maneuver and neck circumference, the independent predictors of severe OSA had 100% sensitivity and 65% specificity. Currently, further validation and application in different ethnicity are warranted. T3-14-IN04 Airway Ultrasonography in Critical Care Wan-Ching Lien Assistant Professor, Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taiwan Airway ultrasound is a valuable, non-invasive, simple, and portable diagnostic tool point. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinicians to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and detecting upper airway pathologies. Better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future.
T3-14-IN05 Lung Ultrasound in the Breathless Patient Adrian Goudie Fiona Stanley Hospital & King Edward Hospital for Women
T3. Chest Ultrasound Symposium
T3-14-IN01 Ultrasound Guided Biopsy of Chest and Lung Lesions Michael G. Kawooya Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda Approach to biopsy of intrathoracic and mediastinal structures are often performed by CT scan or fluoroscopy. Ultrasound has been rarely used because of overlying aerated lung which obscures sonographic visualization of lung many lung lesions. This is especially so for central lung lesions. For more superficial lesions adjacent to the pleura and for lesions overlaid by pleural effusions, ultrasound is at times used to guide biopsy and aspiration with accuracy approaching 90% and complications of less than 5%. In developing countries where CT scan is not so widely available, accessible and affordable, ultrasound is often the only method to guide chest and mediastinal biopsies. We retrospectively reviewed 100 cases of ultrasound –guided chest procedures, the majority of which were lung biopsies, followed by pleural biopsy for complex pleural effusions. Histological analysis revealed adenocarcinoma of the lung as the commonest lesion followed by inflammatory pleural thickening. Lymphoma was the second commonest mediastinal and lung tumor. The accuracy of the procedure was 90%. Unsuccessful procedures were in areas overlaid by the scapula, the thick muscles of the posterior chest wall and proximity to vital mediastinal structures. Complications occurred in less than 2% of patients, and this was occasional hemoptysis and mild chest pain which all did not require admission. These findings are comparable to several other studies. Ultrasound guidance is advocated for pleural, lung and mediastinal lesions as a flexible, portable, safe, affordable and accurate alternative to other imaging technologies. T3-14-IN02 The Sound of Lung – Ultrasound of the Lung and Mediastinum Christoph F. Dietrich Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim The analysis of lung artefacts has gained increasing importance as markers of lung pathology. B-line artefact (BLA), caused by a reverberation phenomenon, is the most important lung artefact. In this presentation the current role of BLA in pneumology is discussed. The current literature about BLA is summarized in healthy subjects and patients with interstitial syndrome (pulmonary fibrosis and edema) including technical factors influencing BLA visualization. BLA imaging is influenced by more factors than recently assumed [(1, 2)]. When multiple BLA are visualized in the lung, they represent a sign of increased density due to the loss of aeration in the lung periphery. This condition may indicate different diseases including cardiogenic pulmonary edema, diffuse or focal
S29
interstitial lung diseases, infections and acute respiratory distress syndrome (ARDS). Correct interpretation of BLA in lung ultrasound is strongly influenced by associated sonographic signs and careful integration of all relevant clinical information. BLA are useful to monitor clinical response, and may become crucial in directing the diagnostic process [(3)]. T3-14-IN03 Transcutaneous Airway Ultrasonography Chin-Chung Shu Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University, Taiwan Airway plays an important role in respiration and once it becomes dysfunctional, many chest diseases develop. In fact, airway is not easily measured and the NTUH team successfully measured trachea disease and detect the extubation failure by tracheal and laryngeal ultrasound. In addition, obstructive sleep apnea is a frequent disease. MRI and CT have been previously used for measuring the collapse of pharyngeal airway during sleep apnea but the cost and radiation are not good for general application. We aimed to explore the association between obstructive sleep apnea severity and pharyngeal parameters using transcutaneous pharyngeal ultrasound. The diameters of the retro-glossal (RG) and retro-palatal (RP) regions were measured by pharyngeal ultrasound through submental approach. The procedure of M€uller maneuver was applied. Using the prediction model constructed with changes of RP diameters at M€uller maneuver and neck circumference, the independent predictors of severe OSA had 100% sensitivity and 65% specificity. Currently, further validation and application in different ethnicity are warranted. T3-14-IN04 Airway Ultrasonography in Critical Care Wan-Ching Lien Assistant Professor, Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taiwan Airway ultrasound is a valuable, non-invasive, simple, and portable diagnostic tool point. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinicians to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and detecting upper airway pathologies. Better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future.
T3-14-IN05 Lung Ultrasound in the Breathless Patient Adrian Goudie Fiona Stanley Hospital & King Edward Hospital for Women