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- Impact of ultrasound settings on lung vertical artefacts: an observational study in mechanically ventilated patientsPublication . Leote, João; Gonçalves, Andreia; Fonseca, Júlia; Loução, Ricardo; Dias, Maria Hermínia Monteiro Brites; Ribeiro, Maria Inês; Meireles, Ricardo; Varudo, Rita; Bacariza, Jacobo; Gonzalez, FilipeThe number of vertical artefacts (VAs) in lung ultrasound (LUS) impacts patients' clinical management. This study aimed to demonstrate the influence of ultrasound settings on the number of VAs in patients under invasive mechanical ventilation (IMV). Methods: Patients under IMV were recruited for LUS, including three breathing cycles with a motionless curvilinear probe on the thoracic region with the most VAs. Three experts in LUS were asked about the number of VAs at random, and blinded after altering the settings for a total of 20 test recordings per patient. The correlation between expert classifications was tested after grading the classifications. The number of VAs across clinicians was compared between baseline recordings and test condition recordings to determine statistical differences. Results: 29 patients were enrolled with a median Sequential Organ Failure Assessment score of 6 (interquartile range (IQR) 3). IMV was mainly due to stroke (n=10) and pneumonia (n=6). LUS was made between days 1 and 6 (IQR). Baseline recordings showed a median of 2±2 VAs in inspiration and a median of 1±2 in expiration from 3636 expert classifications, with a strong agreement among patients. A probe frequency of 8 MHz, artefact filtering, speckle reduction, and frame average reduced the median VA number by one. A power of -20 dB and a dynamic range of 32 dB abolished the VAs. A gain above 90% increased the median number of VAs by one. Conclusion: In this in vivo study, the LUS settings influenced the VA number in IMV patients, after controlling for physiological and operator confounders.
- Concordance between FVC and FEV6 for identifying chronic airflow obstruction and spirometric restriction in the Burden of Obstructive Lung Disease (BOLD) studyPublication . Knox-Brown, Ben; Potts, James; Franssen, Frits M. E.; Nielsen, Rune; Denguezli, Meriem; Rotevatn, Anders Ørskov; Juvekar, Sanjay K.; Cherkaski, Hamid Hacene; Studnicka, Michael; Sylvester, Karl Peter; Mortimer, Kevin; Bateman, Eric D.; Janson, Christer; Malinovschi, Andrei; Seemungal, Terence; Koul, Parvaiz; Mannino, David; Mahesh, Padukudru Anand; Jogi, Rain; Mejza, Filip; Al Ghobain, Mohammed; Paraguas, Stefanni Nonna M.; Welte, Tobias; Wouters, Eliel; Gislason, Thorarinn; Harrabi, Imed; Dias, Maria Hermínia Monteiro Brites; Obaseki, Daniel O.; Kocabas, Ali; Barbara, Cristina; Cardoso, João; Agarwal, Dhiraj; Nafees, Asaad Ahmed; Rodrigues, Fatima; Garcia-Larsen, Vanessa; Erhabor, Gregory E.; Loh, Li-Cher; Amaral, Andre F. S.Introduction: We investigated whether the forced expiratory volume in 6 s (FEV6) can be used as a surrogate for the forced vital capacity (FVC). Methods: The Burden of Obstructive Lung Disease is a multinational cohort study. At baseline, data were collected from adults aged 40 years or older, from 41 sites across 34 countries. Participants from 18 sites were followed up after a median of 8.3 years. Participants who completed the study core questionnaire and had acceptable post-bronchodilator spirometry were included. We performed receiver operating characteristic analyses to measure the ability of FEV1/FEV6 less than the lower limit of normal (LLN) to correctly classify FEV1/FVC less than the LLN, and FEV6 less than the LLN to correctly classify FVC less than the LLN. We used multilevel regression analyses to assess the association of discordant measurements with respiratory symptoms, quality of life, and lung function decline. Results: At baseline, 28,604 participants were included. 53% were female (15,060). 10% (2876) had chronic airflow obstruction for FEV1/FVC, compared with 9% (2704) for FEV1/FEV6. 37% (10,637) had spirometric restriction for FVC, compared with 35% (9978) for FEV6. The FEV1/FEV6 had excellent accuracy in identifying FEV1/FVC less than the LLN (area under the curve (AUC): 0.90, 95% CI, 0.89 to 0.91, κ coefficient 0.82). The FEV6 also had excellent agreement in identifying FVC less than the LLN (AUC: 0.95, 95% CI, 0.94 to 0.95, κ coefficient 0.90). Discordant reductions in FEV1/FEV6 (1%, 345) and FEV6 (1%, 309) were associated with greater odds of having respiratory symptoms and a lower physical quality of life. 3870 participants were followed up with. Those with discordant reductions in FEV1/FEV6 and FEV6 were more likely to have chronic airflow obstruction and spirometric restriction at follow-up. Conclusions: There is strong agreement between the FVC and FEV6 in the identification of chronic airflow obstruction and spirometric restriction.
- Diaphragm ultrasound for muscle strength assessment: a systematic literature reviewPublication . Leote, João; Monteiro, Margarida; Rocha, Cláudia; Rodrigues, Carolina; Pereira, Marco; Antunes, Maria Luz; Dias, Maria Hermínia Monteiro BritesObjective: To assess if diaphragmatic ultrasound (DU) reflects diaphragmatic muscle strength when compared to respiratory tests and neurophysiological studies. Methods: A systematic literature review was conducted on adults undergoing DU, compared to any respiratory or neurophysiological technique. The search strategy was applied in PubMed, Scopus, and Web of Science, and the analysis was conducted using the PRISMA methodology. Three eligibility assessment stages were performed: title, abstract, and full-text reading. The risk of bias was evaluated using the RoB 2.0, ROBINS-I, and Newcastle-Ottawa Scale tools. Results: Out of 155 identified articles, 25 were selected for full-text review (14 non-randomised studies, 8 case-control studies, and 3 randomised studies). The overall risk of bias was moderate, with the main biases related to population selection and intervention assessment. Twenty-three articles used maximal inspiratory pressure measurement as a comparator, which showed a weak-to-moderate correlation, significant in 10 studies, with diaphragmatic excursion. Three studies reported a weak association between diaphragmatic thickening and sniff pressure. Five articles reported a concordant correlation between diaphragmatic thickening and compound muscle action potential amplitude, significant only in one study. Conclusion: The variability of results obtained across different pathologies does not support the use of DU alone to predict diaphragmatic muscle strength.