Chest U/S in Differentiating Lung Congestion & Pneumonia in Adult Critically-ill Patients and Its Prognostic Impact

The Role of Chest Ultrasound in Differentiating Lung Congestion and Pneumonia in Adult Critically-ill Patients and Its Prognostic Impact

This study aim will be to assess the effectiveness of chest ultrasound as a diagnostic and differentiating modality in cases of pneumonia and lung congestion . It also evaluates chests sonography effectiveness in follow-up of patients with pneumonia and lung congestion .

Study Overview

• Status: Recruiting
• Conditions: Pneumonia; Pulmonary Edema
• Intervention / Treatment: Device: Chest ultrasound

Detailed Description

Lung ultrasound (LUS) is used at the bedside in emergency and critical care settings. It is a rapid and low-cost approach that can direct patient care without the use of harmful radiation. The success of this technique depends on its simplicity to discover the sonographic signs which indicate certain lung pathology. These signs include a hyperechoic and sliding line, moving forward and back with ventilation seen 0.5 cm below the rib line and is called the pleural line. The A-profile associates anterior lung sliding with A lines. A lines are horizontal repetition artifacts of the pleural line. The B-profile associates anterior lung sliding with B lines. B lines appear as shining vertical lines arising from the pleural line and reach the edge of the screen.

Several pathological etiologies can fill the alveolar spaces, with fluid (heart failure), pus (pneumonia which is the commonest), blood (pulmonary hemorrhage), and cells (lung cancer).

Other causes of lung consolidation may include atelectasis, pulmonary edema, infarction, and lung cancer. Chest imaging with CT is regarded as the gold standard modality allowing for the diagnosis of pneumonia in earlier stage and with higher sensitivity and specificity. On the contrary, cardiogenic pulmonary edema (CPE) is defined as alveolar transudation caused by elevated pulmonary capillary hydrostatic pressure secondary to increased pulmonary venous pressure with low-protein content in the interstitial tissue of lung as a result of cardiac dysfunction

• Study Type: Observational
• Enrollment (Anticipated): 60

Contacts and Locations

• Study Contact: Name: Nardin Aymn, resident; Phone Number: 01285151220; Email: Nardeen.14223960@med.aun.edu.eg
• Study Contact Backup: Name: Alaa Ahmed, lecturer; Email: alaa_omar11@aun.edu.eg

Study Locations

• Egypt
  • Asyut
    • Assiut, Asyut, Egypt, 71511
      • Recruiting
      • Nardin Aymn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

both genders adult (above age of 18 years) critically ill patients

Description

Inclusion Criteria:

• Adult (above 18 years old)
• Both genders
• Patient with symptoms suggestive of pneumonia
• Patient with symptoms suggestive of acute congestive heart failure
• admitted to Critical care unit

Exclusion Criteria:

• Patients with Renal induced lung congestion

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with Pneumonia (1); Patients presented with symptoms suggestive of pneumonia as fever, tachypnea, cough with sputum. These patients will receive IV fluids & antibiotics with follow up of sepsis parameters	Device: Chest ultrasound; chest ultrasound as a non invasive, low cost & bedside device for differentiation & follow up of lung congestion & pneumonia
Patients with decongestive heart failure (2); Patients presented with symptoms suggestive of acute congestive heart failure as dyspnea, orthopnea, bilateral lower limb edema. These patients will receive anti-failure treatment as diuretics, ACE inhibitors & Beta blockers with follow up of resolving signs of decompensated heart failure	Device: Chest ultrasound; chest ultrasound as a non invasive, low cost & bedside device for differentiation & follow up of lung congestion & pneumonia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diagnostic tool	Diagnosis of pneumonia vs lung congestion by using chest ultrasound examination viewing A-lines, B-lines, pleural effusion presence & its initial amount .	Baseline
Follow up after initiation of treatment	Follow up of findings of chest U.S on day 1 after initiating therapy using same parameters ( A-lines, B-lines, pleural effusion) on day 3 of hospital admission	Baseline ( day 3 of hospital admission)
Follow up before assessing final outcome	Follow up of findings of chest U.S on day 1 after initiating therapy using same parameters ( A-lines, B-lines, pleural effusion) on day 7 of hospital admission	Baseline ( day 7 of hospital admission)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
morbidity & mortality	if patient's symptoms improved or not If patient died or not	baseline

Collaborators and Investigators

• Sponsor: Assiut University
• Investigators: Study Director: Mahmoud Ashry, Professor, Professor Faculty of Medicine, Assiut University

Publications and helpful links

General Publications

• Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015 Jun;147(6):1659-1670. doi: 10.1378/chest.14-1313.
• Volpicelli G, Cardinale L, Garofalo G, Veltri A. Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD. Emerg Radiol. 2008 May;15(3):145-51. doi: 10.1007/s10140-008-0701-x. Epub 2008 Jan 31.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2022
• Primary Completion (Anticipated): November 30, 2024
• Study Completion (Anticipated): July 31, 2025

Study Registration Dates

• First Submitted: November 4, 2022
• First Submitted That Met QC Criteria: December 1, 2022
• First Posted (Actual): December 5, 2022

Study Record Updates

• Last Update Posted (Actual): December 5, 2022
• Last Update Submitted That Met QC Criteria: December 1, 2022
• Last Verified: December 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Pneumonia; Pulmonary Edema
• Other Study ID Numbers: chest US for lung conditions

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No