Clinical trial NCT05636631: Chest U/S in Differentiating Lung Congestion & Pneumonia in Adult Critically-ill Patients and Its Prognostic Impact
Official title: The Role of Chest Ultrasound in Differentiating Lung Congestion and Pneumonia in Adult Critically-ill Patients and Its Prognostic Impact
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Pneumonia
Pulmonary Edema
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2022-12-05
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: both genders adult (above age of 18 years) critically ill patients

Brief summary: 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 .

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

Eligibility criteria: 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

Primary outcomes:
measure: Diagnostic tool
timeFrame: Baseline
measure: Follow up after initiation of treatment
timeFrame: Baseline ( day 3 of hospital admission)
measure: Follow up before assessing final outcome
timeFrame: Baseline ( day 7 of hospital admission)
Secondary outcomes:
measure: morbidity & mortality
timeFrame: baseline
Other outcomes:
Locations:
city: Assiut
country: Egypt
facility: Nardin Aymn
state: Asyut
Study officials:
affiliation: Professor Faculty of Medicine, Assiut University
name: Mahmoud Ashry, Professor
role: STUDY_DIRECTOR
References:
citation: 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.
citation: 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.