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Objective: To investigate the differences of the locations and signs of the phrenic points between the Modified Bedside Lung Ultrasound Examination (M-BLUE) and Bedside Lung Ultrasound Examination (BLUE)., Methods: A total of 61 consecutive patients who were treated in the Department of Critical Care Medicine at Peking Union Medical College Hospital in January and February of 2015 were enrolled in this study. BLUE and M-BLUE were both performed on each patient. The differences of examination results were compared., Results: (1) There were 47.5% (58/122) different locations of the phrenic points and 18.0% (22/122) different echo-signs between the BLUE protocol and the M-BLUE protocol. (2) Compared with BLUE protocol, changes of locations [67.9% (19/28) vs 33.3% (11/33)] and signs [42.9% (12/28) vs 12.1% (4/33)] of the phrenic points in the M-BLUE protocol in patients with respiratory failure were significantly higher than those without pulmonary diseases. Among 5 patients with acute respiratory distress syndrome and 6 patients with chronic obstructive pulmonary disease, all presented changes in locations of the phrenic point in the M-BLUE protocol, while 3 and 4 showed changes in signs respectively. (3) Signs of the phrenic point in the M-BLUE protocol were more consistent with the result of the chest CT than those in the BLUE protocol., Conclusion: Compared with BLUE protocol, M-BLUE protocol seems more accurate in locating the phrenic point and more specific for the diagnosis of pulmonary disease. Compared with BLUE protocol, M-BLUE is more valuable for critical patients.

Objective: To investigate the shape change index (SCI) of inferior vena cava (IVC) measured from subcostal area and right mid-axillary line through ultrasonography laying the foundation for future research about SCI and volume status., Methods: A total of 107 patients were enrolled in the Critical Care Medicine Department of Peking Union Medical College Hospital from December, 2014-January, 2015. The maximal diameter (MXD) and the minimal diameter (MID) were measured transversely from subcostal area and right mid-axillary line. The SCI was calculated., Results: Totally 47 patients (42 with spontaneous breathing and 5 on mechanical ventilation) achieved measurements on transversal plane from subcostal area and right mid-axillary line. (1) The internal diameter of IVC on longitudinal plane measured from subcostal area was statistically different from that measured from right mid-axillary line both at end inspiration (P=0.001) and at end expiration (P=0.027). (2) No difference were found in the SCI measured from subcostal and right mid-axillary line both at end inspiration and at expiration. (3) The internal diameter of IVC and the SCI measured on transversal plane from subcostal area correlated well with that measured from mid-axillary line both at end inspiration (SCI:r=0.866, P=0.000) and at end expiration (SCI: r=0.887, P=0.000)., Conclusions: Inferior vena cava internal diameters and the shape change index measured through ultrasonography on transversal planefrom subcostal area are correlated well with those from mid-axillary line. Measurements from the two sites can be replacedby each other.

Objective: To investigate the inferior vena cava internal diameter (IVCID) and inferior vena cava variability (IVCV) on longitudinal plane measured from subcostal area and right mid-axillary line through ultrasonography and to find out if the measuring site and different respiratory status were related to the IVCID and IVCV., Methods: A total of 127 patients were enrolled successively in Critical Care Medical Department of Peking Union Medical Hospital from November to December, 2013. IVCID and IVCV of patients on mechanical ventilation or with spontaneous breathing were measured longitudinally from subcostal area and right mid-axillary line., Results: (1) Totally 124 out of the 127 patients achieved measurement from right mid-axillary line, while only 83 patients achieved measurement from subcostal area. The difference was statistically significant (χ(2) = 74.42, P < 0.01) . Eighty-one patients can be measured from both sites, with 44 had spontaneous breathing and 37 on mechanical ventilation. (2)Whether in spontaneous or mechanically ventilated patients, IVCID measured from subcostal area was statistically different from right mid-axillary line measurement at both end expiration and end inspiration. (3) In mechanically ventilated patients with IVCID ≥ 2 cm measured from subcostal area at end expiration, no statistical difference was found between the IVCID from right mid-axillary line and from subcostal area[ (2.25 ± 0.32) cm vs (2.10 ± 0.12) cm, P = 0.083]. In spontaneous breathing patients with IVCID ≥ 2 cm measured from subcostal area at end expiration, there were significant differences between the IVCID from right mid-axillary line and from subcostal area at both end expiration and end inspiration. The IVCV between the two sites were also statistically different. In mechanically ventilated patients with IVCID ≤ 1.5 cm measured from subcostal area at end expiration, there were significant difference between the IVCID from right mid-axillary line and from subcostal area [ (1.58 ± 0.43) cm vs (1.09 ± 0.38) cm, P = 0.026]. In spontaneous breathing patients with IVCID ≤ 1.5 cm measured from subcostal area at end expiration, there were significant difference between the IVCID from right mid-axillary line and from subcostal area at both end expiration and end inspiration. The IVCV between the two sites were also statistically different. (4) Correlation analysis showed in mechanically ventilated patients, IVCID measured from right mid-axillary line at end expiration was correlated with the IVCID measured from subcostal area at end expiration(r = 0.565, P = 0.000). In spontaneous breathing patients, IVCID measured at end expiration from right mid-axillary line was correlated with the IVCID measured from subcostal area (r = 0.526, P = 0.000) . IVCID measured at end inspiration from right mid-axillary line was correlated with the IVCID measured from subcostal area (r = 0.454, P = 0.002). IVCV measured from right mid-axillary line was correlated with IVCV measured from subcostal area (r = 0.513, P = 0.000)., Conclusions: Inferior vena cava internal diameter and variability measured longitudinally through ultrasonography from subcostal area is different with measurements from right mid-axillary line. Measurements from the two sites are not replaceable with each other. Further studies are needed before the clinical use of inferior vena cava internal diameter and variability measured from right mid-axillary line.

Objective: To investigate the effects of Peking Union Medical College Hospital (PUMCH) Critical Ultrasonic Management (PCUM) scheme on the etiological diagnosis and treatment decisions for the patients with dyspnea and/or hemodynamic instability in ICU., Methods: Patients who suffered from dyspnea and/or hemodynamic instability in PUMCH ICU were included in this study. The time to preliminary diagnosis, time to final diagnosis, diagnostic accuracy, time to accurate treatment, time to consultation with other specialties, time to other examinations were recorded., Results: A total of 129 patients were included in this study. In patients applied with PCUM scheme, time to preliminary diagnosis, final diagnosis and accurate treatment were (15 ± 6)min, (65 ± 16)min and (34 ± 14)min respectively, and the accuracy of diagnosis was 93.0%. PCUM patients had high sensitivity and specificity for the diagnosis of acute respiratory distress syndrome (ARDS)(sensitivity 90.2%/specificity 93.6%), distributive shock(sensitivity 92.5%/specificity 93.6%) and pulmonary edema(sensitivity 93.4%/specificity 92.7%) etc., Conclusions: The PCUM scheme is associated with short time to preliminary diagnosis and high diagnostic accuracy and could improve the treatment for patients with dyspnea and/or hemodynamic instability.