Point-of-care lung ultrasound can rule out pulmonary congestion in critically ill patients with acute kidney injury, suggest findings published August 1 in the International Journal of Nursing Knowledge.
A team led by Bruna Barbeiro from the University of São Paulo in Brazil found that a single well-trained nurse achieved high specificity using lung ultrasound at the bedside in these patients, corresponding well to nursing reference terminology.
"Bedside nurse-performed [lung ultrasound] can strengthen clinical decision-making by quickly excluding pulmonary congestion, thereby informing volume-management interventions aligned with the NANDA-I taxonomy," the Barbeiro team wrote.
Previous studies from around the world have demonstrated success in training nonexperts, including nursing staff, to use ultrasound in settings that may not have easy access to medical care. Nurses use NANDA-I for reference to standardized nursing terminology.
The success of these training efforts with point-of-care ultrasound (POCUS) adds promise to the modality’s use in remote care settings.
Barbeiro and co-authors evaluated the diagnostic accuracy of lung ultrasound for finding pulmonary congestion in patients with acute kidney injury, with a nurse performing the exams. They also compared the ultrasound findings to defining characteristics from the NANDA-I nursing diagnosis of excess fluid volume.
For the study, a critical care nurse performed bedside lung ultrasound, which followed the bedside lung ultrasound in emergency protocol. Final analysis included a convenience sample of 64 intensive care unit patients with acute kidney injury in a general hospital in Brazil.
The researchers defined pulmonary congestion as ≥ 3 B-lines in ≥ 2 intercostal spaces per hemithorax. They also used radiological evidence of vascular congestion on chest radiograph or CT as the reference standard. The researchers found pulmonary congestion in 14 patients (21.9%).
The team reported the following findings:
Lung ultrasound sensitivity was 50% and specificity was 94%. Positive and negative predictive values were 70% and 87%, respectively.
Findings from lung ultrasound and radiological reference standards achieved substantial agreement (0.77).
The presence of ≥ 3 B-lines, a sonographic marker of interstitial fluid, corresponded to the characteristic of "pulmonary congestion" from NANDA-I diagnostic terminology.
Finally, the investigators reported no occurrences of adverse events from bedside lung ultrasound exams.
The results, including linking B-lines to defining characteristics of excess fluid volume, support POCUS’s use in nursing diagnostic reasoning, the study authors highlighted.
"Limited sensitivity and wide confidence intervals highlight the need for larger, multicenter studies with sufficient positive cases," they wrote.
The full study can be found here.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
