Reply to the comments of Dr. Quarato et al.
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LETTER TO THE EDITOR
Reply to the comments of Dr. Quarato et al. Ana Pičuljan1 · Marko Šustić2 · Alan Šustić1,3 Received: 6 February 2020 / Accepted: 12 February 2020 © Springer Nature B.V. 2020
We appreciate the interest of Dr. Quarato et al. in our manuscript investigating inter-observer and intra-observer agreement in the estimation of the exact number of B-lines between observers with three different levels of experience and by the software algorithm in real-time point-of-care ultrasound. However, we should comment on certain points of their letter. Firstly, the concern of Quarato et al. regards our claim that the cause of B-lines is “interstitial edema” suggesting that it is not always the case, while in fact we clearly emphasize that “… this artifact of various etiologies, although most commonly associated with increased interstitial edema, has also been detected in different interstitial lung diseases”. Secondly, although Quarato et al. claim that some study did not find a significant difference in the number of B-lines between patients with acute pulmonary edema and those with other pulmonary disease, several important recent researches highlighted the clinical significance of the exact numbering of B-lines [1, 2]. Hence, Ferre et al. find an increase of six Delta-B-line as the threshold value to diagnose weaning-induced pulmonary edema, Miglioranza et al., counting B-lines in predicting of heart decompensation, find two threshold points; B-lines number ≥ 30 identified a group at high risk of pulmonary edema and number of B-lines
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