1
|
Chua MT, Boon Y, Yeoh CK, Li Z, Goh CJM, Kuan WS. Point-of-care ultrasound use in COVID-19: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:13. [PMID: 38304913 PMCID: PMC10777239 DOI: 10.21037/atm-23-1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024]
Abstract
Background and Objective The coronavirus disease 2019 (COVID-19) pandemic that began in early 2020 resulted in significant mortality from respiratory tract infections. Existing imaging modalities such as chest X-ray (CXR) lacks sensitivity in its diagnosis while computed tomography (CT) scan carries risks of radiation and contamination. Point-of-care ultrasound (POCUS) has the advantage of bedside testing with higher diagnostic accuracy. We aim to describe the various applications of POCUS for patients with suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the emergency department (ED) and intensive care unit (ICU). Methods We performed literature search on the use of POCUS in the diagnosis and management of COVID-19 in MEDLINE, Embase and Scopus databases using the following search terms: "ultrasonography", "ultrasound", "COVID-19", "SARS-CoV-2", "SARS-CoV-2 variants", "emergency services", "emergency department" and "intensive care units". Search was performed independently by two reviewers with any discrepancy adjudicated by a third member. Key Content and Findings Lung POCUS in patients with COVID-19 shows different ultrasonographic features from pulmonary oedema, bacterial pneumonia, and other viral pneumonia, thus useful in differentiating between these conditions. It is more sensitive than CXR, and more accessible and widely available than CT scan. POCUS can be used to diagnose COVID-19 pneumonia, screen for COVID-19-related pulmonary and extrapulmonary complications, and guide management of ICU patients, such as timing of ventilator weaning based on lung POCUS findings. Conclusions POCUS is a useful and rapid point-of-care modality that can be used to aid in diagnosis, management, and risk stratification of COVID-19 patients in different healthcare settings.
Collapse
Affiliation(s)
- Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuru Boon
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chew Kiat Yeoh
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carmen Jia Man Goh
- Emergency Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
2
|
Zheng LL, Chen R, Zheng CH, Dai XJ, Zheng WD, Zhang JX. The correlation between lung ultrasound scores and outcomes of high-flow nasal cannula therapy in infants with severe pneumonia. BMC Pediatr 2024; 24:51. [PMID: 38229006 DOI: 10.1186/s12887-024-04522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE The study aimed to explore the effectiveness of bedside lung ultrasound (LUS) combined with the PaO2/FiO2 (P/F) ratio in evaluating the outcomes of high-flow nasal cannula (HFNC) therapy in infants with severe pneumonia. METHODS This retrospective study analyzed the clinical data of 150 infants diagnosed with severe pneumonia and treated with HFNC therapy at our hospital from January 2021 to December 2021. These patients were divided into two groups based on their treatment outcomes: the HFNC success group (n = 112) and the HFNC failure group (n = 38). LUS was utilized to evaluate the patients' lung conditions, and blood gas results were recorded for both groups upon admission and after 12 h of HFNC therapy. RESULTS At admission, no significant differences were observed between the two groups in terms of age, gender, respiratory rate, partial pressure of oxygen, and partial pressure of carbon dioxide. However, the P/F ratios at admission and after 12 h of HFNC therapy were significantly lower in the HFNC failure group (193.08 ± 49.14, 228.63 ± 80.17, respectively) compared to the HFNC success group (248.51 ± 64.44, 288.93 ± 57.17, respectively) (p < 0.05). Likewise, LUS scores at admission and after 12 h were significantly higher in the failure group (18.42 ± 5.3, 18.03 ± 5.36, respectively) than in the success group (15.09 ± 4.66, 10.71 ± 3.78, respectively) (p < 0.05). Notably, in the success group, both P/F ratios and LUS scores showed significant improvement after 12 h of HFNC therapy, a trend not observed in the failure group. Multivariate regression analysis indicated that lower P/F ratios and higher LUS scores at admission and after 12 h were predictive of a greater risk of HFNC failure. ROC analysis demonstrated that an LUS score > 20.5 at admission predicted HFNC therapy failure with an AUC of 0.695, a sensitivity of 44.7%, and a specificity of 91.1%. A LUS score > 15.5 after 12 h of HFNC therapy had an AUC of 0.874, with 65.8% sensitivity and 89.3% specificity. An admission P/F ratio < 225.5 predicted HFNC therapy failure with an AUC of 0.739, 60.7% sensitivity, and 71.1% specificity, while a P/F ratio < 256.5 after 12 h of HFNC therapy had an AUC of 0.811, 74.1% sensitivity, and 73.7% specificity. CONCLUSION Decreased LUS scores and increased P/F ratio demonstrate a strong correlation with successful HFNC treatment outcomes in infants with severe pneumonia. These findings may provide valuable support for clinicians in managing such cases.
Collapse
Affiliation(s)
- Li-Ling Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Rou Chen
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Chan-Hua Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Xiao-Juan Dai
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Wei-Da Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Jia-Xiang Zhang
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China.
| |
Collapse
|
3
|
Oricco S, Medico D, Tommasi I, Bini RM, Rabozzi R. Lung ultrasound score in dogs and cats: A reliability study. J Vet Intern Med 2024; 38:336-345. [PMID: 38009739 PMCID: PMC10800220 DOI: 10.1111/jvim.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a noninvasive tool for examining respiratory distress patients. The lung ultrasound score (LUSS) can be used to quantify and monitor lung aeration loss with good reliability. HYPOTHESIS/OBJECTIVES Assess the reliability of a new LUSS among raters with different levels of experience and determine how well the same raters agree on identifying patterns of LUS abnormalities. ANIMALS Forty LUS examinations of dogs and cats and 320 videos were reviewed from a digital database. METHODS Retrospective reliability study with post hoc analysis. Protocolized LUS were randomly selected; intrarater and interrater reliability of the LUSS and pattern recognition agreement among 4 raters with different levels of experience in LUS were tested. RESULTS The intrarater intraclass correlation coefficient (ICC) single measurement, absolute agreement, and 2-way mixed effects model was 0.967 for the high-experience rater (H-Exp), 0.963 and 0.952 for the medium-experience raters (M-Exp-1; M-Exp-2), and 0.950 for the low-experience rater (L-Exp). The interrater ICC average measurement, absolute agreement, and 2-way random effects model among the observers was 0.980. The Fleiss' kappa (k) values showed almost perfect agreement (k = 1) among raters in identifying pleural effusion and translobar tissue-like pattern, strong agreement for A-lines (k = 0.881) and B-lines (k = 0.806), moderate agreement (k = 0.693) for subpleural loss of aeration, and weak agreement (k = 0.474) for irregularities of the pleural line. CONCLUSIONS AND CLINICAL IMPORTANCE Our results indicate excellent intra- and interrater reliability for LUS scoring and pattern identification, providing a foundation for the use of the LUSS in emergency medicine and intensive care.
Collapse
Affiliation(s)
- Stefano Oricco
- Centro Veterinario ImperieseImperiaItaly
- Department of Veterinary SciencesUniversity of ParmaParmaItaly
| | | | | | | | | |
Collapse
|
4
|
Lai SY, Schafer JM, Meinke M, Beals T, Doff M, Grossestreuer A, Hoffmann B. Lung Ultrasound Score in COVID-19 Patients Correlates with PO 2/FiO 2, Intubation Rates, and Mortality. West J Emerg Med 2024; 25:28-39. [PMID: 38205982 PMCID: PMC10777190 DOI: 10.5811/westjem.59975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The point-of-care lung ultrasound (LUS) score has been used in coronavirus 2019 (COVID-19) patients for diagnosis and risk stratification, due to excellent sensitivity and infection control concerns. We studied the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (PO2/FiO2), intubation rates, and mortality correlation to the LUS score. Methods We conducted a systematic review using PRISMA guidelines. Included were articles published from December 1, 2019-November 30, 2021 using LUS in adult COVID-19 patients in the intensive care unit or the emergency department. Excluded were studies on animals and on pediatric and pregnant patients. We assessed bias using QUADAS-2. Outcomes were LUS score and correlation to PO2/FiO2, intubation, and mortality rates. Random effects model pooled the meta-analysis results. Results We reviewed 27 of 5,267 studies identified. Of the 27 studies, seven were included in the intubation outcome, six in the correlation to PO2/FiO2 outcome, and six in the mortality outcome. Heterogeneity was found in ultrasound protocols and outcomes. In the pooled results of 267 patients, LUS score was found to have a strong negative correlation to PO2/FiO2 with a correlation coefficient of -0.69 (95% confidence interval [CI] -0.75, -0.62). In pooled results, 273 intubated patients had a mean LUS score that was 6.95 points higher (95% CI 4.58-9.31) than that of 379 non-intubated patients. In the mortality outcome, 385 survivors had a mean LUS score that was 4.61 points lower (95% CI 3.64-5.58) than that of 181 non-survivors. There was significant heterogeneity between the studies as measured by the I2 and Cochran Q test. Conclusion A higher LUS score was strongly correlated with a decreasing PO2/FiO2 in COVID-19 pneumonia patients. The LUS score was significantly higher in intubated vs non-intubated patients with COVID-19. The LUS score was significantly lower in critically ill patients with COVID-19 pneumonia that survive.
Collapse
Affiliation(s)
- Shin-Yi Lai
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- St Vincent Hospital, Department of Emergency Medicine, Associated Physicians of Harvard Medical Faculty Physicians, Worcester, Massachusetts
| | - Jesse M Schafer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Mary Meinke
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Tyler Beals
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Doff
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Anne Grossestreuer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| |
Collapse
|
5
|
Clofent D, Culebras M, Felipe-Montiel A, Arjona-Peris M, Granados G, Sáez M, Pilia F, Ferreiro A, Álvarez A, Loor K, Bosch-Nicolau P, Polverino E. Serial lung ultrasound in monitoring viral pneumonia: the lesson learned from COVID-19. ERJ Open Res 2023; 9:00017-2023. [PMID: 37583967 PMCID: PMC10423983 DOI: 10.1183/23120541.00017-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/15/2023] [Indexed: 08/17/2023] Open
Abstract
Background Lung ultrasound (LUS) has proven to be useful in the evaluation of lung involvement in COVID-19. However, its effectiveness for predicting the risk of severe disease is still up for debate. The aim of the study was to establish the prognostic accuracy of serial LUS examinations in the prediction of clinical deterioration in hospitalised patients with COVID-19. Methods Prospective single-centre cohort study of patients hospitalised for COVID-19. The study protocol consisted of a LUS examination within 24 h from admission and a follow-up examination on day 3 of hospitalisation. Lung involvement was evaluated by a 14-area LUS score. The primary end-point was the ability of LUS to predict clinical deterioration defined as need for intensive respiratory support with high-flow oxygen or invasive mechanical ventilation. Results 200 patients were included and 35 (17.5%) of them reached the primary end-point and were transferred to the intensive care unit (ICU). The LUS score at admission had been significantly higher in the ICU group than in the non-ICU group (22 (interquartile range (IQR) 20-26) versus 12 (IQR 8-15)). A LUS score at admission ≥17 was shown to be the best cut-off point to discriminate patients at risk of deterioration (area under the curve (AUC) 0.95). The absence of progression in LUS score on day 3 significantly increased the prediction accuracy by ruling out deterioration with a negative predictive value of 99.29%. Conclusion Serial LUS is a reliable tool in predicting the risk of respiratory deterioration in patients hospitalised due to COVID-19 pneumonia. LUS could be further implemented in the future for risk stratification of viral pneumonia.
Collapse
Affiliation(s)
- David Clofent
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Mario Culebras
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Almudena Felipe-Montiel
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marta Arjona-Peris
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Galo Granados
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - María Sáez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Florencia Pilia
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Antía Ferreiro
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Álvarez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Karina Loor
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eva Polverino
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| |
Collapse
|
6
|
Orosz G, Gyombolai P, Tóth JT, Szabó M. Reliability and clinical correlations of semi-quantitative lung ultrasound on BLUE points in COVID-19 mechanically ventilated patients: The 'BLUE-LUSS'-A feasibility clinical study. PLoS One 2022; 17:e0276213. [PMID: 36240250 PMCID: PMC9565374 DOI: 10.1371/journal.pone.0276213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/01/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Bedside lung ultrasound has gained a key role in each segment of the treatment chain during the COVID-19 pandemic. During the diagnostic assessment of the critically ill patients in ICUs, it is highly important to maximize the amount and quality of gathered information while minimizing unnecessary interventions (e.g. moving/rotating the patient). Another major factor is to reduce the risk of infection and the workload of the staff. OBJECTIVES To serve these significant issues we constructed a feasibility study, in which we used a single-operator technique without moving the patient, only assessing the easily achievable lung regions at conventional BLUE points. We hypothesized that calculating this 'BLUE lung ultrasound score' (BLUE-LUSS) is a reasonable clinical tool. Furthermore, we used both longitudinal and transverse scans to measure their reliability and assessed the interobserver variability as well. METHODS University Intensive Care Unit based, single-center, prospective, observational study was performed on 24 consecutive SARS-CoV2 RT-PCR positive, mechanically ventilated critically ill patients. Altogether 400 loops were recorded, rated and assessed off-line by 4 independent intensive care specialists (each 7+ years of LUS experience). RESULTS Intraclass correlation values indicated good reliability for transversal and longitudinal qLUSS scores, while we detected excellent interrater agreement of both cLUSS calculation methods. All of our LUS scores correlated inversely and significantly to the P/F values. Best correlation was achieved in the case of longitudinal qLUSS (r = -0.55, p = 0.0119). CONCLUSION Summarized score of BLUE-LUSS can be an important, easy-to-perform adjunct tool for assessing and quantifying lung pathology in critically ill ventilated patients at bedside, especially for the P/F ratio. The best agreement for the P/F ratio can be achieved with the longitudinal scans. Regarding these findings, assessing BLUE-points can be extended with the BLUE-LUSS for daily routine using both transverse and longitudinal views.
Collapse
Affiliation(s)
- Gábor Orosz
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Pál Gyombolai
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - József T. Tóth
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marcell Szabó
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
7
|
Ciurba BE, Sárközi HK, Szabó IA, Ianoși ES, Grigorescu BL, Csipor-Fodor A, Tudor TP, Jimborean G. Applicability of lung ultrasound in the assessment of COVID-19 pneumonia: Diagnostic accuracy and clinical correlations. Respir Investig 2022; 60:762-771. [PMID: 35995704 PMCID: PMC9359491 DOI: 10.1016/j.resinv.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to assess the diagnostic accuracy of lung ultrasound (LUS) in determining the severity of coronavirus disease 2019 (COVID-19) pneumonia compared with thoracic computed tomography (CT) and establish the correlations between LUS score, inflammatory markers, and percutaneous oxygen saturation (SpO2). METHODS This prospective observational study, conducted at Târgu-Mureș Pulmonology Clinic included 78 patients with confirmed severe acute respiratory syndrome coronavirus-2 infection via nasopharyngeal real-time-polymerase chain reaction (RT-PCR) (30 were excluded). Enrolled patients underwent CT, LUS, and blood tests on admission. Lung involvement was evaluated in 16 thoracic areas, using AB1 B2 C (letters represent LUS pattern) scores ranging 0-48. RESULTS LUS revealed bilateral B-lines (97.8%), pleural irregularities with thickening/discontinuity (75%), and subpleural consolidations (70.8%). Uncommon sonographic patterns were alveolar consolidations with bronchogram (33%) and pleural effusion (2%). LUS score cutoff values of ≤14 and > 22 predicted mild COVID-19 (sensitivity [Se] = 84.6%; area under the curve [AUC] = 0.72; P = 0.002) and severe COVID-19 (Se = 50%, specificity (Sp) = 91.2%, AUC = 0.69; P = 0.02), respectively, and values > 29 predicted the patients' transfer to the intensive care unit (Se = 80%, Sp = 97.7%). LUS score positively correlated with CT score (r = 0.41; P = 0.003) and increased with the decrease of SpO2 (r = -0.49; P = 0.003), with lymphocytes decline (r = -0.52; P = 0.0001). Patients with consolidation patterns had higher ferritin and C-reactive protein than those with B-line patterns (P = 0.01; P = 0.03). CONCLUSIONS LUS is a useful, non-invasive and effective tool for diagnosis, monitoring evolution, and prognostic stratification of COVID-19 patients.
Collapse
Affiliation(s)
- Bianca Emilia Ciurba
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - Hédi Katalin Sárközi
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - István Adorjan Szabó
- 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania.
| | - Edith Simona Ianoși
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - Bianca Liana Grigorescu
- 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania; Anesthesiology and Intensive Therapy Department from Emergency Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 50, Târgu Mureș, Postal code 540136, Romania
| | - Alpar Csipor-Fodor
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania
| | - Toma P Tudor
- University Hospital Lewisham & Greenwich, Owen Centre Lewisham Hospital Lewisham High Street, London SE13 6LH, UK
| | - Gabriela Jimborean
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| |
Collapse
|
8
|
Kumar A, Weng I, Graglia S, Lew T, Gandhi K, Lalani F, Chia D, Duanmu Y, Jensen T, Lobo V, Nahn J, Iverson N, Rosenthal M, Gordon AJ, Kugler J. Point-of-Care Ultrasound Predicts Clinical Outcomes in Patients With COVID-19. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1367-1375. [PMID: 34468039 PMCID: PMC8661628 DOI: 10.1002/jum.15818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/04/2021] [Accepted: 08/16/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) detects the pulmonary manifestations of COVID-19 and may predict patient outcomes. METHODS We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID-19. Inclusion criteria included adult patients hospitalized for COVID-19 who received lung POCUS with a 12-zone protocol. Each image was interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was the need for intensive care unit (ICU) admission versus no ICU admission. Secondary outcomes included intubation and supplemental oxygen usage. RESULTS N = 160 patients were included. Among critically ill patients, B-lines (94 vs 76%; P < .01) and consolidations (70 vs 46%; P < .01) were more common. For scans collected within 24 hours of admission (N = 101 patients), early B-lines (odds ratio [OR] 4.41 [95% confidence interval, CI: 1.71-14.30]; P < .01) or consolidations (OR 2.49 [95% CI: 1.35-4.86]; P < .01) were predictive of ICU admission. Early consolidations were associated with oxygen usage after discharge (OR 2.16 [95% CI: 1.01-4.70]; P = .047). Patients with a normal scan within 24 hours of admission were less likely to require ICU admission (OR 0.28 [95% CI: 0.09-0.75]; P < .01) or supplemental oxygen (OR 0.26 [95% CI: 0.11-0.61]; P < .01). Ultrasound findings did not dynamically change over a 28-day scanning window after symptom onset. CONCLUSIONS Lung POCUS findings detected within 24 hours of admission may provide expedient risk stratification for important COVID-19 clinical outcomes, including future ICU admission or need for supplemental oxygen. Conversely, a normal scan within 24 hours of admission appears protective. POCUS findings appeared stable over a 28-day scanning window, suggesting that these findings, regardless of their timing, may have clinical implications.
Collapse
Affiliation(s)
- Andre Kumar
- Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Isabel Weng
- Quantitative Sciences UnitStanford UniversityStanfordCAUSA
| | - Sally Graglia
- Department of Emergency MedicineUniversity of California San Francisco and Zuckerberg San Francisco General HospitalSan FranciscoCAUSA
| | - Thomas Lew
- Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Kavita Gandhi
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Farhan Lalani
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - David Chia
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Youyou Duanmu
- Department of Emergency MedicineStanford University School of MedicineStanfordCAUSA
| | - Trevor Jensen
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Viveta Lobo
- Department of Emergency MedicineStanford University School of MedicineStanfordCAUSA
| | - Jeffrey Nahn
- Department of Emergency MedicineUniversity of California San Francisco and Zuckerberg San Francisco General HospitalSan FranciscoCAUSA
| | - Nicholas Iverson
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Molly Rosenthal
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | | | - John Kugler
- Department of MedicineStanford University School of MedicineStanfordCAUSA
| |
Collapse
|
9
|
Boccatonda A, Grignaschi A, Lanotte AMG, Cocco G, Vidili G, Giostra F, Schiavone C. Role of Lung Ultrasound in the Management of Patients with Suspected SARS-CoV-2 Infection in the Emergency Department. J Clin Med 2022; 11:jcm11082067. [PMID: 35456160 PMCID: PMC9025104 DOI: 10.3390/jcm11082067] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The lung ultrasound (LUS) score has been proposed as an optimal scheme for the ultrasound study of patients with suspected/confirmed COVID-19 pneumonia. The aims of our study were to evaluate the use of lung ultrasound as a diagnostic tool for diagnosing SARS-CoV-2 pneumonia, to examine the validity of the LUS score for the diagnosis of COVID-19 pneumonia, and to correlate this score with hospitalization rate and 30-day mortality. Materials and Methods: A retrospective analysis was performed on 1460 patients who were referred to the General Emergency Department of the S. Orsola-Malpighi Hospital from April 2020 to May 2020 for symptoms suspected to indicate SARS-CoV-2 infection. The ultrasound examination was based on a common execution scheme called the LUS score, as previously described. Results and Conclusions: The LUS score was found to correlate with the degree of clinical severity and respiratory failure (paO2/FiO2 ratio and the alveolar−arterial gradient increase than expected for age). It was shown that COVID-19 patients with an LUS score of >7 require the use of oxygen support, and a value of >10 is associated with an increased risk of oro-tracheal intubation. The LUS score was found to present higher values in hospitalized patients, increasing according to the degree of care intensity. Patients who died from COVID-19 were characterized by a mean LUS score of 11 at presentation to the emergency department. An LUS score of >7.5 was found to indicate a sensitivity of 83% and a specificity of 89% for 30-day mortality in COVID-19 patients. The use of LUS seems to be an optimal first level method for pneumonia detection and risk stratification in patients with suspected SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Andrea Boccatonda
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.M.G.L.); (F.G.)
- Correspondence: ; Tel.: +39-051-214-3324; Fax: +39-051-214-3349
| | - Alice Grignaschi
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.M.G.L.); (F.G.)
| | - Antonella Maria Grazia Lanotte
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.M.G.L.); (F.G.)
| | - Giulio Cocco
- Internal Medicine, G. d’Annunzio University, 66100 Chieti, Italy; (G.C.); (C.S.)
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Fabrizio Giostra
- Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.M.G.L.); (F.G.)
| | - Cosima Schiavone
- Internal Medicine, G. d’Annunzio University, 66100 Chieti, Italy; (G.C.); (C.S.)
| |
Collapse
|
10
|
Ito GNW, Rodrigues VAC, Hümmelgen J, Meschino GSPG, Abou‐Rejaile GM, Brenny ID, de Castro Júnior CR, Artigas RC, Munhoz JPS, Cardoso GC, Picheth GF. COVID-19 pathophysiology and ultrasound imaging: A multiorgan review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:326-338. [PMID: 35218034 PMCID: PMC9088355 DOI: 10.1002/jcu.23160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 05/09/2023]
Abstract
COVID-19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID-19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID-19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID-19 in the lungs, heart and liver.
Collapse
Affiliation(s)
- Giovana N. W. Ito
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | - Juliana Hümmelgen
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | | | - Isadora D. Brenny
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | - Rafaela C. Artigas
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | | | - Guilherme F. Picheth
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
- Department of Basic PathologyFederal University of ParanáCuritibaBrazil
| |
Collapse
|
11
|
Nekludova G, Avdeev S, Trushenko N. Lung ultrasound presentation of covid-19 patients: phenotypes and correlations-comment. Intern Emerg Med 2021; 16:1417-1418. [PMID: 34056696 PMCID: PMC8164956 DOI: 10.1007/s11739-021-02777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Galina Nekludova
- Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya Str., 119991, Moscow, Russia
| | - Sergey Avdeev
- Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya Str., 119991, Moscow, Russia.
| | - Natalia Trushenko
- Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya Str., 119991, Moscow, Russia
| |
Collapse
|
12
|
Tekin AB, Yassa M. Implementation of lung ultrasound in the triage of pregnant women during the SARS-CoV-2 pandemics. Artif Intell Med Imaging 2021; 2:56-63. [DOI: 10.35711/aimi.v2.i3.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Lung ultrasound (US) has been shown that it is able to detect interstitial lung disease, subpleural consolidations and acute respiratory distress syndrome in clinical and physical studies that assess its role in upper respiratory infections. It is used worldwide in the coronavirus disease 2019 (COVID-19) outbreak and the effectiveness has been assessed in several studies. Fast diagnosis of COVID-19 is essential in deciding for patient isolation, clinical care and reducing transmission. Imaging the lung and pleura by ultrasound is efficient, cost-effective, and safe and it is recognized as rapid, repeatable, and reliable. Obstetricians are already using the US and are quite proficient in doing so. During the pandemic, performing lung US (LUS) right after the fetal assessment until reverse transcription polymerase chain reaction results are obtained, particularly in settings that have a centralized testing center, was found feasible for the prediction of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The use of LUS is efficient in the triage and monitoring of pregnant women. Clinicians dealing with pregnant women should consider LUS as the first-line diagnostic tool in pregnant women during the SARS-CoV-2 pandemic.
Collapse
Affiliation(s)
- Arzu Bilge Tekin
- Department of Obstetrics and Gynecology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul 34785, Sancaktepe, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul 34785, Sancaktepe, Turkey
| |
Collapse
|
13
|
Association of Lung Ultrasound Score with Mortality and Severity of COVID-19: A Meta-Analysis and Trial Sequential Analysis. Int J Infect Dis 2021; 108:603-609. [PMID: 34146693 PMCID: PMC8266421 DOI: 10.1016/j.ijid.2021.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world. Lung ultrasound (LUS) has emerged as a useful tool for diagnosing many respiratory diseases. The prognostic role of LUS in COVID-19 patients has not yet been established. METHODS Several databases were searched on 09 April 2021. The difference in LUS score between the death and survival groups, and the relationship between LUS score and COVID-19 severity were both assessed. RESULTS The LUS score was significantly higher in the death group compared with the survival group (weighted mean difference (WMD) = 8.21, 95% CI: 4.74-11.67, P < 0.001), which was confirmed by trial sequential analysis. Those with mild/moderate, severe and critical COVID-19 had a progressively higher LUS score (critical vs. severe: WMD = 8.78, 95% CI: 4.17-13.38; P < 0.001; critical vs. mild/moderate/severe: WMD = 10.00, 95% CI: 6.83-13.17, P < 0.001; severe vs. moderate: WMD = 5.96, 95% CI: 3.48-8.44, P < 0.001; severe vs. mild/moderate: WMD = 7.31, 95% CI: 4.45-10.17, P < 0.001). CONCLUSIONS The LUS score was associated with mortality and severity of COVID-19. The LUS score might be a risk stratification tool for COVID-19 patients.
Collapse
|
14
|
Can Alveolar-Arterial Difference and Lung Ultrasound Help the Clinical Decision Making in Patients with COVID-19? Diagnostics (Basel) 2021; 11:diagnostics11050761. [PMID: 33922829 PMCID: PMC8145474 DOI: 10.3390/diagnostics11050761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure − H2O pressure) − (PaCO2/R)) − PaO2. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). Conclusions: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.
Collapse
|
15
|
Secco G, Cappa G, Barcella B, Perlini S. The role of emergency medicine residents during the global SARS-Cov-2 pandemic: The Pavia experience. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In late January 2020, the first cases of Covid-19 were diagnosed in Italy. A month later the epidemic broke out in Lombardy bringing along dire consequences. Up to January 23rd 2021, the region counted 522,000 cases, and 26.518 deaths on a population of nearly 10 million. For many weeks thereafter tens of emergency COVID-19 patients were admitted every day through the ED requiring further adjustments in the organization of the Hospital, always in close cooperation with the out-of-hospital Emergency network. Among these, important and time-sensitive changes took place in the role of Residents in Emergency Medicine. As residents who worked through the first and second wave of the Sars-CoV-2 pandemic in the Emergency Department, we would like to discuss the consequences of our massive involvement on the front line of the healthcare effort to fight it.
Collapse
|