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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.
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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
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Basu S, Verma RN, Joshi A, Dwivedi D, Mateen MA, Bhatia JS. A prospective observational study to correlate lung ultrasound with clinical severity and prognosis score in patients with primary pulmonary pathology on invasive ventilatory support. Int J Crit Illn Inj Sci 2023; 13:151-158. [PMID: 38292395 PMCID: PMC10824203 DOI: 10.4103/ijciis.ijciis_31_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 02/01/2024] Open
Abstract
Background Lung ultrasound (LUS) is a known imaging modality employed for monitoring patients in an intensive care unit. This study evaluates, LUS in assessing disease severity and prognosis, by correlating its score with the three commonly used clinical severity scoring systems (CSSS), namely, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE) II score, and simplified acute physiology score (SAPS) II. Methods This single-center prospective observational study included 54 adult patients of primary lung disease-induced acute respiratory distress syndrome (ARDS), on invasive ventilation. The primary objective was to correlate LUS score with SOFA score. Secondary objectives were to correlate LUS score with APACHE II and SAPS II scores. LUS score was also correlated with the estimated mortality derived from the above-mentioned scores. A subgroup analysis on COVID-19-positive cases was also carried out. All scores were calculated on the initiation of mechanical ventilation, daily for 7 days or mortality, whichever was earlier. Results A significant positive correlation (P < 0.001) was found between LUS and all three severity scores, as well as their corresponding estimated mortality percentages, for all days of the study period, in both non-COVID-19 ARDS patients and in COVID-19 patients. The merit of all four scores in differentiating between the survivor and mortality group for the duration of study also showed significant (P < 0.05) to very significant (P < 0.001) results. Conclusion Point-of-care LUS in conjunction with CSSS is a reliable tool for assessing the severity and progression of primary lung disease.
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Affiliation(s)
- Sulagna Basu
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Rishiraj Narayan Verma
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Aditya Joshi
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Mohammad Abdul Mateen
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Jagdeep Singh Bhatia
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
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Calamai I, Greco M, Savi M, Vitiello G, Garbero E, Spina R, Pisani L, Mongodi S, Finazzi S. Thoracic UltrasONOgraphy Reporting: The TUONO Consensus. Diagnostics (Basel) 2023; 13:diagnostics13091535. [PMID: 37174927 PMCID: PMC10177560 DOI: 10.3390/diagnostics13091535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
The widespread use of the lung ultrasound (LUS) has not been followed by the development of a comprehensive standardized tool for its reporting in the intensive care unit (ICU) which could be useful to promote consistency and reproducibility during clinical examination. This work aims to define the essential features to be included in a standardized reporting tool and provides a structured model form to fully express the diagnostic potential of LUS and facilitate intensivists in the use of a LUS in everyday clinical ICU examination. We conducted a modified Delphi process to build consensus on the items to be integrated in a standardized report form and on its structure. A committee of 19 critical care physicians from 19 participating ICUs in Italy was formed, including intensivists experienced in ultrasound from both teaching hospitals and referral hospitals, and internationally renowned experts on the LUS. The consensus for 31 statements out of 33 was reached at the third Delphi round. A structured model form was developed based on the approved statements. The development of a standardized model as a backbone to report a LUS may facilitate the guidelines' application in clinical practice and increase inter-operator agreement. Further studies are needed to evaluate the effects of standardized reports in critically ill patients.
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Affiliation(s)
- Italo Calamai
- Anesthesia and Intensive Care Unit AUsl Toscana Centro, Ospedale San Giuseppe, Viale Boccaccio 16/20, 50053 Empoli, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Marzia Savi
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Gaia Vitiello
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 20156 Ranica, Italy
| | - Elena Garbero
- Laboratory of Clinical Data Science, Mario Negri Institute of Pharmacological Research IRCCS, 20156 Ranica, Italy
| | - Rosario Spina
- Anesthesia and Intensive Care Unit AUsl Toscana Centro, Ospedale San Giuseppe, Viale Boccaccio 16/20, 50053 Empoli, Italy
| | - Luigi Pisani
- Intensive Care Unit, Ospedale Generale Regionale Miulli, 70021 Acquaviva delle Fonti, Italy
- Mahidol Oxford Tropical Research Unit, Bangkok 10400, Thailand
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, San Matteo Hospital, 94403 Pavia, Italy
| | - Stefano Finazzi
- Laboratory of Clinical Epidemiology, Mario Negri Institute of Pharmacological Research IRCCS, 20156 Ranica, Italy
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Franchi R, Okoye C, Morelli V, Guarino D, Mazzarone T, Coppini G, Peta U, Rogani S, Fabbri A, Polini A, Monzani F. Utility of lung ultrasound in selecting older patients with hyperinflammatory phase in COVID-19 pneumonia. A monocentric, cross-sectional pilot study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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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.
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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
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus that gains entry via angiotensin-converting enzyme 2 (ACE2) within airway epithelium. Patients exhibit a spectrum of respiratory symptoms from asymptomatic to respiratory failure. Patient factors including obesity, tobacco use, and black race are all associated with increased ACE2 expression and may contribute to increased complications. Consolidation and ground-glass opacities on chest imaging are typical but not specific for coronavirus disease 2019 (COVID-19). Venous thromboembolism occurs infrequently when prophylactic anticoagulation is provided. However, capillary microthrombosis is nearly ubiquitous, suggesting that it contributes to hypoxemia. Remdesivir and glucocorticoids may benefit some hospitalized patients. Many of those afflicted remain symptomatic two weeks following diagnosis and continue to require health care. Total lung capacity, diffusion capacity, and maximal oxygen consumption may be reduced for months in some survivors. Lung transplant offers chronically critically ill patients new hope, and this option may have increasing potential for outpatients with COVID-19-associated fibrosis.
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Affiliation(s)
- Kevin C Doerschug
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA; ,
| | - Gregory A Schmidt
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA; ,
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Darlington DN. What's New in Shock, August 2021? Shock 2021; 56:155-157. [PMID: 34172610 DOI: 10.1097/shk.0000000000001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel N Darlington
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Department of Surgery, University of Texas Health, San Antonio, Texas
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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: 15] [Impact Index Per Article: 5.0] [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.
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