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Butler CR, Webster LB, Diekema DS. Staffing crisis capacity: a different approach to healthcare resource allocation for a different type of scarce resource. JOURNAL OF MEDICAL ETHICS 2022:medethics-2022-108262. [PMID: 35777960 PMCID: PMC9844994 DOI: 10.1136/jme-2022-108262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: (1) prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and (2) prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies-while potentially resulting in care that deviates from usual standards-support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Hospital and Speciality Medicine, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Laura B Webster
- Bioethics Progam, Virginia Mason Medical Center, Seattle, Washington, USA
- Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas S Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Trueman Katz Center for Pediatric Bioethics, Seattle Children's Research Institure, Seattle, Washington, USA
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2
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Garcia Eijo PM, D’Adamo J, Bianchetti A, Duriez T, Cabaleiro JM, Irrazabal C, Otero P, Artana G. Exhalatory dynamic interactions between patients connected to a shared ventilation device. PLoS One 2021; 16:e0250672. [PMID: 33945551 PMCID: PMC8096090 DOI: 10.1371/journal.pone.0250672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
In this work a shared pressure-controlled ventilation device for two patients is considered. By the use of different valves incorporated to the circuit, the device enables the restriction of possible cross contamination and the individualization of tidal volumes, driving pressures, and positive end expiratory pressure PEEP. Possible interactions in the expiratory dynamics of different pairs of patients are evaluated in terms of the characteristic exhalatory times. These characteristic times can not be easily established using simple linear lumped element models. For this purpose, a 1D model using the Hydraulic and Mechanical libraries in Matlab Simulink was developed. In this sense, experiments accompany this study to validate the model and characterize the different valves of the circuit. Our results show that connecting two patients in parallel to a ventilator always resulted in delays of time during the exhalation. The size of this effect depends on different parameters associated with the patients, the circuit and the ventilator. The dynamics of the exhalation of both patients is determined by the ratios between patients exhalatory resistances, compliances, driving pressures and PEEPs. Adverse effects on exhalations became less noticeable when respiratory parameters of both patients were similar, flow resistances of valves added to the circuit were negligible, and when the ventilator exhalatory valve resistance was also negligible. The asymmetries of driving pressures, compliances or resistances exacerbated the possibility of auto-PEEP and the increase in relaxation times became greater in one patient than in the other. In contrast, exhalatory dynamics were less sensitive to the ratio of PEEP imposed to the patients.
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Affiliation(s)
- Pedro M. Garcia Eijo
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Juan D’Adamo
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Arturo Bianchetti
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Thomas Duriez
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Juan M. Cabaleiro
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Célica Irrazabal
- División Terapia Intensiva del Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Otero
- Cátedra de Anestesiología y Algiología, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Artana
- Laboratorio de Fluidodinámica, Facultad de Ingeniería, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
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Sojar SH, Quinn AM, Bortcosh WH, Decerbo PC, Chung E, La Vita CJ, Jay GD. Titration of Parameters in Shared Ventilation With a Portable Ventilator. Respir Care 2021; 66:758-768. [PMID: 33298622 PMCID: PMC9994126 DOI: 10.4187/respcare.08446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Dual-patient, single-ventilator protocols (ie, protocols to ventilate 2 patients with a single conventional ventilator) may be required in times of crisis. This study demonstrates a means to titrate peak inspiratory pressure (PIP), PEEP, and [Formula: see text] for test lungs ventilated via a dual-patient, single-ventilator circuit. METHODS This prospective observational study was conducted using a ventilator connected to 2 test lungs. Changes in PIP, PEEP, and [Formula: see text] were made to the experimental lung, while no changes were made to the control lung. Measurements were obtained simultaneously from each test lung. PIP was titrated using 3D-printed resistors added to the inspiratory circuit. PEEP was titrated using expiratory circuit tubing with an attached manual PEEP valve. [Formula: see text] was titrated by using a splitter added to the ventilator tubing. RESULTS PIP, PEEP, and [Formula: see text] were reliably and incrementally titratable in the experimental lung, with some notable but manageable changes in pressure and [Formula: see text] documented in the control lung during these titrations. Similar results were measured in lungs with identical and different compliances. CONCLUSIONS Pressures and [Formula: see text] can be reliably adjusted when utilizing a dual-patient, single-ventilator circuit with simple, low-cost modifications to the circuit. This innovation could potentially be lifesaving in a resource-limited or crisis setting. Understanding the interactions of these circuits is imperative for making their use safer.
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Affiliation(s)
- Sakina H Sojar
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island.
| | - Austin M Quinn
- Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - William H Bortcosh
- Division of Pediatric Critical Care Medicine, University of Florida Shands Hospital, Gainesville, Florida
| | - Paul C Decerbo
- Lifespan Simulation Center, Rhode Island Hospital, Providence, Rhode Island
| | - Esther Chung
- Division of Respiratory Therapy, Massachusetts General Hospital, Boston, Massachusetts
| | - Carolyn J La Vita
- Division of Respiratory Therapy, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory D Jay
- Department of Emergency Medicine, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
- Lifespan Simulation Center, Rhode Island Hospital, Providence, Rhode Island
- School of Engineering, Brown University, Providence, Rhode Island
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Measuria HD, Verma YV, Kerstein R, Tucker S. Modified full-face snorkel mask: answer to the PPE crisis? BMJ INNOVATIONS 2021; 7:308-310. [PMID: 37556243 PMCID: PMC7789198 DOI: 10.1136/bmjinnov-2020-000468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Harshul D Measuria
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
| | - Yash V Verma
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
| | - Ryan Kerstein
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
| | - Sarah Tucker
- Department of Plastic
Surgery, Oxford University Hospitals NHS Foundation
Trust, Oxford, Oxfordshire, UK
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Abstract
BACKGROUND Non-invasive respiratory support for neonates using bubble continuous positive airway pressure (bCPAP) delivery systems is now widespread owing to its safety, cost effectiveness and easy applicability. Many innovative solutions have been suggested to deal with the possible shortage in desperate situations like disasters, pandemics and resource-limited settings. Although splitting of invasive ventilation has been reported previously, no attempts to split non-invasive respiratory support have been reported. OBJECTIVE The primary objective was to test the feasibility of splitting the bCPAP assembly using a T-piece splitter in a simulation model. METHODS A pilot simulation-based study was done to split a single bCPAP assembly using a T-piece. Other materials consisted of a heated humidification system, an air oxygen blender, corrugated inspiratory and expiratory tubing, nasal interfaces and two intercostal chest tube drainage bags. Two pressure manometers were used simultaneously to measure delivered pressures at different levels of set bCPAPs at the expiratory limb of nasal interfaces. RESULTS Pressures measured at the expiratory end of two nasal interfaces were 5.1 and 5.2 cm H2O, respectively, at a flow of 6 L/min and a water level of 5 cm H2O in both chest bags. When tested across different levels of set continuous positive airway pressure (3-8 cmH2O) and fractional inspired oxygen concentration (0.30-1.0), measured parameters corresponded to set parameters. CONCLUSION bCPAP splitting using a T-piece splitter is a technically simple, feasible and reliable strategy tested in a simulation model. Further testing is needed in a simulated lung model.
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Affiliation(s)
- Akanksha Verma
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jaiswal
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kirti M Naranje
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Girish Gupta
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anita Singh
- Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Serpa Neto A, Checkley W, Sivakorn C, Hashmi M, Papali A, Schultz MJ. Pragmatic Recommendations for the Management of Acute Respiratory Failure and Mechanical Ventilation in Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:60-71. [PMID: 33534774 PMCID: PMC7957237 DOI: 10.4269/ajtmh.20-0796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Management of patients with severe or critical COVID-19 is mainly modeled after care for patients with severe pneumonia or acute respiratory distress syndrome (ARDS) from other causes, and these recommendations are based on evidence that often originates from investigations in resource-rich intensive care units located in high-income countries. Often, it is impractical to apply these recommendations to resource-restricted settings, particularly in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for acute respiratory failure and mechanical ventilation management in patients with severe/critical COVID-19 in LMICs. We suggest starting supplementary oxygen when SpO2 is persistently lower than 94%. We recommend supplemental oxygen to keep SpO2 at 88-95% and suggest higher targets in settings where continuous pulse oximetry is not available but intermittent pulse oximetry is. We suggest a trial of awake prone positioning in patients who remain hypoxemic; however, this requires close monitoring, and clear failure and escalation criteria. In places with an adequate number and trained staff, the strategy seems safe. We recommend to intubate based on signs of respiratory distress more than on refractory hypoxemia alone, and we recommend close monitoring for respiratory worsening and early intubation if worsening occurs. We recommend low-tidal volume ventilation combined with FiO2 and positive end-expiratory pressure (PEEP) management based on a high FiO2/low PEEP table. We recommend against using routine recruitment maneuvers, unless as a rescue therapy in refractory hypoxemia, and we recommend using prone positioning for 12-16 hours in case of refractory hypoxemia (PaO2/FiO2 < 150 mmHg, FiO2 ≥ 0.6 and PEEP ≥ 10 cmH2O) in intubated patients as standard in ARDS patients. We also recommend against sharing one ventilator for multiple patients. We recommend daily assessments for readiness for weaning by a low-level pressure support and recommend against using a T-piece trial because of aerosolization risk.
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Affiliation(s)
- Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘Academic Medical Center’, Amsterdam, The Netherlands
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Chaisith Sivakorn
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Madiha Hashmi
- Department of Anaesthesiology, Ziauddin University, Karachi, Pakistan
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘Academic Medical Center’, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘Academic Medical Center’, Amsterdam, The Netherlands
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, University of Melbourne, Melbourne, Australia
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Anaesthesiology, Ziauddin University, Karachi, Pakistan
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
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Mebrate Y, Phillips S, Field D, Mumuni I, Josse P, Alexander D, Das-Gupta R, Trimlett R, Polkey MI. Modification of a domiciliary ventilator to increase FiO 2: an off-label modification which may be of value in COVID-19. Thorax 2021; 76:83-85. [PMID: 33077616 PMCID: PMC7569708 DOI: 10.1136/thoraxjnl-2020-215487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022]
Abstract
Although nasal continuous positive airway pressure or non-invasive ventilation is used to manage some patients with acute lung injury due to COVID-19, such patients also demonstrate increased minute ventilation which makes it hard, if the device is used in line with the manufacturer's instructions, to achieve adequate oxygen delivery. In addition, if a hospital contains many such patients, then it is possible that the oxygen requirements will exceed infrastructure capacity. Here we describe a simple modification of two exemplar ventilators normally used for domiciliary ventilation, which substantially increased the fraction of inspired oxygen (FiO2) delivered.
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Affiliation(s)
- Yoseph Mebrate
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Steven Phillips
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Debbie Field
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ivy Mumuni
- Department of Biomedical Engineering, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Paul Josse
- Department of Design, Brunel University College of Engineering Design and Physical Sciences, Uxbridge, Hillingdon, UK
| | - David Alexander
- Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rishi Das-Gupta
- Department of Innovation and Technology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Richard Trimlett
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Michael I Polkey
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Thoracic Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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8
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Longhitano GA, Candido G, Ribeiro Machado LM, Neto PI, de Oliveira MF, Noritomi PY, Mais FG, de Paula Souza VL, Lopes da Silva JV. 3D-printed valves to assist noninvasive ventilation procedures during the COVID-19 pandemic: a case study. JOURNAL OF 3D PRINTING IN MEDICINE 2020. [PMCID: PMC7863678 DOI: 10.2217/3dp-2020-0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To produce valves to be used with full-face snorkeling masks for noninvasive ventilation (NIV) procedure during the coronavirus disease 2019 (COVID-19) pandemic. Materials & methods: ISINNOVA’s Charlotte valves for full-face snorkeling masks used for NIV procedures were redesigned, produced by selective laser sintering additive manufacturing, and submitted to air leakage tests. Results: The final model assembly did not present air leakage during the NIV procedure on human models, minimizing risks of air contamination. Conclusion: This study shows the feasibility of using additive manufactured valves with snorkel facial masks to support health systems during COVID-19 and possible future pandemics.
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Affiliation(s)
- Guilherme Arthur Longhitano
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
- School of Chemical Engineering, University of Campinas, Campinas 13083-852, Brazil
| | - Geovany Candido
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
| | - Leonardo Mendes Ribeiro Machado
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
| | - Paulo Inforçatti Neto
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
| | - Marcelo Fernandes de Oliveira
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
| | - Pedro Yoshito Noritomi
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
| | | | | | - Jorge Vicente Lopes da Silva
- Laboratory for three-dimensional technologies, Center for Information Technology Renato Archer (CTI), Campinas 13069-901, Brazil
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Stiers M, Bleeser T, Mergeay M, Pinson H, Janssen L, Schepens T. Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model. Crit Care 2020; 24:523. [PMID: 32854740 PMCID: PMC7450145 DOI: 10.1186/s13054-020-03248-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Michiel Stiers
- Department of Emergency Medicine, St-Dimpna, J-B Stessensstraat 2, 2440, Geel, Belgium.
| | - Tom Bleeser
- Department of Anesthesiology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias Mergeay
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J-B Stessensstraat 2, 2440, Geel, Belgium
| | - Hannah Pinson
- Applied Physics and Data Analytics, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Luc Janssen
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J-B Stessensstraat 2, 2440, Geel, Belgium
| | - Tom Schepens
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Mohamed MFH, Al-Shokri S, Yousaf Z, Danjuma M, Parambil J, Mohamed S, Mubasher M, Dauleh MM, Hasanain B, AlKahlout MA, Abubeker IY. Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2020; 103:815-821. [PMID: 32500849 PMCID: PMC7410428 DOI: 10.4269/ajtmh.20-0371] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94–1.00 I2 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13–1.00 I2 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11–0.95 I2 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21–0.58 I2 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00–0.37 I2 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2–infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19–specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.
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Affiliation(s)
- Mouhand F H Mohamed
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shaikha Al-Shokri
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Danjuma
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jessiya Parambil
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Samreen Mohamed
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mujahed M Dauleh
- Nephrology Department, PennState Hershey Medical Center, Hershey, Pennsylvania
| | | | - Mohamed Awni AlKahlout
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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