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Banegas-Deras EJ, Mazón-Ruiz J, Romero-González G, Ruiz-Cobo JC, Sanz-García C, Serrano-Soto M, Sánchez E, Argaiz ER. Acute kidney injury and point-of-care ultrasound in liver cirrhosis: redefining hepatorenal syndrome. Clin Kidney J 2024; 17:sfae112. [PMID: 38726210 PMCID: PMC11079671 DOI: 10.1093/ckj/sfae112] [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: 01/04/2024] [Indexed: 05/12/2024] Open
Abstract
Acute kidney injury (AKI) in patients with cirrhosis is a diagnostic challenge due to multiple and sometimes overlapping possible etiologies. Many times, diagnosis cannot be made based on case history, physical examination or laboratory data, especially when the nephrologist is faced with AKI with a hemodynamic basis, such as hepatorenal syndrome. In addition, the guidelines still include generalized recommendations regarding withdrawal of diuretics and plasma volume expansion with albumin for 48 h, which may be ineffective and counterproductive and may have iatrogenic effects, such as fluid overload and acute cardiogenic pulmonary edema. For this reason, the use of new tools, such as hemodynamic point-of-care ultrasound (PoCUS), allows us to phenotype volume status more accurately and ultimately guide medical treatment in a noninvasive, rapid and individualized manner.
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Affiliation(s)
| | - Jaime Mazón-Ruiz
- Nephrology Department, Central University Hospital of Asturias, Oviedo, Spain
| | - Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Juan Carlos Ruiz-Cobo
- Liver Unit, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Sanz-García
- Nephrology Department, Grande Covián de Arriondas Hospital, Arriondas, Spain
| | - Mara Serrano-Soto
- International Renal Research Institute of Vicenza, Vicenza, Italy
- Nephrology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Emilio Sánchez
- Nephrology Department, Cabueñes University Hospital, Gijón, Spain
| | - Eduardo R Argaiz
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Boyko VV, Tkachenko VV, Sochnieva AL, Kritsak VV. Modern view on the problem of acute pleural empyema surgical treatment. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:327-337. [PMID: 38592997 DOI: 10.36740/wlek202402121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Aim: data study on the results of treatment of acute non-specific purulent-destructive pleura diseases with the purpose of further improvement of its results on the basis of improvement of diagnostics, identification of factors of disease prognosis and by implementing differential tactics of surgical treatment with the use of minimally invasive interventions. PATIENTS AND METHODS Materials and Methods: We have studied modern literary sources on the topic of current trends in the treatment of acute pleural empyema and its complications. The studied material is summarized and presented in the form of a literature review in this article. CONCLUSION Conclusions: These issues cannot be considered to be completely solved and require further study. Everything mentioned above dictates the search of new effective methods of the treatment of the mentioned pathology and proves the relevance of the theme. The outlined information highlights the necessity of improvement of surgical tactics in patients with pleural empyema.
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Affiliation(s)
- Valeriy V Boyko
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE; SI "ZAITSEV INSTITUTE OF GENERAL AND EMERGENCY SURGERY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE", KHARKIV, UKRAINE
| | - Vladimir V Tkachenko
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY ≪KHARKIV POLYTECHNIC INSTITUTE≫, KHARKIV, UKRAINE
| | - Anastasiia L Sochnieva
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY ≪KHARKIV POLYTECHNIC INSTITUTE≫, KHARKIV, UKRAINE
| | - Vasyl V Kritsak
- SI "ZAITSEV INSTITUTE OF GENERAL AND EMERGENCY SURGERY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE", KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY ≪KHARKIV POLYTECHNIC INSTITUTE≫, KHARKIV, UKRAINE
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Koratala A, Kazory A. Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology. World J Nephrol 2023; 12:112-119. [PMID: 38230300 PMCID: PMC10789085 DOI: 10.5527/wjn.v12.i5.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/22/2023] Open
Abstract
Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
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Atmowihardjo LN, Schippers JR, Haaksma ME, Smit MR, Bogaard HJ, Heunks L, Juffermans NP, Schultz MJ, Endeman H, van Velzen P, Tuinman PR, Aman J, Bos LDJ. The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS. Ultrasound J 2023; 15:40. [PMID: 37782370 PMCID: PMC10545605 DOI: 10.1186/s13089-023-00340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS. OBJECTIVES This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS. METHODS In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS-ARDS), an 8-region anterior-lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated. RESULTS 26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS-ARDS (r = 0.58) and anterior-lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior-lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior-lateral and 0.85 for the LUS-ARDS score. CONCLUSIONS Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate-to-severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020-005447-23.
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Affiliation(s)
- Leila N Atmowihardjo
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands.
| | - Job R Schippers
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark E Haaksma
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marry R Smit
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Harm J Bogaard
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole P Juffermans
- Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus University, Rotterdam, the Netherlands
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Henrik Endeman
- Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Patricia van Velzen
- Dijklander Hospital Location Purmerend, Intensive Care, Waterlandlaan 250, Purmerend, The Netherlands
| | - Pieter R Tuinman
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography, Amsterdam, The Netherlands
| | - Jurjan Aman
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Saran S, Misra S, Agrawal A, Siddiqui SS. Can normal breath sounds in mechanically ventilated patients be termed vesicular? Crit Care 2023; 27:377. [PMID: 37777735 PMCID: PMC10543330 DOI: 10.1186/s13054-023-04667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Sai Saran
- Department of Critical Care Medicine, King George Medical University, Lucknow, Chowk, Uttar Pradesh, 226003, India.
| | - Saumitra Misra
- Department of Critical Care Medicine, King George Medical University, Lucknow, Chowk, Uttar Pradesh, 226003, India
| | - Avinash Agrawal
- Department of Critical Care Medicine, King George Medical University, Lucknow, Chowk, Uttar Pradesh, 226003, India
| | - Suhail Sarwar Siddiqui
- Department of Critical Care Medicine, King George Medical University, Lucknow, Chowk, Uttar Pradesh, 226003, India
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Bhasin-Chhabra B, Koratala A. Point of care ultrasonography in onco-nephrology: A stride toward better physical examination. World J Nephrol 2023; 12:29-39. [PMID: 37035508 PMCID: PMC10075017 DOI: 10.5527/wjn.v12.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023] Open
Abstract
Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.
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Affiliation(s)
- Bhavna Bhasin-Chhabra
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Chen J, Shen M, Hou S, Duan X, Yang M, Cao Y, Qin W, Niu Q, Li Q, Zhang Y, Wang Y. Intelligent interpretation of four lung ultrasonographic features with split attention based deep learning model. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Devangam S, Sigakis M, Palmer LJ, Goeddel L, Fiza B. Point-of-Care Ultrasound: A Moving Picture Is Worth a Thousand Tests. Anesthesiol Clin 2023; 41:231-248. [PMID: 36872001 DOI: 10.1016/j.anclin.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The effective utilization of point-of-care ultrasound may decrease the utilization of conventional diagnostic modalities. This review describes the various pathologies that can be effectively and rapidly identified with point-of-care cardiac, lung, abdominal, vascular airway, and ocular ultrasonography.
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Affiliation(s)
- Suhas Devangam
- Department of Anesthesiology, Division of Critical Care, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA
| | - Matthew Sigakis
- Department of Anesthesiology, Division of Critical Care, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA
| | - Louisa J Palmer
- Department of Anesthesiology, Division of Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, USA
| | - Lee Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Bloomberg 6320, 1800 Orleans Street, Baltimore, MD, USA 21287
| | - Babar Fiza
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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Garg S, Kapoor PM. POCUS and Fluid Responsiveness on Venoarterial ECMO. JOURNAL OF CARDIAC CRITICAL CARE TSS 2023. [DOI: 10.25259/jccc_4_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.
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Affiliation(s)
- Sanchita Garg
- Department of Anesthesiolgy and Critical Care, Fortis Hospital, Mohali, Punjab, India,
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Mehta A, Reierson K, Mathews B. Missing Inferior Vena Cava on POCUS: A Case of Left-Sided IVC with Azygos Continuation. POCUS JOURNAL 2023; 8:43-47. [PMID: 37152340 PMCID: PMC10155737 DOI: 10.24908/pocus.v8i1.16240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The merits of utilizing point of care ultrasound (POCUS) in acutely ill patients is leading to a widespread embrace. Assessment of IVC via POCUS as part of a comprehensive multi-organ approach can help guide volume tolerance. Anatomical/developmental variations of IVC can vary widely in prevalence. As the use of POCUS expands as a diagnostic modality, it is prudent for frontline POCUS users to be cognizant of the IVC anomalies. We present a case of left sided IVC with azygous continuation discovered with POCUS that was performed to assess the volume status of the patient. This case illustrates that the awareness of different anomalies of the IVC is necessary for POCUS users to prevent misinterpretation of aberrant vessels and avoid diagnostic pitfalls.
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Affiliation(s)
- Ankit Mehta
- Department of Internal Medicine, HealthPartnersSt. Paul, MNUSA
- Department of Internal Medicine, University of MinnesotaMinneapolis, MNUSA
| | - Kreegan Reierson
- Department of Internal Medicine, HealthPartnersSt. Paul, MNUSA
- Department of Internal Medicine, University of MinnesotaMinneapolis, MNUSA
| | - Benji Mathews
- Department of Internal Medicine, HealthPartnersSt. Paul, MNUSA
- Department of Internal Medicine, University of MinnesotaMinneapolis, MNUSA
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Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
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Bhasin-Chhabra B, Veitla V, Weinberg S, Koratala A. Demystifying hyponatremia: A clinical guide to evaluation and management. Nutr Clin Pract 2022; 37:1023-1032. [PMID: 36036229 DOI: 10.1002/ncp.10907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 08/05/2022] [Indexed: 12/20/2022] Open
Abstract
Hyponatremia (serum sodium <135 mEq/L) is a frequent electrolyte abnormality complicating the clinical care of hospitalized patients. Hyponatremia has been associated with an increased risk of mortality. Hyponatremia can be seen in patients with euvolemia, hypovolemia, or hypervolemia. Evaluation of hyponatremia relies on clinical assessment and estimation of serum sodium, urine electrolytes, and serum and urine osmolality in addition to other case-specific laboratory parameters. In addition, point-of-care ultrasonography is an important adjunct to physical assessment in estimation of volume status. Understanding the pathophysiology of the underlying process can lead to a timely diagnosis and appropriate management of hyponatremia.
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Affiliation(s)
- Bhavna Bhasin-Chhabra
- Division of Nephrology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Vineet Veitla
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel Weinberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Abhilash Koratala
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Mitchell J, Tybout CE, Gorelik L, Bhandary SP, Flores AS. A Case of Severe Tricuspid Valve Regurgitation in a Patient Undergoing Orthotopic Liver Transplantation: Whether to Proceed, or Not. Cureus 2022; 14:e24119. [PMID: 35573521 PMCID: PMC9106544 DOI: 10.7759/cureus.24119] [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] [Accepted: 04/09/2022] [Indexed: 11/11/2022] Open
Abstract
A 38-year-old male presented for orthotopic liver transplantation complicated by new-onset torrential tricuspid regurgitation before incision. Subclinical volume overload and functional tricuspid regurgitation created a challenging scenario in which the benefits of expeditious transplant were weighed against the risks of allograft congestion and failure. Intraoperative transesophageal echocardiography proved critical in diagnosing severe tricuspid regurgitation and guided clinical decision making. In this article, we describe the intraoperative presentation of acutely elevated right heart pressures and the subsequent management of this patient prior to ultimately successful liver transplantation.
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Ilieșiu AM, Hodorogea AS, Balahura AM, Bădilă E. Non-Invasive Assessment of Congestion by Cardiovascular and Pulmonary Ultrasound and Biomarkers in Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12040962. [PMID: 35454010 PMCID: PMC9024731 DOI: 10.3390/diagnostics12040962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Worsening chronic heart failure (HF) is responsible for recurrent hospitalization and increased mortality risk after discharge, irrespective to the ejection fraction. Symptoms and signs of pulmonary and systemic congestion are the most common cause for hospitalization of acute decompensated HF, as a consequence of increased cardiac filling pressures. The elevated cardiac filling pressures, also called hemodynamic congestion, may precede the occurrence of clinical congestion by days or weeks. Since HF patients often have comorbidities, dyspnoea, the main symptom of HF, may be also caused by respiratory or other illnesses. Recent studies underline the importance of the diagnosis and treatment of hemodynamic congestion before HF symptoms worsen, reducing hospitalization and improving prognosis. In this paper we review the role of integrated evaluation of biomarkers and imaging technics, i.e., echocardiography and pulmonary ultrasound, for the diagnosis, prognosis and treatment of congestion in HF patients.
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Affiliation(s)
- Adriana Mihaela Ilieșiu
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Andreea Simona Hodorogea
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Correspondence: ; Tel.: +40-72-631-5872
| | - Ana-Maria Balahura
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| | - Elisabeta Bădilă
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
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Automated 3D thorax model generation using handheld video-footage. Int J Comput Assist Radiol Surg 2022; 17:1707-1716. [PMID: 35357633 PMCID: PMC9463355 DOI: 10.1007/s11548-022-02593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE For the visualization of pulmonary ventilation with Electrical Impedance Tomography (EIT) most devices use standard reconstruction models, featuring common thorax dimensions and predetermined electrode locations. Any discrepancies between the available model and the patient in terms of body shape and electrode position lead to incorrectly displayed impedance distributions. This work addresses that problem by presenting and evaluating a method for 3D model generation of the thorax and any affixed electrodes based on handheld video-footage. METHODS Therefore, a process was developed, providing users with the ability to capture a patient's chest and the attached electrodes via smartphone. Once data is collected, extracted images are used to generate a 3D model with a structure from motion approach and locate electrodes with ArUco markers. For the evaluation of the developed method, multiple tests were performed in laboratory environments, which were compared with manually created reference models and differences quantified based on mean distance, standard deviation, and maximum distance. RESULTS The implemented workflow allows for automated model reconstruction based on videos or selected images captured with a handheld device. It generates sparse point clouds from which a surface mesh is reconstructed and returns relative coordinates of any identified ArUco marker. The average value for the mean distance error of two model generations was 5.4 mm while the mean standard deviation was 6.0 mm. The average runtime of twelve reconstructions was 5:17 min, with a minimal runtime of 3:22 min and a maximal runtime of 7:29 min. CONCLUSION The presented methods and results show that model reconstruction of a patient's thorax and applied electrodes at an emergency site is feasible with already available devices. This is a first step toward the automated generation of patient-specific reconstruction models for Electrical Impedance Tomography based on images recorded with handheld devices.
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Antúnez-Montes O, Buonsenso D. Routine use of Point-of-Care lung ultrasound during the COVID-19 pandemic. MEDICINA INTENSIVA (ENGLISH EDITION) 2022; 46:42-45. [PMID: 34991872 PMCID: PMC8720945 DOI: 10.1016/j.medine.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
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Abstract
Volume status assessment is a critical but challenging clinical skill and is especially important for the management of patients in the emergency department, intensive care unit, and dialysis unit where accurate intravascular assessment is necessary to guide appropriate fluid management. Assessment of volume status is subjective and can vary from provider to provider, posing clinical dilemmas. Traditional non-invasive methods of volume assessment include assessment of skin turgor, axillary sweat, peripheral edema, pulmonary crackles, orthostatic vital signs, and jugular venous distension. Invasive assessments of volume status include direct measurement of central venous pressure and pulmonary artery pressures. Each of these has their own limitations, challenges, and pitfalls and were often validated based on small cohorts with questionable comparators. In the past 30 years, the increased availability, progressive miniaturization, and falling price of ultrasound devices has made point of care ultrasound (POCUS) widely available. Emerging evidence base and increased uptake across multiple subspecialities has facilitated the adoption of this technology. POCUS is now widely available, relatively inexpensive, free of ionizing radiation, and can help providers make medical decisions with more precision. POCUS is not intended to replace the physical exam, but rather to complement clinical assessment, guiding providers to give thorough and accurate clinical care to their patients. We should be mindful of the nascent literature supporting the use of POCUS and other limitations as uptake increases among providers and be wary not to use POCUS to substitute clinical judgement, but integrate ultrasonographic findings carefully with history and clinical examination.
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Affiliation(s)
- David Kearney
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
| | - Nathaniel Reisinger
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
| | - Sadichhya Lohani
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
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18
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Antúnez-Montes OY, Buonsenso D. Routine use of Point-of-Care lung ultrasound during the COVID-19 pandemic. Med Intensiva 2022. [PMID: 32386997 DOI: 10.1016/j.medin.2020.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- O Y Antúnez-Montes
- Departamento de Docencia e Investigación. Instituto Latinoamericano de Ecografía en Medicina (ILEM), Ciudad de México, Mexico
- SOLJAC MD Servicios Médicos de Emergencia, Aeropuerto Internacional de la Ciudad de México AICM, Mexico
| | - D Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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19
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Ibrahim A, Elbeny HM, Soliman R, Belal S. Lung Ultrasound versus Pulmonary Auscultation in Detecting Pulmonary Congestion in the Critically Ill. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound (LUS) as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema.
AIM: The aim of this study was to compare LUS versus pulmonary auscultation for detecting pulmonary edema in critically ill patients.
PATIENTS AND METHODS: Sixty-one patients were included in this study, all included patients underwent clinical examination, chest auscultation of anterior and lateral (axillary) chest wall and back in each hemithorax in supine position was done, followed by LUS using Bedside LUS in Emergency (BLUE) protocol. LUS score was recorded; abnormal auscultation was defined as the presence of rales or wheezes. Laboratory tests were done on admission such as pro-BNP, renal function, and blood gases. Pro-BNP was used as diagnostic tool for volume overload and was correlated with LUS and stethoscope for detecting pulmonary edema. Pneumonia was excluded with normal total leukocyte counts, C-reactive protein, and absence of fever.
RESULTS: This study included 61 patients with diagnosis of pulmonary edema, all data were recorded on admission and showed that there was statistically significant good positive correlation between LUS and Pro-BNP (p < 0.05), and Pearson correlation between LUS and Pro-BNP among the studied patients is statistically significant at the 0.01 level (two-tailed). Furthermore, we found that both LUS and Pro-BNP were statistically significant higher among patients with rales (p < 0.05) only 36 (59%) patients were positive as pulmonary edema with pulmonary auscultation (presence of rales) and 25 (41%) patients were negative for pulmonary edema (NO RALES) while they were positive for pulmonary edema with LUS (high LUS score)and pro-BNP.
CONCLUSION: Pulmonary auscultation has poor sensitivity for pulmonary congestion while LUS had statistically significant higher sensitivity for pulmonary edema.
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20
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Argaiz ER, Koratala A, Reisinger N. Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography. KIDNEY360 2021; 2:1326-1338. [PMID: 35369665 PMCID: PMC8676400 DOI: 10.34067/kid.0006482020 10.34067/kid.0006482020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2024]
Abstract
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Affiliation(s)
- Eduardo R. Argaiz
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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21
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Argaiz ER, Koratala A, Reisinger N. Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography. KIDNEY360 2021; 2:1326-1338. [PMID: 35369665 PMCID: PMC8676400 DOI: 10.34067/kid.0006482020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Affiliation(s)
- Eduardo R. Argaiz
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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22
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Koratala A, Ronco C, Kazory A. Albumin Infusion in Patients with Cirrhosis: Time for POCUS-Enhanced Physical Examination. Cardiorenal Med 2021; 11:161-165. [PMID: 34261064 DOI: 10.1159/000517363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
Objective assessment of fluid status is of utmost significance in the management of patients with complex disorders involving hemodynamics and multi-organ crosstalk such as cardiorenal or hepatorenal syndrome. The role of volume expansion using intravenous albumin in the setting of hepatorenal syndrome has been an everlasting debate among clinicians. With the accumulating evidence on the deleterious consequences of iatrogenic fluid overload, empiric albumin administration in these patients has been the focus of much attention, and the findings of recent studies suggest a higher incidence of pulmonary complications with albumin. Poor sensitivity of conventional physical examination has led to an interest in the utility of novel noninvasive bedside tools such as point-of-care ultrasonography (POCUS) to evaluate hemodynamics more precisely. Once confined to specialties such as obstetrics and emergency medicine, the scope of diagnostic POCUS is rapidly expanding in other fields including internal medicine and nephrology. Herein, we offer our perspective on the emerging role of POCUS for objective evaluation of patients with suspected hepatorenal physiology based on our experience. We propose that future clinical trials consider incorporating this strategy and explore the impact of POCUS-guided therapy on the outcomes.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Claudio Ronco
- Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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23
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Koratala A, Kazory A. An Introduction to Point-of-Care Ultrasound: Laennec to Lichtenstein. Adv Chronic Kidney Dis 2021; 28:193-199. [PMID: 34906303 DOI: 10.1053/j.ackd.2021.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Point-of-care ultrasonography (POCUS) is rapidly evolving as a noninvasive adjunct to physical examination among various specialties. POCUS increases the sensitivity of conventional physical examination by providing the answers to simple clinical questions at the bedside. As such, it can reduce fragmentation of care and expedite management. In addition, using bedside ultrasound as the first-line investigation may eliminate unnecessary radiation and contrast exposure. The advent of highly portable and affordable ultrasound devices has made the use of POCUS more practical and user-friendly, making it the stethoscope of the 21st century. This review will provide an overview of the rationale for integrating POCUS into nephrology practice. We also discuss the current scope of POCUS practice and state of training.
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24
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Goyal P, Minardi J, Sakhuja A. Cardiac Ultrasound for the Nephrologist: Know Thy Heart to Know Thy Kidneys. Adv Chronic Kidney Dis 2021; 28:208-217. [PMID: 34906305 DOI: 10.1053/j.ackd.2021.04.001] [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: 12/15/2020] [Revised: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 11/11/2022]
Abstract
Kidney disease patients have a high prevalence of cardiovascular morbidity and mortality. It can be challenging to adequately assess their cardiovascular status based on physical examination alone. Cardiac ultrasound has proven to be a powerful tool to accomplish this objective and is increasingly being adopted by noncardiologists to augment their skills and expedite clinical decision-making. With the advent of inexpensive and portable ultrasound equipment, simplified protocols, and focused training, it is becoming easier to master basic cardiac ultrasound techniques. After a short course of training in focused cardiac ultrasound, nephrologists can quickly and reliably assess ventricular size and function, detect clinically relevant pericardial effusion and volume status in their patients. Additional training in Doppler ultrasound can extend their capability to measure cardiac output, right ventricular systolic pressure, and diastolic dysfunction. This information can be instrumental in effectively managing patients in inpatient, office, and dialysis unit settings. The purpose of this review is to highlight the importance and feasibility of incorporating cardiac ultrasound in nephrology practice, discuss the principles of basic and Doppler ultrasound modalities and their clinical utility from a nephrologist's perspective.
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25
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Lehoczky L, Southworth AB, Martinez GZ, Belfort MA, Shamshirsaz AA, Shamshirsaz A, Sanz Cortes M, Nassr AA, Donepudi R, Whitehead WE, Johnson R, Meshinchi N, Espinoza J. Magnesium sulfate titration reduces maternal complications following fetoscopic closure of spina bifida. Prenat Diagn 2021; 41:983-988. [PMID: 33591585 DOI: 10.1002/pd.5923] [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: 06/11/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate if magnesium sulfate (MgSO4 ) titration following fetoscopic spina bifida closure is associated with fewer maternal complications than the Management of Myelomeningocele Study (MOMS) tocolytic regimen. METHODS This prospective cohort study included 73 consecutive patients undergoing fetoscopic closure of spina bifida between 2015 and 2020. A policy of using the MgSO4 regimen per the MOMS trial was changed to a flexible one in which MgSO4 was titrated according to the frequency of the uterine contractions following surgery. The frequency of maternal pulmonary edema, low maternal oxygen saturation requiring oxygen supplementation, atelectasis, hypocalcemia, and preterm delivery was compared before and after the policy was changed. RESULTS A higher proportion of women in the group that used the MOMS MgSO4 regimen had pulmonary edema compared to those in the flexible one (26.1% [6/23] vs. 6% [3/50]; p = 0.024). Multivariate analysis showed that the MOMS tocolytic regimen was independently associated with a higher risk of pulmonary edema (adjusted odds ratio: 8.57; 95% confidence interval: 1.54-47.7; p = 0.014) than a flexible one. There was no difference in the rate of preterm delivery. CONCLUSION Following fetoscopic closure of spina bifida, the MOMS MgSO4 regimen is associated with an increased risk of pulmonary edema than a more flexible regimen.
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Affiliation(s)
- Lucy Lehoczky
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA.,Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Annie B Southworth
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Gabriela Z Martinez
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Michael A Belfort
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Alireza A Shamshirsaz
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Amir Shamshirsaz
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Magdalena Sanz Cortes
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Ahmed A Nassr
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Roopali Donepudi
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - William E Whitehead
- Department of Neurosurgery, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Rebecca Johnson
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Nazli Meshinchi
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
| | - Jimmy Espinoza
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas, USA
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26
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Öztürk Sönmez L, Katipoğlu B, Vatansev H, Kaykisiz EK, Yüce N, Szarpak L, Evrin T. The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments. Ultrasound Q 2021; 37:261-266. [PMID: 34478425 DOI: 10.1097/ruq.0000000000000559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). METHODS Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. RESULTS According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). CONCLUSIONS In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap.
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Affiliation(s)
| | - Burak Katipoğlu
- Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara
| | - Hülya Vatansev
- Department of Chest Diseases, Meram Medical Faculty, Necmettin Erbakan University, Konya
| | | | - Nalan Yüce
- Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara
| | | | - Togay Evrin
- Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara
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27
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Antúnez‐Montes OY, Buonsenso D, Paz‐Ortega SO. Feasibility of Lung Point-of-Care Ultrasound for Patients With COVID-19 in Air Medical Transport: Triage of 2 Initially Suspected Cases on Mexico's Front Line. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:419-427. [PMID: 32757224 PMCID: PMC7436421 DOI: 10.1002/jum.15414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Omar Yassef Antúnez‐Montes
- Departamento de Docencia e InvestigaciónInstituto Latinoamericano de Ecografía en MedicinaMexico CityMexico
- Ángel Flight Mx, Fundación Para el Traslado del Paciente en Estado Crítico por Helicóptero AmbulanciaMexico CityMexico
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere ScientificoRomeItaly
- Isituto di Microbiologia, Università Cattolica del Sacro CuoreRomeItaly
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28
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Kiefl D, Eisenmann S, Michels G, Schmid M, Ludwig C, Pin M, Glöckner E, Petersen PF, Damjanovic D, Schellhaas S, Janssens U, Fandler M, Blaschke S, Geuting M, Müller T, Menzel J, Heinzmann A, Helm M, Dinse-Lambracht A, Bernhard M, Spethmann S, Stock KF, Clevert DA, Breitkreutz R. [German recommendations on lung and thoracic ultrasonography in patients with COVID-19]. Med Klin Intensivmed Notfmed 2020; 115:654-667. [PMID: 33044655 PMCID: PMC7548535 DOI: 10.1007/s00063-020-00740-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV‑2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).
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Affiliation(s)
- Daniel Kiefl
- Klinik für Interdisziplinäre Notfallmedizin, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach am Main, Deutschland.
| | - Stephan Eisenmann
- Schwerpunkt Pneumologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Mathias Schmid
- Klinik für Gastroenterologie, Pneumologie, Internistische Akut- und Intensivmedizin, München Klinik Harlaching, München, Deutschland
| | - Corinna Ludwig
- Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale interdisziplinäre Notaufnahme und Aufnahmebereich, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Erika Glöckner
- Klinik für Gastroenterologie, Endokrinologie und Zentrale Notaufnahme Nord, Klinikum Nürnberg Nord, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | | | - Domagoj Damjanovic
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Martin Fandler
- Interdisziplinäre Notaufnahme, Klinikum Bamberg, Bamberg, Deutschland
| | - Sabine Blaschke
- Interdisziplinäre Notaufnahme, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Markus Geuting
- Abteilung Anästhesie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - Thomas Müller
- Medizinische Klinik II, St. Josefs-Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Joseph Menzel
- DEGUM Kursleiter Innere Medizin, Endosonographie, Medizinische Klinik II, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | | | - Matthias Helm
- Abteilung X (Anästhesie), Bundeswehrkrankenhaus, Ulm, Deutschland
| | - Alexander Dinse-Lambracht
- Interdisziplinäres Notfallzentrum, Trägergesellschaft Kliniken Aurich-Emden-Norden, Aurich-Emden-Norden, Deutschland
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Sebastian Spethmann
- Medizinische Klinik A, Kardiologie, Angiologie, Nephrologie, internistische Intensivmedizin, Medizinische Hochschule Brandenburg, Campus Ruppiner Kliniken, Neuruppin, Deutschland
| | - Konrad F Stock
- Nephrologisches Ultraschalllabor, TU München, München, Deutschland
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschallzentrum, Universität München, Klinikum Großhadern, München, Deutschland
| | - Raoul Breitkreutz
- Fachbereich/Institut f. Gesundheit & Soziales (IfGS), FOM Hochschule für Ökonomie & Management, Franklinstr. 52, 60486, Frankfurt am Main, Deutschland.
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29
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Palmese F, Caroli B, Graziani A, Zanframundo G, Del Toro R, Sagrini E, Cataleta P, Domenicali M. Daily Evaluation of COVID-19 Patients Primarily Based on Lung Ultrasound: In Times of Emergency, It's Time to Change Some Paradigms. Am J Trop Med Hyg 2020; 103:922-923. [PMID: 32534598 PMCID: PMC7410475 DOI: 10.4269/ajtmh.20-0596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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30
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Koratala A, Ronco C, Kazory A. Need for Objective Assessment of Volume Status in Critically Ill Patients with COVID-19: The Tri-POCUS Approach. Cardiorenal Med 2020; 10:209-216. [PMID: 32460302 PMCID: PMC7316643 DOI: 10.1159/000508544] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) continues to spread across the globe, the knowledge of its epidemiology, clinical features, and management is rapidly evolving. Nevertheless, the data on optimal fluid management strategies for those who develop critical illness remain sparse. Adding to the challenge, the fluid volume status of these patients has been found to be dynamic. Some present with several days of malaise, gastrointestinal symptoms, and consequent hypovolemia requiring aggressive fluid resuscitation, while a subset develop acute respiratory distress syndrome with renal dysfunction and lingering congestion necessitating restrictive fluid management. Accurate objective assessment of volume status allows physicians to tailor the fluid management goals throughout this wide spectrum of critical illness. Conventional point-of-care ultrasonography (POCUS) enables the reliable assessment of fluid status and reducing the staff exposure. However, due to specific characteristics of COVID-19 (e.g., rapidly expanding lung lesions), a single imaging method such as lung POCUS will have significant limitations. Herein, we suggest a Tri-POCUS approach that represents concurrent bedside assessment of the lungs, heart, and the venous system. This combinational approach is likely to overcome the limitations of the individual methods and provide a more precise evaluation of the volume status in critically ill patients with COVID-19.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA,
| | - Claudio Ronco
- Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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Antúnez-Montes OY, Buonsenso D. Routine use of Point-of-Care lung ultrasound during the COVID-19 pandemic. Med Intensiva 2020; 46:42-45. [PMID: 32386997 PMCID: PMC7174161 DOI: 10.1016/j.medin.2020.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- O Y Antúnez-Montes
- Departamento de Docencia e Investigación. Instituto Latinoamericano de Ecografía en Medicina (ILEM), Ciudad de México, Mexico; SOLJAC MD Servicios Médicos de Emergencia, Aeropuerto Internacional de la Ciudad de México AICM, Mexico.
| | - D Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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