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Zhang Q, Song R, Hang J, Wei S, Zhu Y, Zhang G, Ding B, Ye X, Guo X, Zhang D, Wu P, Lin H, Tu J. A lung disease diagnosis algorithm based on 2D spectral features of ultrasound RF signals. ULTRASONICS 2024; 140:107315. [PMID: 38603903 DOI: 10.1016/j.ultras.2024.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
Lung diseases are commonly diagnosed based on clinical pathological indications criteria and radiological imaging tools (e.g., X-rays and CT). During a pandemic like COVID-19, the use of ultrasound imaging devices has broadened for emergency examinations by taking their unique advantages such as portability, real-time detection, easy operation and no radiation. This provides a rapid, safe, and cost-effective imaging modality for screening lung diseases. However, the current pulmonary ultrasound diagnosis mainly relies on the subjective assessments of sonographers, which has high requirements for the operator's professional ability and clinical experience. In this study, we proposed an objective and quantifiable algorithm for the diagnosis of lung diseases that utilizes two-dimensional (2D) spectral features of ultrasound radiofrequency (RF) signals. The ultrasound data samples consisted of a set of RF signal frames, which were collected by professional sonographers. In each case, a region of interest of uniform size was delineated along the pleural line. The standard deviation curve of the 2D spatial spectrum was calculated and smoothed. A linear fit was applied to the high-frequency segment of the processed data curve, and the slope of the fitted line was defined as the frequency spectrum standard deviation slope (FSSDS). Based on the current data, the method exhibited a superior diagnostic sensitivity of 98% and an accuracy of 91% for the identification of lung diseases. The area under the curve obtained by the current method exceeded the results obtained that interpreted by professional sonographers, which indicated that the current method could provide strong support for the clinical ultrasound diagnosis of lung diseases.
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Affiliation(s)
- Qi Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Jing Hang
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Siqi Wei
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yifei Zhu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Guofeng Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Bo Ding
- Zhuhai Ecare Electronics Science & Technology Co., Ltd., Zhuhai 519041, China
| | - Xinhua Ye
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiasheng Guo
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Pingping Wu
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China
| | - Han Lin
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China.
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China.
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Snelling PJ, Jones P, Connolly R, Jelic T, Mirsch D, Myslik F, Phillips L, Blecher G. Comparison of lung ultrasound scoring systems for the prognosis of COVID-19 in the emergency department: An international prospective cohort study. Australas J Ultrasound Med 2024; 27:75-88. [PMID: 38784699 PMCID: PMC11109992 DOI: 10.1002/ajum.12364] [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: 05/25/2024] Open
Abstract
Purpose The purpose of this study was to evaluate whether the lung ultrasound (LUS) scores applied to an international cohort of patients presenting to the emergency department (ED) with suspected COVID-19, and subsequently admitted with proven disease, could prognosticate clinical outcomes. Methods This was an international, multicentre, prospective, observational cohort study of patients who received LUS and were followed for the composite primary outcome of intubation, intensive care unit (ICU) admission or death. LUS scores were later applied including two 12-zone protocols ('de Alencar score' and 'CLUE score'), a 12-zone protocol with lung and pleural findings ('Ji score') and an 11-zone protocol ('Tung-Chen score'). The primary analysis comprised logistic regression modelling of the composite primary outcome, with the LUS scores analysed individually as predictor variables. Results Between April 2020 to April 2022, 129 patients with COVID-19 had LUS performed according to the protocol and 24 (18.6%) met the composite primary endpoint. No association was seen between the LUS score and the composite primary end point for the de Alencar score [odds ratio (OR) = 1.04; 95% confidence interval (CI): 0.97-1.11; P = 0.29], the CLUE score (OR = 1.03; 95% CI: 0.96-1.10; P = 0.40), the Ji score (OR = 1.02; 95% CI: 0.97-1.07; P = 0.40) or the Tung-Chen score (OR = 1.02; 95% CI: 0.97-1.08). Discussion Compared to these earlier studies performed at the start of the pandemic, the negative outcome of our study could reflect the changing scenario of the COVID-19 pandemic, including patient, disease, and system factors. The analysis suggests that the study may have been underpowered to detect a weaker association between a LUS score and the primary outcome. Conclusion In an international cohort of adult patients presenting to the ED with suspected COVID-19 disease who had LUS performed and were subsequently admitted to hospital, LUS severity scores did not prognosticate the need for invasive ventilation, ICU admission or death.
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Affiliation(s)
- Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Philip Jones
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Rory Connolly
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Dan Mirsch
- Department of Emergency MedicineUniversity at BuffaloBuffaloNew YorkUSA
| | - Frank Myslik
- Division of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Luke Phillips
- Department of Emergency MedicineAlfred HospitalMelbourneVictoriaAustralia
- Department of Epidemiology and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Gabriel Blecher
- Emergency Services, Peninsula HealthFrankstonVictoriaAustralia
- Peninsula Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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3
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Lai SY, Schafer JM, Meinke M, Beals T, Doff M, Grossestreuer A, Hoffmann B. Lung Ultrasound Score in COVID-19 Patients Correlates with PO 2/FiO 2, Intubation Rates, and Mortality. West J Emerg Med 2024; 25:28-39. [PMID: 38205982 PMCID: PMC10777190 DOI: 10.5811/westjem.59975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The point-of-care lung ultrasound (LUS) score has been used in coronavirus 2019 (COVID-19) patients for diagnosis and risk stratification, due to excellent sensitivity and infection control concerns. We studied the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (PO2/FiO2), intubation rates, and mortality correlation to the LUS score. Methods We conducted a systematic review using PRISMA guidelines. Included were articles published from December 1, 2019-November 30, 2021 using LUS in adult COVID-19 patients in the intensive care unit or the emergency department. Excluded were studies on animals and on pediatric and pregnant patients. We assessed bias using QUADAS-2. Outcomes were LUS score and correlation to PO2/FiO2, intubation, and mortality rates. Random effects model pooled the meta-analysis results. Results We reviewed 27 of 5,267 studies identified. Of the 27 studies, seven were included in the intubation outcome, six in the correlation to PO2/FiO2 outcome, and six in the mortality outcome. Heterogeneity was found in ultrasound protocols and outcomes. In the pooled results of 267 patients, LUS score was found to have a strong negative correlation to PO2/FiO2 with a correlation coefficient of -0.69 (95% confidence interval [CI] -0.75, -0.62). In pooled results, 273 intubated patients had a mean LUS score that was 6.95 points higher (95% CI 4.58-9.31) than that of 379 non-intubated patients. In the mortality outcome, 385 survivors had a mean LUS score that was 4.61 points lower (95% CI 3.64-5.58) than that of 181 non-survivors. There was significant heterogeneity between the studies as measured by the I2 and Cochran Q test. Conclusion A higher LUS score was strongly correlated with a decreasing PO2/FiO2 in COVID-19 pneumonia patients. The LUS score was significantly higher in intubated vs non-intubated patients with COVID-19. The LUS score was significantly lower in critically ill patients with COVID-19 pneumonia that survive.
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Affiliation(s)
- Shin-Yi Lai
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- St Vincent Hospital, Department of Emergency Medicine, Associated Physicians of Harvard Medical Faculty Physicians, Worcester, Massachusetts
| | - Jesse M Schafer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Mary Meinke
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Tyler Beals
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Doff
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Anne Grossestreuer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
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Sultan LR, Haertter A, Al-Hasani M, Demiris G, Cary TW, Tung-Chen Y, Sehgal CM. Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound. AI 2023; 4:875-887. [PMID: 37929255 PMCID: PMC10623579 DOI: 10.3390/ai4040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a computer-based system for COVID-19 detection using lung ultrasound. The purpose of the analysis was to emphasize the potential of the proposed AI technology for improving diagnostic performance, especially for users with less experience.
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Affiliation(s)
- Laith R. Sultan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Allison Haertter
- Radiation Oncology Department, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryam Al-Hasani
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - George Demiris
- Informatics Division of the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore W. Cary
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - Yale Tung-Chen
- Emergency Medicine Department, La Madrida Hospital, 28006 Madrid, Spain
| | - Chandra M. Sehgal
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
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Kheir M, Dong V, Roselli V, Mina B. The role of ultrasound in predicting non-invasive ventilation outcomes: a systematic review. Front Med (Lausanne) 2023; 10:1233518. [PMID: 38020158 PMCID: PMC10644356 DOI: 10.3389/fmed.2023.1233518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To systematically review and compare ultrasonographic methods and their utility in predicting non-invasive ventilation (NIV) outcomes. Methods A systematic review was performed using the PubMed, Medline, Embase, and Cochrane databases from January 2015 to March 2023. The search terms included the following: ultrasound, diaphragm, lung, prediction, non-invasive, ventilation, and outcomes. The inclusion criteria were prospective cohort studies on adult patients requiring non-invasive ventilation in the emergency department or inpatient setting. Results Fifteen studies were analyzed, which comprised of 1,307 patients (n = 942 for lung ultrasound score studies; n = 365 patients for diaphragm dysfunction studies). Lung ultrasound scores (LUS) greater than 18 were associated with NIV failure with a sensitivity 62-90.5% and specificity 60-91.9%. Similarly, a diaphragm thickening fraction (DTF) of less than 20% was also associated with NIV failure with a sensitivity 80-84.6% and specificity 76.3-91.5%. Conclusion Predicting NIV failure can be difficult by routine initial clinical impression and diagnostic work up. This systematic review emphasizes the importance of using lung and diaphragm ultrasound, in particular the lung ultrasound score and diaphragm thickening fraction respectively, to accurately predict NIV failure, including the need for ICU-level of care, requiring invasive mechanical ventilation, and resulting in higher rates of mortality.
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Affiliation(s)
- Matthew Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Vincent Dong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, United States
| | - Victoria Roselli
- Office of Clinical Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Bushra Mina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Schäfer VS, Recker F, Kretschmer E, Putensen C, Ehrentraut SF, Staerk C, Fleckenstein T, Mayr A, Seibel A, Schewe JC, Petzinna SM. Lung Ultrasound in Predicting Outcomes in Patients with COVID-19 Treated with Extracorporeal Membrane Oxygenation. Viruses 2023; 15:1796. [PMID: 37766203 PMCID: PMC10535976 DOI: 10.3390/v15091796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Pulmonary involvement due to SARS-CoV-2 infection can lead to acute respiratory distress syndrome in patients with COVID-19. Consequently, pulmonary imaging is crucial for management of COVID-19. This study aimed to evaluate the prognostic value of lung ultrasound (LUS) with a handheld ultrasound device (HHUD) in patients with COVID-19 treated with extracorporeal membrane oxygenation (ECMO). Therefore, patients underwent LUS with a HHUD every two days until they were either discharged from the intensive care unit or died. The study was conducted at the University Hospital of Bonn's anesthesiological intensive care ward from December 2020 to August 2021. A total of 33 patients (median [IQR]: 56.0 [53-60.5] years) were included. A high LUS score was associated with a decreased P/F ratio (repeated measures correlation [rmcorr]: -0.26; 95% CI: -0.34, -0.15; p < 0.001), increased extravascular lung water, defined as fluid accumulation in the pulmonary interstitium and alveoli (rmcorr: 0.11; 95% CI: 0.01, 0.20; p = 0.030), deteriorated electrolyte status (base excess: rmcorr: 0.14; 95% CI: 0.05, 0.24; p = 0.004; pH: rmcorr: 0.12; 95% CI: 0.03, 0.21; p = 0.001), and decreased pulmonary compliance (rmcorr: -0.10; 95% CI: -0.20, -0.01; p = 0.034). The maximum LUS score was lower in survivors (median difference [md]: -0.35; 95% CI: -0.55, -0.06; p = 0.006). A cutoff value for non-survival was calculated at a LUS score of 2.63. At the time of maximum LUS score, P/F ratio (md: 1.97; 95% CI: 1.12, 2.76; p < 0.001) and pulmonary compliance (md: 18.67; 95% CI: 3.33, 37.15; p = 0.018) were higher in surviving patients. In conclusion, LUS with a HHUD enables continuous evaluation of cardiopulmonary function in COVID-19 patients receiving ECMO support therapy and provides prognostic value in determining the patients' likelihood of survival.
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Affiliation(s)
- Valentin Sebastian Schäfer
- Department of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, 53113 Bonn, Germany; (V.S.S.); (E.K.)
| | - Florian Recker
- Department of Obstetrics and Gynecology, University Hospital of Bonn, 53113 Bonn, Germany;
| | - Edgar Kretschmer
- Department of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, 53113 Bonn, Germany; (V.S.S.); (E.K.)
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, 53113 Bonn, Germany; (C.P.); (S.F.E.); (J.-C.S.)
| | - Stefan Felix Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, 53113 Bonn, Germany; (C.P.); (S.F.E.); (J.-C.S.)
| | - Christian Staerk
- Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53113 Bonn, Germany; (C.S.); (T.F.); (A.M.)
| | - Tobias Fleckenstein
- Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53113 Bonn, Germany; (C.S.); (T.F.); (A.M.)
| | - Andreas Mayr
- Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53113 Bonn, Germany; (C.S.); (T.F.); (A.M.)
| | - Armin Seibel
- Department of Intensive Care Medicine, DRK Hospital Kirchen, 57548 Kirchen, Germany;
| | - Jens-Christian Schewe
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, 53113 Bonn, Germany; (C.P.); (S.F.E.); (J.-C.S.)
- Department of Anaesthesiology Intensive Care Medicine and Pain Therapy, University Medical Centre Rostock, 18057 Rostock, Germany
| | - Simon Michael Petzinna
- Department of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, 53113 Bonn, Germany; (V.S.S.); (E.K.)
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Clofent D, Culebras M, Felipe-Montiel A, Arjona-Peris M, Granados G, Sáez M, Pilia F, Ferreiro A, Álvarez A, Loor K, Bosch-Nicolau P, Polverino E. Serial lung ultrasound in monitoring viral pneumonia: the lesson learned from COVID-19. ERJ Open Res 2023; 9:00017-2023. [PMID: 37583967 PMCID: PMC10423983 DOI: 10.1183/23120541.00017-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/15/2023] [Indexed: 08/17/2023] Open
Abstract
Background Lung ultrasound (LUS) has proven to be useful in the evaluation of lung involvement in COVID-19. However, its effectiveness for predicting the risk of severe disease is still up for debate. The aim of the study was to establish the prognostic accuracy of serial LUS examinations in the prediction of clinical deterioration in hospitalised patients with COVID-19. Methods Prospective single-centre cohort study of patients hospitalised for COVID-19. The study protocol consisted of a LUS examination within 24 h from admission and a follow-up examination on day 3 of hospitalisation. Lung involvement was evaluated by a 14-area LUS score. The primary end-point was the ability of LUS to predict clinical deterioration defined as need for intensive respiratory support with high-flow oxygen or invasive mechanical ventilation. Results 200 patients were included and 35 (17.5%) of them reached the primary end-point and were transferred to the intensive care unit (ICU). The LUS score at admission had been significantly higher in the ICU group than in the non-ICU group (22 (interquartile range (IQR) 20-26) versus 12 (IQR 8-15)). A LUS score at admission ≥17 was shown to be the best cut-off point to discriminate patients at risk of deterioration (area under the curve (AUC) 0.95). The absence of progression in LUS score on day 3 significantly increased the prediction accuracy by ruling out deterioration with a negative predictive value of 99.29%. Conclusion Serial LUS is a reliable tool in predicting the risk of respiratory deterioration in patients hospitalised due to COVID-19 pneumonia. LUS could be further implemented in the future for risk stratification of viral pneumonia.
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Affiliation(s)
- David Clofent
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Mario Culebras
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Almudena Felipe-Montiel
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marta Arjona-Peris
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Galo Granados
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - María Sáez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Florencia Pilia
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Antía Ferreiro
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Álvarez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Karina Loor
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eva Polverino
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
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8
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Gil-Rodríguez J, Martos-Ruiz M, Benavente-Fernández A, Aranda-Laserna P, Montero-Alonso MÁ, Peregrina-Rivas JA, Fernández-Reyes D, Martínez de Victoria-Carazo J, Guirao-Arrabal E, Hernández-Quero J. Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:531-539. [PMID: 37337552 PMCID: PMC10273011 DOI: 10.1016/j.medcle.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/06/2023] [Indexed: 06/21/2023]
Abstract
Objectives Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. Methods Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. Results From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS > 15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR] = 3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR = 1.303, CI 1.137-1.493), and with 28-days mortality (OR = 1.024, CI 1.006-1.042). LUS > 15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS ≤ 7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS > 20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917). Conclusions LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS ≤ 7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS > 15 would be the point which better discriminates mild from severe disease.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Miguel Ángel Montero-Alonso
- Department of Statistics and Operational Research, University of Granada, Avenida de la Investigación n° 11, 18071 Granada, Spain
| | | | - Daniel Fernández-Reyes
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - José Hernández-Quero
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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Maggi L, De Fazio G, Guglielmi R, Coluzzi F, Fiorelli S, Rocco M. COVID-19 Lung Ultrasound Scores and Lessons from the Pandemic: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111972. [PMID: 37296825 DOI: 10.3390/diagnostics13111972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The WHO recently declared that COVID-19 no longer constitutes a public health emergency of international concern; however, lessons learned through the pandemic should not be left behind. Lung ultrasound was largely utilized as a diagnostic tool thanks to its feasibility, easy application, and the possibility to reduce the source of infection for health personnel. Lung ultrasound scores consist of grading systems used to guide diagnosis and medical decisions, owning a good prognostic value. In the emergency context of the pandemic, several lung ultrasound scores emerged either as new scores or as modifications of pre-existing ones. Our aim is to clarify the key aspects of lung ultrasound and lung ultrasound scores to standardize their clinical use in a non-pandemic context. The authors searched on PubMed for articles related to "COVID-19", "ultrasound", and "Score" until 5 May 2023; other keywords were "thoracic", "lung", "echography", and "diaphragm". A narrative summary of the results was made. Lung ultrasound scores are demonstrated to be an important tool for triage, prediction of severity, and aid in medical decisions. Ultimately, the existence of numerous scores leads to a lack of clarity, confusion, and an absence of standardization.
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Affiliation(s)
- Luigi Maggi
- Government of Italy Ministry of Interior, 00189 Rome, Italy
| | - Giulia De Fazio
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Riccardo Guglielmi
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Silvia Fiorelli
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Monica Rocco
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
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Nova A, Rezoagli E, Eronia N, Benini A, Scognamiglio A, Foti G, Bellani G. Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19. Diagnostics (Basel) 2023; 13:diagnostics13071361. [PMID: 37046578 PMCID: PMC10093387 DOI: 10.3390/diagnostics13071361] [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: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Background: Noninvasive ventilation, mainly helmet CPAP, was widely used during the COVID-19 pandemic, even outside of intensive care units. Both the ROX index and the LUS score (LUSS) have been proposed as tools to predict negative outcomes in patients with hypoxemia treated with noninvasive ventilation (NIV) outside of ICUs. We aim to evaluate whether the combination of LUSS with the ROX index improves the predictive performance of these indices in patients with hypoxemia due to COVID-19 pneumonia, treated with NIV outside of ICUs. Methods: This is a monocentric prospective observational study conducted at the university teaching hospital Fondazione IRCCS San Gerardo dei Tintori (Monza, Italy) from February to April 2021. LUSS and ROX were collected at the same time in noninvasively ventilated patients outside of the ICU. An LUS exam was performed by 3 emergency medicine attending physicians with at least 5 years' experience in point-of-care ultrasonography using a 12-zone system. To evaluate the accuracy of the prognostic indices in predicting a composite outcome (endotracheal intubation and mortality), ROC curves were used. A logistic multivariable model was used to explore the predictors of the composite outcome of endotracheal intubation and in-hospital mortality. An unadjusted Kaplan-Meier analysis was used to explore the association with the composite outcome of survival without invasive mechanical ventilation at the 30-day follow-up by stratifying the 3 indices by their best cut-offs. Results: A total of 79 patients were included in the statistical analysis and stratified into 2 groups based on the presence of a negative outcome, which was reported in 24 patients out of 79 (30%). A great proportion of patients (66 patients-84%) were treated with helmet CPAP. All three indices (LUSS, ROX and LUSS/ROX) were independently associated with negative outcomes in the multivariable analyses. Although the comparison between the AUROC of LUSS or ROX versus LUSS/ROX did not reveal a statistically significant difference, we observed a trend toward a higher accuracy for predicting negative outcomes using the LUSS/ROX index as compared to using LUSS. With the Kaplan-Maier approach, all three indices stratified by the best cut-off reported a significant association with the outcome of 30-day survival without mechanical ventilation. Conclusions: A multimodal noninvasive approach that combines ultrasound (i.e., LUSS) and a bedside clinical evaluation (i.e., the ROX index) may help clinicians to predict outcomes and to identify patients who would benefit the most from invasive respiratory support.
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Affiliation(s)
- Alice Nova
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva Adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Nilde Eronia
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Annalisa Benini
- Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva Adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Scognamiglio
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva Adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Giacomo Bellani
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS (Azienda Provinciale per i Servizi Sanitari), 38123 Trento, Italy
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11
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Cammarota G, Vetrugno L, Longhini F. Lung ultrasound monitoring: impact on economics and outcomes. Curr Opin Anaesthesiol 2023; 36:234-239. [PMID: 36728722 DOI: 10.1097/aco.0000000000001231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the impact of lung ultrasonography (LUS) on economics and possible impact on patients' outcomes, proven its diagnostic accuracy in patients with acute respiratory failure. RECENT FINDINGS Despite some previous ethical concerns on LUS examination, today this technique has showed several advantages. First, it is now clear that the daily use of LUS can provide a relevant cost reduction in healthcare of patients with acute respiratory failure, while reducing the risk of transport of patients to radiological departments for chest CT scan. In addition, LUS reduces the exposition to x-rays since can replace the bedside chest X-ray examination in many cases. Indeed, LUS is characterized by a diagnostic accuracy that is even superior to portable chest X-ray when performed by well trained personnel. Finally, LUS examination is a useful tool to predict the course of patients with pneumonia, including the need for hospitalization and ICU admission, noninvasive ventilation failure and orotracheal intubation, weaning success, and mortality. SUMMARY LUS should be implemented not only in Intensive Care Units, but also in other setting like emergency departments. Since most data comes from the recent coronavirus disease 2019 pandemic, further investigations are required in Acute Respiratory Failure of different etiologies.
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Affiliation(s)
- Gianmaria Cammarota
- Anesthesia and Intensive Care Unit 2, Department of Medicine and Surgery, University of Perugia
| | - Luigi Vetrugno
- Anesthesiology, Critical Care Medicine, and Emergency, 'S.S. Annunziata' Hospital, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Gabriele d'Annunzio University of Chieti and Pescara
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Mater Domini' University Hospital, Magna Graecia University, Catanzaro, Italy
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12
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Heldeweg MLA, Lieveld AW, Walburgh-Schmidt RS, Smit JM, Haaksma ME, Veldhuis L, de Grooth HJ, Girbes AR, Heunks LM, Tuinman PR. Concise Versus Extended Lung Ultrasound Score to Monitor Critically Ill Patients With COVID-19. Respir Care 2023; 68:400-407. [PMID: 36649978 PMCID: PMC10027145 DOI: 10.4187/respcare.10406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lung ultrasound (LUS) can be used to monitor critically ill patients with COVID-19, but the optimal number of examined lung zones is disputed. METHODS This was a prospective observational study. The objective was to investigate whether concise (6 zones) and extended (12 zones) LUS scoring protocols are clinically equivalent in critically ill ICU subjects with COVID-19. The primary outcome of this study was (statistical) agreement between concise and extended LUS score index evaluated in both supine and prone position. Agreement was determined using correlation coefficients and Bland-Altman plots to detect systematic differences between protocols. Secondary outcomes were difference between LUS score index in supine and prone position using similar methods. RESULTS We included 130 LUS examinations in 40 subjects (mean age 69.0 ± 8.5y, 75% male). Agreement between concise and extended LUS score index had no clinically relevant constant or proportional bias and limits of agreement were below the smallest detectable change. Across position changes, supine LUS score index was 8% higher than prone LUS score index and had limits above the smallest detectable change, indicating true LUS score index differences between protocols may occur due to the position change itself. Lastly, inter-rater and intra-rater agreement were very good. CONCLUSIONS Concise LUS was equally informative as extended LUS for monitoring critically ill subjects with COVID-19 in supine or prone position. Clinicians can monitor patients undergoing position changes but must be wary that LUS score index alterations may result from the position change itself rather than disease progression or clinical improvement.
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Affiliation(s)
- Micah LA Heldeweg
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; and Amsterdam Leiden IC Focused Echography, Amsterdam, the Netherlands.
| | - Arthur We Lieveld
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; and Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Robin S Walburgh-Schmidt
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Jasper M Smit
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; and Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Mark E Haaksma
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; and Amsterdam Leiden IC Focused Echography, Amsterdam, the Netherlands
| | - Lars Veldhuis
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Harm-Jan de Grooth
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Armand Rj Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Leo Ma Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; and Amsterdam Leiden IC Focused Echography, Amsterdam, the Netherlands
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13
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Lieveld AWE, Heldeweg MLA, Schouwenburg J, Veldhuis L, Haaksma ME, van Haaften RM, Teunissen BP, Smit JM, Twisk J, Heunks L, Nanayakkara PWB, Tuinman PR. Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? Ultrasound J 2023; 15:11. [PMID: 36842163 PMCID: PMC9968403 DOI: 10.1186/s13089-022-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/27/2022] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints. METHODS This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models. RESULTS 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31-0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73-0.95), 0.94 (95% CI 0.90-0.96), and 0.84 (95% CI 0.65-0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC. CONCLUSIONS LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool.
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Affiliation(s)
- Arthur W. E. Lieveld
- grid.509540.d0000 0004 6880 3010Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location VU Medical Center, Postbox 7507, 1007MB Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands
| | - Micah L. A. Heldeweg
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands ,Amsterdam Leiden IC Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Jasper Schouwenburg
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands
| | - Lars Veldhuis
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands
| | - Mark E. Haaksma
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands ,Amsterdam Leiden IC Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Rutger M. van Haaften
- grid.509540.d0000 0004 6880 3010Section Emergency Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Berend P. Teunissen
- grid.509540.d0000 0004 6880 3010Section Emergency Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Jasper M. Smit
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands ,Amsterdam Leiden IC Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Jos Twisk
- grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Leo Heunks
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands
| | - Prabath W. B. Nanayakkara
- grid.509540.d0000 0004 6880 3010Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location VU Medical Center, Postbox 7507, 1007MB Amsterdam, The Netherlands
| | - Pieter Roel Tuinman
- grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, The Netherlands ,Amsterdam Leiden IC Focused Echography (ALIFE), Amsterdam, The Netherlands
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Nicolotti D, Grossi S, Nicolini F, Gallingani A, Rossi S. Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review. J Clin Med 2023; 12:jcm12020497. [PMID: 36675426 PMCID: PMC9867514 DOI: 10.3390/jcm12020497] [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: 11/16/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.
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Affiliation(s)
- Davide Nicolotti
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-703286
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Francesco Nicolini
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Alan Gallingani
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
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15
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Xing W, Li G, He C, Huang Q, Cui X, Li Q, Li W, Chen J, Ta D. Automatic detection of A-line in lung ultrasound images using deep learning and image processing. Med Phys 2023; 50:330-343. [PMID: 35950481 DOI: 10.1002/mp.15908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/29/2022] [Accepted: 07/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Auxiliary diagnosis and monitoring of lung diseases based on lung ultrasound (LUS) images is important clinical research. A-line is one of the most common indicators of LUS that can offer support for the assessment of lung diseases. A traditional A-line detection method mainly relies on experienced clinicians, which is inefficient and cannot meet the needs of these areas with backward medical level. Therefore, how to realize the automatic detection of A-line in LUS image is important. PURPOSE In order to solve the disadvantages of traditional A-line detection methods, realize automatic and accurate detection, and provide theoretical support for clinical application, we proposed a novel A-line detection method for LUS images with different probe types in this paper. METHODS First, the improved Faster R-CNN model with a selection strategy of localization box was designed to accurately locate the pleural line. Then, the LUS image below the pleural line was segmented for independent analysis excluding the influence of other similar structures. Next, image-processing methods based on total variation, matched filter, and gray difference were applied to achieve the automatic A-line detection. Finally, the "depth" index was designed to verify the accuracy by judging whether the automatic measurement results belong to corresponding manual results (±5%). In experiments, 3000 convex array LUS images were used for training and validating the improved pleural line localization model by five-fold cross validation. 850 convex array LUS images and 1080 linear array LUS images were used for testing the trained pleural line localization model and the proposed image-processing-based A-line detection method. The accuracy analysis, error statistics, and Harsdorff distance were employed to evaluate the experimental results. RESULTS After 100 epochs, the mean loss value of training and validation set of improved Faster R-CNN model reached 0.6540 and 0.7882, with the validation accuracy of 98.70%. The trained pleural line localization model was applied in the testing set of convex and linear probes and reached the accuracy of 97.88% and 97.11%, respectively, which were 3.83% and 8.70% higher than the original Faster R-CNN model. The accuracy, sensitivity, and specificity of A-line detection reached 95.41%, 0.9244%, 0.9875%, and 94.63%, 0.9230%, and 0.9766% for convex and linear probes, respectively. Compared to the experienced clinicians' results, the mean value and p value of depth error were 1.5342 ± 1.2097 and 0.9021, respectively, and the Harsdorff distance was 5.7305 ± 1.8311. In addition, the accumulated accuracy of the two-stage experiment (pleural line localization and A-line detection) was calculated as the final accuracy of the whole A-line detection system. They were 93.39% and 91.90% for convex and linear probes, respectively, which were higher than these previous methods. CONCLUSIONS The proposed method combining image processing and deep learning can automatically and accurately detect A-line in LUS images with different probe types, which has important application value for clinical diagnosis.
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Affiliation(s)
- Wenyu Xing
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China
| | - Guannan Li
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
| | - Chao He
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qiming Huang
- School of Advanced Computing and Artificial Intelligence, Xi'an Jiaotong-liverpool University, Suzhou, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
| | - Wenfang Li
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiangang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China.,Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Dean Ta
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China.,Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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16
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Volpicelli G, Fraccalini T, Cardinale L, Stranieri G, Senkeev R, Maggiani G, Pacielli A, Basile D. Feasibility of a New Lung Ultrasound Protocol to Determine the Extent of Lung Injury in COVID-19 Pneumonia. Chest 2023; 163:176-184. [PMID: 35921882 PMCID: PMC9339094 DOI: 10.1016/j.chest.2022.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) scanning is useful to diagnose and assess the severity of pulmonary lesions during COVID-19-related ARDS (CoARDS). A conventional LUS score is proposed to measure the loss of aeration during CoARDS. However, this score was validated during the pre-COVID-19 era in patients with ARDS in the ICU and does not consider the differences with CoARDS. An alternative LUS method is based on grading the percentage of extension of the typical signs of COVID-19 pneumonia on the lung surface (LUSext). RESEARCH QUESTION Is LUSext feasible in patients with COVID-19 at the onset of disease, and does it correlate with the volumetric measure of severity of COVID-19 pneumonia lesions at CT scan (CTvol)? STUDY DESIGN AND METHODS This observational study enrolled a convenience sampling of patients in the ED with confirmed COVID-19 whose condition demonstrated pneumonia at bedside LUS and CT scan. LUSext was visually quantified. All CT scan studies were analyzed retrospectively by a specifically designed software to calculate the CTvol. The correlation between LUSext and CTvol, and the correlations of each score with Pao2/Fio2 ratio were calculated. RESULTS We analyzed data from 179 patients. Feasibility of LUSext was 100%. Time to perform LUS scan was 5 ± 1.5 mins. LUSext and CTvol were correlated positively (R = 0.67; P < .0001). Both LUSext and CTvol showed negative correlation with Pao2/Fio2 ratio (R = -0.66 and R = -0.54; P < .0001, respectively). INTERPRETATION LUSext is a valid measure of the severity of the lesions when compared with the CT scan. Not only are LUSext and CTvol correlated, but they also have similar inverse correlation with the severity of respiratory failure. LUSext is a practical and simple bedside measure of the severity of pneumonia in CoARDS, whose clinical and prognostic impact need to be investigated further.
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Affiliation(s)
- Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy.
| | - Thomas Fraccalini
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Luciano Cardinale
- Department of Oncology, Radiology Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Giuseppe Stranieri
- Department of Oncology, Radiology Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Rouslan Senkeev
- Department of Oncology, Radiology Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Guido Maggiani
- Department of Medical Sciences, Section of Geriatrics, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Alberto Pacielli
- Department of Oncology, Radiology Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Domenico Basile
- Department of Oncology, Radiology Unit, San Luigi Gonzaga University Hospital, Torino, Italy
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17
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Conners GP. PEGALUS and other patient predictive scores of COVID-19 patients. Intern Emerg Med 2023; 18:207-209. [PMID: 36449259 PMCID: PMC9709369 DOI: 10.1007/s11739-022-03160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Gregory P Conners
- Departments of Pediatrics, Emergency Medicine, and Public Health and Preventive Medicine, Norton College of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
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Ross DW, Moses AA, Niyyar VD. Point-of-care ultrasonography in nephrology comes of age. Clin Kidney J 2022; 15:2220-2227. [PMID: 36381376 PMCID: PMC9664573 DOI: 10.1093/ckj/sfac160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 03/22/2024] Open
Abstract
The physical exam is changing. Many have argued that the physical exam of the 21st century should include point-of-care ultrasound (POCUS). POCUS is being taught in medical schools and has been endorsed by the major professional societies of internal medicine. In this review we describe the trend toward using POCUS in medicine and describe where the practicing nephrologist fits in. We discuss what a nephrologist's POCUS exam should entail and we give special attention to what nephrologists can gain from learning POCUS. We suggest a 'nephro-centric' approach that includes not only ultrasound of the kidney and bladder, but of the heart, lungs and vascular access. We conclude by reviewing some of the sparse data available to guide training initiatives and give suggested next steps for advancing POCUS in nephrology.
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Affiliation(s)
- Daniel W Ross
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Division of Kidney Diseases and Hypertension, Great Neck, NY, USA
| | - Andrew A Moses
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lenox Hill Division of Nephrology, New York, NY, USA
| | - Vandana Dua Niyyar
- Emory University, Division of Nephrology, Woodruff Memorial Research Building, Atlanta GA, USA
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Franchi R, Okoye C, Morelli V, Guarino D, Mazzarone T, Coppini G, Peta U, Rogani S, Fabbri A, Polini A, Monzani F. Utility of lung ultrasound in selecting older patients with hyperinflammatory phase in COVID-19 pneumonia. A monocentric, cross-sectional pilot study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Coronavirus disease 2019 (COVID-19) is a viral disease that causes life-threatening health problems during acute illness, causing a pandemic and millions of deaths. Although computed tomography (CT) was used as a diagnostic tool for COVID-19 in the early period of the pan demic due to the inaccessibility or long duration of the polymerase chain reaction tests, cur rent studies have revealed that CT scan should not be used to diagnose COVID-19. However, radiologic findings are vital in assessing pneumonia severity and investigating complications in patients with COVID-19. Long-term symptoms, also known as long COVID, in people recovering from COVID-19 affect patients' quality of life and cause global health problems. Herein, we aimed to summarize the lessons learned in COVID-19 pneumonia, the challenges in diagnosing the disease and complications, and the prospects for future studies.
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Affiliation(s)
- Furkan Ufuk
- Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey
| | - Recep Savaş
- Department of Radiology, School of Medicine, University of Ege, Izmir, Turkey
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21
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Russo G, Flor N, Casella F, Ippolito S, Leidi F, Casazza G, Radovanovic D, Vezzulli F, Santus P, Cogliati C. Lung ultrasound in the follow-up of severe COVID-19 pneumonia: six months evaluation and comparison with CT. Intern Emerg Med 2022; 17:2261-2268. [PMID: 36103083 PMCID: PMC9472735 DOI: 10.1007/s11739-022-03084-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
While lung ultrasonography (LUS) proved to be a useful diagnostic and prognostic tool in acute phase of COVID 19 pneumonia, its role in detecting long-term pulmonary sequelae has yet to be explored. In our prospective observational study we assessed the potential of LUS in detecting the presence of computed tomography (CT) fibrotic-like changes after 6 months from COVID-19 pneumonia. Patients who were discharged with a diagnosis of severe COVID-19 pneumonia were enrolled. After 6 months from hospital discharge they underwent LUS, chest CT scan and pulmonary function tests. A logistic regression analysis was performed to assess the association between presence of symptoms, LUS score and diffusing capacity for carbon monoxide (DLCO) at 6-month after hospital discharge and CT scan fibrotic-like changes. A second logistic model was performed to assess the value of some predefined baseline factors (age, sex, worst PaO2/FiO2, ventilator support, worst CRP value, worst D-dimer value and worst LUS score during hospitalization) to predict fibrotic-like changes on 6-month CT scan. Seventy-four patients were enrolled in the study. Twenty-four (32%) showed lung abnormalities suitable for fibrotic-like changes. At multivariate logistic regression analysis LUS score after 6 months from acute disease was significantly associated with fibrotic-like pattern on CT scan. The second logistic model showed that D-dimer value was the only baseline predictive variable of fibrotic-like changes at multivariate analysis. LUS performed after 6 months from severe COVID-19 pneumonia may be a promising tool for detection and follow-up of pulmonary fibrotic sequelae.
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Affiliation(s)
- Giulia Russo
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy.
- Emerging Bacterial Pathogen Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Nicola Flor
- Radiology Unit, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Francesco Casella
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Sonia Ippolito
- Radiology Unit, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federica Leidi
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Università Degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federico Vezzulli
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Università Degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
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22
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Innocenti F, Lazzari C, Paolucci E, De Paris A, Lagomarsini A, Guerra F, Alleonato P, Casalini L, Buggea M, Caldi F, Zanobetti M, Pieralli F, Guazzini G, Lastraioli L, Luise F, Milia A, Sammicheli L, Maddaluni L, Lavorini F, Pini R. Role of prognostic scores in predicting in-hospital mortality and failure of non-invasive ventilation in adults with COVID-19. Intern Emerg Med 2022; 17:2367-2377. [PMID: 35918627 PMCID: PMC9345392 DOI: 10.1007/s11739-022-03058-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022]
Abstract
We tested the prognostic performance of different scores for the identification of subjects with acute respiratory failure by COVID-19, at risk of in-hospital mortality and NIV failure. We conducted a retrospective study, in the Medical High-Dependency Unit of the University-Hospital Careggi. We included all subjects with COVID-19 and ARF requiring non-invasive ventilation (NIV) between March 2020 and January 2021. Clinical parameters, the HACOR score (Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory Rate) and ROX index ((SpO2/FiO2)/respiratory rate) were collected 3 (-3) and 1 day (-1) before the NIV initiation, the first day of treatment (Day0) and after 1 (+1), 2 (+2), 5 (+5), 8 (+8) and 11 (+11) of treatment. The primary outcomes were in-hospital mortality and NIV failure. We included 135 subjects, mean age 69±13 years, 69% male. Patients, who needed mechanical ventilation, showed a higher HACOR score (Day0: 6 [5-7] vs 6 [6-7], p=.057; Day+2: 6 [6-6] vs 6 [4-6], p=.013) and a lower ROX index (Day0: 4.2±2.3 vs 5.1±2.3, p=.055; Day+2: 4.4±1.2.vs 5.5±1.3, p=.001) than those with successful NIV. An HACOR score >5 was more frequent among nonsurvivors (Day0: 82% vs 58%; Day2: 82% vs 48%, all p<0.01) and it was associated with in-hospital mortality (Day0: RR 5.88, 95%CI 2.01-17.22; Day2: RR 4.33, 95%CI 1.64-11.41) independent to age and Charlson index. In conclusion, in subjects treated with NIV for ARF caused by COVID19, respiratory parameters collected after the beginning of NIV allowed to identify those at risk of an adverse outcome. An HACOR score >5 was independently associated with increased mortality rate.
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Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy.
| | - Cristian Lazzari
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Elisa Paolucci
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Anna De Paris
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Alessia Lagomarsini
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Federica Guerra
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Patrizia Alleonato
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Lisa Casalini
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Michele Buggea
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Francesca Caldi
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Maurizio Zanobetti
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Giulia Guazzini
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Lisa Lastraioli
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Fabio Luise
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Alessandro Milia
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Lucia Sammicheli
- Intermediate Care Unit, Careggi University-Hospital, Florence, Italy
| | - Lucia Maddaluni
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Emergency Department, Careggi University-Hospital, Lg. Brambilla 3, 50134, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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23
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Borio G, Tentori S, Farolfi F, Suma GV, Rienzo P, D'ambrosio A, Citro M, Antonini M, Maffi P. PEGALUS: predictivity of elderly age, arterial gas analysis, and lung ultrasound. A new prognostic score for COVID-19 patients in the emergency department-an observational prospective study. Intern Emerg Med 2022; 17:2357-2365. [PMID: 35895235 PMCID: PMC9327975 DOI: 10.1007/s11739-022-03047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Periodic surges of COVID-19 patients seeking care in the hospital environment overwhelm systems reduce the availability of resources for treatment of non-COVID-19 cases (Zheng et al. in J Hosp Infect 106:325-329, 2020). Hospital flow and resource management could be greatly enhanced by differentiating patients who are likely at risk of adverse clinical outcomes from those who could safely be discharged after evaluation and managed outside of the hospital setting (Sun et al. in J Infect Dis 223:38-46, 2021). Herein, we propose a prognostic score named PEGALUS (Predictivity of Elderly age, arterial blood Gas Analysis and Lung UltraSound) that could potentially help clinicians properly and rapidly choose the appropriate allocation of COVID-19 patients admitted to the emergency department (ED). METHODS This observational prospective study enrolled COVID-19 patients who were admitted to the ED of IRCCS San Raffaele Hospital (HSR). RESULTS 230 COVID-19 patients were enrolled and 30-day follow-up data was collected. Composite outcome was death or need for oro-tracheal intubation (OTI). 50 patients (21.5%) reached the outcome during the observational period. In multivariate Cox analysis, age, PO2/FiO2 ratio, pCO2, duration of symptoms, and lung ultrasound evaluation were significantly associated with the adverse outcome. We obtained a new scorecard (PEGALUS) according to the hazard ratio of the identified predictors. PEGALUS score performed well in predicting the composite outcome (AUC 0.866, 95% IC 0.812-0.921; p < 0.001). Kaplan-Meier showed that a PEGALUS score < 7 was associated with a good 30-day prognosis (survival rate 97.5%), compared to a PEGALUS score of 7-11 (survival rate 85.9%; p log-rank 0.009) and PEGALUS score > 11 (survival rate 49.3%; p log-rank < 0.001). CONCLUSIONS PEGALUS score performed at the admission can predict adverse outcomes in patients with COVID-19. The systematic application of this score might permit a more accurate and rapid treatment allocation in this setting.
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Affiliation(s)
- Giorgia Borio
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Stefano Tentori
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Internal Medicine and Transplantation Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Farolfi
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gloria Vanessa Suma
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Rienzo
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Annapaola D'ambrosio
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Citro
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mariachiara Antonini
- Emergency Department, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Maffi
- Internal Medicine and Transplantation Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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24
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Orosz G, Gyombolai P, Tóth JT, Szabó M. Reliability and clinical correlations of semi-quantitative lung ultrasound on BLUE points in COVID-19 mechanically ventilated patients: The 'BLUE-LUSS'-A feasibility clinical study. PLoS One 2022; 17:e0276213. [PMID: 36240250 PMCID: PMC9565374 DOI: 10.1371/journal.pone.0276213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/01/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Bedside lung ultrasound has gained a key role in each segment of the treatment chain during the COVID-19 pandemic. During the diagnostic assessment of the critically ill patients in ICUs, it is highly important to maximize the amount and quality of gathered information while minimizing unnecessary interventions (e.g. moving/rotating the patient). Another major factor is to reduce the risk of infection and the workload of the staff. OBJECTIVES To serve these significant issues we constructed a feasibility study, in which we used a single-operator technique without moving the patient, only assessing the easily achievable lung regions at conventional BLUE points. We hypothesized that calculating this 'BLUE lung ultrasound score' (BLUE-LUSS) is a reasonable clinical tool. Furthermore, we used both longitudinal and transverse scans to measure their reliability and assessed the interobserver variability as well. METHODS University Intensive Care Unit based, single-center, prospective, observational study was performed on 24 consecutive SARS-CoV2 RT-PCR positive, mechanically ventilated critically ill patients. Altogether 400 loops were recorded, rated and assessed off-line by 4 independent intensive care specialists (each 7+ years of LUS experience). RESULTS Intraclass correlation values indicated good reliability for transversal and longitudinal qLUSS scores, while we detected excellent interrater agreement of both cLUSS calculation methods. All of our LUS scores correlated inversely and significantly to the P/F values. Best correlation was achieved in the case of longitudinal qLUSS (r = -0.55, p = 0.0119). CONCLUSION Summarized score of BLUE-LUSS can be an important, easy-to-perform adjunct tool for assessing and quantifying lung pathology in critically ill ventilated patients at bedside, especially for the P/F ratio. The best agreement for the P/F ratio can be achieved with the longitudinal scans. Regarding these findings, assessing BLUE-points can be extended with the BLUE-LUSS for daily routine using both transverse and longitudinal views.
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Affiliation(s)
- Gábor Orosz
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Pál Gyombolai
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - József T. Tóth
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marcell Szabó
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Hepworth-Warren KL, Nelson N, Dembek KA, Young KAS. Comparison of thoracic ultrasonography and thoracic radiography between healthy adult horses and horses with bacterial pneumonia using a novel, objective ultrasonographic scoring system. Front Vet Sci 2022; 9:991634. [PMID: 36311667 PMCID: PMC9608548 DOI: 10.3389/fvets.2022.991634] [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: 07/11/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background Thoracic ultrasonography (TUS) is widely used in equine practice but comparison to radiography is limited in horses. Objectives To validate a novel, objective scoring system for TUS in adult horses and to compare ultrasonographic and radiographic findings. Animals 13 healthy horses and 9 with confirmed bacterial pneumonia Methods Prospective study in which TUS and radiography were performed on healthy horses and those with bacterial pneumonia confirmed by clinical signs and results of transtracheal wash analysis. Ultrasonography was scored utilizing a novel scoring system evaluating number of comet tail lesions, the presence or absence of pleural effusion and/or pulmonary consolidation in each intercostal space. Eighteen horses had thoracic radiographs taken that were scored by a board-certified radiologist utilizing a previously described system. Total scores were recorded and compared between control and diseased patients. Results/Findings Ultrasonographic scores were significantly higher in the diseased group (median= 126) than in the control group (median = 20, p = 0.01). Receiver operating characteristics (ROC) analysis identified a sensitivity of 66.7% (95% CI 0.417–1) and specificity of 92.3% (95% CI 0.462–1) for the ability of ultrasonography to identify bacterial pneumonia utilizing a TUS score cutoff of 37. Conclusions and clinical importance TUS had moderate sensitivity and high specificity for identification of bacterial pneumonia in adult horses. TUS appears to be an acceptable stand-alone imaging modality for diagnosis of bacterial pneumonia in horses when radiography is not practical.
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Affiliation(s)
- Kate L. Hepworth-Warren
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States,*Correspondence: Kate L. Hepworth-Warren
| | - Nathan Nelson
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Katarzyna A. Dembek
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Kimberly A. S. Young
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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26
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Kazi MA, Roychowdhury S, Ghosh S, Mahapatra MK, Bhakta S, Konar MC, Sarkar M. Characteristics and predictors of outcomes of critically Ill children with SARS-CoV-2 infection - the PICU experience. J Pediatr (Rio J) 2022; 98:504-512. [PMID: 35139344 PMCID: PMC8801309 DOI: 10.1016/j.jped.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/23/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the clinical characteristics, laboratory parameters, treatment, and predictors of an unfavorable outcome of critically ill children with SARS-CoV-2 infection. METHOD This was a prospective observational study performed in a pediatric intensive care unit (PICU) of a tertiary care COVID referral hospital among critically ill children in the age group 1 month - 12 years admitted due to SARS-CoV-2 infection from June to December 2020. Demographic, clinical profile, pSOFA and PRISM III scores, laboratory parameters, treatment, and outcomes of the patients were recorded. Children who had a prolonged PICU stay (>14 days) or died were compared with those who were discharged from PICU within 14 days to assess predictors of unfavorable outcomes. RESULTS PICU admission rate among hospitalized SARS-CoV-2 infected children was 22.1% (92/416). Infants comprised the majority of the ICU population. Invasive mechanical ventilation and inotropic support were required for 28.3% and 37% of patients, respectively. Remdesivir, IVIg, and steroids were administered to 15.2%, 26.1%, and 54.3% of the subjects, respectively. The mortality rate was 7.6 %. MIS-C patients were older, less comorbid, and required less ventilator support but more inotrope support than acute severe COVID-19 patients. Predictors of unfavorable outcomes were age < 1 year, fever duration > 5 days, respiratory distress, shock, comorbidity, elevated CRP (> 50 mg/L), procalcitonin (> 6 ng/L), D-dimer (> 6 µg/L) and arterial lactate (> 2 mmol/L). CONCLUSION Critically ill children with unfavorable outcomes were predominantly infants, comorbid, prolonged fever, respiratory distress, shock and elevated inflammatory markers, D-dimer and lactate. These factors may be useful for watchful monitoring and early intervention.
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Affiliation(s)
- Maha Ashraf Kazi
- Department of Pediatrics, Medical College and Hospital, Kolkata, India
| | | | - Sanajit Ghosh
- Department of Pediatrics, Medical College and Hospital, Kolkata, India
| | | | - Subhajit Bhakta
- PICU Unit, Department of Pediatrics, Medical College and Hospital, Kolkata, India
| | - Mithun Chandra Konar
- PICU Unit, Department of Pediatrics, Medical College and Hospital, Kolkata, India
| | - Mihir Sarkar
- PICU Unit, Department of Pediatrics, Medical College and Hospital, Kolkata, India.
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27
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Lê MP, Jozwiak M, Laghlam D. Current Advances in Lung Ultrasound in COVID-19 Critically Ill Patients: A Narrative Review. J Clin Med 2022; 11:jcm11175001. [PMID: 36078934 PMCID: PMC9457386 DOI: 10.3390/jcm11175001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Lung ultrasound (LUS) has a relatively recent democratization due to the better availability and training of physicians, especially in intensive care units. LUS is a relatively cheap and easy-to-learn and -use bedside technique that evaluates pulmonary morphology when using simple algorithms. During the global COVID-19 pandemic, LUS was found to be an accurate tool to quickly diagnose, triage and monitor patients with COVID-19 pneumonia. This paper aims to provide a comprehensive review of LUS use during the COVID-19 pandemic. The first section of our work defines the technique, the practical approach and the semeiotic signs of LUS examination. The second section exposed the COVID-19 pattern in LUS examination and the difference between the differential diagnosis patterns and the well-correlation found with computer tomography scan findings. In the third section, we described the utility of LUS in the management of COVID-19 patients, allowing an early diagnosis and triage in the emergency department, as the monitoring of pneumonia course (pneumonia progression, alveolar recruitment, mechanical ventilation weaning) and detection of secondary complications (pneumothorax, superinfection). Moreover, we describe the usefulness of LUS as a marker of the prognosis of COVID-19 pneumonia in the fourth section. Finally, the 5th part is focused on describing the interest of the LUS, as a non-ionized technique, in the management of pregnant COVID-19 women.
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Affiliation(s)
- Minh Pierre Lê
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, 75014 Paris, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet 1, 151 Route Saint Antoine de Ginestière, 06200 Nice, France
- UR2CA, Unité de Recherche Clinique Côte d’Azur, Université Côte d’Azur, 06200 Nice, France
| | - Driss Laghlam
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, 75014 Paris, France
- Correspondence: ; Tel.: +33-158-414-145; Fax: +33-158-412-505
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28
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Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study. Crit Care Explor 2022; 4:e0732. [PMID: 35982837 PMCID: PMC9377680 DOI: 10.1097/cce.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear. DESIGN Prospective cohort study. SETTING A large tertiary care center in Maryland, between April 2020 and September 2021. PATIENTS Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction results. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28 days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive mechanical ventilation, within 28 days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5-1.3). Following enrollment, 27 participants (10.0%) went on to require ICU-level care, and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27-10.2) and 28-day mortality (aHR, 3.10; 95% CI, 1.29-7.50). Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI, 3.33-131.30). CONCLUSIONS Participants with a mLUSS greater than or equal to 1 or pleural line changes on LUS had an increased likelihood of subsequent requirement of high-flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.
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Prolonged mechanical ventilation in patients with severe COVID-19 is associated with serial modified-lung ultrasound scores: A single-centre cohort study. PLoS One 2022; 17:e0271391. [PMID: 35830460 PMCID: PMC9278739 DOI: 10.1371/journal.pone.0271391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Lung ultrasound (LUS), a rapid, bedside, goal-oriented diagnostic test, can be quantitatively assessed, and the scores can be used to evaluate disease progression. However, little data exists on predicting prolonged mechanical ventilation (PMV) and successful extubation using serial LUS scores. We examined the relationship of PMV with successful extubation in patients with severe coronavirus disease (COVID-19) by using two types of serial LUS scores. One LUS score evaluated both the pleura and lung fields, while the other assessed each separately (modified-LUS score). Both LUS scores were determined for 20 consecutive patients with severe COVID-19 at three timepoints: admission (day-1), after 48 h (day-3), and on the seventh follow-up day (day-7). We compared LUS scores with the radiographic assessment of the lung oedema (RALE) scores and laboratory test results, at the three timepoints. The PMV and successful extubation groups showed no significant differences in mortality, but significant differences occurred on day-3 and day-7 both LUS scores, day-7 RALE score, and day-7 PaO2/FiO2 ratio, in the PMV group (p<0.05); and day-3 and day-7 modified-LUS scores, day-7 C-reactive protein levels, and day-7 PaO2/FiO2 ratio, in the successful extubation group (p<0.05). The area under the curves (AUC) of LUS scores on day-3 and day-7, modified-LUS scores on day-3 and day-7,RALE score on day-7, and PaO2/FiO2 ratio on day-7 in the PMV group were 0.98, 0.85, 0.88, 0.98, 0.77, and 0.80, respectively. The AUC of modified-LUS scores on day-3 and day-7, C-reactive protein levels on day-7, and PaO2/FiO2 ratio on day-7 in the successful extubation group were 0.79, 0.90, 0.82, and 0.79, respectively. The modified-LUS score on day 7 was significantly higher than that on day 1 in PMV group (p<0.05). While the LUS score did not exhibit significant differences. The serial modified-LUS score of patients with severe COVID-19 could predict PMV.
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Leote J, Judas T, Broa AL, Lopes M, Abecasis F, Pintassilgo I, Gonçalves A, Gonzalez F. Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction. Ultrasound J 2022; 14:28. [PMID: 35796809 PMCID: PMC9261145 DOI: 10.1186/s13089-022-00278-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/25/2022] [Indexed: 01/08/2023] Open
Abstract
Background Lung ultrasound (LUS) is a valuable tool to predict and monitor the COVID-19 pneumonia course. However, the influence of cardiac dysfunction (CD) on LUS findings remains to be studied. Our objective was to determine the effect of CD on LUS in hospitalized patients with COVID-19 pneumonia. Material and methods Fifty-one patients with COVID-19 pneumonia participated in the study. Focused echocardiography (FoCUS) was carried out on day 1 to separate patients into two groups depending on whether they had FoCUS signs of CD (CD+ vs CD−). LUS scores, based on the thickness of the pleural line, the B-line characteristics, and the presence or not of consolidations, were obtained three times along the patient’s admission (D1, D5, D10) and compared between CD+ and CD− patients. A correlation analysis was carried out between LUS scores and the ratio of the arterial partial pressure of oxygen to the fraction of the inspired oxygen (P/F ratio). Results Twenty-two patients were CD+ and 29 patients were CD−. Among the CD+ patients, 19 were admitted to the intensive care unit (ICU), seven received invasive mechanical ventilation (IMV), and one did not survive. Among the CD− patients, 11 were admitted to the ICU, one received IMV and seven did not survive. CD+ patients showed a significantly lower P/F ratio than CD− patients. However, LUS scores showed no between-group differences, except for fewer subpleural consolidations in the upper quadrants of CD+ than on CD− patients. Conclusion In patients with COVID-19, CD contributed to a worse clinical course, but it did not induce significant changes in LUS. Our findings suggest that pathophysiological factors other than those reflected by LUS may be responsible for the differences in clinical condition between CD+ and CD− patients.
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Affiliation(s)
- Joao Leote
- Critical Care Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal.
| | - Tiago Judas
- Internal Medicine Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Ana Luísa Broa
- Internal Medicine Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Miguel Lopes
- Pulmonology Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Francisca Abecasis
- Internal Medicine Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Inês Pintassilgo
- Internal Medicine Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Afonso Gonçalves
- Radiology Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Filipe Gonzalez
- Critical Care Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal
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Levy Adatto N, Preisler Y, Shetrit A, Shepshelovich D, Hershkoviz R, Isakov O. Rapid 8-Zone Lung Ultrasound Protocol is Comparable to a Full 12-Zone Protocol for Outcome Prediction in Hospitalized COVID-19 Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1677-1687. [PMID: 34698389 PMCID: PMC8661589 DOI: 10.1002/jum.15849] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Safety precautions limit the clinical assessment of hospitalized Coronavirus disease 2019 (COVID-19) patients. The minimal exposure required to perform lung ultrasound (LUS) paired with its high accuracy, reproducibility, and availability make it an attractive solution for initial assessment of COVID-19 patients. We aim to evaluate whether the association between sonographic findings and clinical outcomes among COVID 19 patients is comparable between the validated 12-zone protocol and a shorter, 8-zone protocol, in which the posterior lung regions are omitted. METHODS One hundred and one COVID-19 patients hospitalized in a dedicated COVID-19 ward in a tertiary referral hospital were examined upon admission and scored by 2 LUS protocols. The association between the scores and a composite outcome consisting of death, transfer to the intensive care unit (ICU) or initiation of invasive or noninvasive mechanical ventilation was estimated and compared. RESULTS LUS scores in both the 8- and the 12-zone protocols were associated with the composite outcome during hospitalization (hazard ratio [HR] 1.21 [1.03-1.42, P = .022] and HR 1.13 [1.01-1.27, P = .037], respectively). The observed difference in the discriminatory ROC-AUC values for the 8- and 12-zone scores was not significant (0.767 and 0.754 [P = .647], respectively). CONCLUSION A short 8-zone LUS protocol is as accurate as the previously validated, 12-zone protocol for prognostication of clinical deterioration in nonventilated COVID-19 patients.
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Affiliation(s)
- Nimrod Levy Adatto
- Department of Internal Medicine “T”, Tel Aviv Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yoav Preisler
- Department of Internal Medicine “T”, Tel Aviv Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Aviel Shetrit
- Department of Internal Medicine “T”, Tel Aviv Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Daniel Shepshelovich
- Department of Internal Medicine “T”, Tel Aviv Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Rami Hershkoviz
- Department of Internal Medicine “T”, Tel Aviv Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ofer Isakov
- Department of Internal Medicine “T”, Tel Aviv Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
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ACAR H, YAMANOĞLU A, ARIKAN C, BİLGİN S, AKYOL PY, KAYALI A, KARAKAYA Z. COVID-19 triajında CLUE protokolünün etkinliği. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1086062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the effectiveness of the CLUE protocol in COVID-19 triage.
Materials and Methods: Patients who presented to the emergency department due to dyspnea with oxygen saturation below 95 % and were diagnosed with COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) tests were included in this prospective, observational study. Patients included in the study underwent lung ultrasound (LUS) in the light of the CLUE protocol, and were accordingly given LUS scores of between 0 and 36, also within the scope of the protocol. Patients were placed under observation, and clinical outcomes of discharge from the emergency department, admission to the ward, and admission to intensive care or discharge were recorded. ROC analysis was applied in the calculation of threshold values for LUS scores predicting discharge, admission to intensive care, and mortality.
Results: Forty-five patients with a mean age of 63 ± 18 years were included in the study. Fifteen patients (33 %) were treated on an outpatient basis and discharged, while 12 (27 %) were admitted to the ward and 18 (40 %) to the intensive care unit. Mortality occurred in 15 (33 %) patients. An LUS score lower than 3 was 97 % sensitive and 80 % specific for discharge, a score greater than 10 was 94 % sensitive and 78 % specific for admission to the intensive care unit, and a score higher than 11 was 93 % sensitive and 87 % specific for mortality. Based on regression analysis, an LUS score higher than 10 emerged as an independent risk factor for intensive care requirement, a score lower than 3 for discharge, and a score over 11 for mortality.
Conclusion: The CLUE protocol may be a useful bedside test in COVID-19 triage, and one that does not involve radiation or require laboratory tests.
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Affiliation(s)
| | - Adnan YAMANOĞLU
- İzmir Katip Çelebi Üniversitesi, Atatürk Eğitim ve Araştırma Hastanesi
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González-Suárez S, Barbara Ferreras A, Caicedo Toro M, Aznar de Legarra M. Detection of residual pulmonary alterations with lung ultrasound and effects on postoperative pulmonary complications for patients with asymptomatic SARS-CoV-2 infection undergoing surgeries. BMC Anesthesiol 2022; 22:186. [PMID: 35710326 PMCID: PMC9200944 DOI: 10.1186/s12871-022-01715-4] [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: 01/09/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients with a clinical course of active SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, there may be a higher risk of perioperative complications. Our main objective is to detect the residual pulmonary alterations in asymptomatic patients after SARS-CoV-2 infection undergoing surgery and determine their relationship with the clinical course of SARS-CoV-2 infection. The secondary aim is to investigate whether the presence of residual pulmonary alterations have any affects on the severity of postoperative pulmonary complications. METHODS After approval by the Hospital's Ethical Committee, this prospective observational study included consecutive patients (n=103) undergoing various surgical procedures and anesthetic techniques with a history of past SARS-CoV-2 infection. On the day of surgery these patients remained asymptomatic and the polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. The history, physical findings, and clinical course of SARS-CoV-2 infection were recorded. Lung ultrasound was performed before surgery to evaluate the possible residual pulmonary alterations (≥ 3 B-lines and pleural thickening), along with determitation of pulmonary static compliance values during surgery. Postoperative pulmonary complications were collected during hospital stay. RESULTS 24.27% (n=25) patients presented ≥ 3 B-lines, and 28% (n=29) patients presented pleural thickening. For 15 patients (21.7%) the pulmonary compliance was < 40 mL/cm H2O. Patients with pleural thickening had a higher incidence of pneumonia, acute respiratory syndrome distress, a need for vasoactive drugs and required more days of hospitalization during SARS-CoV-2 infection (p= 0.004, 0.001, 0.03, 0.00 respectively). Patients with ≥ 3 B-lines needed more days in an intensive care unit and vasoactive drugs during SARS-CoV2 infection (p= 0.04, 0.004 respectively). Postoperative pulmonary complications were observed in 5.8% (n=6) of the patients, and were more frequent in the presence of both, ≥ 3 B-lines and pleural thickening (p= 0.01). CONCLUSIONS In asymptomatic post-COVID-19 patients, pathological findings detected by lung ultrasound before surgery are associated with the severity of the SARS-CoV2 infection and resulted in more postoperative pulmonary complications. In these patients, the incidence of postoperative pulmonary complications appears similar to that described in the surgical population before the pandemic. TRIAL REGISTRATION clinicaltrials.gov (NCT04922931). June 21, 2021. "Retrospectively registered".
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Affiliation(s)
- Susana González-Suárez
- Department of Anesthesiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain. .,Universitat Autònoma de Barcelona, UAB, Barcelona, Spain.
| | - Antonio Barbara Ferreras
- Department of Anesthesiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Melissa Caicedo Toro
- Department of Anesthesiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Macarena Aznar de Legarra
- Department of Anesthesiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
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Kimura BJ, Resnikoff PM, Tran EM, Bonagiri PR, Spierling Bagsic SR. Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early COVID-19 Infection. J Am Soc Echocardiogr 2022; 35:1047-1054. [PMID: 35691456 PMCID: PMC9183238 DOI: 10.1016/j.echo.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In COVID-19, inpatient studies have demonstrated that lung ultrasound B-lines relate to disease severity and mortality and can occur in apical regions that can be imaged by the patients themselves. However, as illness begins in an ambulatory setting, we sought to determine the prevalence of B-lines in early outpatient infection and then test the accuracy of their detection using telehealth and automated methods. METHODS Consecutive adult patients (N=201) with positive testing for SARS-CoV-2, at least one clinical risk factor, and mild-moderate disease were prospectively enrolled at a monoclonal antibody infusion clinic. Physician imaging of the lung apices for 3 B-lines (ULC+) using 3MHz ultrasound was performed on all patients for prevalence data and served as the standard for a nested subset (n=50) to test the accuracy of telehealth methods, including patient self-imaging and automated B-line detection. Patient characteristics, vaccination data and hospitalizations were analyzed for associations with ULC+. RESULTS Mean patient age of 54 ±15 years, all lacking hypoxemia or fever, ULC+ was present in 55/201(27%) at a median of 7 symptomatic days (IQR:5-8) and in 4/5 patients who were later hospitalized (p=0.03). ULC+ was associated with unvaccinated status (OR=4.11[95% CI:1.85-9.33], p=0.001), diabetes (OR=2.56[95% CI:1.08-6.05], p=0.03), male sex (OR=2.14[95% CI:1.07-4.37], p=0.03), and hypertension/cardiovascular disease (OR=2.06[95% CI:1.02-4.23], p=0.04), while adjusting for BMI >25kg/m2. Telehealth and automated B-line detection had 84% and 82% accuracy, respectively. CONCLUSIONS In high-risk outpatients, B-lines in the upper lungs were common in early COVID-19 infection, related to subsequent hospitalization, and could be detected by telehealth and automated methods.
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Affiliation(s)
- Bruce J Kimura
- Dept of Medicine, Scripps Mercy Hospital, San Diego, California.
| | | | - Eric M Tran
- Dept of Medicine, Scripps Mercy Hospital, San Diego, California
| | | | - Samantha R Spierling Bagsic
- Dept of Medicine, Scripps Mercy Hospital, and the Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California
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Kimura BJ, Shi R, Tran EM, Spierling Bagsic SR, Resnikoff PM. Outcomes of Simplified Lung Ultrasound Exam in COVID-19: Implications for Self-Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1377-1384. [PMID: 34473363 PMCID: PMC8661724 DOI: 10.1002/jum.15820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/26/2021] [Accepted: 08/20/2021] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Lung ultrasound B-lines represent interstitial thickening or edema and relate to mortality in COVID-19. As B-lines can be detected with minimal training using point-of-care ultrasound (POCUS), we examined the frequency, clinical associations, and outcomes of B-lines when found using a simplified POCUS method in acutely ill patients with COVID-19. METHODS In this retrospective cohort study, hospital data from COVID-19 patients who had undergone lung imaging during standard echocardiography or POCUS were reviewed for an ultrasound lung comet (ULC) sign, defined as the presence of ≥3 B-lines from images of only the antero-apex of either lung (ULC+). Clinical risk factors, oximetry and radiographic results, and disease severity were analyzed for associations with ULC+. Clinical risk factors and ULC+ were analyzed for associations with hospital mortality or the need for intensive care in multivariable models. RESULTS Of N = 160 patients, age (mean ± standard deviation) was 64.8 ± 15.5 years, and 46 (29%) died. ULC+ was present in 100/160 (62%) of patients overall, in 81/103 (79%) of severe-or-greater disease versus 19/57 (33%) of moderate-or-less disease (P < .0001) and was associated with mortality (odds ratio [OR] = 2.4 [95% confidence interval [CI]: 1.1-5.4], P = .02) and the need for intensive care (OR = 5.23 [95% CI: 2.42-12.40], P < .0001). In the multivariable models, symptom duration and severe-or-greater disease were associated with ULC+, and ULC+, diabetes, and symptom duration were associated with the need for intensive care. CONCLUSIONS B-lines in the upper chest were common and related to disease severity, intensive care, and hospital mortality in COVID-19. Validation of a simplified lung POCUS exam could provide the evidence basis for a self-imaging application during the pandemic.
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Affiliation(s)
| | - Rujing Shi
- Department of MedicineScripps Mercy HospitalSan DiegoCAUSA
| | - Eric M. Tran
- Department of MedicineScripps Mercy HospitalSan DiegoCAUSA
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Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department. J Clin Med 2022; 11:jcm11113032. [PMID: 35683419 PMCID: PMC9181775 DOI: 10.3390/jcm11113032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68−0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan−Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95−9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8−88.8) and 74% (95%CI 69.5−78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions.
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Calcium–Permeable Channels and Endothelial Dysfunction in Acute Lung Injury. Curr Issues Mol Biol 2022; 44:2217-2229. [PMID: 35678679 PMCID: PMC9164020 DOI: 10.3390/cimb44050150] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
The increased permeability of the lung microvascular endothelium is one critical initiation of acute lung injury (ALI). The disruption of vascular-endothelium integrity results in leakiness of the endothelial barrier and accumulation of protein-rich fluid in the alveoli. During ALI, increased endothelial-cell (EC) permeability is always companied by high frequency and amplitude of cytosolic Ca2+ oscillations. Mechanistically, cytosolic calcium oscillations include calcium release from internal stores and calcium entry via channels located in the cell membrane. Recently, numerous publications have shown substantial evidence that calcium-permeable channels play an important role in maintaining the integrity of the endothelium barrier function of the vessel wall in ALI. These novel endothelial signaling pathways are future targets for the treatment of lung injury. This short review focuses on the up-to-date research and provide insight into the contribution of calcium influx via ion channels to the disruption of lung microvascular endothelial-barrier function during ALI.
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Zaky S, Fathelbab HK, Elbadry M, El-Raey F, Abd-Elsalam SM, Makhlouf HA, Makhlouf NA, Metwally MA, Ali-Eldin F, Hasan AA, Alboraie M, Yousef AM, Shata HM, Eid A, Asem N, Khalaf A, Elnady MA, Elbahnasawy M, Abdelaziz A, Shaltout SW, Elshemy EE, Wahdan A, Hegazi MS, Abdel Baki A, Hassany M. Egyptian Consensus on the Role of Lung Ultrasonography During the Coronavirus Disease 2019 Pandemic. Infect Drug Resist 2022; 15:1995-2013. [PMID: 36176457 PMCID: PMC9513721 DOI: 10.2147/idr.s353283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background & Aims Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.
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Affiliation(s)
- Samy Zaky
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Elbadry
- Department of Endemic Medicine, Helwan University, Cairo, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Sherief M Abd-Elsalam
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
- Correspondence: Sherief M Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta, Egypt, Tel +201063319696, Email
| | | | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Mohamed A Metwally
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Benha University, Benha, Egypt
| | - Fatma Ali-Eldin
- Department of Tropical medicine; Ain Shams University, Cairo, Egypt
| | | | - Mohamed Alboraie
- Department of Internal Medicine; Al-Azhar University, Cairo, Egypt
| | - Ahmed M Yousef
- Department of Community and Industrial Medicine, Damietta, Al-Azhar University, Damietta, Egypt
| | - Hanan M Shata
- Department of Chest Medicine; Mansoura University, Mansoura, Egypt
| | - Alshaimaa Eid
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University and Ministry of Health and Population, Cairo, Egypt
| | - Asmaa Khalaf
- Department of Radiology, Minia University, Minia, Egypt
| | - Mohamed A Elnady
- Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elbahnasawy
- Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt
| | - Ahmed Abdelaziz
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Shaker W Shaltout
- Department of Tropical Medicine, Port Said University, Port Said, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Atef Wahdan
- Department of Chest Diseases, Damietta, Al-Azhar University, Damietta, Egypt
| | - Mohamed S Hegazi
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Amin Abdel Baki
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
| | - Mohamed Hassany
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
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Vetrugno L, Meroi F, Orso D, D’Andrea N, Marin M, Cammarota G, Mattuzzi L, Delrio S, Furlan D, Foschiani J, Valent F, Bove T. Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study. Healthcare (Basel) 2022; 10:healthcare10030568. [PMID: 35327046 PMCID: PMC8955357 DOI: 10.3390/healthcare10030568] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival.
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Affiliation(s)
- Luigi Vetrugno
- Dipartimento di Scienze, Orali e Biotecnologiche, Università degli Studi “G. d’Annunzio”, 66100 Chieti, Italy;
| | - Francesco Meroi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
- Correspondence:
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Natascia D’Andrea
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Matteo Marin
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Gianmaria Cammarota
- Division of Anesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Lisa Mattuzzi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Silvia Delrio
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Davide Furlan
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Jonathan Foschiani
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Francesca Valent
- Clinical and Evaluational Epidemiologic Service, Department of Governance, Local Health Authority, 38123 Trento, Italy;
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
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Pettenuzzo T, Giraudo C, Fichera G, Della Paolera M, Tocco M, Weber M, Gorgi D, Carlucci S, Lionello F, Lococo S, Boscolo A, De Cassai A, Pasin L, Rossato M, Vianello A, Vettor R, Sella N, Navalesi P. Chest X-ray Does Not Predict the Risk of Endotracheal Intubation and Escalation of Treatment in COVID-19 Patients Requiring Noninvasive Respiratory Support. J Clin Med 2022; 11:jcm11061636. [PMID: 35329962 PMCID: PMC8950017 DOI: 10.3390/jcm11061636] [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: 02/20/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Forms of noninvasive respiratory support (NIRS) have been widely used to avoid endotracheal intubation in patients with coronavirus disease-19 (COVID-19). However, inappropriate prolongation of NIRS may delay endotracheal intubation and worsen patient outcomes. The aim of this retrospective study was to assess whether the CARE score, a chest X-ray score previously validated in COVID-19 patients, may predict the need for endotracheal intubation and escalation of respiratory support in COVID-19 patients requiring NIRS. From December 2020 to May 2021, we included 142 patients receiving NIRS who had a first chest X-ray available at NIRS initiation and a second one after 48–72 h. In 94 (66%) patients, the level of respiratory support was increased, while endotracheal intubation was required in 83 (58%) patients. The CARE score at NIRS initiation was not predictive of the need for endotracheal intubation (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.96–1.06) or escalation of treatment (OR 1.01, 95% CI 0.96–1.07). In conclusion, chest X-ray severity, as assessed by the CARE score, did not allow predicting endotracheal intubation or escalation of respiratory support in COVID-19 patients undergoing NIRS.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Chiara Giraudo
- Institute of Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Giulia Fichera
- Pediatric Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
| | - Michele Della Paolera
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Martina Tocco
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Michael Weber
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 23 Spitalgasse, 1090 Vienna, Austria;
| | - Davide Gorgi
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Silvia Carlucci
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Federico Lionello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Sara Lococo
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Annalisa Boscolo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Alessandro De Cassai
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Laura Pasin
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Marco Rossato
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Roberto Vettor
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Nicolò Sella
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Correspondence:
| | - Paolo Navalesi
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
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Gil-Rodríguez J, Pérez de Rojas J, Aranda-Laserna P, Benavente-Fernández A, Martos-Ruiz M, Peregrina-Rivas JA, Guirao-Arrabal E. Ultrasound findings of lung ultrasonography in COVID-19: A systematic review. Eur J Radiol 2022; 148:110156. [PMID: 35078136 PMCID: PMC8783639 DOI: 10.1016/j.ejrad.2022.110156] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify the defining lung ultrasound (LUS) findings of COVID-19, and establish its association to the initial severity of the disease and prognostic outcomes. METHOD Systematic review was conducted according to the PRISMA guidelines. We queried PubMed, Embase, Web of Science, Cochrane Database and Scopus using the terms ((coronavirus) OR (covid-19) OR (sars AND cov AND 2) OR (2019-nCoV)) AND (("lung ultrasound") OR (LUS)), from 31st of December 2019 to 31st of January 2021. PCR-confirmed cases of SARS-CoV-2 infection, obtained from original studies with at least 10 participants 18 years old or older, were included. Risk of bias and applicability was evaluated with QUADAS-2. RESULTS We found 1333 articles, from which 66 articles were included, with a pooled population of 4687 patients. The most examined findings were at least 3 B-lines, confluent B-lines, subpleural consolidation, pleural effusion and bilateral or unilateral distribution. B-lines, its confluent presentation and pleural abnormalities are the most frequent findings. LUS score was higher in intensive care unit (ICU) patients and emergency department (ED), and it was associated with a higher risk of developing unfavorable outcomes (death, ICU admission or need for mechanical ventilation). LUS findings and/or the LUS score had a good negative predictive value in the diagnosis of COVID-19 compared to RT-PCR. CONCLUSIONS The most frequent ultrasound findings of COVID-19 are B-lines and pleural abnormalities. High LUS score is associated with developing unfavorable outcomes. The inclusion of pleural effusion in the LUS score and the standardisation of the imaging protocol in COVID-19 LUS remains to be defined.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain,Corresponding author
| | - Javier Pérez de Rojas
- Preventive Medicine and Public Health Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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Sarkar M, Das B, Mahapatra MK, Roychowdhoury S, Das S, Konar MC. A Retrospective Analysis of Clinical Manifestations, Management and Outcome of Acute Respiratory Distress Syndrome Associated with Coronavirus Disease-2019 Infection in Children. Indian J Crit Care Med 2022; 26:331-338. [PMID: 35519909 PMCID: PMC9015940 DOI: 10.5005/jp-journals-10071-24145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Patients and methods Results Conclusion How to cite this article
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Affiliation(s)
- Mihir Sarkar
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
- Satyabrata Roychowdhoury, Department of Pediatrics, Medical College, Kolkata, West Bengal, India, Phone: +91 9433765529, e-mail:
| | - Bratesh Das
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
| | - Manas K Mahapatra
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
| | | | - Sambhunath Das
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
| | - Mithun C Konar
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
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Di Meglio L, Carriero S, Biondetti P, Wood BJ, Carrafiello G. Chest imaging in patients with acute respiratory failure because of coronavirus disease 2019. Curr Opin Crit Care 2022; 28:17-24. [PMID: 34864792 PMCID: PMC8711303 DOI: 10.1097/mcc.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to explore the different imaging modalities, such as chest radiography (CXR), computed tomography (CT), ultrasound, PET/CT scan, and MRI to describe the main features for the evaluation of the chest in COVID-19 patients with ARDS. RECENT FINDINGS This article includes a systematic literature search, evidencing the different chest imaging modalities used in patients with ARDS from COVID-19. Literature evidences different possible approaches going from the conventional CXR and CT to the LUS, MRI, and PET/CT. SUMMARY CT is the technique with higher sensitivity and definition for studying chest in COVID-19 patients. LUS or bedside CXR are critical in patients requiring close and repeated monitoring. Moreover, LUS and CXR reduce the radiation burden and the risk of infection compared with CT. PET/CT and MRI, especially in ARDS patients, are not usually used for diagnostic or follow-up purposes.
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Affiliation(s)
- Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano
| | - Serena Carriero
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano
| | - Pierpaolo Biondetti
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Parulekar P, Powys-Lybbe J, Knight T, Smallwood N, Lasserson D, Rudge G, Miller A, Peck M, Aron J. CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine) study: National service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19. J Intensive Care Soc 2022; 24:186-194. [DOI: 10.1177/17511437211065611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic. Method Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database. Results 372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction ( p < 0.05). Change in management occurred in 65% of patients following a combined scan. Conclusions In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.
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Affiliation(s)
- Prashant Parulekar
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust
| | | | - Thomas Knight
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, England
| | | | - Daniel Lasserson
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, England
| | - Gavin Rudge
- University of Birmingham, Birmingham, England
| | - Ashley Miller
- Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, England
| | - Marcus Peck
- Intensive Care Frimley Park Hospital NHS Foundation Trust, Frimley, England
| | - Jonathon Aron
- St George’s Hospital NHS Foundation TrustLondon, England
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Wang Y, Zhang Y, He Q, Liao H, Luo J. Quantitative Analysis of Pleural Line and B-Lines in Lung Ultrasound Images for Severity Assessment of COVID-19 Pneumonia. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:73-83. [PMID: 34428140 PMCID: PMC8905613 DOI: 10.1109/tuffc.2021.3107598] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/21/2021] [Indexed: 06/12/2023]
Abstract
Specific patterns of lung ultrasound (LUS) images are used to assess the severity of coronavirus disease 2019 (COVID-19) pneumonia, while such assessment is mainly based on clinicians' qualitative and subjective observations. In this study, we quantitatively analyze the LUS images to assess the severity of COVID-19 pneumonia by characterizing the patterns related to the pleural line (PL) and B-lines (BLs). Twenty-seven patients with COVID-19 pneumonia, including 13 moderate cases, seven severe cases, and seven critical cases, are enrolled. Features related to the PL, including the thickness (TPL) and roughness of the PL (RPL), and the mean (MPLI) and standard deviation (SDPLI) of the PL intensities are extracted from the LUS images. Features related to the BLs, including the number (NBL), accumulated width (AWBL), attenuation coefficient (ACBL), and accumulated intensity (AIBL) of BLs, are also extracted. The correlations of these features with the disease severity are evaluated. The performances of the binary severe/non-severe classification are assessed for each feature and support vector machine (SVM) classifiers with various combinations of features as input. Several features, including the RPL, NBL, AWBL, and AIBL, show significant correlations with disease severity (all ). The classification performance is optimal using the SVM classifier using all the features as input (area under the receiver operating characteristic (ROC) curve = 0.96, sensitivity = 0.93, and specificity = 1). These findings demonstrate that the proposed method may be a promising tool for automatic grading diagnosis and follow-up of patients with COVID-19 pneumonia.
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Affiliation(s)
- Yuanyuan Wang
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Yao Zhang
- Department of UltrasoundBeijing Ditan HospitalCapital Medical UniversityBeijing100015China
| | - Qiong He
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Hongen Liao
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Jianwen Luo
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
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Chevallier Lugon C, Kharat A, Soccal PM, Guessous I, Spechbach H, Salamun J. Implementing Lung Ultrasound in the Outpatient Management of COVID-19 Pneumonia: A Pilot Study to Update Local Guidelines. Front Med (Lausanne) 2021; 8:774035. [PMID: 34901090 PMCID: PMC8660970 DOI: 10.3389/fmed.2021.774035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Lung ultrasound (LUS) has a good performance with a high sensitivity and specificity for the diagnosis of pneumonia compared with chest X-ray, and it has been extensively used to assess patients during the COVID-19 pandemic. This study aims to evaluate the potential advantages of the regular use of LUS for the assessment of the severity and prognosis of COVID-19 pneumonia and to propose an adapted protocol with its inclusion in current local validated and published guidelines. Methods: This is a single-center prospective study conducted during the first (April–May 2020) and second (October 2020–January 2021) waves of the SARS-CoV2 pandemic in Switzerland. All adult patients presenting to dedicated test centers with a suspicion of mild-to-moderate COVID-19 pneumonia and not requiring hospitalization at the time of diagnosis were included. Patients with confirmed COVID-19 pneumonia were referred to an ambulatory follow-up unit at our institution for reassessment, with the inclusion of the use of LUS in a random selection. Descriptive statistics were calculated for demographics using percentages, means, and standard deviations according to the distribution of variables. Results: Eighty-eight ambulatory patients with a confirmed COVID-19 pneumonia were included (men = 57 [59%]; mean age, 52.1 ± 13.5 years). Among these, 19 (21%) were hospitalized and none died. Twenty-five lung assessments by ultrasound were performed during the follow-up consultation. All were consistent with the clinical examination and confirmed the clinician's opinion. Conclusion: The use of a standardized pleuro-pulmonary ultrasound protocol for ambulatory patients with COVID-19 could help to reduce the use of chest X-rays and improve overall management at the time of referral and eventual follow-up. However, a specific study including LUS in a systematic approach should be performed to evaluate the outcome of patients according to findings.
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Affiliation(s)
| | - Aileen Kharat
- Department of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Paola M Soccal
- Department of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hervé Spechbach
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Salamun
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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Vetrugno L, Mojoli F, Cortegiani A, Bignami EG, Ippolito M, Orso D, Corradi F, Cammarota G, Mongodi S, Boero E, Iacovazzo C, Vargas M, Poole D, Biasucci DG, Persona P, Bove T, Ball L, Chiumello D, Forfori F, de Robertis E, Pelosi P, Navalesi P, Giarratano A, Petrini F. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO). JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8611396 DOI: 10.1186/s44158-021-00015-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-021-00015-6.
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Ma IWY, Noble VE, Mints G, Wong T, Tonelli AC, Hussain A, Liu RB, Hergott CA, Dumoulin E, Chee A, Miller DJ, Walker B, Buchanan B, Wagner M, Arishenkoff S, Liteplo AS. On Recommending Specific Lung Ultrasound Protocols in the Assessment of Medical Inpatients with Known or Suspected Coronavirus Disease-19 Reply. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2785-2786. [PMID: 33555607 PMCID: PMC8013807 DOI: 10.1002/jum.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 05/15/2023]
Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of Emergency Ultrasound, Department of Emergency MedicineMassachusetts General Hospital, Boston, Harvard Medical SchoolBostonMassachusettsUSA
| | - Vicki E. Noble
- Department of Emergency MedicineUniversity Hospitals, Cleveland Medical Center, Case Western Reserve School of MedicineClevelandOhioUSA
| | - Gregory Mints
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Tanping Wong
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Ana Claudia Tonelli
- Department of General Internal Medicine, Hospital de Clinicas de Porto Alegre and Department of MedicineUnisinos UniversitySão LeopoldoRSBrazil
| | - Arif Hussain
- Division of Cardiac Critical Care, Department of Cardiac SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
| | - Rachel B. Liu
- Section of Emergency Ultrasound, Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Christopher A. Hergott
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Elaine Dumoulin
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Alex Chee
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Daniel J. Miller
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Brandie Walker
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Brian Buchanan
- Department of Critical CareUniversity of AlbertaEdmontonAlbertaCanada
| | - Michael Wagner
- Division of Hospital Medicine, Department of MedicinePrisma Health‐UpstateGreenvilleSouth CarolinaUSA
| | - Shane Arishenkoff
- Division of General Internal Medicine, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Andrew S. Liteplo
- Division of Emergency Ultrasound, Department of Emergency MedicineMassachusetts General Hospital, Boston, Harvard Medical SchoolBostonMassachusettsUSA
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ACE2 and Innate Immunity in the Regulation of SARS-CoV-2-Induced Acute Lung Injury: A Review. Int J Mol Sci 2021; 22:ijms222111483. [PMID: 34768911 PMCID: PMC8583933 DOI: 10.3390/ijms222111483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Despite the protracted battle against coronavirus acute respiratory infection (COVID-19) and the rapid evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), no specific and effective drugs have to date been reported. Angiotensin-converting enzyme 2 (ACE2) is a zinc metalloproteinase and a critical modulator of the renin-angiotensin system (RAS). In addition, ACE2 has anti-inflammatory and antifibrosis functions. ACE has become widely known in the past decade as it has been identified as the primary receptor for SARS-CoV and SARS-CoV-2, being closely associated with their infection. SARS-CoV-2 primarily targets the lung, which induces a cytokine storm by infecting alveolar cells, resulting in tissue damage and eventually severe acute respiratory syndrome. In the lung, innate immunity acts as a critical line of defense against pathogens, including SARS-CoV-2. This review aims to summarize the regulation of ACE2, and lung host cells resist SARS-CoV-2 invasion by activating innate immunity response. Finally, we discuss ACE2 as a therapeutic target, providing reference and enlightenment for the clinical treatment of COVID-19.
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Torres-Macho J, Sánchez-Fernández M, Arnanz-González I, Tung-Chen Y, Franco-Moreno AI, Duffort-Falcó M, Beltrán-Romero L, Rodríguez-Suaréz S, Bernabeu-Wittel M, Urbano E, Méndez-Bailon M, Roque-Rojas F, García-Guijarro E, García-Casasola G. Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study). J Clin Med 2021; 10:jcm10214818. [PMID: 34768337 PMCID: PMC8584928 DOI: 10.3390/jcm10214818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/16/2021] [Indexed: 12/23/2022] Open
Abstract
The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0–48 h and 72–96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer–Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0–11 points, 12–24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58–0.85) vs. 0.61 (0.52–0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66–0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
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Affiliation(s)
- Juan Torres-Macho
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Correspondence:
| | | | - Irene Arnanz-González
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Emergency Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain
| | - Yale Tung-Chen
- Emergency Department, La Paz University Hospital, 28046 Madrid, Spain;
- Enfermera Isabel Zendal Emergency Hospital, 28055 Madrid, Spain
| | - Ana Isabel Franco-Moreno
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
| | - Mercedes Duffort-Falcó
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
| | - Luis Beltrán-Romero
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Santiago Rodríguez-Suaréz
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Máximo Bernabeu-Wittel
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Elena Urbano
- Internal Medicine Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Manuel Méndez-Bailon
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Internal Medicine Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Fernando Roque-Rojas
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
| | - Elena García-Guijarro
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
| | - Gonzalo García-Casasola
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
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