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Ovesen SH, Clausen AH, Kirkegaard H, Løfgren B, Aagaard R, Skaarup SH, Arvig MD, Lorentzen MH, Kristensen AH, Cartuliares MB, Falster C, Tong L, Rabajoli A, Leth R, Desy J, Ma IWY, Weile J. Point-of-Care Lung Ultrasound in Emergency Medicine: A Scoping Review With an Interactive Database. Chest 2024; 166:544-560. [PMID: 38458431 DOI: 10.1016/j.chest.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives. RESEARCH QUESTION Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine? STUDY DESIGN AND METHODS We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels. RESULTS A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM_240216/INFO). INTERPRETATION Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits.
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Affiliation(s)
- Stig Holm Ovesen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Emergency Department, Horsens Regional Hospital, Horsens, Denmark.
| | | | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Rasmus Aagaard
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hjarnø Lorentzen
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Anne Heltborg Kristensen
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mariana Bichuette Cartuliares
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Liting Tong
- Emergency Department, Nykøbing F. Hospital, Zealand Denmark Region, Denmark
| | - Alessandra Rabajoli
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ronja Leth
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Emergency Department, Horsens Regional Hospital, Horsens, Denmark
| | - Janeve Desy
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Irene W Y Ma
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jesper Weile
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Emergency Department, Horsens Regional Hospital, Horsens, Denmark
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Rodríguez García L, Hierro Delgado E, Oulego Erroz I, Rey Galán C, Mayordomo Colunga J. Clinical-Ultrasound Model to Predict the Clinical Course in Bronchiolitis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:987. [PMID: 39201922 PMCID: PMC11352824 DOI: 10.3390/children11080987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND The aim of the present study was to develop a clinical-ultrasound model for early detection of hospital admission, pediatric intensive care unit (PICU) admission, and oxygen requirement in children diagnosed with acute bronchiolitis (AB). Furthermore, the prognostic ability of models including sonographic data from antero-lateral, lateral-posterior, and posterior areas (eight zones) vs. antero-lateral and lateral-posterior areas (six zones) vs. only antero-lateral areas (four zones) was analyzed. METHODS A prospective study was conducted on infants under 12 months with AB. A lung ultrasound (LUS) was performed within 24 h of hospital care and analyzed using the Lung Ultrasound Combined Score (LUCS) based on the ultrasound patterns and their extent. Regression models combining LUCS (using eight, six, or four lung areas) with age and clinical scale were created. RESULTS A total of 90 patients were included (62 admitted to the ward, 15 to PICU), with a median age of 3.7 months. Clinical-ultrasound models with eight and six lung zones predicted hospital admission (AUC 0.89), need for oxygen therapy (AUC 0.88), and its duration (40% explanatory capacity). Models using four lung areas had lower prognostic yield. No model predicted PICU admission needs or duration. CONCLUSIONS The ultrasound pattern and its extension combined with clinical information may be useful to predict hospital admission and oxygen requirement.
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Affiliation(s)
- Lucía Rodríguez García
- Childhood and Adolescence Clinical Management Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.R.G.)
| | - Elena Hierro Delgado
- Paediatrics Department, Complejo Asistencial Universitario de León, 24071 León, Spain
| | - Ignacio Oulego Erroz
- Paediatrics Department, Complejo Asistencial Universitario de León, 24071 León, Spain
- Institute of Biomedicine of León, Universidad de León, 24071 León, Spain
| | - Corsino Rey Galán
- Childhood and Adolescence Clinical Management Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.R.G.)
- Cooperative Research Networks Oriented to Health Outcomes (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28029 Madrid, Spain
- Department of Medicine, Universidad de Oviedo, 33006 Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Juan Mayordomo Colunga
- Childhood and Adolescence Clinical Management Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.R.G.)
- Cooperative Research Networks Oriented to Health Outcomes (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28029 Madrid, Spain
- Department of Medicine, Universidad de Oviedo, 33006 Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
- Biomedical Research Networking Center (CIBER)-Respiratory Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Chua MT, Boon Y, Yeoh CK, Li Z, Goh CJM, Kuan WS. Point-of-care ultrasound use in COVID-19: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:13. [PMID: 38304913 PMCID: PMC10777239 DOI: 10.21037/atm-23-1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024]
Abstract
Background and Objective The coronavirus disease 2019 (COVID-19) pandemic that began in early 2020 resulted in significant mortality from respiratory tract infections. Existing imaging modalities such as chest X-ray (CXR) lacks sensitivity in its diagnosis while computed tomography (CT) scan carries risks of radiation and contamination. Point-of-care ultrasound (POCUS) has the advantage of bedside testing with higher diagnostic accuracy. We aim to describe the various applications of POCUS for patients with suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the emergency department (ED) and intensive care unit (ICU). Methods We performed literature search on the use of POCUS in the diagnosis and management of COVID-19 in MEDLINE, Embase and Scopus databases using the following search terms: "ultrasonography", "ultrasound", "COVID-19", "SARS-CoV-2", "SARS-CoV-2 variants", "emergency services", "emergency department" and "intensive care units". Search was performed independently by two reviewers with any discrepancy adjudicated by a third member. Key Content and Findings Lung POCUS in patients with COVID-19 shows different ultrasonographic features from pulmonary oedema, bacterial pneumonia, and other viral pneumonia, thus useful in differentiating between these conditions. It is more sensitive than CXR, and more accessible and widely available than CT scan. POCUS can be used to diagnose COVID-19 pneumonia, screen for COVID-19-related pulmonary and extrapulmonary complications, and guide management of ICU patients, such as timing of ventilator weaning based on lung POCUS findings. Conclusions POCUS is a useful and rapid point-of-care modality that can be used to aid in diagnosis, management, and risk stratification of COVID-19 patients in different healthcare settings.
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Affiliation(s)
- Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuru Boon
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chew Kiat Yeoh
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carmen Jia Man Goh
- Emergency Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Patel D, Bailitz J, Ymson S, Neichin J, Peksa GD, Gottlieb M. Diagnostic accuracy of real-time ultrasound for detecting pulmonary edema by lung region. Am J Emerg Med 2024; 75:181-182. [PMID: 37516628 DOI: 10.1016/j.ajem.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 07/31/2023] Open
Affiliation(s)
- Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | | | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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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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Pelosi P, Tonelli R, Torregiani C, Baratella E, Confalonieri M, Battaglini D, Marchioni A, Confalonieri P, Clini E, Salton F, Ruaro B. Different Methods to Improve the Monitoring of Noninvasive Respiratory Support of Patients with Severe Pneumonia/ARDS Due to COVID-19: An Update. J Clin Med 2022; 11:1704. [PMID: 35330029 PMCID: PMC8952765 DOI: 10.3390/jcm11061704] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
The latest guidelines for the hospital care of patients affected by coronavirus disease 2019 (COVID-19)-related acute respiratory failure have moved towards the widely accepted use of noninvasive respiratory support (NIRS) as opposed to early intubation at the pandemic onset. The establishment of severe COVID-19 pneumonia goes through different pathophysiological phases that partially resemble typical acute respiratory distress syndrome (ARDS) and have been categorized into different clinical-radiological phenotypes. These can variably benefit on the application of external positive end-expiratory pressure (PEEP) during noninvasive mechanical ventilation, mainly due to variable levels of lung recruitment ability and lung compliance during different phases of the disease. A growing body of evidence suggests that intense respiratory effort producing excessive negative pleural pressure swings (Ppl) plays a critical role in the onset and progression of lung and diaphragm damage in patients treated with noninvasive respiratory support. Routine respiratory monitoring is mandatory to avoid the nasty continuation of NIRS in patients who are at higher risk for respiratory deterioration and could benefit from early initiation of invasive mechanical ventilation instead. Here we propose different monitoring methods both in the clinical and experimental settings adapted for this purpose, although further research is required to allow their extensive application in clinical practice. We reviewed the needs and available tools for clinical-physiological monitoring that aims at optimizing the ventilatory management of patients affected by acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.
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Affiliation(s)
- Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (P.P.); (D.B.)
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy; (R.T.); (A.M.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy
| | - Chiara Torregiani
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy;
| | - Marco Confalonieri
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Denise Battaglini
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (P.P.); (D.B.)
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy; (R.T.); (A.M.); (E.C.)
| | - Paola Confalonieri
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Enrico Clini
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy; (R.T.); (A.M.); (E.C.)
| | - Francesco Salton
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Barbara Ruaro
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
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