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Siniscalchi C, Nouvenne A, Cerundolo N, Meschi T, Ticinesi A. Diaphragm Ultrasound in Different Clinical Scenarios: A Review with a Focus on Older Patients. Geriatrics (Basel) 2024; 9:70. [PMID: 38920426 PMCID: PMC11202496 DOI: 10.3390/geriatrics9030070] [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: 04/15/2024] [Revised: 05/08/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Diaphragm muscle dysfunction is increasingly recognized as a fundamental marker of several age-related diseases and conditions including chronic obstructive pulmonary disease, heart failure and critical illness with respiratory failure. In older individuals with physical frailty and sarcopenia, the loss of muscle mass and function may also involve the diaphragm, contributing to respiratory dysfunction. Ultrasound has recently emerged as a feasible and reliable strategy to visualize diaphragm structure and function. In particular, it can help to predict the timing of extubation in patients undergoing mechanical ventilation in intensive care units (ICUs). Ultrasonographic evaluation of diaphragmatic function is relatively cheap, safe and quick and can provide useful information for real-time monitoring of respiratory function. In this review, we aim to present the current state of scientific evidence on the usefulness of ultrasound in the assessment of diaphragm dysfunction in different clinical settings, with a particular focus on older patients. We highlight the importance of the qualitative information gathered by ultrasound to assess the integrity, excursion, thickness and thickening of the diaphragm. The implementation of bedside diaphragm ultrasound could be useful for improving the quality and appropriateness of care, especially in older subjects with sarcopenia who experience acute respiratory failure, not only in the ICU setting.
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Affiliation(s)
- Carmine Siniscalchi
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
| | - Antonio Nouvenne
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Nicoletta Cerundolo
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
| | - Tiziana Meschi
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Andrea Ticinesi
- Department of Continuity of Care and Multicomplexity, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (C.S.); (A.N.); (N.C.); (T.M.)
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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Siniscalchi C, Ticinesi A, Nouvenne A, Guerra A, Parise A, Finardi L, Cerundolo N, Prati B, Guida L, Meschi T. Non-Invasive Ventilation Support during Hospitalization for SARS-CoV-2 and the Risk of Venous Thromboembolism. J Clin Med 2024; 13:2737. [PMID: 38792278 PMCID: PMC11122199 DOI: 10.3390/jcm13102737] [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: 04/08/2024] [Revised: 04/19/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Although SARS-CoV-2 infection is a significant risk factor for venous thromboembolism (VTE), data on the impact of the use of non-invasive ventilation support (NIVS) to mitigate the risk of VTE during hospitalization are scarce. Methods: Data for 1471 SARS-CoV-2 patients, hospitalized in a single hub during the first pandemic wave, were collected from clinical records, including symptom duration and type, information on lung abnormalities on chest computed tomography (CT), laboratory parameters and the use of NIVS. Determining VTE occurrence during hospital stays was the main endpoint. Results: Patients with VTE (1.8%) had an increased prevalence of obesity (26% vs. 11%), diabetes (41% vs. 21%), higher CHA2DS2VASC score (4, IQR 2-5 vs. 3, IQR 1-4, age- and sex-adjusted, p = 0.021) and cough (65% vs. 44%) and experienced significantly higher rates of NIVS (44% vs. 8%). Using a stepwise multivariate logistic regression model, the prevalence of electrocardiogram abnormalities (odds ratio (OR) 2.722, 95% confidence interval (CI) 1.039-7.133, p = 0.042), cough (OR 3.019, 95% CI 1.265-7.202, p = 0.013), CHA2DS2-VASC score > 3 (OR 3.404, 95% CI 1.362-8.513, p = 0.009) and the use of NIVS (OR 15.530, 95% CI 6.244-38.627, p < 0.001) were independently associated with a risk of VTE during hospitalization. NIVS remained an independent risk factor for VTE even after adjustment for the period of admission within the pandemic wave. Conclusions: Our study suggests that NIVS is a risk factor for VTE during hospitalization in SARS-CoV-2 patients. Future studies should assess the optimal prophylactic strategy against VTE in patients with a SARS-CoV-2 infection candidate to non-invasive ventilatory support.
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Affiliation(s)
- Carmine Siniscalchi
- General and Specialistic Medicine Department, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Alberto Parise
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Lorenzo Finardi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Beatrice Prati
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Loredana Guida
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
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Gok F, Kollu K, Poyraz N, Vatansev H, Yosunkaya A. The Comparison of Ultrasound and Tomographic Images of Lung Involvement in Critically Ill Patients With COVID-19 Pneumonia: A Prospective Observational Study. Cureus 2024; 16:e58201. [PMID: 38616976 PMCID: PMC11015859 DOI: 10.7759/cureus.58201] [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] [Accepted: 04/13/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Computed tomography (CT) has a high sensitivity for diagnosing COVID-19 pneumonia in critically ill patients, but it has significant limitations. Lung ultrasonography (LUS) is an imaging method increasingly used in intensive care units. Our primary aim is to evaluate the relationship between LUS and CT images by scoring a critically ill patient who was previously diagnosed with COVID-19 pneumonia and underwent CT, as well as to determine their relationship with the patient's oxygenation. Methods This was a single-center, prospective observational study. The study included COVID-19 patients (positive reverse transcription polymerase chain reaction, RT-PCR) who were admitted to the intensive care unit between June 2020 and December 2020, whose oxygen saturation (SpO2) was below 92%, and who underwent a chest tomography scan within the last 12 hours. CT findings were scored by the radiologist using the COVID-19 Reporting and Data System (CO-RADS). The intensivist evaluated 12 regions to determine the LUS score. The ratio of the partial pressure of oxygen in the arterial blood to the inspiratory oxygen concentration (PaO2/FiO2) was used to assess the patient's oxygenation. Results The study included 30 patients and found a weak correlation (ICC = 0.45, 95% CI = 0.25-0.65, p < 0.05) between total scores obtained from LUS and CT scans. The correlation between the total LUS score and oxygenation (r = -0.514, p = 0.004) was stronger than that between the CT score and oxygenation (r = -0.400, p = 0.028). The most common sonographic findings were abnormalities in the pleural line, white lung, and subpleural consolidation. On the other hand, the CT images revealed dense ground-glass opacities and consolidation patterns classified as CO-RADS 5. Conclusion A weak correlation was found between LUS and CT scores in critically ill COVID-19 pneumonia patients. Also, as both scores increased, oxygenation was detected to be impaired, and such a correlation is more evident with the LUS score.
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Affiliation(s)
- Funda Gok
- Department of Critical Care Medicine, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
| | - Korhan Kollu
- Department of Critical Care Medicine, Konya City Education and Research Hospital, Konya, TUR
| | - Necdet Poyraz
- Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
| | - Hulya Vatansev
- Department of Pulmonology, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
| | - Alper Yosunkaya
- Department of Critical Care Medicine, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
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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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Scarlata S, Okoye C, Zotti S, Lauretani F, Nouvenne A, Cerundolo N, Bruni AA, Torrini M, Finazzi A, Mazzarone T, Lunian M, Zucchini I, Maccioni L, Guarino D, Fabbri Della Faggiola S, Capacci M, Bianco MG, Guarona G, Bellelli G, Monzani F, Virdis A, Antonelli Incalzi R, Ungar A, Ticinesi A. Advancing healthcare through thoracic ultrasound research in older patients. Aging Clin Exp Res 2023; 35:2887-2901. [PMID: 37950845 PMCID: PMC10721707 DOI: 10.1007/s40520-023-02590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy.
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Sonia Zotti
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Adriana Antonella Bruni
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Monica Torrini
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Tessa Mazzarone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Marco Lunian
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Irene Zucchini
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Lorenzo Maccioni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Marco Capacci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Giovanna Bianco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guglielmo Guarona
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Fabio Monzani
- Casa di Cura Venerabile Confraternita di Misericordia Navacchio, 56023, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
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Han J, Xue J, Ye X, Xu W, Jin R, Liu W, Meng S, Zhang Y, Hu X, Yang X, Li R, Meng F. Comparison of Ultrasound and CT Imaging for the Diagnosis of Coronavirus Disease and Influenza A Pneumonia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2557-2566. [PMID: 37334890 DOI: 10.1002/jum.16289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The outbreak of coronavirus disease (COVID-19) coincided with the season of influenza A pneumonia, a common respiratory infectious disease. Therefore, this study compared ultrasonography and computed tomography (CT) for the diagnosis of the two diseases. METHODS Patients with COVID-19 or influenza A infection hospitalized at our hospital were included. The patients were examined by ultrasonography every day. The CT examination results within 1 day before and after the day of the highest ultrasonography score were selected as the controls. The similarities and differences between the ultrasonography and CT results in the two groups were compared. RESULTS There was no difference between the ultrasonography and CT scores (P = .307) for COVID-19, while there was a difference between ultrasonography and CT scores for influenza A pneumonia (P = .024). The ultrasonography score for COVID-19 was higher than that for influenza A pneumonia (P = .000), but there was no difference between the CT scores (P = .830). For both diseases, there was no difference in ultrasonography and CT scores between the left and right lungs; there were differences between the CT scores of the upper and middle lobes, as well as between the upper and lower lobes of the lungs; however, there was no difference between the lower and middle lobes of the lungs. CONCLUSION Ultrasonography is equivalent to the gold standard CT for diagnosing and monitoring the progression of COVID-19. Because of its convenience, ultrasonography has important application value. Furthermore, the diagnostic value of ultrasonography for COVID-19 is higher than that for influenza A pneumonia.
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Affiliation(s)
- Jing Han
- Ultrasound and Functional Diagnosis Center, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Jun Xue
- Department of Echocardiography, China Emergency General Hospital, Beijing, China
| | - Xiangyang Ye
- Department of Orthopaedics, Nanyang Central Hospital, Nanyang, China
| | - Wei Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ronghua Jin
- Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Liu
- Ultrasound and Functional Diagnosis Center, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Sha Meng
- Department of Science and Technology Department, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Ultrasound and Functional Diagnosis Center, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Xing Hu
- Ultrasound and Functional Diagnosis Center, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Xi Yang
- Department of ultrasound, Hanyang Hospital Affiliated to Wuhan University of science and technology, Wuhan, China
| | - Ruili Li
- Radiology Department, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Fankun Meng
- Ultrasound and Functional Diagnosis Center, Beijing You An Hospital, Capital Medical University, Beijing, China
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Tana C, Moffa L, Falasca K, Vecchiet J, Tana M, Mantini C, Ricci F, Ticinesi A, Meschi T, Cipollone F, Giamberardino MA. Approach to COVID-19 in older adults and indications for improving the outcomes. Ann Med 2023; 55:2265298. [PMID: 37839411 PMCID: PMC10578089 DOI: 10.1080/07853890.2023.2265298] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023] Open
Abstract
Background: COVID-19 continues to present challenges in the care of older adults with frailty and/or comorbidities and very old patients, who can be hospitalized with severe COVID-19 despite full vaccination. Frailty is a heterogeneous syndrome characterized by an increased aging-related vulnerability due to a reduced physiological reserve and function of systemic organs, and is associated with an impairment of activities of daily living. Frail older adults remain at elevated risk of mortality from COVID-19 compared to older adults without frailty, and some pre-existing risk factors such as malnutrition, prolonged bed rest, and the association with comorbidities can aggravate the SARS-CoV-2 infection. Furthermore, the severity of COVID-19 can impact on long-term functioning of older patients surviving from the infection. Persistent symptoms are another emerging problem of the post-vaccination phase of pandemic, as most patients suffer from chronic symptoms which can become debilitating and affect the daily routine. Aim of this review: In this complex relationship, the evaluation of COVID-19 in vulnerable categories is still a matter of high interest and personalized care plans based on a comprehensive geriatric assessment, tailored interventions; specific therapeutic algorithms among older adults are thus recommended in order to improve the outcomes.
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Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
| | - Livia Moffa
- Infectious Disease Department and COVID-19 Unit, University Hospital of Chieti, Chieti, Italy
| | - Katia Falasca
- Infectious Disease Department and COVID-19 Unit, University Hospital of Chieti, Chieti, Italy
| | - Jacopo Vecchiet
- Infectious Disease Department and COVID-19 Unit, University Hospital of Chieti, Chieti, Italy
| | - Marco Tana
- Internal Medicine Unit, SS. Annunziata Hospital of Chieti, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D’Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D’Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Italy and Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Italy and Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesco Cipollone
- Medical Clinic, SS. Annunziata Hospital of Chieti, Department of Medicine and Science of Aging, "G. D’Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Maria Adele Giamberardino
- Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
- Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti, Italy
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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. Med Clin (Barc) 2023; 160:531-539. [PMID: 36990898 PMCID: PMC9998289 DOI: 10.1016/j.medcli.2023.01.024] [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: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 03/12/2023]
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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9
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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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10
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Li X, Li W, Sun L, Ren J, Xu Y, Zheng Y, Bai W. Efficacy of low-intensity pulsed ultrasound for the treatment of viral pneumonia: study protocol for a randomized controlled trial. Trials 2023; 24:389. [PMID: 37296443 DOI: 10.1186/s13063-023-07382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Viral pneumonia has always been a problem faced by clinicians because of its insidious onset, strong infectivity, and lack of effective drugs. Patients with advanced age or underlying diseases may experience more severe symptoms and are prone to severe ventilation dysfunction. Reducing pulmonary inflammation and improving clinical symptoms is the focus of current treatment. Low-intensity pulsed ultrasound (LIPUS) can mitigate inflammation and inhibit edema formation. We aimed to investigate the efficacy of therapeutic LIPUS in improving lung inflammation in hospitalized patients with viral pneumonia. METHODS Sixty eligible participants with clinically confirmed viral pneumonia will be assigned to either (1) intervention group (LIPUS stimulus), (2) control group (null stimulus), or (3) self-control group (LIPUS stimulated areas versus non-stimulated areas). The primary outcome will be the difference in the extent of absorption and dissipation of lung inflammation on computed tomography. Secondary outcomes include changes in lung inflammation on ultrasonography images, pulmonary function, blood gas analysis, fingertip arterial oxygen saturation, serum inflammatory factor levels, the sputum excretion volume, time to the disappearance of pulmonary rales, pneumonia status score, and course of pneumonia. Adverse events will be recorded. DISCUSSION This study is the first clinical study of the efficacy of therapeutic LIPUS in the treatment of viral pneumonia. Given that the current clinical recovery mainly depends on the body's self-limiting and conventional symptomatic treatment, LIPUS, as a new therapy method, might be a major advance in the treatment of viral pneumonia. TRIAL REGISTRATION ChiCTR2200059550 Chinese Clinical Trial Registry, May 3, 2022.
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Affiliation(s)
- Xiao Li
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Wen Li
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Lianjie Sun
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Wutaishan Road 1677, Qingdao, 266555, China
| | - Junyi Ren
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Ying Xu
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China.
| | - Wenkun Bai
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Ultrasound in Medicine, Yishan Road 600, Shanghai, 200233, China.
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11
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Cheng L, Lan L, Ramalingam M, He J, Yang Y, Gao M, Shi Z. A review of current effective COVID-19 testing methods and quality control. Arch Microbiol 2023; 205:239. [PMID: 37195393 DOI: 10.1007/s00203-023-03579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
COVID-19 is a highly infectious disease caused by the SARS-CoV-2 virus, which primarily affects the respiratory system and can lead to severe illness. The virus is extremely contagious, early and accurate diagnosis of SARS-CoV-2 is crucial to contain its spread, to provide prompt treatment, and to prevent complications. Currently, the reverse transcriptase polymerase chain reaction (RT-PCR) is considered to be the gold standard for detecting COVID-19 in its early stages. In addition, loop-mediated isothermal amplification (LMAP), clustering rule interval short palindromic repeats (CRISPR), colloidal gold immunochromatographic assay (GICA), computed tomography (CT), and electrochemical sensors are also common tests. However, these different methods vary greatly in terms of their detection efficiency, specificity, accuracy, sensitivity, cost, and throughput. Besides, most of the current detection methods are conducted in central hospitals and laboratories, which is a great challenge for remote and underdeveloped areas. Therefore, it is essential to review the advantages and disadvantages of different COVID-19 detection methods, as well as the technology that can enhance detection efficiency and improve detection quality in greater details.
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Affiliation(s)
- Lijia Cheng
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China.
| | - Liang Lan
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China
| | - Murugan Ramalingam
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China
| | - Jianrong He
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China
| | - Yimin Yang
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China
| | - Min Gao
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China
| | - Zheng Shi
- Clinical Medical College & Affiliated Hospital, School of Basic Medical Sciences, Chengdu University, Chengdu, 610106, China.
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12
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Chrzan R, Polok K, Antczak J, Siwiec-Koźlik A, Jagiełło W, Popiela T. The value of lung ultrasound in COVID-19 pneumonia, verified by high resolution computed tomography assessed by artificial intelligence. BMC Infect Dis 2023; 23:195. [PMID: 37003997 PMCID: PMC10064611 DOI: 10.1186/s12879-023-08173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is an increasingly popular imaging method in clinical practice. It became particularly important during the COVID-19 pandemic due to its mobility and ease of use compared to high-resolution computed tomography (HRCT). The objective of this study was to assess the value of LUS in quantifying the degree of lung involvement and in discrimination of lesion types in the course of COVID-19 pneumonia as compared to HRCT analyzed by the artificial intelligence (AI). METHODS This was a prospective observational study including adult patients hospitalized due to COVID-19 in whom initial HRCT and LUS were performed with an interval < 72 h. HRCT assessment was performed automatically by AI. We evaluated the correlations between the inflammation volume assessed both in LUS and HRCT, between LUS results and the HRCT structure of inflammation, and between LUS and the laboratory markers of inflammation. Additionally we compared the LUS results in subgroups depending on the respiratory failure throughout the hospitalization. RESULTS Study group comprised 65 patients, median 63 years old. For both lungs, the median LUS score was 19 (IQR-interquartile range 11-24) and the median CT score was 22 (IQR 16-26). Strong correlations were found between LUS and CT scores (for both lungs r = 0.75), and between LUS score and percentage inflammation volume (PIV) (r = 0.69). The correlations remained significant, if weakened, for individual lung lobes. The correlations between LUS score and the value of the percentage consolidation volume (PCV) divided by percentage ground glass volume (PGV), were weak or not significant. We found significant correlation between LUS score and C-reactive protein (r = 0.55), and between LUS score and interleukin 6 (r = 0.39). LUS score was significantly higher in subgroups with more severe respiratory failure. CONCLUSIONS LUS can be regarded as an accurate method to evaluate the extent of COVID-19 pneumonia and as a promising tool to estimate its clinical severity. Evaluation of LUS in the assessment of the structure of inflammation, requires further studies in the course of the disease. TRIAL REGISTRATION The study has been preregistered 13 Aug 2020 on clinicaltrials.gov with the number NCT04513210.
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Affiliation(s)
- Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Kopernika 19, 31-501, Krakow, Poland.
| | - Kamil Polok
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Antczak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Andżelika Siwiec-Koźlik
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Jagiełło
- Second Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Kopernika 19, 31-501, Krakow, Poland
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13
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Ticinesi A, Parise A, Nouvenne A, Cerundolo N, Prati B, Guerra A, Tuttolomondo D, Gaibazzi N, Meschi T. Insights from comparison of the clinical presentation and outcomes of patients hospitalized with COVID-19 in an Italian internal medicine ward during first and third wave. Front Med (Lausanne) 2023; 10:1112728. [PMID: 36817786 PMCID: PMC9928966 DOI: 10.3389/fmed.2023.1112728] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Abstract
Background The reasons of variability of clinical presentation of coronavirus disease-19 (COVID-19) across different pandemic waves are not fully understood, and may include individual risk profile, SARS-CoV-2 lineage and seasonal variations of viral spread. The objective of this retrospective study was to compare the characteristics and outcomes of patients admitted with confirmed coronavirus disease-19 (COVID-19) in the same season during the first (March 2020) and the third pandemic wave (March 2021, dominance of SARS-CoV-2 B.1.1.7 lineage) in an internal medicine ward of a large teaching hospital in Italy. Materials and methods Data of 769 unvaccinated patients (399 from the first and 370 from the third wave) were collected from clinical records, including symptom type and duration, extension of lung abnormalities on chest computed tomography (CT) and PaO2/FiO2 ratio on admission arterial blood gas analysis. Results Third wave patients were in average younger (median 65, interquartile range [IQR] 55-75, vs. 72, IQR 61-81 years old, p < 0.001), with less comorbidities and better pulmonary (CT visual score median 25, IQR 15-40, vs. 30, IQR 15-50, age- and sex-adjusted p = 0.017) and respiratory involvement (PaO2/FiO2 median 288, IQR 237-338, vs. 233, IQR 121-326 mmHg, age- and sex-adjusted p < 0.001) than first wave patients. Hospital mortality was lower (19% vs. 36%, p < 0.001), but not for subjects over 75 years old (46 vs. 49%). Age, number of chronic illnesses, PCT levels, CT visual score [Odds Ratio (OR) 1.022, 95% confidence interval (CI) 1.009-1.036, p < 0.001] and PaO2/FiO2 (OR 0.991, 95% CI 0.988-0.994, p < 0.001), but not the pandemic wave, were associated with mortality on stepwise multivariate logistic regression analysis. Conclusion Despite the higher virulence of B.1.1.7 lineage, we detected milder clinical presentation and improved mortality in patients hospitalized during the third COVID-19 wave, with involvement of younger subjects. The reasons of this discrepancy are unclear, but could involve the population effect of vaccination campaigns, that were being conducted primarily in older frail subjects during the third wave.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy,*Correspondence: Andrea Ticinesi, ✉
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Parma, Italy,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Domenico Tuttolomondo
- Department of Medicine and Surgery, University of Parma, Parma, Italy,Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicola Gaibazzi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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14
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Burkert J, Jarman R, Deol P. Evolution of Lung Abnormalities on Lung Ultrasound in Recovery From COVID-19 Disease-A Prospective, Longitudinal Observational Cohort Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:147-159. [PMID: 35429016 PMCID: PMC9088416 DOI: 10.1002/jum.15990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES SARS-CoV-2 can cause respiratory diseases with various manifestations. However, little is known about its potential for lung recovery. Lung ultrasound has shown characteristic changes during COVID-19 and has proven to be useful for triage, diagnosis, and therapy. This study investigated how the recovery process from COVID-19 respiratory disease can be monitored using 12-zone lung ultrasound. METHODS This prospective observational cohort study was conducted in a busy urban emergency department in London, United Kingdom, over a 20-week period between April and October 2020. We followed 24 patients recovering from COVID-19 with varying disease severity using 12-zone lung ultrasound at 2-week intervals and monitored the changes in the prevalence of lung abnormalities previously described in COVID-19 infection (irregular pleura, subpleural consolidation, B-lines, and small localized effusions). RESULTS Lung ultrasound showed that the lung recovers significantly over 20 weeks postdisease. Individual lung abnormalities also resolved at different rates. The entire rib space occupied by confluent B-lines wane after the acute phase, whereas irregular pleura and subpleural consolidations resolved more gradually. Separate wide B-lines moving with the pleura during respiration may represent more stable features, indicating residual fibrotic changes. Small, localized effusions appear transiently after the initial acute phase of the disease, peaking at approximately 10 weeks after infection. The measured lung abnormalities were strong predictors of perceived shortness of breath during ambulation. CONCLUSION Lung ultrasound can be a useful tool for long-term monitoring of COVID-19 lung disease, avoiding repeated exposure to ionizing radiation, and may distinguish between acute and past infections.
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Affiliation(s)
- Julia Burkert
- Chelsea and Westminster NHS Foundation TrustLondonEngland
| | - Robert Jarman
- Department of Emergency MedicineNewcastle upon Tyne Hospitals NHS Foundation Trust, Teesside University, School of Health & Life SciencesMiddlesbroughEngland
| | - Paramjeet Deol
- Department of Emergency MedicineChelsea and Westminster NHS Foundation TrustLondonEngland
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15
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Detection of COVID-19 Case from Chest CT Images Using Deformable Deep Convolutional Neural Network. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:4301745. [PMID: 36844950 PMCID: PMC9949952 DOI: 10.1155/2023/4301745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/14/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
The infectious coronavirus disease (COVID-19) has become a great threat to global human health. Timely and rapid detection of COVID-19 cases is very crucial to control its spreading through isolation measures as well as for proper treatment. Though the real-time reverse transcription-polymerase chain reaction (RT-PCR) test is a widely used technique for COVID-19 infection, recent researches suggest chest computed tomography (CT)-based screening as an effective substitute in cases of time and availability limitations of RT-PCR. In consequence, deep learning-based COVID-19 detection from chest CT images is gaining momentum. Furthermore, visual analysis of data has enhanced the opportunities of maximizing the prediction performance in this big data and deep learning realm. In this article, we have proposed two separate deformable deep networks converting from the conventional convolutional neural network (CNN) and the state-of-the-art ResNet-50, to detect COVID-19 cases from chest CT images. The impact of the deformable concept has been observed through performance comparative analysis among the designed deformable and normal models, and it is found that the deformable models show better prediction results than their normal form. Furthermore, the proposed deformable ResNet-50 model shows better performance than the proposed deformable CNN model. The gradient class activation mapping (Grad-CAM) technique has been used to visualize and check the targeted regions' localization effort at the final convolutional layer and has been found excellent. Total 2481 chest CT images have been used to evaluate the performance of the proposed models with a train-valid-test data splitting ratio of 80 : 10 : 10 in random fashion. The proposed deformable ResNet-50 model achieved training accuracy of 99.5% and test accuracy of 97.6% with specificity of 98.5% and sensitivity of 96.5% which are satisfactory compared with related works. The comprehensive discussion demonstrates that the proposed deformable ResNet-50 model-based COVID-19 detection technique can be useful for clinical applications.
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16
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Neag MA, Vulturar DM, Gherman D, Burlacu CC, Todea DA, Buzoianu AD. Gastrointestinal microbiota: A predictor of COVID-19 severity? World J Gastroenterol 2022; 28:6328-6344. [PMID: 36533107 PMCID: PMC9753053 DOI: 10.3748/wjg.v28.i45.6328] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by a severe acute respiratory syndrome coronavirus 2 infection, has raised serious concerns worldwide over the past 3 years. The severity and clinical course of COVID-19 depends on many factors (e.g., associated comorbidities, age, etc) and may have various clinical and imaging findings, which raises management concerns. Gut microbiota composition is known to influence respiratory disease, and respiratory viral infection can also influence gut microbiota. Gut and lung microbiota and their relationship (gut-lung axis) can act as modulators of inflammation. Modulating the intestinal microbiota, by improving its composition and diversity through nutraceutical agents, can have a positive impact in the prophylaxis/treatment of COVID-19.
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Affiliation(s)
- Maria Adriana Neag
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400337, Romania
| | - Damiana-Maria Vulturar
- Department of Pneumology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400332, Romania
| | - Diana Gherman
- Department of Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Codrin-Constantin Burlacu
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Doina Adina Todea
- Department of Pneumology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400332, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400337, Romania
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17
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D'Ardes D, Tana C, Salzmann A, Ricci F, Guagnano MT, Giamberardino MA, Cipollone F. Ultrasound assessment of SARS-CoV-2 pneumonia: a literature review for the primary care physician. Ann Med 2022; 54:1140-1149. [PMID: 35465821 PMCID: PMC9045761 DOI: 10.1080/07853890.2022.2067896] [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] [Indexed: 11/08/2022] Open
Abstract
The SARS-CoV-2 pandemic is considered one of the most critical global health emergencies in the last century. The diagnostic approach to the novel coronavirus disease (COVID-19) and its possible complications through a point-of-care-ultrasound (POCUS) evaluation could represent a good solution in the primary care setting. POCUS is a non-invasive technique that can be used outside hospitals to screen COVID-19 patients and their complications safely. Moreover, it offers several applications of diagnostic evaluation not only on lung parenchyma but also to search disease complications, such as the cardiovascular system, even at the patients' home. This narrative review aims to analyse the literature and provide data to primary care physicians engaged in monitoring and treating patients with SARS-CoV-2 infection. Key MessagesPOCUS is an important tool for the diagnostic approach in the primary care setting already before the start of the SARS-CoV-2 pandemic.Portable devices are useful in monitoring the clinical evolution of patients with infection from SARS-CoV-2 at home.The ultrasonographic features can help the general practice physicians to evaluate the presence of lung involvement and to diagnose complications from the SARS-CoV-2 infection involving districts such as the cardiovascular system.
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Affiliation(s)
- Damiano D'Ardes
- "Clinica Medica" Institute, "SS. Annunziata" Hospital of Chieti, Department of Medicine and Aging Sciences, "G. D'Annunzio", University of Chieti, Pescara, Italy
| | - Claudio Tana
- "Geriatric and COVID-19 Unit", "SS. Annunziata" Hospital of Chieti, "G. D'Annunzio" University of Chieti, Pescara, Italy
| | - Alessandro Salzmann
- "Clinica Medica" Institute, "SS. Annunziata" Hospital of Chieti, Department of Medicine and Aging Sciences, "G. D'Annunzio", University of Chieti, Pescara, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Maria Teresa Guagnano
- "Clinica Medica" Institute, "SS. Annunziata" Hospital of Chieti, Department of Medicine and Aging Sciences, "G. D'Annunzio", University of Chieti, Pescara, Italy
| | - Maria Adele Giamberardino
- "Geriatric and COVID-19 Unit", "SS. Annunziata" Hospital of Chieti, "G. D'Annunzio" University of Chieti, Pescara, Italy
| | - Francesco Cipollone
- "Clinica Medica" Institute, "SS. Annunziata" Hospital of Chieti, Department of Medicine and Aging Sciences, "G. D'Annunzio", University of Chieti, Pescara, Italy
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Franchi R, Okoye C, Morelli V, Guarino D, Mazzarone T, Coppini G, Peta U, Rogani S, Fabbri A, Polini A, Monzani F. Utility of lung ultrasound in selecting older patients with hyperinflammatory phase in COVID-19 pneumonia. A monocentric, cross-sectional pilot study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lung Ultrasound as a Triage Method in Primary Care for Patients with Suspected SARS-CoV-2 Pneumonia. J Clin Med 2022; 11:jcm11216420. [PMID: 36362647 PMCID: PMC9657854 DOI: 10.3390/jcm11216420] [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: 10/11/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Currently, there are few studies that have analyzed the benefits of using lung ultrasound in the field of primary care, including in homes and nursing homes, for patients with suspected COVID-19 pneumonia and subsequent follow-ups. The aim of this study was to demonstrate that lung ultrasound is a useful technique for triaging these patients. Methods: An observational and retrospective study of individuals who presented with clinical suspicion of SARS-CoV-2 pneumonia was carried out during the months of March to June 2020 in Health Center number 2 of Ciudad Real and in homes of patients and nursing homes belonging to the Health Service of Castilla-La Mancha (Spain). Results: A total of 209 patients, of whom 86 (41.1%) were male, were included in the study. The most frequent ultrasound findings were bilateral B-lines, with a right predominance, specifically in the posterobasal region. Additionally, there was a statistical significance (p < 0.05) correlation between pathological positivity on lung ultrasound and PCR and chest X-ray positivity. When calculating the sensitivity and specificity of ultrasound and X-ray, ultrasound had a sensitivity of 93%, and X-ray had a sensitivity of 75%. Conclusion: Due to its high sensitivity and negative predictive value, lung ultrasound is very useful as a triage tool for patients with suspected SARS-CoV-2 pneumonia.
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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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21
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Vetrugno L, Mojoli F, Boero E, Berchialla P, Bignami EG, Orso D, Cortegiani A, Forfori F, Corradi F, Cammarota G, De Robertis E, Mongodi S, Chiumello D, Poole D, Ippolito M, Biasucci DG, Persona P, Bove T, Ball L, Pelosi P, Navalesi P, Antonelli M, Corcione A, Giarratano A, Petrini F. Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:464-472. [PMID: 34734405 PMCID: PMC9534595 DOI: 10.1055/a-1634-4710] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. MATERIALS AND METHODS The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. RESULTS 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001). CONCLUSION This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Italy
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Correspondence Dr. Luigi Vetrugno Department of Medicine, University of UdineVia Colugna 5033100 UdineItaly+39/4 32/55 95 01
| | - Francesco Mojoli
- Anesthesiology, Intensive Care and Pain Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- Anesthesia and Intensive Care, University Hospital of Pavia, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care, Hospital Saint-Giovanni Bosco Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin Faculty of Medicine and Surgery, Torino, Italy
| | - Elena Giovanna Bignami
- Department of Medicine and Surgery, University of Parma Department of Medicine and Surgery, Parma, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia Department of Medicine, Perugia, Italy
| | - Silvia Mongodi
- Anesthesiology and Intensive Care, University Hospital of Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
| | - Davide Chiumello
- Department of Anesthesiology and Intensive Care, University of Milan, Milano, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, Hospital Saint-Martinus, Belluno, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Paolo Persona
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Antonio Corcione
- Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Italy, Naples, Italy
| | - Antonino Giarratano
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Flavia Petrini
- Anesthesia, Intensive Care and Pain Management, President Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), Rome Italy, Rome, Italy
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22
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Poli V, Spinelli S, Toscano M, Vitale F, Ranalli A, Tonerini M, Romei C, De Liperi A, Barbieri G. A direct comparison between five lung-US and chest-CT-scans in a patient infected by SARS-CoV-2. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The gold standard for SARS-CoV-2 pneumonia diagnosis is chest Computed Tomography (CT), but Lung Ultrasound (LUS) is also useful in differential diagnosis and in-hospital monitoring of patients with infection by new Coronavirus 2019 disease (COVID- 19). We present a case of a young man who was infected with SARS-CoV-2 pneumoniae and underwent five steps of chest imaging, including LUS aeration scorings and chest CT scans. Each decrease or increase in LUS scoring could accurately predict CT scan changes.
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Ticinesi A, Parise A, Cerundolo N, Nouvenne A, Prati B, Chiussi G, Guerra A, Meschi T. Multimorbidity and Frailty Are the Key Characteristics of Patients Hospitalized with COVID-19 Breakthrough Infection during Delta Variant Predominance in Italy: A Retrospective Study. J Clin Med 2022; 11:jcm11185442. [PMID: 36143095 PMCID: PMC9503996 DOI: 10.3390/jcm11185442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aims of this study were to describe the characteristics of patients hospitalized with delta SARS-CoV-2 breakthrough infection, and to identify factors associated with pneumonia on chest Computed Tomography (CT) and mortality. The clinical records of 229 patients (105 F), with a median age of 81 (interquartile range, IQR, 73−88) years old, hospitalized between June and December 2021 after completion of the primary vaccination cycle, were retrospectively analyzed, retrieving data on comorbidities, Clinical Frailty Scale (CFS), clinical presentation and outcomes. Multimorbidity (91.7% with ≥2 chronic illnesses) and frailty (61.6% with CFS ≥ 5) were highly prevalent. CFS (OR 0.678, 95% CI 0.573−0.803, p < 0.001) and hypertension were independently associated with interstitial pneumonia. Mortality was 25.1% and unrelated with age. PaO2/FiO2 on blood gas analysis performed upon admission (OR 0.986, 95% CI 0.977−0.996, p = 0.005), and CFS (OR 1.723, 95% CI 1.152−2.576, p = 0.008) were independently associated with mortality only in subjects < 85 years old. Conversely, serum PCT levels were associated with mortality in subjects ≥ 85 years old (OR 3.088, 95% CI 1.389−6.8628, p = 0.006). In conclusion, hospitalization for COVID-19 breakthrough infection mainly involved geriatric patients, with those aged ≥ 85 more characterized by decompensation of baseline comorbidities rather than typical COVID-19 respiratory symptoms.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Correspondence:
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Giulia Chiussi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
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24
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Ciurba BE, Sárközi HK, Szabó IA, Ianoși ES, Grigorescu BL, Csipor-Fodor A, Tudor TP, Jimborean G. Applicability of lung ultrasound in the assessment of COVID-19 pneumonia: Diagnostic accuracy and clinical correlations. Respir Investig 2022; 60:762-771. [PMID: 35995704 PMCID: PMC9359491 DOI: 10.1016/j.resinv.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to assess the diagnostic accuracy of lung ultrasound (LUS) in determining the severity of coronavirus disease 2019 (COVID-19) pneumonia compared with thoracic computed tomography (CT) and establish the correlations between LUS score, inflammatory markers, and percutaneous oxygen saturation (SpO2). METHODS This prospective observational study, conducted at Târgu-Mureș Pulmonology Clinic included 78 patients with confirmed severe acute respiratory syndrome coronavirus-2 infection via nasopharyngeal real-time-polymerase chain reaction (RT-PCR) (30 were excluded). Enrolled patients underwent CT, LUS, and blood tests on admission. Lung involvement was evaluated in 16 thoracic areas, using AB1 B2 C (letters represent LUS pattern) scores ranging 0-48. RESULTS LUS revealed bilateral B-lines (97.8%), pleural irregularities with thickening/discontinuity (75%), and subpleural consolidations (70.8%). Uncommon sonographic patterns were alveolar consolidations with bronchogram (33%) and pleural effusion (2%). LUS score cutoff values of ≤14 and > 22 predicted mild COVID-19 (sensitivity [Se] = 84.6%; area under the curve [AUC] = 0.72; P = 0.002) and severe COVID-19 (Se = 50%, specificity (Sp) = 91.2%, AUC = 0.69; P = 0.02), respectively, and values > 29 predicted the patients' transfer to the intensive care unit (Se = 80%, Sp = 97.7%). LUS score positively correlated with CT score (r = 0.41; P = 0.003) and increased with the decrease of SpO2 (r = -0.49; P = 0.003), with lymphocytes decline (r = -0.52; P = 0.0001). Patients with consolidation patterns had higher ferritin and C-reactive protein than those with B-line patterns (P = 0.01; P = 0.03). CONCLUSIONS LUS is a useful, non-invasive and effective tool for diagnosis, monitoring evolution, and prognostic stratification of COVID-19 patients.
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Affiliation(s)
- Bianca Emilia Ciurba
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - Hédi Katalin Sárközi
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - István Adorjan Szabó
- 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania.
| | - Edith Simona Ianoși
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
| | - Bianca Liana Grigorescu
- 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania; Anesthesiology and Intensive Therapy Department from Emergency Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 50, Târgu Mureș, Postal code 540136, Romania
| | - Alpar Csipor-Fodor
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania
| | - Toma P Tudor
- University Hospital Lewisham & Greenwich, Owen Centre Lewisham Hospital Lewisham High Street, London SE13 6LH, UK
| | - Gabriela Jimborean
- Pneumology Department from Mureș; County Clinical Hospital, Gheorghe Marinescu Street Number 5, Târgu Mureș, Postal code 540098, Romania; 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology from Târgu Mureș, Gheorghe Marinescu Street Number 38, Postal code 540139, Romania
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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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Pare JR, Gjesteby LA, Telfer BA, Tonelli MM, Leo MM, Billatos E, Scalera J, Brattain LJ. Transfer Learning for Automated COVID-19 B-Line Classification in Lung Ultrasound. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1675-1681. [PMID: 36086232 DOI: 10.1109/embc48229.2022.9871894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lung ultrasound (LUS) as a diagnostic tool is gaining support for its role in the diagnosis and management of COVID-19 and a number of other lung pathologies. B-lines are a predominant feature in COVID-19, however LUS requires a skilled clinician to interpret findings. To facilitate the interpretation, our main objective was to develop automated methods to classify B-lines as pathologic vs. normal. We developed transfer learning models based on ResNet networks to classify B-lines as pathologic (at least 3 B-lines per lung field) vs. normal using COVID-19 LUS data. Assessment of B-line severity on a 0-4 multi-class scale was also explored. For binary B-line classification, at the frame-level, all ResNet models pretrained with ImageNet yielded higher performance than the baseline nonpretrained ResNet-18. Pretrained ResNet-18 has the best Equal Error Rate (EER) of 9.1% vs the baseline of 11.9%. At the clip-level, all pretrained network models resulted in better Cohen's kappa agreement (linear-weighted) and clip score accuracy, with the pretrained ResNet-18 having the best Cohen's kappa of 0.815 [95% CI: 0.804-0.826], and ResNet-101 the best clip scoring accuracy of 93.6%. Similar results were shown for multi-class scoring, where pretrained network models outperformed the baseline model. A class activation map is also presented to guide clinicians in interpreting LUS findings. Future work aims to further improve the multi-class assessment for severity of B-lines with a more diverse LUS dataset.
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Can Lung Imaging Scores and Clinical Variables Predict Severe Course and Fatal Outcome in COVID-19 Pneumonia Patients? A Single-Center Observational Study. Life (Basel) 2022; 12:life12050735. [PMID: 35629402 PMCID: PMC9147733 DOI: 10.3390/life12050735] [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: 04/20/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19 prediction models mostly consist of combined clinical features, laboratory parameters, and, less often, chest X-ray (CXR) findings. Our main goal was to propose a prediction model involving imaging methods, specifically ultrasound. This was a single-center, retrospective cohort observational study of patients admitted to the University Hospital Split from November 2020 to May 2021. Imaging protocols were based on the assessment of 14 lung zones for both lung ultrasound (LUS) and computed tomography (CT), correlated to a CXR score assessing 6 lung zones. Prediction models for the necessity of mechanical ventilation (MV) or a lethal outcome were developed by combining imaging, biometric, and biochemical parameters. A total of 255 patients with COVID-19 pneumonia were included in the study. Four independent predictors were added to the regression model for the necessity of MV: LUS score, day of the illness, leukocyte count, and cardiovascular disease (χ2 = 29.16, p < 0.001). The model accurately classified 89.9% of cases. For the lethal outcome, only two independent predictors contributed to the regression model: LUS score and patient’s age (χ2 = 48.56, p < 0.001, 93.2% correctly classified). The predictive model identified four key parameters at patient admission which could predict an adverse outcome.
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Mauer N, Chiecca G, Carioli G, Gianfredi V, Iacoviello L, Bertagnolio S, Guerra R, Odone A, Signorelli C. The First 110,593 COVID-19 Patients Hospitalised in Lombardy: A Regionwide Analysis of Case Characteristics, Risk Factors and Clinical Outcomes. Int J Public Health 2022; 67:1604427. [PMID: 35645700 PMCID: PMC9131487 DOI: 10.3389/ijph.2022.1604427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/01/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives: To describe the monthly distribution of COVID-19 hospitalisations, deaths and case-fatality rates (CFR) in Lombardy (Italy) throughout 2020. Methods: We analysed de-identified hospitalisation data comprising all COVID-19-related admissions from 1 February 2020 to 31 December 2020. The overall survival (OS) from time of first hospitalisation was estimated using the Kaplan-Meier method. We estimated monthly CFRs and performed Cox regression models to measure the effects of potential predictors on OS. Results: Hospitalisation and death peaks occurred in March and November 2020. Patients aged ≥70 years had an up to 180 times higher risk of dying compared to younger patients [70–80: HR 58.10 (39.14–86.22); 80–90: 106.68 (71.01–160.27); ≥90: 180.96 (118.80–275.64)]. Risk of death was higher in patients with one or more comorbidities [1: HR 1.27 (95% CI 1.20–1.35); 2: 1.44 (1.33–1.55); ≥3: 1.73 (1.58–1.90)] and in those with specific conditions (hypertension, diabetes). Conclusion: Our data sheds light on the Italian pandemic scenario, uncovering mechanisms and gaps at regional health system level and, on a larger scale, adding to the body of knowledge needed to inform effective health service planning, delivery, and preparedness in times of crisis.
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Affiliation(s)
- Nicole Mauer
- Vita-Salute San Raffaele University, Milan, Italy
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | | | | | - Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- *Correspondence: Vincenza Gianfredi,
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, University of Insubria, Varese, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Ticinesi A, Nouvenne A, Parise A, Prati B, Meschi T. Defining SARS-CoV-2 breakthrough infection needing hospitalization in mass vaccination era: from disease-centered to patient-centered care. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022182. [PMID: 35546003 PMCID: PMC9171889 DOI: 10.23750/abm.v93i2.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
After the implementation of mass vaccination campaigns, breakthrough infections by SARS-CoV-2 are being increasingly observed worldwide, due to high pervasiveness of viral spread, emergence of novel variants, progressive ease of restrictive measures and waning protection against infection. Although breakthrough infections have generally lower clinical severity than COVID-19 in unvaccinated subjects, a consistent number of patients may still require hospitalization. These patients are generally old, frail and with a high number of comorbidities. Despite COVID-19-related symptoms are generally milder, they may still exhibit complicated clinical course for their intrinsic clinical complexity. The abrupt emergence of the SARS-CoV-2 omicron variant in the final weeks of 2021 could also contribute to increase the burden of breakthrough infection needing hospitalization, due to its extremely high infectiousness and the serious concerns over failure of immune response induced by available vaccines. The organization of hospital care should thus consider the changing epidemiology of patients admitted with SARS-CoV-2 infection in the post-vaccine era, to improve the quality and appropriateness of care and specifically address the needs of each patient. (www.actabiomedica.it)
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Affiliation(s)
- Andrea Ticinesi
- a:1:{s:5:"en_US";s:55:"Department of Medicine and Surgery, University of Parma";}.
| | | | | | | | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma.
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30
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Fuchs L, Galante O, Almog Y, Dayan RR, Smoliakov A, Ullman Y, Shamia D, Ohayon RBD, Golbets E, El Haj K, Taylor J, Weissberg I, Novack V, Barski L, Rosenberg E, Gohar E, Abed MA, Sagy I. Point of Care Lung Ultrasound Injury Score—A simple and reliable assessment tool in COVID-19 patients (PLIS I): A retrospective study. PLoS One 2022; 17:e0267506. [PMID: 35544450 PMCID: PMC9094523 DOI: 10.1371/journal.pone.0267506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/10/2022] [Indexed: 12/26/2022] Open
Abstract
Background In COVID-19 patients, lung ultrasound is superior to chest radiograph and has good agreement with computerized tomography to diagnose lung pathologies. Most lung ultrasound protocols published to date are complex and time-consuming. We describe a new illustrative Point-of-care ultrasound Lung Injury Score (PLIS) to help guide the care of patients with COVID-19 and assess if the PLIS would be able to predict COVID-19 patients’ clinical course. Methods This retrospective study describing the novel PLIS was conducted in a large tertiary-level hospital. COVID-19 patients were included if they required any form of respiratory support and had at least one PLIS study during hospitalization. Data collected included PLIS on admission, demographics, Sequential Organ Failure Assessment (SOFA) scores, and patient outcomes. The primary outcome was the need for intensive care unit (ICU) admission. Results A total of 109 patients and 293 PLIS studies were included in our analysis. The mean age was 60.9, and overall mortality was 18.3%. Median PLIS score was 5.0 (3.0–6.0) vs. 2.0 (1.0–3.0) in ICU and non-ICU patients respectively (p<0.001). Total PLIS scores were directly associated with SOFA scores (inter-class correlation 0.63, p<0.001), and multivariate analysis showed that every increase in one PLIS point was associated with a higher risk for ICU admission (O.R 2.09, 95% C.I 1.59–2.75) and in-hospital mortality (O.R 1.54, 95% C.I 1.10–2.16). Conclusions The PLIS for COVID-19 patients is simple and associated with SOFA score, ICU admission, and in-hospital mortality. Further studies are needed to demonstrate whether the PLIS can improve outcomes and become an integral part of the management of COVID-19 patients.
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Affiliation(s)
- Lior Fuchs
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
| | - Ori Galante
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Almog
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roy R. Dayan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alexander Smoliakov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuval Ullman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Shamia
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ran Ben David Ohayon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Evgeny Golbets
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Khaled El Haj
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jonathan Taylor
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Itai Weissberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Barski
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Eli Rosenberg
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Gohar
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Muhammad Abo Abed
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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31
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Henning RJ. Handheld ultrasound is an adjunct to the physical examination in the diagnosis of cardiopulmonary disease. Future Cardiol 2022; 18:585-600. [PMID: 35543226 DOI: 10.2217/fca-2021-0142] [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: 11/21/2022] Open
Abstract
Handheld 2D ultrasound devices (HUDs) have become available as an adjunct to physical examinations, visualizing the heart and lungs in real time and facilitating prompt patient diagnosis and treatment of cardiopulmonar.y disorders. These devices provide simple and rapid bedside alternatives to repetitive chest x-rays, standard ultrasound examinations and thoracic CT scans. Two currently available HUDs are described. This paper discusses the use of HUDs in the diagnosis of patients with pericardial effusion and tamponade, ventricular dilation, aortic and mitral regurgitation, cardiogenic pulmonary edema, viral and bacterial pneumonia, pleural effusion and pneumothorax. The use of a HUD by physicians increases clinical diagnostic accuracy, adds quantitative information about cardiopulmonary disease severity and guides the use of medications and interventions.
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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: 36] [Impact Index Per Article: 18.0] [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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Maggi L, Biava AM, Fiorelli S, Coluzzi F, Ricci A, Rocco M. Lung Ultrasound: A Diagnostic Leading Tool for SARS-CoV-2 Pneumonia: A Narrative Review. Diagnostics (Basel) 2021; 11:2381. [PMID: 34943618 PMCID: PMC8699896 DOI: 10.3390/diagnostics11122381] [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: 11/08/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 01/15/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global pandemic. In this context, lung ultrasound (LUS) has played an important role due to its high diagnostic sensitivity, low costs, simplicity of execution and radiation safeness. Despite computed tomography (CT) being the imaging gold standard, lung ultrasound point of care exam is essential in every situation where CT is not readily available nor applicable. The aim of our review is to highlight the considerable versatility of LUS in diagnosis, framing the therapeutic route and follow-up for SARS-CoV-2 interstitial syndrome.
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Affiliation(s)
- Luigi Maggi
- Department of Central Prevention Police, Ministry of Interior, 00198 Rome, Italy
| | - Anna Maria Biava
- Department of Medical-Surgical Sciences and Translational Medicine, Via di Grottarossa 1035, Sapienza University of Rome, 00189 Rome, Italy; (A.M.B.); (S.F.); (A.R.); (M.R.)
| | - Silvia Fiorelli
- Department of Medical-Surgical Sciences and Translational Medicine, Via di Grottarossa 1035, Sapienza University of Rome, 00189 Rome, Italy; (A.M.B.); (S.F.); (A.R.); (M.R.)
| | - Flaminia Coluzzi
- Department Medical and Surgical Sciences and Biotechnologies, Piazzale Aldo Moro 5, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alberto Ricci
- Department of Medical-Surgical Sciences and Translational Medicine, Via di Grottarossa 1035, Sapienza University of Rome, 00189 Rome, Italy; (A.M.B.); (S.F.); (A.R.); (M.R.)
| | - Monica Rocco
- Department of Medical-Surgical Sciences and Translational Medicine, Via di Grottarossa 1035, Sapienza University of Rome, 00189 Rome, Italy; (A.M.B.); (S.F.); (A.R.); (M.R.)
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Spampinato MD, Sposato A, Migliano MT, Gordini G, Bua V, Sofia S. Lung Ultrasound Severity Index: Development and Usefulness in Patients with Suspected SARS-Cov-2 Pneumonia-A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3333-3342. [PMID: 34548188 PMCID: PMC8405447 DOI: 10.1016/j.ultrasmedbio.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 05/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has spread across the world with a strong impact on populations and health systems. Lung ultrasound is increasingly employed in clinical practice but a standard approach and data on the accuracy of lung ultrasound are still needed. Our study's objective was to evaluate lung ultrasound diagnostic and prognostic characteristics in patients with suspected COVID-19. We conducted a monocentric, prospective, observational study. Patients with respiratory distress and suspected COVID-19 consecutively admitted to the Emergency Medicine Unit were enrolled. Lung ultrasound examinations were performed blindly to clinical data. Outcomes were diagnosis of COVID-19 pneumonia and in-hospital mortality. One hundred fifty-nine patients were included in our study; 66% were males and 63.5% had a final diagnosis of COVID-19. COVID-19 patients had a higher mortality rate (18.8% vs. 6.9%, p = 0.04) and Lung Ultrasound Severity Index (16.14 [8.71] vs. 10.08 [8.92], p < 0.001) compared with non-COVID-19 patients. This model proved able to distinguish between positive and negative cases with an area under the receiver operating characteristic (AUROC) equal to 0.72 (95% confidence interval [CI]: 0.64-0.78) and to predict in-hospital mortality with an AUROC equal to 0.81 (95% CI: 0.74-0.86) in the whole population and an AUROC equal to 0.76 (95% CI: 0.66-0.84) in COVID-19 patients. The Lung Ultrasound Severity Index can be a useful tool in diagnosing COVID-19 in patients with a high pretest probability of having the disease and to identify, among them, those with a worse prognosis.
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Affiliation(s)
| | - Andrea Sposato
- University of Bologna Alma Mater Studiorum, Bologna, Italy
| | | | | | - Vincenzo Bua
- Emergency Department, AUSL Bologna, Bologna, Italy
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Gil-Rodríguez J, Martos-Ruiz M, Peregrina-Rivas JA, Aranda-Laserna P, Benavente-Fernández A, Melchor J, Guirao-Arrabal E. Lung Ultrasound, Clinical and Analytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort. Diagnostics (Basel) 2021; 11:diagnostics11122211. [PMID: 34943448 PMCID: PMC8699931 DOI: 10.3390/diagnostics11122211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
At the moment, several COVID-19 scoring systems have been developed. It is necessary to determine which one better predicts a poor outcome of the disease. We conducted a single-center prospective cohort study to validate four COVID-19 prognosis scores in adult patients with confirmed infection at ward. These are National Early Warning Score (NEWS) 2, Lung Ultrasound Score (LUS), COVID-19 Worsening Score (COWS), and Spanish Society of Infectious Diseases and Clinical Microbiology score (SEIMC Score). Our outcomes were the combined variable “poor outcome” (non-invasive mechanical ventilation, intubation, intensive care unit admission, and death at 28 days) and death at 28 days. Scores were analysed using univariate logistic regression models, receiver operating characteristic curves, and areas under the curve. Eighty-one patients were included, from which 21 had a poor outcome, and 9 died. We found a statistically significant correlation between poor outcome and NEWS2, LUS > 15, and COWS. Death at 28 days was statistically correlated with NEWS2 and SEIMC Score although COWS also performs well. NEWS2, LUS, and COWS accurately predict poor outcome; and NEWS2, SEIMC Score, and COWS are useful for anticipating death at 28 days. Lung ultrasound is a diagnostic tool that should be included in COVID-19 patients evaluation.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | | | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | - Alberto Benavente-Fernández
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | - Juan Melchor
- Department of Statistics and Operations Research, University of Granada, 18011 Granada, Spain
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain
- Research Unit “Modelling Nature” (MNat), University of Granada, 18011 Granada, Spain
- Correspondence: (J.M.); (E.G.-A.)
| | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, 18012 Granada, Spain;
- Correspondence: (J.M.); (E.G.-A.)
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36
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Okoye C, Calsolaro V, Fabbri A, Franchi R, Antognoli R, Zisca L, Bianchi C, Calabrese AM, Rogani S, Monzani F. Usefulness of lung ultrasound for selecting asymptomatic older patients with COVID 19 pneumonia. Sci Rep 2021; 11:22892. [PMID: 34819555 PMCID: PMC8613196 DOI: 10.1038/s41598-021-02275-2] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Clinical and prognostic differences between symptomatic and asymptomatic older patients with COVID-19 are of great interest since frail patients often show atypical presentation of illness. Lung Ultrasound (LUS) has been proven to be a reliable tool for detecting early-phase COVID-19 pneumonic alterations. The current prospective bicentric study aimed to compare LUS score and 3-month overall mortality between asymptomatic and symptomatic older patients with COVID-19, according to frailty status. Patients were stratified according to LUS score tertiles and Clinical Frailty Scale categories. Survival rate was assessed by telephone interviews 3 months after discharge. 64 symptomatic (24 women, aged 80.0 ± 10.8 years) and 46 asymptomatic (31 women, aged 84.3 ± 8.8 years) were consecutively enrolled. LUS score resulted an independent predictor of 3-month mortality [OR 2.27 (CI95% 1.09-4.8), p = 0.03], and the highest mortality rate was observed in symptomatic and asymptomatic pre-frail and frail patients (70.6% and 66.7%, respectively) with greater LUS abnormalities (3rd tertile). In conclusion, LUS identified an acute interstitial lung involvement in most of the older asymptomatic patients. Mortality rate progressively increased according to clinical frailty and LUS score degree, resulting a reliable prognostic tool in both symptomatic and asymptomatic patients.
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Affiliation(s)
- Chukwuma Okoye
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
- Low Care Unit, Presidio Sanitario "Anna Torrigiani", Firenze, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Alessandra Fabbri
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Riccardo Franchi
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Ludovica Zisca
- Low Care Unit, Presidio Sanitario "Anna Torrigiani", Firenze, Italy
| | - Camilla Bianchi
- Low Care Unit, Presidio Sanitario "Anna Torrigiani", Firenze, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Sara Rogani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
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Peixoto AO, Costa RM, Uzun R, Fraga AMA, Ribeiro JD, Marson FAL. Applicability of lung ultrasound in COVID-19 diagnosis and evaluation of the disease progression: A systematic review. Pulmonology 2021; 27:529-562. [PMID: 33931378 PMCID: PMC7983424 DOI: 10.1016/j.pulmoe.2021.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic originated in China and within about 4 months affected individuals all over the world. One of the limitations to the management of the COVID-19 is the diagnostic imaging to evaluate lung impairment and the patients' clinical evolution, mainly, in more severe cases that require admission into the intensive care unit. Among image examinations, lung ultrasound (LU) might be a useful tool to employ in the treatment of such patients. METHODS A survey was carried out on PubMed to locate studies using the descriptors: ((Lung ultrasound OR ultrasound OR lung ultrasonography OR lung US) AND (coronavirus disease-19 OR coronavirus disease OR corona virus OR COVID-19 OR COVID19 OR SARS-CoV-2)). The period covered by the search was November 2019 to October 2020 and the papers selected reported LU in COVID-19. RESULTS Forty-three studies were selected to produce this systematic review. The main LU findings referred to the presence of focal, multifocal and/or confluent B lines and the presence of pleural irregularities. CONCLUSIONS The use of LU in the evaluation of patients with COVID-19 should be encouraged due to its intrinsic characteristics; a low cost, radiation free, practical method, with easy to sanitize equipment, which facilitates structural evaluation of lung damage caused by SARS-CoV-2. With the increase in the number of studies and the use of ultrasound scans, LU has been shown as a useful tool to evaluate progression, therapeutic response and follow-up of pulmonary disease in the patients with COVID-19.
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Affiliation(s)
- A O Peixoto
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP: 13083-887, Brazil.
| | - R M Costa
- Anesthesiology Service, Pitangueiras Hospital, Sobam Group - United Health Group, Pitangueiras, 651, Vila Vianelo, Jundiaí, São Paulo, CEP: 13206-716, Brazil; Anesthesiology Service, Hospital Sobrapar - Brazilian Society of Craniofacial Rehabilitation Research and Assistance, Av. Adolfo Lutz, 100, Jardim Santa Genebra, Campinas, São Paulo, CEP: 13084-880, Brazil.
| | - R Uzun
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP: 13083-887, Brazil.
| | - A M A Fraga
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP: 13083-887, Brazil.
| | - J D Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP: 13083-887, Brazil.
| | - F A L Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP: 13083-887, Brazil; Laboratory of Medical Genetics and Genome Medicine, Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP: 13083-887, Brazil; Laboratory of Human and Medical Genetics, São Francisco University, Avenida São Francisco de Assis, 218, Jardim São José, Bragança Paulista, São Paulo, CEP: 12916-900, Brazil.
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Schilp CM, Meijer L, Stocker M, Langermans JAM, Bakker J, Stammes MA. A Comparative Study of Chest CT With Lung Ultrasound After SARS-CoV-2 Infection in the Assessment of Pulmonary Lesions in Rhesus Monkeys ( Macaca Mulatta). Front Vet Sci 2021; 8:748635. [PMID: 34778433 PMCID: PMC8585853 DOI: 10.3389/fvets.2021.748635] [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: 07/28/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023] Open
Abstract
Lung ultrasound (LUS) is a fast and non-invasive modality for the diagnosis of several diseases. In humans, LUS is nowadays of additional value for bedside screening of hospitalized SARS-CoV-2 infected patients. However, the diagnostic value of LUS in SARS-CoV-2 infected rhesus monkeys, with mild-to-moderate disease, is unknown. The aim of this observational study was to explore correlations of the LUS appearance of abnormalities with COVID-19-related lesions detected on computed tomography (CT). There were 28 adult female rhesus monkeys infected with SARS-CoV-2 included in this study. Chest CT and LUS were obtained pre-infection and 2-, 7-, and 14-days post infection. Twenty-five animals were sub-genomic PCR positive in their nose/throat swab for at least 1 day. CT images were scored based on the degree of involvement for lung lobe. LUS was scored based on the aeration and abnormalities for each part of the lungs, blinded to CT findings. Most common lesions observed on CT were ground glass opacities (GGOs) and crazy paving patterns. With LUS, confluent or multiple B-lines with or without pleural abnormalities were observed which is corresponding with GGOs on CT. The agreement between the two modalities was similar over the examination days. Pleural line abnormalities were clearly observed with LUS, but could be easily missed on CT. Nevertheless, due to the air interface LUS was not able to examine the complete volume of the lung. The sensitivity of LUS was high though the diagnostic efficacy for mild-to-moderate disease, as seen in macaques, was relatively low. This leaves CT the imaging modality of choice for diagnosis, monitoring, and longitudinal assessment of a SARS-CoV-2 infection in macaques.
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Affiliation(s)
| | - Lisette Meijer
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Martina Stocker
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Jan A. M. Langermans
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
- Department of Population Health Sciences, Unit Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jaco Bakker
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
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Churruca M, Martínez-Besteiro E, Couñago F, Landete P. COVID-19 pneumonia: A review of typical radiological characteristics. World J Radiol 2021; 13:327-343. [PMID: 34786188 PMCID: PMC8567439 DOI: 10.4329/wjr.v13.i10.327] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first discovered after unusual cases of severe pneumonia emerged by the end of 2019 in Wuhan (China) and was declared a global public health emergency by the World Health Organization in January 2020. The new pathogen responsible for the infection, genetically similar to the beta-coronavirus family, is known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the current gold standard diagnostic tool for its detection in respiratory samples is the reverse transcription-polymerase chain reaction test. Imaging findings on COVID-19 have been widely described in studies published throughout last year, 2020. In general, ground-glass opacities and consolidations, with a bilateral and peripheral distribution, are the most typical patterns found in COVID-19 pneumonia. Even though much of the literature focuses on chest computed tomography (CT) and X-ray imaging and their findings, other imaging modalities have also been useful in the assessment of COVID-19 patients. Lung ultrasonography is an emerging technique with a high sensitivity, and thus useful in the initial evaluation of SARS-CoV-2 infection. In addition, combined positron emission tomography-CT enables the identification of affected areas and follow-up treatment responses. This review intends to clarify the role of the imaging modalities available and identify the most common radiological manifestations of COVID-19.
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Affiliation(s)
- María Churruca
- Pulmonology Department, Hospital Universitario de La Princesa, Madrid 28006, Spain
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine,Universidad Europea de Madrid, Madrid 28670, Spain
| | - Pedro Landete
- Department of Pneumology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid 28006, Spain
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40
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Nassar B, Mallat J. Risk-stratifying COVID-19 patients using lung ultrasonography: an underutilized tool with growing evidence. Minerva Anestesiol 2021; 87:965-967. [PMID: 34612616 DOI: 10.23736/s0375-9393.21.16003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Boulos Nassar
- Division of Pulmonary and Critical Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jihad Mallat
- Department of Critical Care Medicine, Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates - .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Normandy University, UNICAEN, ED 497, Caen, France
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41
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Signorelli C, Odone A, Gianfredi V, Balzarini F, Bucci D, Croci R, Gaetti G, Stirparo G, Guerra R. Epidemiological assessment of the first COVID-19 epidemic wave in Lombardy. A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021462. [PMID: 34739453 PMCID: PMC8851015 DOI: 10.23750/abm.v92is6.12340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM After the first cases of COVID-19 detected in Wuhan (China), the virus rapidly spread in the world, so much so that on February 20 the first autochthonous case was officially identified in Italy. However, this person had no apparent history of travel abroad or contact with people tested positive for the virus. For this reason, the aim of this literature review was to reconstruct the epidemiological dynamics of the first wave of SARS-CoV-2 infection in the Lombardy Region. METHODS To this end, a systematic review was carried out on PubMed/MEDLINE and EMBASE, and on grey literature. All article assessing incidence, mortality and hospitalizations by Lombardy province and municipality, and the impact of the main containment and organizational measures were considered eligible. In addition, data on general mortality and mortality due to COVID-19, hospital admission, and serological and environmental were also retrieved. RESULTS From the included studies, it emerged that Lombardy was the first European region in which the virus began to circulate as early as January 2020 (and probably even earlier). Despite the high number of cases and deaths recorded, the reproduction number observed in Lombardy Region was, at the beginning of March 2020, the same (or lower) than in other regions. CONCLUSIONS In conclusion, data of the first epidemic wave in Lombardy, compared to other Italian and foreign regions, highlight the extreme criticality of having had the first autochthonous case (and the first substantial outbreaks) when knowledge was still scarce and individual prevention measures were not widespread.
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Affiliation(s)
- Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
| | - Vincenza Gianfredi
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy; CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Federica Balzarini
- Dipartimento per la Programmazione, Accreditamento, Acquisto delle Prestazioni Sanitarie e Sociosanitarie (P.A.A.P.S.S.), Servizio Autorizzazione e Accreditamento, Agenzia di Tutela della Salute (ATS) di Bergamo, Via Galliccioli, 4, 24121 Bergamo, Italy.
| | - Daria Bucci
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.
| | - Roberto Croci
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.
| | - Giovanni Gaetti
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.
| | - Giuseppe Stirparo
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.
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Cavanna L, Cremona G, Citterio C, Nunzio CD, Muroni M, Andena AM, Cattadori E, Gubbelini M, Muroni L, Schiavo R, Nolli M, Codeluppi M, Maniscalco P, Pedrazzini G. COVID-19 Outbreak in Italy: Report on the First 124 Consecutive Patients Treated at Home. TOHOKU J EXP MED 2021; 255:61-69. [PMID: 34588347 DOI: 10.1620/tjem.255.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
North Italy emerged as an epicenter of COVID-19 in the Western world. The majority of studies of patients with COVID-19 have focused on hospitalized patients, and data on early outpatient treatment are limited. This research retrospectively examines consecutive symptomatic adults who did not present to a hospital but who experience laboratory confirmed (nasopharyngeal swabs) or probable COVID-19 infection. From March 12 to April 12, 2020, 124 consecutive patients with laboratory-confirmed COVID-19 infection (84%) or with epidemiologically linked exposure to a person with confirmed infection (16%) were managed at home. The diagnosis of pneumonia was made with a portable ultrasound. COVID-19 treatment was based on low-dose hydroxychloroquine with or without darunavir/cobicistat or azithromycin and enoxaparine for bedridden patients. The patients were monitored by telemedicine. The primary endpoints were clinical improvement or hospitalization, and the secondary endpoints were mortality at day 30 and at day 60. Forty-seven (37.9%) patients had mild COVID-19 infection, 44 (35.5%) had moderate COVID-19 infection, and 33 (26.6%) had severe COVID-19 infection. Four patients (3.2%) were hospitalized and there were no deaths at day 30 and at day 60. Only mild side effects were reported. Early home treatment of COVID-19 patients resulted in a low hospitalization rate with no deaths, with the limitations of the small sample size and that it was conducted within a single geographic area. We believe that this model may be easily reproduced in both cities and rural areas around the world to treat COVID-19 infection.
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Affiliation(s)
- Luigi Cavanna
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital
| | - Gabriele Cremona
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital
| | - Chiara Citterio
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital
| | - Camilla Di Nunzio
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital
| | - Monica Muroni
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital
| | | | | | | | - Lara Muroni
- Nurse Directory Unit, Piacenza General Hospital
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Lisciandro GR, Lisciandro SC. Lung Ultrasound Fundamentals, "Wet Versus Dry" Lung, Signs of Consolidation in Dogs and Cats. Vet Clin North Am Small Anim Pract 2021; 51:1125-1140. [PMID: 34535335 DOI: 10.1016/j.cvsm.2021.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vet BLUE, a standardized and validated rapid lung ultrasound examination, includes 9 acoustic windows: 4 transthoracic bilaterally applied named Caudodorsal, Perihilar, Middle, and Cranial Lung Regions plus the Diaphragmatico-Hepatic view of AFAST/TFAST. Moreover, Vet BLUE has a B-line scoring system (weak positives-1, 2, and 3 and strong positives->3 and infinite) that semiquantitate degree of alveolar-interstitial syndrome and a visual lung language for signs of consolidation (Shred Sign [air bronchogram], Tissue Sign [hepatization], Nodule Sign, and Wedge Sign [pulmonary infarction]). Using its regional, pattern-based approach, a respiratory working diagnosis may be rapidly developed point-of-care and followed serially.
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Affiliation(s)
| | - Stephanie C Lisciandro
- Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX, USA; Oncura Partners, Fort Worth, TX, USA
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44
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Kok B, Schuit F, Lieveld A, Azijli K, Nanayakkara PW, Bosch F. Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department. BMJ Open 2021; 11:e048795. [PMID: 34531211 PMCID: PMC8449840 DOI: 10.1136/bmjopen-2021-048795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy. DESIGN A multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED. SETTING/PATIENTS Adult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR. MEASUREMENTS We assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard. RESULTS Between 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16. CONCLUSION Identifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement. TRIAL REGISTRATION NUMBER NL8497.
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Affiliation(s)
- Bram Kok
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Frederik Schuit
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Arthur Lieveld
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Kaoutar Azijli
- Department of Emergency Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Prabath Wb Nanayakkara
- Department of Internal Medicine, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Frank Bosch
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
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45
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Sosa FA, Matarrese A, Saavedra S, Osatnik J, Roberti J, Oribe BT, Ivulich D, Durán AL, Caputo C, Benay C. Lung ultrasound as a predictor of mortality of patients with COVID-19. J Bras Pneumol 2021; 47:e20210092. [PMID: 34495211 PMCID: PMC8647154 DOI: 10.36416/1806-3756/e20210092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the performance of lung ultrasound to determine short-term outcomes of patients with COVID-19 admitted to the intensive care unit. METHODS This is a Prospective, observational study. Between July and November 2020, 59 patients were included and underwent at least two LUS assessments using LUS score (range 0-42) on day of admission, day 5th, and 10th of admission. RESULTS Age was 66.5±15 years, APACHE II was 8.3±3.9, 12 (20%) patients had malignancy, 46 (78%) patients had a non-invasive ventilation/high-flow nasal cannula and 38 (64%) patients required mechanical ventilation. The median stay in ICU was 12 days (IQR 8.5-20.5 days). ICU or hospital mortality was 54%. On admission, the LUS score was 20.8±6.1; on day 5th and day 10th of admission, scores were 27.6±5.5 and 29.4±5.3, respectively (P=0.007). As clinical condition deteriorated the LUS score increased, with a positive correlation of 0.52, P <0.001. Patients with worse LUS on day 5th versus better score had a mortality of 76% versus 33% (OR 6.29, 95%CI 2.01-19.65, p. 0.003); a similar difference was observed on day 10. LUS score of 5th day of admission had an area under the curve of 0.80, best cut-point of 27, sensitivity and specificity of 0.75 and 0.78 respectively. CONCLUSION These findings position LUS as a simple and reproducible method to predict the course of COVID-19 patients.
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Affiliation(s)
| | | | | | | | - Javier Roberti
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Lungensonographie bei COVID‑19. WIENER KLINISCHES MAGAZIN 2021; 24:164-172. [PMID: 34422123 PMCID: PMC8371606 DOI: 10.1007/s00740-021-00403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Die medizinische Versorgung von Patienten, die im Zusammenhang mit der pandemischen Coronaviruserkrankung 2019 („coronavirus disease 2019“, COVID-19) erkrankt sind, stellt für die staatlichen Gesundheitssysteme weltweit eine große Herausforderung dar. Das Virus mit dem Namen „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) zeigt eine hohe Organspezifität zu den unteren Atemwegen. Da bislang weder eine wirksame Therapie noch Impfung gegen das Virus existieren, kommt der diagnostischen Früherkennung eine große Bedeutung zu. Durch den spezifischen Aspekt der überwiegend im peripheren Lungenparenchym beginnenden Infektion ist die Lungensonographie als bildgebende Diagnostikmethode geeignet, Verdachtsfälle bereits im Frühstadium der Erkrankung als solche zu identifizieren. Serielle Ultraschalluntersuchungen an Patienten mit bestätigter Infektion können bettseitig und zeitnah Veränderungen im betroffenen Lungengewebe nachweisen. Dieser Artikel fasst das diagnostische Potenzial der Lungensonographie im Hinblick auf Screening und therapeutische Entscheidungsfindung bei Patienten mit vermuteter oder bestätigter SARS-CoV-2-Pneumonie zusammen.
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47
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Tana C, Ricci F, Coppola MG, Mantini C, Lauretani F, Campanozzi D, Renda G, Gallina S, Lugará M, Cipollone F, Giamberardino MA, Mucci L. Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study. Respiration 2021; 101:122-131. [PMID: 34515247 PMCID: PMC8450833 DOI: 10.1159/000518516] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background Point-of-care lung ultrasound (LUS) score is a semiquantitative score of lung damage severity. High-resolution computed tomography (HRCT) is the gold standard method to evaluate the severity of lung involvement from the novel coronavirus disease (COVID-19). Few studies have investigated the clinical significance of LUS and HRCT scores in patients with COVID-19. Therefore, the aim of this study was to evaluate the prognostic yield of LUS and of HRCT in COVID-19 patients. Methods We carried out a multicenter, retrospective study aimed at evaluating the prognostic yield of LUS and HRCT by exploring the survival curve of COVID-19 inpatients. LUS and chest CT scores were calculated retrospectively by 2 radiologists with >10 years of experience in chest imaging, and the decisions were reached in consensus. LUS score was calculated on the basis of the presence or not of pleural line abnormalities, B-lines, and lung consolidations. The total score (range 0–36) was obtained from the sum of the highest scores obtained in each region. CT score was calculated for each of the 5 lobes considering the anatomical extension according to the percentage parenchymal involvement. The resulting overall global semiquantitative CT score was the sum of each single lobar score and ranged from 0 (no involvement) to 25 (maximum involvement). Results One hundred fifty-three COVID-19 inpatients (mean age 65 ± 15 years; 65% M), including 23 (15%) in-hospital deaths for any cause over a mean follow-up of 14 days were included. Mean LUS and CT scores were 19 ± 12 and 10 ± 7, respectively. A strong positive linear correlation between LUS and CT scores (Pearson correlation r = 0.754; R<sup>2</sup> = 0.568; p < 0.001) was observed. By ROC curve analysis, the optimal cut-point for mortality prediction was 20 for LUS score and 4.5 for chest CT score. According to Kaplan-Meier survival analysis, in-hospital mortality significantly increased among COVID-19 patients presenting with an LUS score ≥20 (log-rank 0.003; HR 9.87, 95% CI: 2.22–43.83) or a chest CT score ≥4.5 (HR 4.34, 95% CI: 0.97–19.41). At multivariate Cox regression analysis, LUS score was the sole independent predictor of in-hospital mortality yielding an adjusted HR of 7.42 (95% CI: 1.59–34.5). Conclusion LUS score is useful to stratify the risk in COVID-19 patients, predicting those that are at high risk of mortality.
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Affiliation(s)
- Claudio Tana
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden.,Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
| | | | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Cognitive and Motor Center, Geriatric-Rehabilitation Department of Parma, University-Hospital of Parma, Parma, Italy
| | - Daniele Campanozzi
- Internal Medicine and Covid-19 Unit, Pesaro Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marina Lugará
- COVID-19 Medicine Unit, Ospedale del Mare, Napoli, Italy
| | - Francesco Cipollone
- COVID-19 Medicine Unit and Medical Clinic, SS Annunziata Hospital of Chieti, Department of Medicine and Science of Aging, G D'Annunzio University of Chieti, Chieti, Italy
| | - Maria Adele Giamberardino
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, Department of Medicine and Science of Aging, and CAST, G D'Annunzio University of Chieti, Chieti, Italy
| | - Luciano Mucci
- Internal Medicine and Covid-19 Unit, Pesaro Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
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48
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Fairchild RM, Horomanski A, Mar DA, Triant GR, Lu R, Lu D, Guo HH, Baker MC. Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection. BMJ Open Respir Res 2021; 8:8/1/e000947. [PMID: 34385149 PMCID: PMC8361701 DOI: 10.1136/bmjresp-2021-000947] [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: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is a convenient tool for detection of COVID-19 pneumonia. Identifying SARS-CoV-2 infected outpatients with pulmonary disease may be important for early risk stratification. OBJECTIVES To investigate the prevalence, natural history and clinical significance of pulmonary disease in outpatients with SARS-CoV-2. METHODS SARS-CoV-2 PCR positive outpatients (CV(+)) were assessed with LUS to identify the presence of interstitial pneumonia. Studies were considered positive based on the presence of B-lines, pleural irregularity and consolidations. A subset of patients underwent longitudinal examinations. Correlations between LUS findings and patient symptoms, demographics, comorbidities and clinical outcomes over 8 weeks were evaluated. RESULTS 102 CV(+) patients underwent LUS with 42 (41%) demonstrating pulmonary involvement. Baseline LUS severity scores correlated with shortness of breath on multivariate analysis. Of the CV(+) patients followed longitudinally, a majority showed improvement or resolution in LUS findings after 1-2 weeks. Only one patient in the CV(+) cohort was briefly hospitalised, and no patient died or required mechanical ventilation. CONCLUSION We found a high prevalence of LUS findings in outpatients with SARS-CoV-2 infection. Given the pervasiveness of pulmonary disease across a broad spectrum of LUS severity scores and lack of adverse outcomes, our findings suggest that LUS may not be a useful as a risk stratification tool in SARS-CoV-2 in the general outpatient population.
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Affiliation(s)
- Robert M Fairchild
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Audra Horomanski
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Diane A Mar
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Gabriela R Triant
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Rong Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Di Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Haiwei Henry Guo
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Matthew C Baker
- Department of Immunology & Rheumatology, Stanford University, Stanford, California, USA
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49
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Barssoum K, Victor V, Salem A, Kumar A, Mubasher M, Hassib M, Magdi M, Renjithlal S, Abdelazeem M, Shariff M, Idemudia O, Ibrahim M, Mohamed A, Thakkar S, Patel H, Diab M, Szeles A, Ibrahim F, Jha R, Chowdhury M, Akula N, Kalra A, Nanda NC. Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID-19: A systematic review. Echocardiography 2021; 38:1365-1404. [PMID: 34236091 PMCID: PMC8444724 DOI: 10.1111/echo.15152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The manifestations of COVID-19 as outlined by imaging modalities such as echocardiography, lung ultrasound (LUS), and cardiac magnetic resonance (CMR) imaging are not fully described. METHODS We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, CMR, and pulmonary manifestations using LUS. We queried PubMed, EMBASE, and Web of Science for relevant articles. Original studies and case series were included. RESULTS This review describes the most common abnormalities encountered on echocardiography, LUS, and CMR in patients infected with COVID-19.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Varun Victor
- Department of Internal MedicineCanton Medical Education FoundationCantonOhioUSA
| | - Ahmad Salem
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Ashish Kumar
- Section of Cardiovascular ResearchHeartVascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOhioUSA
- Department of Internal MedicineCleveland Clinic Akron GeneralAkronOhioUSA
| | - Mahmood Mubasher
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | | | - Mohamed Magdi
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Sarathlal Renjithlal
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Mohamed Abdelazeem
- Department of Internal MedicineSt. Elizabeth Medical CenterBrightonMassachusettsUSA
| | | | - Osarenren Idemudia
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Mounir Ibrahim
- Department of Internal MedicineHackensack Meridian Health Palisades Medical CenterNorth BergenNew JerseyUSA
| | - Amr Mohamed
- Department of Internal MedicineRochester General HospitalRochesterNew YorkUSA
| | | | - Harsh Patel
- Department of Internal MedicineLouis A Weiss Memorial HospitalChicagoIllinoisUSA
| | - Mohamed Diab
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Andras Szeles
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Fadi Ibrahim
- American University of AntiguaAntigua and Barbuda
| | - Roshan Jha
- Department of Internal MedicineHackensack Meridian Health Palisades Medical CenterNorth BergenNew JerseyUSA
| | - Medhat Chowdhury
- Department of Internal MedicineRochester General HospitalRochesterNew YorkUSA
| | - Navya Akula
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Ankur Kalra
- Section of Cardiovascular ResearchHeartVascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOhioUSA
- Department of Cardiovascular MedicineHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOhioUSA
| | - Navin C. Nanda
- Division of Cardiovascular DiseaseDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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50
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Harrison SR, Klassen JRL, Bridgewood C, Scarsbrook A, Marzo-Ortega H, McGonagle D. Chest pain mimicking pulmonary embolism may be a common presentation of COVID-19 in ambulant patients without other typical features of infection. J Intern Med 2021; 290:349-358. [PMID: 33560545 PMCID: PMC8013761 DOI: 10.1111/joim.13267] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radiological and pathological studies in severe COVID-19 pneumonia (SARS-CoV-2) have demonstrated extensive pulmonary immunovascular thrombosis and infarction. This study investigated whether these focal changes may present with chest pain mimicking pulmonary emoblism (PE) in ambulant patients. METHODS CTPAs from outpatients presenting with chest pain to Leeds Teaching Hospital NHS Trust 1st March to 31 May 2020 (n = 146) and 2019 (n = 85) were compared. Regions of focal ground glass opacity (GGO), consolidation and/or atelectasis (parenchymal changes) were determined, and all scans were scored using British Society for Thoracic Imaging (BSTI) criteria for COVID-19, and the 2020 cohort was offered SARS-CoV-2 antibody testing. RESULTS Baseline demographic and clinical data were similar between groups with absence of fever, normal lymphocytes and marginally elevated CRP and D-Dimer values. Evidence of COVID-19 or parenchymal changes was observed in 32.9% (48/146) of cases in 2020 compared to 16.5% (14/85) in 2019 (P = 0.007). 11/146 (7.5%) patients met BSTI criteria for COVID-19 in 2020 compared with 0/14 in 2019 (P = 0.008). 3/39 patients tested had detectable COVID-19 antibodies (2 with parenchymal changes and 1 with normal parenchyma) however 0/6 patients whose CTPA met BSTI criteria "likely/suspicious for COVID-19" and attended antibody testing were SARS-CoV-2 antibody positive. CONCLUSIONS 32.8% ambulatory patients with suspected PE in 2020 had parenchymal changes with 7.5% diagnosed as COVID-19 infection by imaging criteria, despite the absence of other COVID-19 symptoms. These findings suggest that localized COVID-19 pneumonitis with immunothrombosis occurs distal to the bronchiolar arteriolar circulation, causing pleural irritation and chest pain without viraemia, accounting for the lack of fever and systemic symptoms.
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Affiliation(s)
- S R Harrison
- From the, Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - J R L Klassen
- From the, Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - C Bridgewood
- From the, Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - A Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - H Marzo-Ortega
- From the, Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - D McGonagle
- From the, Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
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