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Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, Lorenzo Navarro MD, Nackers F, Stratta E, Lanusse C, Huerga H. Evaluation of a Lung Ultrasound Score in Hospitalized Adult Patients with COVID-19 in Barcelona, Spain. J Clin Med 2024; 13:3282. [PMID: 38892993 PMCID: PMC11172895 DOI: 10.3390/jcm13113282] [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: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes. Methods: We conducted a single-centre prospective study (August 2020-April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64-0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38-20.4), ICU admission (OR 3.50; 95%CI: 1.37-8.94) and need for IMV (OR 3.31; 95%CI: 1.19-9.13). Conclusions: Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
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Affiliation(s)
| | | | | | | | | | | | | | - Erin Stratta
- Médecins Sans Frontières, New York, NY 10006, USA
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2
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Simonte R, Cammarota G, Vetrugno L, De Robertis E, Longhini F, Spadaro S. Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation. J Clin Med 2024; 13:2541. [PMID: 38731069 PMCID: PMC11084162 DOI: 10.3390/jcm13092541] [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: 03/17/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Advanced respiratory monitoring encompasses a diverse range of mini- or noninvasive tools used to evaluate various aspects of respiratory function in patients experiencing acute respiratory failure, including those requiring extracorporeal membrane oxygenation (ECMO) support. Among these techniques, key modalities include esophageal pressure measurement (including derived pressures), lung and respiratory muscle ultrasounds, electrical impedance tomography, the monitoring of diaphragm electrical activity, and assessment of flow index. These tools play a critical role in assessing essential parameters such as lung recruitment and overdistention, lung aeration and morphology, ventilation/perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient-ventilator synchrony. In contrast to conventional methods, advanced respiratory monitoring offers a deeper understanding of pathological changes in lung aeration caused by underlying diseases. Moreover, it allows for meticulous tracking of responses to therapeutic interventions, aiding in the development of personalized respiratory support strategies aimed at preserving lung function and respiratory muscle integrity. The integration of advanced respiratory monitoring represents a significant advancement in the clinical management of acute respiratory failure. It serves as a cornerstone in scenarios where treatment strategies rely on tailored approaches, empowering clinicians to make informed decisions about intervention selection and adjustment. By enabling real-time assessment and modification of respiratory support, advanced monitoring not only optimizes care for patients with acute respiratory distress syndrome but also contributes to improved outcomes and enhanced patient safety.
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Affiliation(s)
- Rachele Simonte
- Department of Medicine and Surgery, Università degli Studi di Perugia, 06100 Perugia, Italy; (R.S.); (E.D.R.)
| | - Gianmaria Cammarota
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Università degli Studi di Perugia, 06100 Perugia, Italy; (R.S.); (E.D.R.)
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Università della Magna Graecia, 88100 Catanzaro, Italy
- Anesthesia and Intensive Care Unit, “R. Dulbecco” University Hospital, 88100 Catanzaro, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44100 Ferrara, Italy;
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3
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Giovanni SP, Seitz KP, Hough CL. Fluid Management in Acute Respiratory Failure. Crit Care Clin 2024; 40:291-307. [PMID: 38432697 PMCID: PMC10910130 DOI: 10.1016/j.ccc.2024.01.004] [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] [Indexed: 03/05/2024]
Abstract
Fluid management in acute respiratory failure is an area of uncertainty requiring a delicate balance of resuscitation and fluid removal to manage hypoperfusion and avoidance of hypoxemia. Overall, a restrictive fluid strategy (minimizing fluid administration) and careful attention to overall fluid balance may be beneficial after initial resuscitation and does not have major side effects. Further studies are needed to improve our understanding of patients who will benefit from a restrictive or liberal fluid management strategy.
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Affiliation(s)
- Shewit P Giovanni
- Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mailing Code UHN67, Portland, OR 97239, USA.
| | - Kevin P Seitz
- Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1215 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Catherine L Hough
- Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mailing Code UHN67, Portland, OR 97239, USA
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4
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Muñoz F, Born P, Bruna M, Ulloa R, González C, Philp V, Mondaca R, Blanco JP, Valenzuela ED, Retamal J, Miralles F, Wendel-Garcia PD, Ospina-Tascón GA, Castro R, Rola P, Bakker J, Hernández G, Kattan E. Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study. Crit Care 2024; 28:52. [PMID: 38374167 PMCID: PMC10877871 DOI: 10.1186/s13054-024-04834-1] [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: 10/16/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This study aims to compare the prevalence of venous congestion in fluid responsive and fluid unresponsive critically ill patients after intensive care (ICU) admission. METHODS Multicenter, prospective cross-sectional observational study conducted in three medical-surgical ICUs in Chile. Consecutive mechanically ventilated patients that required vasopressors and admitted < 24 h to ICU were included between November 2022 and June 2023. Patients were assessed simultaneously for fluid responsiveness and VC at a single timepoint. Fluid responsiveness status, VC signals such as central venous pressure, estimation of left ventricular filling pressures, lung, and abdominal ultrasound congestion indexes and relevant clinical data were collected. RESULTS Ninety patients were included. Median age was 63 [45-71] years old, and median SOFA score was 9 [7-11]. Thirty-eight percent of the patients were fluid responsive (FR+), while 62% were fluid unresponsive (FR-). The most prevalent diagnosis was sepsis (41%) followed by respiratory failure (22%). The prevalence of at least one VC signal was not significantly different between FR+ and FR- groups (53% vs. 57%, p = 0.69), as well as the proportion of patients with 2 or 3 VC signals (15% vs. 21%, p = 0.4). We found no association between fluid balance, CRT status, or diagnostic group and the presence of VC signals. CONCLUSIONS Venous congestion signals were prevalent in both fluid responsive and unresponsive critically ill patients. The presence of venous congestion was not associated with fluid balance or diagnostic group. Further studies should assess the clinical relevance of these results and their potential impact on resuscitation and monitoring practices.
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Affiliation(s)
- Felipe Muñoz
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Pablo Born
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Mario Bruna
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
| | - Rodrigo Ulloa
- Unidad de Cuidados Intensivos, Hospital Las Higueras, Talcahuano, Chile
| | - Cecilia González
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Valerie Philp
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Roberto Mondaca
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Juan Pablo Blanco
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Emilio Daniel Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | | | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gustavo A Ospina-Tascón
- Department of Intensive Care Medicine, Fundación Valle del Lili, Cali, Colombia
- Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Philippe Rola
- Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, USA
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile.
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Chiumello D, Coppola S, Catozzi G, Danzo F, Santus P, Radovanovic D. Lung Imaging and Artificial Intelligence in ARDS. J Clin Med 2024; 13:305. [PMID: 38256439 PMCID: PMC10816549 DOI: 10.3390/jcm13020305] [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: 11/08/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Artificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is characterized by interstitial opacities, mostly in the dependent areas, decreased lung aeration with alveolar collapse, and inflammatory lung edema resulting in elevated lung weight. As a result, lung imaging is a crucial tool for evaluating the mechanical and morphological traits of ARDS patients. Compared to traditional chest radiography, sensitivity and specificity of lung computed tomography (CT) and ultrasound are higher. The state of the art in the application of AI is summarized in this narrative review which focuses on CT and ultrasound techniques in patients with ARDS. A total of eighteen items were retrieved. The primary goals of using AI for lung imaging were to evaluate the risk of developing ARDS, the measurement of alveolar recruitment, potential alternative diagnoses, and outcome. While the physician must still be present to guarantee a high standard of examination, AI could help the clinical team provide the best care possible.
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Affiliation(s)
- Davide Chiumello
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, 20142 Milan, Italy
- Coordinated Research Center on Respiratory Failure, University of Milan, 20122 Milan, Italy
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, 20142 Milan, Italy
| | - Giulia Catozzi
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| | - Fiammetta Danzo
- Division of Respiratory Diseases, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
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6
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Zhang YL, Yang Z, Cao J, Bai YL, Fang CY, Wang W. Clinical Implications of the Lung Ultrasound Score in Patients after Cardiopulmonary Resuscitation. Emerg Med Int 2023; 2023:4951950. [PMID: 38170023 PMCID: PMC10761217 DOI: 10.1155/2023/4951950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Background Lung ultrasound score (LUS) is a clinical index used to measure lung injury, but its clinical value in patients after cardiopulmonary resuscitation (CPR) remains relatively unknown. The purpose of this study was to investigate the clinical value of LUS in patients after CPR. Methods This retrospective study included a total of 34 patients older than 18 years with a nontraumatic cause of in-hospital cardiac arrest, who received standard resuscitation and achieved return of spontaneous circulation (ROSC). All patients underwent bedside lung ultrasound examination within half an hour once ROSC was achieved, and LUSs were calculated. The study included patient death as the endpoint event. Results Compared with the group with lower LUSs, the patients with higher LUSs had a lower oxygenation index, longer duration of CPR, and lower 72 h survival rate. The initial LUS had good clinical value in predicting the secondary outcomes of CPR (adjusted odds ratio (aOR): 1.353, 95% confidence interval (CI): 1.018-1.797, and P = 0.037) and 72 h survival rate of patients who underwent CPR (aOR: 1.145, 95% CI: 1.014-1.294, and P = 0.029). Conclusions LUS was shown to be helpful and had a prognostic value in patients after CPR.
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Affiliation(s)
- Yi-Ling Zhang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhou Yang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Cao
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Long Bai
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun-Yun Fang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Wang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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7
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Pellegrini JAS, Mendes CL, Gottardo PC, Feitosa K, John JF, de Oliveira ACT, Negri AJDA, Grumann AB, Barros DDS, Negri FEFDO, de Macedo GL, Neves JLB, Rodrigues MDS, Spagnól MF, Ferez MA, Chalhub RÁ, Cordioli RL. The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects. CRITICAL CARE SCIENCE 2023; 35:117-146. [PMID: 37712802 PMCID: PMC10406406 DOI: 10.5935/2965-2774.20230310-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/12/2023] [Indexed: 09/16/2023]
Abstract
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
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Affiliation(s)
- José Augusto Santos Pellegrini
- Department of Intensive Care, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Ciro Leite Mendes
- Department of Intensive Care, Hospital Universitário Lauro
Wanderley - João Pessoa (PB), Brazil
| | - Paulo César Gottardo
- Department of Intensive Care, Hospital Nossa Senhora das Neves -
João Pessoa (PB), Brazil
| | - Khalil Feitosa
- Department of Emergency Medicine, Hospital Geral de Fortaleza -
Fortaleza (CE), Brazil
| | - Josiane França John
- Department of Intensive Care, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | - Ana Burigo Grumann
- Department of Intensive Care, Hospital Nereu Ramos -
Florianópolis (SC), Brazil
| | - Dalton de Souza Barros
- Cardiovascular Intensive Care Unit, Hospital Cardiopulmonar
Instituto D’Or - Salvador (BA), Brazil
| | | | | | | | - Márcio da Silveira Rodrigues
- Department of Emergency, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | - Marcus Antonio Ferez
- Intensive Care Unit, Hospital Beneficência Portuguesa -
Ribeirão Preto (SP), Brazil
| | - Ricardo Ávila Chalhub
- Department of Echocardiogram, Hospital Santo Antônio, Obras
Sociais Irmã Dulce - Salvador (BA), Brazil
| | - Ricardo Luiz Cordioli
- Department of Intensive Care, Hospital Israelita Albert Einstein -
São Paulo (SP), Brazil
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Abstract
Advanced respiratory monitoring involves several mini- or noninvasive tools, applicable at bedside, focused on assessing lung aeration and morphology, lung recruitment and overdistention, ventilation-perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient-ventilator asynchrony, in dealing with acute respiratory failure. Compared to a conventional approach, advanced respiratory monitoring has the potential to provide more insights into the pathologic modifications of lung aeration induced by the underlying disease, follow the response to therapies, and support clinicians in setting up a respiratory support strategy aimed at protecting the lung and respiratory muscles. Thus, in the clinical management of the acute respiratory failure, advanced respiratory monitoring could play a key role when a therapeutic strategy, relying on individualization of the treatments, is adopted.
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9
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Kessler D, Dessie A, Kanjanauptom P, Vindas M, Ng L, Youssef MM, Birger R, Shaman J, Dayan P. Lack of Association Between a Quantified Lung Ultrasound Score and Illness Severity in Pediatric Emergency Department Patients With Acute Lower Respiratory Infections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3013-3022. [PMID: 35620855 DOI: 10.1002/jum.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) may help determine illness severity in children with acute lower respiratory tract infections (LRTI) but limited pediatric studies exist. Our objective was to determine the association between LUS findings and illness severity in children with LRTI. METHODS We conducted a prospective study of patients <20 years with LRTI. Trained investigators performed standardized LUS examinations of 12 regions. Blinded sonologists reviewed examinations for individual pathologic features and also calculated a Quantified Lung Ultrasound Score (QLUS). We defined focal severity as QLUS of ≥2 in ≥1 region, and diffuse severity as QLUS of ≥1 in ≥3 regions. The primary outcome was the Respiratory component of the Pediatric Early Warning Score (RPEWS), a 14-item scale measuring respiratory illness severity. Secondary outcomes included hospital admission, length of stay, supplemental oxygen, and antibiotic use. RESULTS We enrolled 85 patients with LRTIs, 46 (54%) whom were hospitalized (5.4% intensive care). Median RPEWS was 1 (interquartile range 2). Neither individual features on ultrasound nor total QLUS were associated with RPEWS, hospitalization, length of stay, or oxygen use. Mean RPEWS was similar for participants regardless of focal (1.46 versus 1.26, P = .57) or diffuse (1.47 versus 1.21, P = .47) severity findings, but those with focal or diffuse severity, or isolated consolidation, had greater antibiotic administration (P < .001). CONCLUSIONS In children with LRTI, neither individual features nor QLUS were associated with illness severity. Antibiotics were more likely in patients with either focal or diffuse severity or presence of consolidation on ultrasound.
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Affiliation(s)
- David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Panida Kanjanauptom
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marc Vindas
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Lorraine Ng
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mariam M Youssef
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Ruthie Birger
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Jeff Shaman
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Peter Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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10
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Zong HF, Guo G, Liu J, Yang CZ, Bao LL. Influence of Alveolar Fluid on Aquaporins and Na+/K+-ATPase and Its Possible Theoretical or Clinical Significance. Am J Perinatol 2022; 29:1586-1595. [PMID: 33611784 DOI: 10.1055/s-0041-1724001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Pulmonary edema is the most common pathophysiological change in pulmonary disease. Aquaporins (AQPs) and Na+/K+-ATPase play pivotal roles in alveolar fluid clearance. This study aimed to explore the influence of increased alveolar fluid on the absorption of lung fluid. STUDY DESIGN Eighty New Zealand rabbits were randomly divided into eight groups (n = 10 in each group), and models of different alveolar fluid contents were established by the infusion of different volumes of normal saline (NS) via the endotracheal tube. Five animals in each group were sacrificed immediately after infusion to determine the wet/dry ratio, while the remaining animals in each group were killed 4 hours later to determine the wet/dry ratio at 4 hours. Additionally, lung specimens were collected from each group, and quantitative real-time PCR (qRT-PCR), western blot, and immunohistochemical (IHC) analyses of AQPs and Na+/K+-ATPase were performed. RESULTS The qRT-PCR analysis and western blot studies showed markedly decreased mRNA and protein levels of AQP1 and Na+/K+-ATPase when the alveolar fluid volume was ≥6 mL/kg, and the mRNA level of AQP5 was significantly reduced when the alveolar fluid volume was ≥4 mL/kg. In addition, IHC analysis showed the same results. At 4 hours, the lung wet/dry ratio was significantly increased when the alveolar fluid volume was ≥6 mL/kg; however, compared with 0 hours after NS infusion, there was still a significant absorption of alveolar fluid for a period of 4 hours. CONCLUSION The results of this study suggest that increased alveolar fluid may induce the downregulation of the mRNA and protein expression of AQPs and Na+/K+-ATPase, which appear to affect alveolar fluid clearance in rabbit lungs. Early intervention is required to avoid excessive alveolar fluid accumulation. KEY POINTS · The expression levels of AQPs and Na+/K+--ATPase were significantly decreased as alveolar fluid increased.. · At 4 hours, wet/dry ratio was significantly increased when infusion volume was ≥ 6 mL/kg.. · Early intervention is required to avoid excessive alveolar fluid accumulation..
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Affiliation(s)
- Hai-Feng Zong
- Neonatal Intensive Care Unit, Southern Medical University, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Guo Guo
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- Department of Pediatrics, Medical School of Chinese PLA, Beijing, China
- Department of Neonatology, The Fifth Medical Center of the PLA General Hospital, Beijing, China
| | - Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Chuan-Zhong Yang
- Neonatal Intensive Care Unit, Southern Medical University, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Lin-Lin Bao
- Department of Dermatology, Shenzhen People's Hospital, Shenzhen, China
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de Souza LAM, Paredes RG, Giraldi T, Franco MH, de Carvalho-Filho MA, Cecilio-Fernandes D, de Figueiredo LC, Santos TM. Implementation and Assessment of Lung Ultrasound Training Curriculum for Physiotherapists With a Focus on Image Acquisition and Calculation of an Aeration Score. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2119-2127. [PMID: 35948457 DOI: 10.1016/j.ultrasmedbio.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Described here is the implementation of a lung ultrasound course for physiotherapists focused on the acquisition and retention of knowledge and skills. Initially, we provided online lectures in a virtual learning environment (VLE), in which we taught the semiquantification of edema through a lung ultrasound score (LUS). Afterward, the physiotherapists participated in face-to-face lectures (which resumed the online lectures), followed by hands-on training and simulation with ultrasound. We assessed knowledge acquisition through a multiple-choice test with 30 questions (totaling 10 points). The test was applied before accessing the VLE (pre-VLE), before the face-to-face course and at its end (pre- and post-course). Physiotherapists collected actual patients' ultrasound scans, which were uploaded to the VLE and assessed by three supervisors, who performed a consensus LUS calculation and gave virtual written feedback. Thirteen physiotherapists collected 59 exams. The test results were 3.60 ± 1.58 (pre-VLE), 5.94 ± 1.45 (pre-course) and 8.50 ± 0.71 (post-course), with p < 0.001 for all. The intraclass correlation coefficient for LUS between physiotherapists and supervisors was 0.814 (p < 0.001), with moderate-to-weak agreement for LUS of the lung apical, median and basal zones, with κ = 0.455.334, and 0.417 (p < 0.001 for all). Trainees were found to have increased short-term acquisition and retention of knowledge and skills, with a good intraclass correlation coefficient between them and the consensus of supervisors for the LUS of actual patients.
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Affiliation(s)
| | - Ramon Gonzalez Paredes
- Postgraduate Department in Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Tiago Giraldi
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mário Henrique Franco
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Dario Cecilio-Fernandes
- Postgraduate Department in Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Thiago Martins Santos
- Discipline of Emergency Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. The emerging concept of fluid tolerance: A position paper. J Crit Care 2022; 71:154070. [PMID: 35660844 DOI: 10.1016/j.jcrc.2022.154070] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022]
Abstract
Fluid resuscitation is a core component of emergency and critical care medicine. While the focus of clinicians has largely been on detecting patients who would respond to fluid therapy, relatively little work has been done on assessing patients' tolerance to this therapy. In this article we seek to review the concept of fluid tolerance, propose a working definition, and introduce relevant clinical signals by which physicians can assess fluid tolerance, hopefully becoming a starting point for further research.
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Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | | | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Philippe Rola
- Chief of Service, Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada.
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13
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Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. Reply to: What is meant by "fluid tolerance ?". J Crit Care 2022; 72:154158. [PMID: 36174433 DOI: 10.1016/j.jcrc.2022.154158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | | | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Philippe Rola
- Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada.
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14
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Kawasaki disease shock syndrome with acute respiratory distress syndrome in a child: a case report and literature review. BMC Pulm Med 2022; 22:220. [PMID: 35668424 PMCID: PMC9168351 DOI: 10.1186/s12890-022-02007-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/25/2022] [Indexed: 12/18/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis that may involve multiple organs. KD shock syndrome (KDSS) is a rare complication of KD. Pulmonary involvement is rare in KD; reports of patients with KD who develop KDSS and acute respiratory distress syndrome (ARDS) are extremely rare. Case presentation A 2-year-old girl was brought to the emergency department with fever, cough and tachypnea. The patient was diagnosed with KDSS and ARDS. Extracorporeal membrane oxygenation (ECMO) and continuous blood purification were performed because of her critical condition. The patient eventually recovered completely. One year after discharge, there has been no coronary artery dilatation or pulmonary fibrosis. Conclusion KDSS patients may develop ARDS due to fluid resuscitation and the release of inflammatory mediators. Early aggressive management and comprehensive treatment may improve prognosis.
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Mao JY, Zhang HM, Liu DW, Wang XT. Visual Rounds Based on Multiorgan Point-of-Care Ultrasound in the ICU. Front Med (Lausanne) 2022; 9:869958. [PMID: 35692540 PMCID: PMC9174546 DOI: 10.3389/fmed.2022.869958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) is performed by a treating clinician at the patient's bedside, provides a acquisition, interpretation, and immediate clinical integration based on ultrasonographic imaging. The use of POCUS is not limited to one specialty, protocol, or organ system. POCUS provides the treating clinician with real-time diagnostic and monitoring information. Visual rounds based on multiorgan POCUS act as an initiative to improve clinical practice in the Intensive Care Unit and are urgently needed as part of routine clinical practice.
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Affiliation(s)
- Jia-Yu Mao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiao-Ting Wang
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16
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Pasqueron J, Dureau P, Arcile G, Duceau B, Hariri G, Lepère V, Lebreton G, Rouby JJ, Bouglé A. Usefulness of lung ultrasound for early detection of hospital-acquired pneumonia in cardiac critically ill patients on venoarterial extracorporeal membrane oxygenation. Ann Intensive Care 2022; 12:43. [PMID: 35596817 PMCID: PMC9124275 DOI: 10.1186/s13613-022-01013-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 12/20/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is the most common and severe complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO) and its diagnosis remains challenging. Nothing is known about the usefulness of lung ultrasound (LUS) in early detection of HAP in patients treated with VA ECMO. Also, LUS and chest radiography were performed when HAP was suspected in cardiac critically ill adult VA ECMO presenting with acute respiratory failure. The sonographic features of HAP in VA ECMO patients were determined and we assessed the performance of the lung ultrasound simplified clinical pulmonary score (LUS-sCPIS), the sCPIS and bioclinical parameters or chest radiography alone for early diagnosis of HAP. Results We included 70 patients, of which 44 (63%) were independently diagnosed with HAP. LUS examination revealed that color Doppler intrapulmonary flow (P = 0.0000043) and dynamic air bronchogram (P = 0.00024) were the most frequent HAP-related signs. The LUS-sCPIS (area under the curve = 0.77) yielded significantly better results than the sCPIS (area under the curve = 0.65; P = 0.004), while leukocyte count, temperature and chest radiography were not discriminating for HAP diagnosis. Discussion Diagnosis of HAP is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Color Doppler intrapulmonary flow and dynamic air bronchogram appear to be particularly insightful for the diagnosis of HAP. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01013-9.
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Affiliation(s)
- Jean Pasqueron
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Pauline Dureau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Gauthier Arcile
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Baptiste Duceau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Geoffroy Hariri
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Victoria Lepère
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Guillaume Lebreton
- Sorbonne Université, Department of Cardiac Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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17
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Corsini I, Ficial B, Ciarcià M, Capasso L, Migliaro F, Rodriguez-Fanjul J, Clemente M, Raimondi F, Dani C. Lung ultrasound scores in neonatal clinical practice: A narrative review of the literature. Pediatr Pulmonol 2022; 57:1157-1166. [PMID: 35229487 DOI: 10.1002/ppul.25875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 11/10/2022]
Abstract
Lung ultrasound (LU) has in recent years increasingly been used as a point-of-care method. Initially, LU was used as a so-called descriptive diagnostic method for neonatal respiratory diseases. Instead, this review article focuses on the use of LU as a "functional" tool using classification of findings in patterns or using semiquantitative scores. We review and describe the evidence that led to the implementation of LU in predicting the need for surfactant replacement therapy in preterm infants and in the identification of newborns at risk of developing bronchopulmonary dysplasia. LU appears to be a very promising method for the future of clinical management of newborns in both acute and chronic phases of pulmonary pathologies related to prematurity. However, further studies are needed to define its role before full implementation.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology and NICU, Federico II University Hospital, Naples, Italy
| | - Fiorella Migliaro
- Division of Neonatology and NICU, Federico II University Hospital, Naples, Italy
| | - Javier Rodriguez-Fanjul
- Neonatal Intensive Care Unit, Department of Paediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Raimondi
- Division of Neonatology and NICU, Federico II University Hospital, Naples, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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18
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Zaky S, Fathelbab HK, Elbadry M, El-Raey F, Abd-Elsalam SM, Makhlouf HA, Makhlouf NA, Metwally MA, Ali-Eldin F, Hasan AA, Alboraie M, Yousef AM, Shata HM, Eid A, Asem N, Khalaf A, Elnady MA, Elbahnasawy M, Abdelaziz A, Shaltout SW, Elshemy EE, Wahdan A, Hegazi MS, Abdel Baki A, Hassany M. Egyptian Consensus on the Role of Lung Ultrasonography During the Coronavirus Disease 2019 Pandemic. Infect Drug Resist 2022; 15:1995-2013. [PMID: 36176457 PMCID: PMC9513721 DOI: 10.2147/idr.s353283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background & Aims Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.
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Affiliation(s)
- Samy Zaky
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Elbadry
- Department of Endemic Medicine, Helwan University, Cairo, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Sherief M Abd-Elsalam
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
- Correspondence: Sherief M Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta, Egypt, Tel +201063319696, Email
| | | | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Mohamed A Metwally
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Benha University, Benha, Egypt
| | - Fatma Ali-Eldin
- Department of Tropical medicine; Ain Shams University, Cairo, Egypt
| | | | - Mohamed Alboraie
- Department of Internal Medicine; Al-Azhar University, Cairo, Egypt
| | - Ahmed M Yousef
- Department of Community and Industrial Medicine, Damietta, Al-Azhar University, Damietta, Egypt
| | - Hanan M Shata
- Department of Chest Medicine; Mansoura University, Mansoura, Egypt
| | - Alshaimaa Eid
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University and Ministry of Health and Population, Cairo, Egypt
| | - Asmaa Khalaf
- Department of Radiology, Minia University, Minia, Egypt
| | - Mohamed A Elnady
- Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elbahnasawy
- Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt
| | - Ahmed Abdelaziz
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Shaker W Shaltout
- Department of Tropical Medicine, Port Said University, Port Said, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Atef Wahdan
- Department of Chest Diseases, Damietta, Al-Azhar University, Damietta, Egypt
| | - Mohamed S Hegazi
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Amin Abdel Baki
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
| | - Mohamed Hassany
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
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19
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Liu R, Zhao G, Wang Q, Gong F. Prognostic value of pulmonary ultrasound score combined with plasma miR-21-3p expression in patients with acute lung injury. J Clin Lab Anal 2022; 36:e24275. [PMID: 35141939 PMCID: PMC8906047 DOI: 10.1002/jcla.24275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to explore the value of the combination between lung ultrasound score (LUS) and the expression of plasma miR‐21‐3p in predicting the prognosis of patients with acute lung injury (ALI). Patients and methods A total of 136 ALI patients were divided into survival (n = 86) and death groups (n = 50), or into low/middle‐risk (n = 77) and high‐risk groups (n = 59) according to APACHE II scores. Bioinformatics was used to explore the mechanism of action of miR‐21‐3p in humans. Real‐time fluorescent quantitative PCR was used to detect the expression of miR‐21‐3p in plasma, and LUS was recorded. Receiver operator characteristic (ROC) curve and Pearson correlation were also used. Results The LUS and expression level of plasma miR‐21‐3p in the death and high‐risk groups were significantly higher than those in the survival and low/middle‐risk groups (p < 0.01 and p < 0.05). miR‐21‐3p expression leads to pulmonary fibrosis and promotes the deterioration of ALI patients by regulating fibroblast growth factor and other target genes. ROC curve analysis showed that the best cutoff values for LUS and plasma miR‐21‐3p expression were 18.60 points and 1.75, respectively. LUS score and miR‐21‐3p combined predicted the death of ALI patients with the largest area under the curve (0.907, 95% CI: 0.850–0.964), with sensitivity and specificity of 91.6% and 85.2%, respectively. The expression level of plasma miR‐21‐3p was positively correlated with LUS in the death group (r = 0.827, p < 0.01). Conclusion LUS and expression level of miR‐21‐3p in plasma are correlated with the severity and prognosis of ALI patients, and their combination has a high value for the prognostic assessment of ALI patients.
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Affiliation(s)
- Renyang Liu
- Emergency & Intensive Care Unit Center, Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Guoxu Zhao
- School of medical imaging, Mudanjiang Medical College, Mudanjiang, China
| | - Qinyu Wang
- Department of Clinical Labortory, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Fangxiao Gong
- Emergency & Intensive Care Unit Center, Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
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20
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The Value of Pulmonary Bedside Ultrasound System in the Evaluation of Severity and Prognosis of Acute Lung Injury. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6471437. [PMID: 35126630 PMCID: PMC8813219 DOI: 10.1155/2022/6471437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Objective. To evaluate the value of pulmonary bedside ultrasound system in the assessment of severity and prognosis of acute lung injury (ALI). Method. Seventy-two ALI patients in the intensive care unit (ICU) of our hospital from April 2019 to April 2021 were selected as subjects. The changes of lung ultrasound score (LUS) and parameters at D1, D2, and D3 after admission were analyzed (LUS, oxygenation index (PaO2/FiO2), Acute Physiology and Chronic Health Evaluation II (APACHE-II), and Sequential Organ Failure Assessment (SOFA) score). Pearson correlation analysis was used to assess the relationship between LUS and PaO2/FiO2, APACHE-II score, and SOFA score at D1, D2, and D3. Logistic regression analysis was used for influencing factors for the prognosis of ALI patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of baseline LUS, PaO2/FiO2, APACHE-II score, and SOFA score for the prognosis of ALI patients. Result. LUSs at D1, D2 and D3 showed an increasing trend with the increase of disease severity (
). From D1 to D3, LUS, PaO2/FiO2, APACHE-II score, and SOFA score showed a downward trend (
). LUS was negatively correlated with PaO2/FiO2 at D1, D2, and D3 but positively correlated with APACHE-II score and SOFA score (
). Logistic regression analysis showed that after controlling for age, PaO2 and PaCO2, an increase in baseline LUS, APACHE-II score, SOFA score, and a decrease in PaO2/FiO2 were independent risk factors for death at 28 d in ALI patients (
). ROC curve showed that LUS, PaO2/FiO2, APACHE-II score, and SOFA score were combined to predict the prognosis of ALI patients with the highest AUC value of 0.920, corresponding sensitivity of 88.89%, and specificity of 95.56%. Conclusion. LUS can evaluate the change of pulmonary ventilation area in ALI patients, further evaluate the severity of the disease, and effectively predict the prognosis of patients.
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21
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Assessment of fluid unresponsiveness guided by lung ultrasound in abdominal surgery: a prospective cohort study. Sci Rep 2022; 12:1350. [PMID: 35079044 PMCID: PMC8789825 DOI: 10.1038/s41598-022-05251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022] Open
Abstract
A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Our objective was to evaluate the appearance of B-lines as a diagnostic marker of preload unresponsiveness and postoperative complications in the operating theater. We conducted a prospective, bicentric, observational study. Adult patients undergoing abdominal surgery were included. Stroke volume (SV) was determined before and after a fluid challenge with 250 mL crystalloids (Delta-SV) using esophageal Doppler monitoring. Responders were defined by an increase of Delta-SV > 10% after fluid challenge. B-lines were collected at four bilateral predefined zones (right and left anterior and lateral). Delta-B-line was defined as the number of newly appearing B-lines after a fluid challenge. Postoperative pulmonary complications were prospectively recorded according to European guidelines. In total, 197 patients were analyzed. After a first fluid challenge, 67% of patients were responders and 33% were non-responders. Delta-B-line was significantly higher in non-responders than responders [4 (2–7) vs 1 (0–3), p < 0.0001]. Delta-B-line was able to diagnose fluid non-responders with an area under the curve of 0.74 (95% CI 0.67–0.80, p < 0.0001). The best threshold was two B-lines with a sensitivity of 80% and a specificity of 57%. The final Delta-B-line could predict postoperative pulmonary complications with an area under the curve of 0.74 (95% CI 0.67–0.80, p = 0.0004). Delta-B-line of two or more detected in four lung ultrasound zones can be considered to be a marker of preload unresponsiveness after a fluid challenge in abdominal surgery. The objectives and procedures of the study were registered at Clinicaltrials.gov (NCT03502460; Principal investigator: Stéphane BAR, date of registration: April 18, 2018).
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22
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Ammar M, Hilal A, Abdalla W. The role of lung ultrasound in procalcitonin-guided antibiotic discontinuation in ventilator-associated pneumonia. Indian J Anaesth 2022; 66:431-435. [PMID: 35903590 PMCID: PMC9316679 DOI: 10.4103/ija.ija_989_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/14/2022] [Accepted: 05/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: Starting antibiotic therapy at the proper time is the cornerstone of the management of ventilator-associated pneumonia (VAP). However, using antibiotics for a long duration of therapy in intensive care leads to increased bacterial resistance, financial burden and adverse drug reactions. We hypothesised that lung ultrasound may have a role in guiding antibiotic discontinuation in patients with VAP that will help to reduce the antibiotic duration and decrease the resistance. Methods: This was a prospective blinded cohort study from October 2020 to September 2021 in which 62 VAP patients were recruited. Antibiotics were started, procalcitonin (PCT) level and clinical pulmonary infection score were estimated and lung ultrasound (US) was performed on day 1 and repeated on day 7. On day 7, discontinuation of antibiotics was recommended if the PCT level was <0.25 μg/L. A lung reaeration score was recorded. Results: Based on the PCT levels, antibiotics were discontinued in 40 patients. The computed tomography findings of VAP had improved in all. The ultrasound reaeration score showed a highly significant negative correlation with the PCT on day 7 (-0.718, P < 0.001). A cut-off of 5 for the US score showed a sensitivity of 92.5%, specificity of 95.5%, positive predictive value of 97.4% and negative predictive value of 87.5% in detecting a low PCT score on day 7. Conclusion: Lung US is a non-invasive and safe method that can be used to guide antibiotic therapy in VAP.
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Wang Y, Zhang Y, He Q, Liao H, Luo J. Quantitative Analysis of Pleural Line and B-Lines in Lung Ultrasound Images for Severity Assessment of COVID-19 Pneumonia. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:73-83. [PMID: 34428140 PMCID: PMC8905613 DOI: 10.1109/tuffc.2021.3107598] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/21/2021] [Indexed: 06/12/2023]
Abstract
Specific patterns of lung ultrasound (LUS) images are used to assess the severity of coronavirus disease 2019 (COVID-19) pneumonia, while such assessment is mainly based on clinicians' qualitative and subjective observations. In this study, we quantitatively analyze the LUS images to assess the severity of COVID-19 pneumonia by characterizing the patterns related to the pleural line (PL) and B-lines (BLs). Twenty-seven patients with COVID-19 pneumonia, including 13 moderate cases, seven severe cases, and seven critical cases, are enrolled. Features related to the PL, including the thickness (TPL) and roughness of the PL (RPL), and the mean (MPLI) and standard deviation (SDPLI) of the PL intensities are extracted from the LUS images. Features related to the BLs, including the number (NBL), accumulated width (AWBL), attenuation coefficient (ACBL), and accumulated intensity (AIBL) of BLs, are also extracted. The correlations of these features with the disease severity are evaluated. The performances of the binary severe/non-severe classification are assessed for each feature and support vector machine (SVM) classifiers with various combinations of features as input. Several features, including the RPL, NBL, AWBL, and AIBL, show significant correlations with disease severity (all ). The classification performance is optimal using the SVM classifier using all the features as input (area under the receiver operating characteristic (ROC) curve = 0.96, sensitivity = 0.93, and specificity = 1). These findings demonstrate that the proposed method may be a promising tool for automatic grading diagnosis and follow-up of patients with COVID-19 pneumonia.
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Affiliation(s)
- Yuanyuan Wang
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Yao Zhang
- Department of UltrasoundBeijing Ditan HospitalCapital Medical UniversityBeijing100015China
| | - Qiong He
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Hongen Liao
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Jianwen Luo
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
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Vetrugno L, Mojoli F, Cortegiani A, Bignami EG, Ippolito M, Orso D, Corradi F, Cammarota G, Mongodi S, Boero E, Iacovazzo C, Vargas M, Poole D, Biasucci DG, Persona P, Bove T, Ball L, Chiumello D, Forfori F, de Robertis E, Pelosi P, Navalesi P, Giarratano A, Petrini F. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO). JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8611396 DOI: 10.1186/s44158-021-00015-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-021-00015-6.
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Milojevic I, Lemma K, Khosla R. Ultrasound use in the ICU for interventional pulmonology procedures. J Thorac Dis 2021; 13:5343-5361. [PMID: 34527370 PMCID: PMC8411174 DOI: 10.21037/jtd-19-3564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical decision-making, at the bedside, in real-time. Once considered impossible, lung ultrasound based on interpretation of artifacts along with true images, has gained momentum during the last decade, as an integral part of rapid evaluation algorithms for acute respiratory failure, shock and cardiac arrest. Procedural ultrasound image guidance is a standard of care for both common bedside procedures, and advanced procedures within interventional pulmonologist’s (IP’s) scope of practice. From IP’s perspective, the lung, pleural, and chest wall ultrasound expertise is a prerequisite for mastery in pleural drainage techniques and transthoracic biopsies. Another ultrasound application of interest to the IP in the intensive care unit (ICU) setting is during percutaneous dilatational tracheostomy (PDT). As ICU demographics shift towards older and sicker patients, the indications for closed pleural drainage procedures, bedside transthoracic biopsies, and percutaneous dilatational tracheostomies have dramatically increased. Although ultrasound expertise is considered an essential IP operator skill there is no validated curriculum developed to address this component. Further, there is a need for developing an educational tool that matches up with the curriculum and could be integrated real-time with ultrasound-guided procedures.
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Affiliation(s)
- Ivana Milojevic
- Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Kewakebt Lemma
- Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Rahul Khosla
- Department of Pulmonary and Critical Care Medicine, US Department of Veterans Affairs, Washington, DC, USA
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26
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Smit MR, Pisani L, de Bock EJE, van der Heijden F, Paulus F, Beenen LFM, Leopold SJ, Huson MAM, Henwood PC, Riviello ED, Walden AP, Dondorp AM, Schultz MJ, Bos LDJ. Ultrasound versus Computed Tomography Assessment of Focal Lung Aeration in Invasively Ventilated ICU Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2589-2597. [PMID: 34172339 DOI: 10.1016/j.ultrasmedbio.2021.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/23/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
It is unknown whether and to what extent the penetration depth of lung ultrasound (LUS) influences the accuracy of LUS findings. The current study evaluated and compared the LUS aeration score and two frequently used B-line scores with focal lung aeration assessed by chest computed tomography (CT) at different levels of depth in invasively ventilated intensive care unit (ICU) patients. In this prospective observational study, patients with a clinical indication for chest CT underwent a 12-region LUS examination shortly before CT scanning. LUS images were compared with corresponding regions on the chest CT scan at different subpleural depths. For each LUS image, the LUS aeration score was calculated. LUS images with B-lines were scored as the number of separately spaced B-lines (B-line count score) and the percentage of the screen covered by B-lines divided by 10 (B-line percentage score). The fixed-effect correlation coefficient (β) was presented per 100 Hounsfield units. A total of 40 patients were included, and 372 regions were analyzed. The best association between the LUS aeration score and CT was found at a subpleural depth of 5 cm for all LUS patterns (β = 0.30, p < 0.001), 1 cm for A- and B1-patterns (β = 0.10, p < 0.001), 6 cm for B1- and B2-patterns (β = 0.11, p < 0.001) and 4 cm for B2- and C-patterns (β = 0.07, p = 0.001). The B-line percentage score was associated with CT (β = 0.46, p = 0.001), while the B-line count score was not (β = 0.07, p = 0.305). In conclusion, the subpleural penetration depth of ultrasound increased with decreased aeration reflected by the LUS pattern. The LUS aeration score and the B-line percentage score accurately reflect lung aeration in ICU patients, but should be interpreted while accounting for the subpleural penetration depth of ultrasound.
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Affiliation(s)
- Marry R Smit
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Technical Medicine Centre, University of Twente, Enschede, The Netherlands.
| | - Luigi Pisani
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Eva J E de Bock
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Technical Medicine Centre, University of Twente, Enschede, The Netherlands
| | - Ferdinand van der Heijden
- Technical Medicine Centre, University of Twente, Enschede, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Stije J Leopold
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Department of Internal Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Michaëla A M Huson
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Patricia C Henwood
- Emergency Medicine Department, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elisabeth D Riviello
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew P Walden
- Department of ICU, Royal Berkshire Hospital, Reading, United Kingdom
| | - Arjen M Dondorp
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Lieuwe D J Bos
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Li L, Qin A, Yang X, Zhou S, Luo Y, Zhu F, Hu B, Li J, Cai S, Peng Z. Findings and Prognostic Value of Lung Ultrasonography in Coronal Virus Disease 2019 (COVID-19) Pneumonia. Shock 2021; 56:200-205. [PMID: 33234837 PMCID: PMC8284347 DOI: 10.1097/shk.0000000000001700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE We used lung ultrasonography to identify features of COVID-19 pneumonia and to evaluate the prognostic value. PATIENTS AND METHODS We performed lung ultrasonography on 48 COVID-19 patients in an intensive care unit (ICU) (Wuhan, China) using a 12-zone method. The associations between lung ultrasonography score, PaO2/FiO2, APACHE II, SOFA, and PaCO2 with 28-day mortality were analyzed and the receiver operator characteristic curve was plotted. RESULTS 25.9% areas in all scanning zones presented with B7 lines and 23.5% with B3 lines (B-pattern) on lung ultrasonography; 13% areas with confluent B lines (B-pattern), 24.9% in areas with consolidations, and 9.9% in areas with A lines. Pleural effusion was observed in 2.8% of areas. Lung ultrasonography score was negatively correlated with PaO2/FiO2 (n = 48, r = -0.498, P < 0.05) and positively correlated with APACHE II (n = 48, r = 0.435, P < 0.05). Lung ultrasonography score was independently associated with 28-day mortality. The areas under receiver operator characteristic curves of lung ultrasonography score were 0.735 (95% CI: 0.586-0.844). The sensitivity, specificity, and cutoff values were 0.833, 0.722, and 22.5, respectively. CONCLUSIONS Lung ultrasonography could be used to assess the severity of COVID-19 pneumonia, and it could also reveal the pathological signs of the disease. The lung ultrasonography score on ICU admission was independently related to the ICU 28-day mortality.
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Affiliation(s)
- Lu Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Abstract
Lung ultrasound is increasingly used in emergency departments, medical wards, and critical care units-adult, pediatric, and neonatal. In vitro and in vivo studies show that the number and type of artifacts visualized change with lung density. This has led to the idea of a quantitative lung ultrasound approach, opening up new prospects for use not only as a diagnostic but also as a monitoring tool. Consequently, the multiple scoring systems proposed in the last few years have different technical approaches and specific clinical indications, adaptable for more or less time-dependent patients. However, multiple scoring systems may generate confusion among physicians aiming at introducing lung ultrasound in their clinical practice. This review describes the various lung ultrasound scoring systems and aims to clarify their use in different settings, focusing on technical aspects, validation with reference techniques, and clinical applications.
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Kong S, Wang J, Li Y, Tian Y, Yu C, Zhang D, Li H, Zhang L, Pang X, Xie M. Value of Bedside Lung Ultrasound in Severe and Critical COVID-19 Pneumonia. Respir Care 2021; 66:920-927. [PMID: 33758057 DOI: 10.4187/respcare.08382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is an effective imaging modality that can differentiate pathological lung from non-diseased lung. We aimed to explore the value of bedside LUS in patients with severe and critical coronavirus disease 2019 (COVID-19)-associated lung injury. METHODS Sixty-three severe and 33 critical hospitalized subjects with COVID-19 were enrolled in this study. Bedside LUS was performed in all subjects; chest computed tomography was performed on the same day as bedside LUS in 23 cases. The LUS protocol consisted of 12 scanning zones. LUS score based on B-lines and lung consolidation was evaluated. RESULTS The most common abnormality of LUS was the various forms of B-lines, detected in 93 (96.9%) subjects; as the second most frequent abnormality, 80 (83.3%) subjects exhibited lung consolidation, mainly located in the posterior lung region. Twenty-four (25.0%) subjects had pleural line abnormalities, and 16 (16.7%) had pleural effusion; 78 (81.3%) subjects had ≥ 2 abnormal LUS patterns, and 93 (96.9%) had bilateral lung involvement. The proportion of bilateral or unilateral lung consolidation and pleural effusion in the critical COVID-19 group were higher than that in the severe group (P < .05). The lung consolidation of critical subjects showed a marked increase in most lung areas, including bilateral lateral lung, posterior lung, and left anterior-inferior lung area. The median (interquartile range) LUS scores of critical cases were higher than those of severe cases: left: 14 (12-17) vs 7 (5-12); right: 14 (10-16) vs 8 (3-12); bilateral: 28 (23-31) vs 15 (8-22) (P < .001 for all). There was a good correlation between the LUS score and the chest computed tomography score (r = 0.887, P < .001). CONCLUSIONS The most common abnormal LUS pattern in subjects with severe and critical COVID-19 pneumonia was B-lines, followed by lung consolidation. Bedside LUS can provide important information for pulmonary involvement in patients with COVID-19.
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Affiliation(s)
- Shuangshuang Kong
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ying Tian
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Cheng Yu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Danqing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hong Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xueqin Pang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Kajal K, Premkumar M, Chaluvashetty SB, Bhujade H, Kulkarni AV. Point-of-Care Thoracic Ultrasonography in Patients With Cirrhosis and Liver Failure. Cureus 2021; 13:e15559. [PMID: 34277182 PMCID: PMC8271278 DOI: 10.7759/cureus.15559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/06/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) helps determine liver-related pathologies like an abscess, portal vein or hepatic vein thromboses, presence of ascites, site for pleural or ascitic paracentesis, and guiding biopsies. POCUS is revolutionizing the management of critically ill patients presenting with pneumonia, acute respiratory distress syndrome, acute-on-chronic liver failure, and in the emergency. The objectives of thoracic ultrasonography (TUS) are to aid the clinician in differentiating between pneumonia, effusions, interstitial edema and collections, and in estimating the volume status of patients with liver disease using inferior vena cava dynamic indices. The use of POCUS in patients with cirrhosis has since evolved. It is now widely used to help diagnose volume status, left ventricular diastolic dysfunction, myocardial infarction, and right ventricular dilation due to pulmonary embolism and to determine the causes for weaning failures such as effusions, lung collapse, and pneumothorax. During the Coronavirus Disease 2019 (COVID-19) pandemic, moving patients for computed tomography can be difficult. Therefore, TUS is now essential in liver transplantation and intensive care practice to assess ventilatory pressures, cardiac function, and fluid management. This review indicates the current and optimized use of TUS, offers a practical guide on TUS in the liver intensive care unit (ICU), and presents a diagnostic pathway for determining lung and pleural pathology, resolution of respiratory failure, and aid weaning from mechanical ventilation.
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Affiliation(s)
- Kamal Kajal
- Anesthesia and Critical Care, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Madhumita Premkumar
- Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | | | - Harish Bhujade
- Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
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Xian J, Pei X, Lu W, Zhong H, Lin Y, Jin H, Su Z. The clinical value of bedside ultrasound in predicting the severity of coronavirus disease-19 (COVID-19). ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:336. [PMID: 33708963 PMCID: PMC7944274 DOI: 10.21037/atm-20-7944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To summarise the ultrasound manifestations of coronavirus disease-19 (COVID-19) patients with lung lesions and explore the clinical value of bedside ultrasound in the identification of patients at risk of progression to severe disease. Methods This retrospective study enrolled 31 patients with COVID-19 who were admitted to our hospital from January 18 to February 5, 2020. Lung ultrasounds were performed in all cases to evaluate the ultrasound manifestations of the patient’s lung lesions and to determine the lung ultrasound scores (LUS). The Cox proportional hazards regression model was used for the multifactor analysis of 7 candidate parameters, including the LUS and the oxygenation index (PaO2/FiO2). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the LUS. Results Lung ultrasound images of COVID-19 patients mainly reflected the presence of interstitial pulmonary lesions (90.3%, 28/31). The lung lesions were primarily distributed in the subpleural and peripheral pulmonary zones. Multivariate analyses identified the oxygenation index, the LUS, and the lymphocyte count as factors related to the progression to severe-critical disease in COVID-19 patients (P<0.05). With a cut-off value of 9.5, the area under the ROC curve was 0.910. The LUS showed a sensitivity and specificity of 81.3% and 93.0%, respectively (P≤0.001), with an overall accuracy of 75%. Conclusions The lung ultrasound findings in COVID-19 patients were mainly and specifically manifested as interstitial lesions involving the peripheral zones of the lung. In addition, ultrasound imaging could predict the likelihood of COVID-19 patients progressing to severe disease, thereby allowing for early intervention. Thus, lung ultrasounds have great clinical value in monitoring and evaluating COVID-19 patients.
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Affiliation(s)
- Jianzhong Xian
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaofeng Pei
- Department of Thoracic Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Wuzhu Lu
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Haihong Zhong
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yuhong Lin
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hongjun Jin
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Wang F, Wang C, Shi J, Shan Y, Miao H, Sun T, Zhou Y, Zhang Y. Lung ultrasound score assessing the pulmonary edema in pediatric acute respiratory distress syndrome received continuous hemofiltration therapy: a prospective observational study. BMC Pulm Med 2021; 21:40. [PMID: 33494739 PMCID: PMC7830818 DOI: 10.1186/s12890-021-01394-w] [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: 05/24/2020] [Accepted: 01/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Lung ultrasound score is a potential method for determining pulmonary edema in acute respiratory distress syndrome (ARDS). Continuous renal replacement therapy (CRRT) has become the preferred modality to manage fluid overload during ARDS. The aim of this study was to evaluate the value of lung ultrasound (LUS) score on assessing the effects of CRRT on pulmonary edema and pulmonary function in pediatric ARDS. Methods We conducted a prospective cohort study in 70 children with moderate to severe ARDS in a tertiary university pediatric intensive care unit from January 2016 to December 2019. 37 patients received CRRT (CRRT group) and 33 patients treated by conventional therapy (Non-CRRT group). LUS score was measured within 2 h identified ARDS as the value of 1st, and the following three days as the 2nd, 3rd, and 4th. We used Spearman correlation analysis to develop the relationship between LUS score and parameters related to respiratory dynamics, clinical outcomes as well as daily fluid balance during the first four days after ARDS diagnosed. Results The 1st LUS score in CRRT group were significantly higher than Non-CRRT group (P < 0.001), but the LUS score decreased gradually following CRRT (P < 0.001). LUS score was significantly correlated with Cdyn (dynamic lung compliance) (1st: r = − 0.757, 2nd: r = − 0.906, 3rd: r = − 0.885, 4th: r = − 0.834), OI (oxygenation index) (1st: r = 0.678, 2nd: r = 0.689, 3rd: r = 0.486, 4th: r = 0.324) based on 1st to 4th values (all P < 0.05). Only values of the 3rd and 4th LUS score after ARDS diagnosed were correlated with duration of mechanical ventilation [1st: r = 0.167, P = 0.325; 2nd: r = 0.299, P = 0.072; 3rd: r = 0.579, P < 0.001; 4th: r = 0.483, P = 0.002]. LUS score decreased from 22 (18–25) to 15 (13–18) and OI decreased from 15.92 (14.07–17.73) to 9.49 (8.70–10.58) after CRRT for four days (both P < 0.001). Conclusions LUS score is significantly correlated with lung function parameters in pediatric ARDS. The improvement of pulmonary edema in patient with ARDS received CRRT can be assessed by the LUS score. Trial registration CCTR, ChiCTR-ONC-16009698. Registered 1 November 2016, prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=16535&htm=4. This study adheres to CONSORT guidelines.
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Affiliation(s)
- Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China. .,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
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de Alencar JCG, Marchini JFM, Marino LO, da Costa Ribeiro SC, Bueno CG, da Cunha VP, Lazar Neto F, Brandão Neto RA, Souza HP. Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department. Ann Intensive Care 2021; 11:6. [PMID: 33427998 PMCID: PMC7797883 DOI: 10.1186/s13613-020-00799-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068). RESULTS The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 ± 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 ± 6.7 vs. 21 ± 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001). CONCLUSIONS In COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.
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Affiliation(s)
- Julio Cesar Garcia de Alencar
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil.
| | - Julio Flavio Meirelles Marchini
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Lucas Oliveira Marino
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Sabrina Correa da Costa Ribeiro
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Cauê Gasparotto Bueno
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Victor Paro da Cunha
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Felippe Lazar Neto
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Rodrigo Antonio Brandão Neto
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
| | - Heraldo Possolo Souza
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 255, Dr. Enéas de Carvalho Aguiar st., São Paulo, SP, Brazil
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Hussain A, Via G, Melniker L, Goffi A, Tavazzi G, Neri L, Villen T, Hoppmann R, Mojoli F, Noble V, Zieleskiewicz L, Blanco P, Ma IWY, Wahab MA, Alsaawi A, Al Salamah M, Balik M, Barca D, Bendjelid K, Bouhemad B, Bravo-Figueroa P, Breitkreutz R, Calderon J, Connolly J, Copetti R, Corradi F, Dean AJ, Denault A, Govil D, Graci C, Ha YR, Hurtado L, Kameda T, Lanspa M, Laursen CB, Lee F, Liu R, Meineri M, Montorfano M, Nazerian P, Nelson BP, Neskovic AN, Nogue R, Osman A, Pazeli J, Pereira-Junior E, Petrovic T, Pivetta E, Poelaert J, Price S, Prosen G, Rodriguez S, Rola P, Royse C, Chen YT, Wells M, Wong A, Xiaoting W, Zhen W, Arabi Y. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus. Crit Care 2020; 24:702. [PMID: 33357240 PMCID: PMC7759024 DOI: 10.1186/s13054-020-03369-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.
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Affiliation(s)
- Arif Hussain
- Department of Cardiac Sciences, King Abdulaziz Medical City and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Lawrence Melniker
- New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Alberto Goffi
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
- Anaesthesia and Intensive Care, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico, Policlinico San Matteo Foundation, Pavia, Italy
| | - Luca Neri
- Emergency Medicine and Critical Care Consultant, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia
| | - Tomas Villen
- School of Medicine, Francisco de Vitoria University, Madrid, Spain
| | - Richard Hoppmann
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Francesco Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Università Degli Studi Di Pavia, Pavia, Italy
| | - Vicki Noble
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Laurent Zieleskiewicz
- Service D'Anesthésie Réanimation Hôpital Nord, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Pablo Blanco
- Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", Necochea, Argentina
| | - Irene W Y Ma
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Mahathar Abd Wahab
- Emergency and Trauma Department, Hospital Kuala Lumpur, 50586, Kuala Lumpur, Malaysia
| | - Abdulmohsen Alsaawi
- King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Majid Al Salamah
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Martin Balik
- Dept of Anaesthesiology and Intensive Care, First Medical Faculty, Charles University, Prague, Czechia
| | - Diego Barca
- Médico Ecografista IADT, Buenos Aires, Argentina
| | - Karim Bendjelid
- Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, C.H.U. Dijon and Université Bourgogne Franche-Comté, LNC UMR866, 21000, Dijon, France
| | | | - Raoul Breitkreutz
- FOM University of Economy & Management, Frankfurt Campus, Frankfurt, Germany
| | - Juan Calderon
- Hospital General, Instituto Mexicano del Seguro Social, De Zona 4 Monterrey, Nuevo Leon, Mexico
| | - Jim Connolly
- Great North Trauma and Emergency Care Newcastle, Newcastle upon Tyne, UK
| | - Roberto Copetti
- Emergency Department, Latisana General Hospital, Latisana, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | | | | | - Young-Rock Ha
- Dept. of Emergency Medicine, Bundang Jesaeng Hospital, Seoul, Korea
| | | | - Toru Kameda
- Department of Clinical Laboratory Medicine and Department of Emergency Medicine, Jichi Medical University, Tokyo, Japan
| | | | - Christian B Laursen
- Department of Respiratory Medicine, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Francis Lee
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Rachel Liu
- Dept. of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Miguel Montorfano
- Department of Ultrasound & Doppler Hospital de Emergencias "Dr. Clemente Alvarez", Rosario, Santa Fe, Argentina
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italia
| | - Bret P Nelson
- Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Aleksandar N Neskovic
- Clinical Hospital Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ramon Nogue
- Faculty of Medecine, University of Lleida, Lleida, Spain
| | - Adi Osman
- Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - José Pazeli
- FAME - Medicine School of Barbacena - MG-Brasil, Barbacena, Brazil
| | | | | | - Emanuele Pivetta
- Città Della Salute E Della Scienza Di Torino Hospital, University of Turin, Turin, Italy
| | - Jan Poelaert
- Faculty of Medicine and Pharmacy VUB, Univ Hospital Brussels, Brussels, Belgium
| | | | - Gregor Prosen
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
| | | | | | - Colin Royse
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - Yale Tung Chen
- Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Mike Wells
- Division of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Wang Xiaoting
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wang Zhen
- The Fourth Military Medical University, Xi'an, 710032, China
| | - Yaseen Arabi
- King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Allegorico E, Buonerba C, Bosso G, Pagano A, Porta G, Serra C, Dolce P, Minerva V, Vicario FD, Altruda C, Arbo P, Russo T, Sio CD, Franco N, Ruffa G, Mormile C, Cannavacciuolo F, Mercurio V, Gervasio G, Costanzo GD, Ragozzino A, Scafuri L, Facchini G, Numis F. The use of chest ultrasonography in suspected cases of COVID-19 in the emergency department. Future Sci OA 2020; 7:FSO635. [PMID: 33432268 PMCID: PMC7745656 DOI: 10.2144/fsoa-2020-0127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-specific reverse transcriptase-polymerase chain reaction (RT-PCR) represents the diagnostic gold standard. We explored the value of chest ultrasonography to predict positivity to SARS-CoV-2 on RT-PCR in suspected COVID-19 cases. Patients & methods Consecutive patients with suspect COVID-19 were included if they had fever and/or history of cough and/or dyspnea. Lung ultrasound score (LUSS) was computed according to published methods. Results A total of 76 patients were included. A 3-variable model based on aspartate transaminase (AST) > upper limit of normal, LUSS >12 and body temperature >37.5°C yielded an overall accuracy of 91%. Conclusion A simple LUSS-based model may represent a powerful tool for initial assessment in suspected cases of COVID-19.
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Affiliation(s)
- Enrico Allegorico
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Carlo Buonerba
- Department of Oncology & Hematology, Regional Reference Center for Rare Tumors, AOU Federico II of Naples, 80131 Naples, Italy.,Centro di Referenza Nazionale per l'Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, 80055, Portici (Na), Italy
| | - Giorgio Bosso
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Antonio Pagano
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Giovanni Porta
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Claudia Serra
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Pasquale Dolce
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Valentina Minerva
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | | | - Concetta Altruda
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Paola Arbo
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Teresa Russo
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Chiara De Sio
- Department of Medical & Surgical Sciences, Università della Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Nicoletta Franco
- Internal Medicine, AOU Federico II of Naples, 80131 Naples, Italy
| | - Gianluca Ruffa
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Cinzia Mormile
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | | | - Valentina Mercurio
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Gelsomina Gervasio
- Department of Diagnostic Imaging "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Giuseppe Di Costanzo
- Department of Diagnostic Imaging "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Alfonso Ragozzino
- Department of Diagnostic Imaging "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Luca Scafuri
- Department of Clinical Medicine & Surgery, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Gaetano Facchini
- Department of Hospital Medicine, Unit of Medical Oncology, ASL Napoli 2 Nord, "S.M. delle Grazie" Hospital, Pozzuoli (NA), Italy
| | - Fabio Numis
- Department of Emergency Medicine "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
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36
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Tonelotto B, Pereira SM, Tucci MR, Vaz DF, Vieira JE, Malbouisson LM, Gay F, Simões CM, Carvalho Carmona MJ, Monsel A, Amato MB, Rouby JJ, Costa Auler JO. Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study. Anaesth Crit Care Pain Med 2020; 39:825-831. [PMID: 33080407 DOI: 10.1016/j.accpm.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. METHODS Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4cmH2O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. RESULTS The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4cmH2O to 10 (8, 13) at PEEP 20cmH2O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p=0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. CONCLUSIONS Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention. TRIAL REGISTRATION NCT02314845 Registered on ClinicalTrials.gov.
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Affiliation(s)
- Bruno Tonelotto
- Divisão de Anestesiologia, Hospital Sírio-Libanês, Dona Adma Jafet Street, 91, São Paulo 1308050, Brazil.
| | - Sérgio Martins Pereira
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Mauro Roberto Tucci
- Divisão de Pneumologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Diogo Florenzano Vaz
- Divisão de Anestesiologia, Hospital Sírio-Libanês, Dona Adma Jafet Street, 91, São Paulo 1308050, Brazil
| | - Joaquim Edson Vieira
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Luiz Marcelo Malbouisson
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Frédérick Gay
- Department of Parasitology-Mycology, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - Claudia Marquez Simões
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Maria José Carvalho Carmona
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - Marcelo Brito Amato
- Divisão de Pneumologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - José Otavio Costa Auler
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
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Pan P, Su L, Liu D, Wang X. Microcirculation-guided protection strategy in hemodynamic therapy. Clin Hemorheol Microcirc 2020; 75:243-253. [PMID: 31903987 DOI: 10.3233/ch-190784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. Currently, more evidence shows that intrinsic septic shock is microcirculatory shock, which results in septic shock that is difficult to resuscitate. At present, treatments are aimed at recovering macro-circulation functions and include fluid resuscitation, vasoactive drugs, positive inotropic drugs, de-obstruction, and even mechanical assistance to improve oxygen delivery. However, the application of these treatments to more accurately improve microcirculation or avoid further microcirculatory damage is more important in clinics. In this article, we discuss the need for microcirculation protection and microcirculation-guided protection strategies in hemodynamic therapies.
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Affiliation(s)
- Pan Pan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.,Center of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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38
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Zou T, Yin W, Li Y, Deng L, Zhou R, Wang X, Chao Y, Zhang L, Kang Y. Hemodynamics in Shock Patients Assessed by Critical Care Ultrasound and Its Relationship to Outcome: A Prospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5175393. [PMID: 33015171 PMCID: PMC7512042 DOI: 10.1155/2020/5175393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Shock is one of the causes of mortality in the intensive care unit (ICU). Traditionally, hemodynamics related to shock have been monitored by broad-spectrum devices with treatment guided by many inaccurate variables to describe the pathophysiological changes. Critical care ultrasound (CCUS) has been widely advocated as a preferred tool to monitor shock patients. The purpose of this study was to analyze and broaden current knowledge of the characteristics of ultrasonic hemodynamic pattern and investigate their relationship to outcome. METHODS This prospective study of shock patients in CCUS was conducted in 181 adult patients between April 2016 and June 2017 in the Department of Intensive Care Unit of West China Hospital. CCUS was performed within the initial 6 hours after shock patients were enrolled. The demographic and clinical characteristics, ultrasonic pattern of hemodynamics, and outcome were recorded. A stepwise bivariate logistic regression model was established to identify the correlation between ultrasonic variables and the 28-day mortality. RESULTS A total of 181 patients with shock were included in our study (male/female: 113/68). The mean age was 58.2 ± 18.0 years; the mean Acute Physiology and Chronic Health Evaluation II (APACHE II score) was 23.7 ± 8.7, and the 28-day mortality was 44.8% (81/181). The details of ultrasonic pattern were well represented, and the multivariate analysis revealed that mitral annular plane systolic excursion (MAPSE), mitral annular peak systolic velocity (S'-MV), tricuspid annular plane systolic excursion (TAPSE), and lung ultrasound score (LUSS) were the independent risk factors for 28-day mortality in our study, as well as APACHE II score, PaO2/FiO2, and lactate (p = 0.047, 0.041, 0.022, 0.002, 0.027, 0.028, and 0.01, respectively). CONCLUSIONS CCUS exam on admission provided valuable information to describe the pathophysiological changes of shock patients and the mechanism of shock. Several critical variables obtained by CCUS were related to outcome, hence deserving more attention in clinical decision-making. Trial Registration. The study was approved by the Ethics Committee of West China Hospital Review Board for human research with the following reference number 201736 and was registered on ClinicalTrials. This trial is registered with NCT03082326 on 3 March 2017 (retrospectively registered).
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Affiliation(s)
- Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Li
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lijing Deng
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ran Zhou
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yangong Chao
- Department of Critical Care Medicine, The First Hospital of Tsinghua University, Beijing 100016, China
| | - Lina Zhang
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
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Mohamed MFH, Malewicz NM, Zehry HI, Hussain DAM, Barouh JL, Cançado AV, Silva JS, Suwileh S, Carvajal JR. Fluid Administration in Emergency Room Limited by Lung Ultrasound in Patients with Sepsis: Protocol for a Prospective Phase II Multicenter Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15997. [PMID: 32657759 PMCID: PMC7481877 DOI: 10.2196/15997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 12/28/2022] Open
Abstract
Background Sepsis remains a major health challenge with high mortality. Adequate volume administration is fundamental for a successful outcome. However, individual fluid needs differ between patients due to varying degrees of systemic vasodilation, circulatory flow maldistribution, and increased vascular permeability. The current fluid resuscitation practice has been questioned. Fluid overload is associated with higher mortality in sepsis. A sign of fluid overload is extravascular lung water, seen as B lines in lung ultrasound. B lines correlate inversely with oxygenation (measured by a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen ie, PaO2/FiO2). Thus, B lines seen by bedside ultrasound may have a role in guiding fluid therapy. Objective We aim to evaluate if fluid administration guided by lung ultrasound in patients with sepsis in emergency departments will lead to better oxygenation and patient outcomes than those in the standard therapy. Methods A phase II, multicenter, randomized, open-label, parallel-group, superiority trial will be performed. Patients will be recruited at emergency departments of the participating centers. A total of 340 patients will be randomly allocated to the intervention or standard-of-care group (30mL/kg). The intervention group will receive ultrasound-guided intravenous fluid until 3 B lines appear. The primary outcome will be oxygenation (measured as PaO2/FiO2 ratio) at 48 hours after starting intravenous fluid administration. Secondary outcomes will be patients’ outcome parameters, including oxygenation after 15 mL/kg fluid at 6, 12, 24, and 48 hours; sepsis progress through Sequential Organ Failure Assessment (SOFA) scores; pulmonary edema evaluation; and 30-day mortality. Results The trial will be conducted in accordance with the Declaration of Helsinki. Institutional review board approval will be sought after the participating sites are selected. The protocol will be registered once the institutional review board approval is granted. The trial duration is expected to be 1.5-2.5 years. The study is planned to be performed from 2021 to 2022, with enrollment starting in 2021. First results are expected in 2022. Informed written consent will be obtained before the patient’s enrollment in the study. An interim analysis and data monitoring will ensure the patient safety. The results will be published in a peer-reviewed journal and discussed at international conferences. Conclusions This is a protocol for a randomized control trial that aims to evaluate the role of bedside ultrasound in guiding fluid therapy in patients with sepsis via B lines evaluation. International Registered Report Identifier (IRRID) PRR1-10.2196/15997
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Affiliation(s)
- Mouhand F H Mohamed
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nathalie M Malewicz
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, United States.,Intensive Care Medicine and Pain Management, Department of Anaesthesiology, Medical Faculty of Ruhr-University, Bochum, Germany
| | - Hanan Ibrahim Zehry
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Faculty of Nursing, Suez Canal University, Ismailia, Egypt
| | | | - Judah Leão Barouh
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Adriana V Cançado
- Radiology Department, Santa Casa Belo Horizonte, Belo Horizonte, Brazil
| | - Jeancarllo Sousa Silva
- Division of Oncological Surgery, State University of Amazonas, Manaus, Brazil.,Division of Oncological Surgery, Getulio Vargas University Hospital, Amazonas, Brazil
| | - Salah Suwileh
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Jose Retamal Carvajal
- Faculty Of Emergency Medicine, Universidad Del Desarrollo-Clinica Alemana De Santiago, Santiago, Chile
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Corsini I, Parri N, Ficial B, Dani C. Lung ultrasound in the neonatal intensive care unit: Review of the literature and future perspectives. Pediatr Pulmonol 2020; 55:1550-1562. [PMID: 32339409 DOI: 10.1002/ppul.24792] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/30/2023]
Abstract
Lung ultrasound (LU) has been increasingly used as a point-of-care method in recent years. LU has numerous advantages compared to traditional imaging tools such as chest X-ray (radiography) (CXR): it is faster and portable, does not use ionizing radiation, is performed by the same physician who cares for the patient, and can be repeated to follow the progress of the disease and the response to treatment. There is a large body of evidence that LU has an excellent diagnostic effectiveness compared to CXR, not only in adults and children, but also in neonates. This review article describes how to perform LU, how to interpret findings, and how to use LU to diagnose and differentiate common neonatal pulmonary diseases. Strengths but also limits of the technique are highlighted. Finally, we describe the recent revolutionary role of LU. The development of scoring methods in neonates with respiratory distress syndrome allowed to quantify the severity of the disease and to assist the physician in the clinical management and follow-up.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Niccolò Parri
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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De Luca D. Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients' ages: The power of data over opinions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1235-1239. [PMID: 31840856 DOI: 10.1002/jum.15195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, Paris-Saclay University Hospitals, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Paris-Saclay University, Physiopathology and Therapeutic Innovation Unit 999, Paris, France
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Mongodi S, Colombo A, Orlando A, Cavagna L, Bouhemad B, Iotti GA, Mojoli F. Combined ultrasound-CT approach to monitor acute exacerbation of interstitial lung disease. Ultrasound J 2020; 12:27. [PMID: 32409952 PMCID: PMC7224726 DOI: 10.1186/s13089-020-00174-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung ultrasound is a bedside non-irradiating tool for assessment and monitoring of lung diseases. A lung ultrasound score based on visualized artefacts allows reliable quantification of lung aeration, and is useful to monitor mechanical ventilation setting, fluid resuscitation and antibiotic response in critical care. In the context of interstitial lung diseases associated to connective tissue disorders, lung ultrasound has been integrated to computed tomography for diagnosis and follow-up monitoring of chronic lung disease progression. CASE PRESENTATION This case describes a severe acute exacerbation of interstitial lung disease associated to dermatomyositis-polymyositis requiring prolonged extra-corporeal life support. Lung ultrasound score was performed daily and allowed monitoring and guiding both the need of advanced imaging as computed tomography and immunosuppressive therapy. CONCLUSIONS This case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk.
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Affiliation(s)
- Silvia Mongodi
- Anaesthesia and Intensive Care, San Matteo Hospital, Viale Golgi 19, Pavia, Italy.
| | - Andrea Colombo
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Anita Orlando
- Anaesthesia and Intensive Care, San Matteo Hospital, Viale Golgi 19, Pavia, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University of Pavia, San Matteo Hospital, Pavia, Italy
| | - Bélaid Bouhemad
- Dijon and Université Bourgogne Franche-Comté LNC UMR866, F-21000 Dijon, BP 77908, Dijon Cedex, 21709, France.,Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon Cedex, France
| | - Giorgio Antonio Iotti
- Anaesthesia and Intensive Care, San Matteo Hospital, Viale Golgi 19, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Francesco Mojoli
- Anaesthesia and Intensive Care, San Matteo Hospital, Viale Golgi 19, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
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Abstract
Abstract
Background
Lung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography, but the best training method remains uncertain. This study describes a training curriculum allowing trainees to acquire basic competence.
Methods
This multicenter, prospective, and educational study was conducted in 10 Intensive Care Units in Brazil, China, France and Uruguay. One hundred residents, respiratory therapists, and critical care physicians without expertise in transthoracic ultrasound (trainees) were trained by 18 experts. The main study objective was to determine the number of supervised exams required to get the basic competence, defined as the trainees’ ability to adequately classify lung regions with normal aeration, interstitial–alveolar syndrome, and lung consolidation. An initial 2-h video lecture provided the rationale for image formation and described the ultrasound patterns commonly observed in critically ill and emergency patients. Each trainee performed 25 bedside ultrasound examinations supervised by an expert. The progression in competence was assessed every five supervised examinations. In a new patient, 12 pulmonary regions were independently classified by the trainee and the expert.
Results
Progression in competence was derived from the analysis of 7,330 lung regions in 2,562 critically ill and emergency patients. After 25 supervised examinations, 80% of lung regions were adequately classified by trainees. The ultrasound examination mean duration was 8 to 10 min in experts and decreased from 19 to 12 min in trainees (after 5 vs. 25 supervised examinations). The median training duration was 52 (42, 82) days.
Conclusions
A training curriculum including 25 transthoracic ultrasound examinations supervised by an expert provides the basic skills for diagnosing normal lung aeration, interstitial–alveolar syndrome, and consolidation in emergency and critically ill patients.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Girona-Alarcón M, Cuaresma-González A, Rodríguez-Fanjul J, Bobillo-Perez S, Inarejos E, Sánchez-de-Toledo J, Jordan I, Balaguer M. LUCAS (lung ultrasonography in cardiac surgery) score to monitor pulmonary edema after congenital cardiac surgery in children. J Matern Fetal Neonatal Med 2020; 35:1213-1218. [PMID: 32216488 DOI: 10.1080/14767058.2020.1743660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aim: Cardiopulmonary bypass (CPB) generates a systemic capillary leak syndrome with pulmonary edema. Lung ultrasound (LUS) could be useful to monitor it. Primary objective was to compare sensitivity, specificity, positive and negative predictive values of chest X-ray and LUS to detect pulmonary edema using a new score (LUCAS). Secondary objectives were to evaluate correlation between LUCAS score and respiratory and inotropic support.Methods: Prospective intervention study including patients <2 months admitted to the Pediatric Intensive Care Unit after CPB. LUS was performed with a lineal probe, screening 3 points in each lung (parasternal, anterolateral and posterior area), pre and post-CPB. Pulmonary edema was evaluated clinically, through LUCAS score and with X-ray.Results: 17 patients were included. LUS achieved higher sensitivity than X-ray to detect pulmonary edema (91.7 versus 44.0%) and greater predictive negative value (88.2 versus 53.3%). There was correlation between higher LUCAS score prior to surgery and longer mechanical ventilation. High values of LUCAS score after surgery correlated with longer CPB time, inotropic support, and FiO2 need.Conclusion: LUS detected pulmonary edema better than chest X-ray, with greater sensitivity and negative predictive value. LUCAS score was useful to predict more inotropic support and longer mechanical ventilation.Key notesCardiopulmonary bypass during cardiac surgery, generates a systemic capillary leak syndrome with pulmonary edema.In this prospective study performed in the Pediatric Intensive Care Unit, lung ultrasound detected pulmonary edema better than X-ray, with greater sensitivity and negative predictive value.LUCAS score was useful to predict more inotropic support and longer mechanical ventilation.
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Affiliation(s)
- M Girona-Alarcón
- Paediatric Intensive Care Unit, Institut de Recerca Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - A Cuaresma-González
- Neonatology Department, BCNatal, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain
| | | | - S Bobillo-Perez
- Paediatric Intensive Care Unit, Institut de Recerca Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Disorders of Immunity and Respiration of the Paediatric Critical Patients Research Group. Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - E Inarejos
- Radiology Department, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain
| | - J Sánchez-de-Toledo
- Paediatric Cardiology Department, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain
| | - I Jordan
- Paediatric Intensive Care Unit, CIBERESP, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain
| | - M Balaguer
- Paediatric Intensive Care Unit, Institut de Recerca Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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Grune J, Beyhoff N, Hegemann N, Lauryn JH, Kuebler WM. From bedside to bench: lung ultrasound for the assessment of pulmonary edema in animal models. Cell Tissue Res 2020; 380:379-392. [PMID: 32009189 PMCID: PMC7210222 DOI: 10.1007/s00441-020-03172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
Traditionally, the lung has been excluded from the ultrasound organ repertoire and, hence, the application of lung ultrasound (LUS) was largely limited to a few enthusiastic clinicians. Yet, in the last decades, the recognition of the previously untapped diagnostic potential of LUS in intensive care medicine has fueled its widespread use as a rapid, non-invasive and radiation-free bedside approach with excellent diagnostic accuracy for many of the most common causes of acute respiratory failure, e.g., cardiogenic pulmonary edema, pneumonia, pleural effusion and pneumothorax. Its increased clinical use has also incited attention for the potential usefulness of LUS in preclinical studies with small animal models mimicking lung congestion and pulmonary edema formation. Application of LUS to small animal models of pulmonary edema may save time, is cost-effective, and may reduce the number of experimental animals due to the possibility of serial evaluations in the same animal as compared with traditional end-point measurements. This review provides an overview of the emerging field of LUS with a specific focus on its application in animal models and highlights future perspectives for LUS in preclinical research.
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Affiliation(s)
- Jana Grune
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany
| | - Niklas Beyhoff
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany.,Institute of Pharmacology, Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Hessische St 3-4, 10115, Berlin, Germany
| | - Niklas Hegemann
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353, Berlin, Germany
| | - Jonathan H Lauryn
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,German Centre for Cardiovascular Research (DZHK), partner site Berlin, 10117, Berlin, Germany. .,The Keenan Research Centre for Biomedical Science at St. Michael's, Toronto, Canada. .,Departments of Surgery and Physiology, University of Toronto, Toronto, Canada.
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Lung Ultrasound for the Diagnosis and Management of Acute Respiratory Failure. Lung 2020; 198:1-11. [PMID: 31894411 DOI: 10.1007/s00408-019-00309-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 12/14/2022]
Abstract
For critically ill patients with acute respiratory failure (ARF), lung ultrasound (LUS) has emerged as an indispensable tool to facilitate diagnosis and rapid therapeutic management. In ARF, there is now evidence to support the use of LUS to diagnose pneumothorax, acute respiratory distress syndrome, cardiogenic pulmonary edema, pneumonia, and acute pulmonary embolism. In addition, the utility of LUS has expanded in recent years to aid in the ongoing management of critically ill patients with ARF, providing guidance in volume status and fluid administration, titration of positive end-expiratory pressure, and ventilator liberation. The aims of this review are to examine the basic foundational concepts regarding the performance and interpretation of LUS, and to appraise the current literature supporting the use of this technique in the diagnosis and continued management of patients with ARF.
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Scully TG, Huang Y, Huang S, McLean AS, Orde SR. The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review. Anaesth Intensive Care 2020; 48:11-24. [DOI: 10.1177/0310057x19893703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.
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Affiliation(s)
| | - Yifan Huang
- Intensive Care Unit, Nepean Hospital, Kingswood, Australia
| | - Stephen Huang
- Intensive Care Unit, Nepean Hospital, Kingswood, Australia
- Discipline of Intensive Care Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Anthony S McLean
- Intensive Care Unit, Nepean Hospital, Kingswood, Australia
- Discipline of Intensive Care Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Sam R Orde
- Intensive Care Unit, Nepean Hospital, Kingswood, Australia
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Xia J, Qian CY, Yang L, Li MJ, Liu XX, Yang T, Lu Q. Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study. J Intensive Care 2019; 7:54. [PMID: 31827802 PMCID: PMC6886226 DOI: 10.1186/s40560-019-0409-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022] Open
Abstract
Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.
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Affiliation(s)
- Jing Xia
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Chuan-Yun Qian
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Li Yang
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Mei-Ju Li
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Xiao-Xue Liu
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Ting Yang
- 1Emergency Department, The First Affiliated Hospital of Kunming Medical University, 295 Xi Chang Road, Kunming, 650032 Yunnan China
| | - Qin Lu
- 2Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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Wu C, Xu J, Jin X, Chen Q, Li Z, Zhang M. Effect of mild hypothermia on lung injury after cardiac arrest in swine based on lung ultrasound. BMC Pulm Med 2019; 19:198. [PMID: 31690318 PMCID: PMC6833209 DOI: 10.1186/s12890-019-0958-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 10/14/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lung injury is common in post-cardiac arrest syndrome, and is associated with increased morbidity and mortality. The aim of this study was to evaluate the effect of mild hypothermia on lung injury after cardiac arrest in swine based on lung ultrasound. METHODS Twenty-three male domestic swine weighing 36 ± 2 kg were randomly assigned to three groups: therapeutic hypothermia (TH, n = 9), normothermia (NT, n = 9), and sham control (control, n = 5) groups. Sham animals only underwent surgical preparation. The animal model was established with 8 min of ventricular fibrillation followed by 5 min of cardiopulmonary resuscitation. Therapeutic hypothermia was induced and maintained until 24 h post-resuscitation in the TH group by surface blanket cooling, followed by rewarming at a rate of 1 °C/h for 5 h. The extravascular lung water index (ELWI), pulmonary vascular permeability index (PVPI), PO2/FiO2, and lung ultrasound score (LUS) were measured at baseline and at 1, 3, 6, 12, 24, and 30 h after resuscitation. After euthanizing the swine, their lung tissues were quickly obtained to evaluate inflammation. RESULTS After resuscitation, ELWI and PVPI in the NT group were higher, and PO2/FiO2 was lower, than in the sham group. However, those measures were significantly better in the TH group than the NT group. The LUS was higher in the NT group than in the sham group at 1, 3, 6, 12, 24, and 30 h after resuscitation. The LUS was significantly better in the TH group compared to the NT group. The lung tissue biopsy revealed that lung injury was more severe in the NT group than in the TH group. Increases in LUS were highly correlated with increases in ELWI (r = 0.613; p < 0.001) and PVPI (r = 0.683; p < 0.001), and decreases in PO2/FiO2 (r = - 0.468; p < 0.001). CONCLUSIONS Mild hypothermia protected against post-resuscitation lung injury in a swine model of cardiac arrest. Lung ultrasound was useful to dynamically evaluate the role of TH in lung protection.
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Affiliation(s)
- Chunshuang Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
| | - Jiefeng Xu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohong Jin
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
- Research fellow, from Department of Emergency Medicine, Wenling People’s Hospital, Taizhou, China
| | - Qijiang Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
- Research fellow, from Department of Emergency Medicine, Ninghai People’s Hospital, Ningbo, China
| | - Zilong Li
- Research fellow, from Department of Emergency Medicine, Yuyao People’s Hospital, Ningbo, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
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Colour Doppler ultrasound after major cardiac surgery improves diagnostic accuracy of the pulmonary infection score in acute respiratory failure. Eur J Anaesthesiol 2019; 36:676-682. [DOI: 10.1097/eja.0000000000001022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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