Bedside Lung Ultrasound for Postoperative Lung Conditions in Cardiothoracic Intensive Care Unit: Diagnostic Value and Comparison with Bedside Chest Roentgenogram

Use of Handheld Ultrasound Device with Artificial Intelligence for Evaluation of Cardiorespiratory System in COVID-19

BACKGROUND

Coronavirus disease-2019 (COVID-19) causes various cardiopulmonary manifestations. Bedside ultrasound helps in the rapid diagnosis of these manifestations. Vscan Extend™ (GE, Wauwatosa, WI, USA) is a handheld ultrasound device with a dual probe and an artificial intelligence application to detect ejection fraction. It can help in reducing the time for diagnosis, duration, and the number of healthcare workers exposed to COVID-19. This is a prospective observational study comparing the cardiorespiratory parameters and time duration for assessment between Vscan Extend™ and the conventional ultrasound machine.

MATERIALS AND METHODS

Paired observations were made in 96 COVID-19 patients admitted to the intensive care unit by two intensivists. Intensivist A used the Vscan Extend™ device to assess the cardiac function, lung fields, diaphragm, deep veins, and abdomen. Intensivist B used clinical examination, X-ray chest, ECG, and conventional echocardiogram for assessment. The agreement between the findings and the time duration required in both the methods was compared.

RESULTS

The use of handheld ultrasound has significantly decreased the duration of bedside examination of patients than the conventional method. The median duration of examination using handheld ultrasound was 9 (8.0-11.0) minutes, compared to 20 (17-22) minutes with the conventional method (P < 0.001). The Cohen's kappa coefficient was 1.0 for left ventricular systolic function, most of the lung fields, and diaphragmatic movement.

CONCLUSION

Vscan Extend™ helps in the rapid identification and diagnosis of cardiopulmonary manifestations in COVID-19 patients. The agreement between the handheld device and the conventional method proves its efficacy and safety.

CTRI NUMBER

CTRI/2020/07/026701.

HOW TO CITE THIS ARTICLE

Maheshwarappa HM, Mishra S, Kulkarni AV, Gunaseelan V, Kanchi M. Use of Handheld Ultrasound Device with Artificial Intelligence for Evaluation of Cardiorespiratory System in COVID-19. J Crit Care Med 2021;25(5):524-527.

[Imaging in intensive care units]

Imaging is essential in the diagnosis and treatment of critically ill patients. Although bedside ultrasound and chest x‑rays are the major tools in the initial assessment, there are a variety of imaging options available to physicians in the intensive care unit such as computed tomography, magnetic resonance imaging, or nuclear medicine. Bedside diagnostic tools or radiology intervention procedures also play an important role in the management of critically ill patients. The choice of imaging modality is sometimes difficult and should be based on current recommendations or guidelines, available equipment, and the experience of the examiner. With the increasing importance of costs, the diagnostic and therapeutic benefits of the imaging process must be maximized in line with minimizing costs. The various indications, strengths, and weaknesses of the imaging modalities are summarized and the diagnostic findings using clinical examples are discussed. The focus of this article is on imaging of the thorax and the diagnostic imaging methods used in the intensive care unit.

Role of Lung Ultrasound in the Detection of Postoperative Pulmonary Complications in Pediatric Patients: A Prospective Observational Study

OBJECTIVE

To evaluate the incremental benefit of lung ultrasound (LUS) over clinical examination and chest x-rays (CXR) together (clinico-radiologic examination) for the diagnosis of postoperative pulmonary complications (PPC).

DESIGN

Prospective observational study.

SETTING

Tertiary care center.

PARTICIPANTS

One hundred children after corrective congenital cardiac surgery with left-to-right shunts.

INTERVENTION

Participants were independently evaluated with clinico-radiologic examination by the treating team, as well as LUS by an investigator at 12, 24, 48, and 72 hours after surgery. After recording the diagnoses, the LUS findings were disclosed to the treating team and a final diagnosis was made. CXR scores and LUS scores were evaluated for their ability to predict PPC.

MEASUREMENTS AND MAIN RESULTS

A total of 34 cases of PPCs were observed. Of these, 32 each were detected by clinico-radiologic examination and LUS alone. Addition of LUS improved total number of PPCs detected in the early postoperative period but not in the late postoperative period. Preoperative and early postoperative LUS scores were superior to CXR scores in predicting occurrence of PPC (area under receiver operating characteristics curve [AUROC] 0.920 v 0.732; p < 0.001 preoperatively; AUROC 0.987 v 0.858, p = 0.001 at 12 hours postoperatively). Multivariate analysis suggested LUS score as an independent predictor of PPC, and LUS score along with aortic cross-clamp time as independent predictors of duration of mechanical ventilation and intensive care unit stay.

CONCLUSIONS

LUS improves identification of PPC over clinico-radiologic examination in the early postoperative period. Preoperative LUS scores have better predictive ability than CXR scores for the occurrence of PPC.

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

Background

Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT).

Methods

Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO₂) less than 92% for more than 30 s under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 h before returning to the ward.

Results

From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%).

Conclusions

Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

Trial registration

Current Controlled Trials NCT03802175, 2018/12/05, www.ClinicalTrials.gov