Impact of lung ultrasound on clinical decision making in critically ill patients

During COVID-19 pandemic Lung ultrasound has rapidly become a tool for diagnosis and monitoring of lung involvement and it’s severity. Accurate evaluation of lung pathologic entities at the bedside, especially in critically ill patients, and those on mechanical ventilation, remains problematic. CT should not be frequently repeated and is not available everywhere, especially for critically ill patients. Limitations of bedside chest X-ray have been well described and lead to poor-quality X-ray films with low sensitivity.The lung ultrasound has been shown to be a useful tool in intensive care patients with adult respiratory distress syndrome (ARDS) and can be used forassessing severity of lung involvement in COVID-19. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. There have been shown that lung ultrasound can predict the deterioration of the patient's conditionand can be used for risk stratification and clinical decision making, reducethe use of both chest x‐rays and computer tomography, what is very important especially in limited resources settings.

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Assessing Diastolic Function as an Important Tool for Clinical Decision-making in Critically Ill Patients

Journal of Cardiovascular Imaging ◽

10.4250/jcvi.2020.0042 ◽

2020 ◽

Vol 28 (3) ◽

pp. 165

Author(s):

Jong-Won Ha

Keyword(s):

Decision Making ◽

Diastolic Function ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Decision Making ◽

Clinical Decision

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Can Alveolar-Arterial Difference and Lung Ultrasound Help the Clinical Decision Making in Patients with COVID-19?

Diagnostics ◽

10.3390/diagnostics11050761 ◽

2021 ◽

Vol 11 (5) ◽

pp. 761

Author(s):

Gianmarco Secco ◽

Francesco Salinaro ◽

Carlo Bellazzi ◽

Marco La Salvia ◽

Marzia Delorenzo ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Signs And Symptoms ◽

Clinical Decision ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Lung Dysfunction ◽

Close Relationship

Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure − H2O pressure) − (PaCO2/R)) − PaO2. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). Conclusions: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

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Thromboelastography in clinical decision-making in the critically ill patient in a district general hospital ICU

Critical Care ◽

10.1186/cc6433 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P212

Author(s):

J Louw ◽

T Veenith ◽

P Moondi

Keyword(s):

Decision Making ◽

General Hospital ◽

Critically Ill ◽

Clinical Decision Making ◽

District General Hospital ◽

Clinical Decision ◽

Critically Ill Patient

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Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study

Palliative Medicine ◽

10.1177/0269216314566060 ◽

2015 ◽

Vol 29 (4) ◽

pp. 324-335 ◽

Cited By ~ 34

Author(s):

Daren K Heyland ◽

Peter Dodek ◽

Sangeeta Mehta ◽

Deborah Cook ◽

Allan Garland ◽

...

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Cohort Study ◽

Intensive Care ◽

Elderly Patients ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Decision Making ◽

Family Members ◽

Very Elderly

Background: Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit. Aim: To describe family members’ perspectives about care provided to very elderly critically ill patients. Design: Multicenter, prospective, cohort study. Participants and setting: In total, 535 family members of patients aged 80 years or older admitted to 22 intensive care units for more than 24 h. Results: Family members reported that the “patient be comfortable and suffer as little as possible” was their most important value and “the belief that life should be preserved at all costs” was their least important value considered in making treatment decisions. Most family members (57.9%) preferred that life support be used for their family member, whereas 24.1% preferred comfort measures only, and 14.4% were unsure of their treatment preferences. Only 57.3% reported that a doctor had talked to them about treatment options for the patient. Overall, 29.7% of patients received life-sustaining treatments for more than 7 days and 50.3% of these died in hospital. Families were most satisfied with the skill and competency of nurses and least satisfied with being included and supported in the decision-making process and with their sense of control over the patient’s care. Conclusion: There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.

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Vascular anatomical considerations and clinical decision making during insertion of the Avalon® Elite Dual Lumen single-site veno-venous ECMO cannula in children weighing less than 20 kg

Perfusion ◽

10.1177/0267659118815104 ◽

2018 ◽

Vol 34 (4) ◽

pp. 267-271 ◽

Cited By ~ 3

Author(s):

William Cory Ellis ◽

Michal Schafer ◽

Cindy S. Barrett ◽

Katie Butler ◽

Andrew Sprowell ◽

...

Keyword(s):

Decision Making ◽

Extracorporeal Membrane Oxygenation ◽

Critically Ill ◽

Mechanical Characteristics ◽

Clinical Decision Making ◽

Clinical Decision ◽

Single Site ◽

Correct Selection ◽

Critically Ill Children ◽

Clinical Strategy

The correct selection and placement of a single-site Avalon® Elite Dual Lumen Cannula for veno-venous extracorporeal membrane oxygenation (ECMO) in children weighing less than 20 kg is dependent on both the mechanical characteristics of the catheter, including length and diameter, as well as the unique vascular anatomic considerations of the patient. This manuscript describes the development of a clinical strategy, over a four-year period from 2012-2016, for cannula selection to reduce the risk of migration and malposition in 20 critically ill children weighing less than 20 kg who presented for veno-venous ECMO.

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