Point of care and intensive care lung ultrasound: A reference guide for practitioners during COVID-19

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

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Consensus of the Study Group for Point-of-Care Lung Ultrasound in the intensive care management of COVID-19 patients

Anestezjologia Intensywna Terapia ◽

10.5114/ait.2020.96560 ◽

2020 ◽

Vol 52 (2) ◽

pp. 83-90 ◽

Cited By ~ 1

Author(s):

Natalia Buda ◽

Paweł Andruszkiewicz ◽

Mirosław Czuczwar ◽

Wojciech Gola ◽

Wojciech Kosiak ◽

...

Keyword(s):

Intensive Care ◽

Care Management ◽

Lung Ultrasound ◽

Point Of Care ◽

Study Group ◽

Intensive Care Management

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COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

Diagnostics ◽

10.3390/diagnostics10070447 ◽

2020 ◽

Vol 10 (7) ◽

pp. 447 ◽

Cited By ~ 5

Author(s):

Hasse Møller-Sørensen ◽

Jakob Gjedsted ◽

Vibeke Lind Jørgensen ◽

Kristoffer Lindskov Hansen

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Imaging Modality ◽

Point Of Care ◽

X Ray ◽

Intensive Care Patients ◽

Reactive Protein ◽

Extracorporal Membrane Oxygenation ◽

Accessible Point ◽

Chest X Ray

The COVID-19 pandemic has increased the need for an accessible, point-of-care and accurate imaging modality for pulmonary assessment. COVID-19 pneumonia is mainly monitored with chest X-ray, however, lung ultrasound (LUS) is an emerging tool for pulmonary evaluation. In this study, patients with verified COVID-19 disease hospitalized at the intensive care unit and treated with ventilator and extracorporal membrane oxygenation (ECMO) were evaluated with LUS for pulmonary changes. LUS findings were compared to C-reactive protein (CRP) and ventilator settings. Ten patients were included and scanned the day after initiation of ECMO and thereafter every second day until, if possible, weaned from ECMO. In total 38 scans adding up to 228 cineloops were recorded and analyzed off-line with the use of a constructed LUS score. The study indicated that patients with a trend of lower LUS scores over time were capable of being weaned from ECMO. LUS score was associated to CRP (R = 0.34; p < 0.03) and compliance (R = 0.60; p < 0.0001), with the strongest correlation to compliance. LUS may be used as a primary imaging modality for pulmonary assessment reducing the use of chest X-ray in COVID-19 patients treated with ventilator and ECMO.

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The role of lung ultrasound in preterm neonates with respiratory distress in neonatal intensive care unit

Indian Journal of Child Health ◽

10.32677/ijch.v8i8.2981 ◽

2021 ◽

Vol 8 (8) ◽

pp. 284-288

Author(s):

Sidhant Swarup ◽

Rakesh Panigrahi ◽

Suryakanta Swain ◽

Hemant Agrawal

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Respiratory Distress ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Lung Ultrasound ◽

Point Of Care ◽

Preterm Neonates ◽

Point Of Care Ultrasound

Introduction: Up to 29% of late preterm babies suffer from respiratory distress due to which they need to be admitted to neonatal intensive care unit (NICU). Point-of-care ultrasound is a useful tool in critical neonate care, providing valuable information without any risk of ionizing radiation to the newborn. Materials and Method: This mono-centric, descriptive, and prospective study was conducted in NICU. Preterm newborns of less than 36 weeks with respiratory distress at birth on non-invasive ventilation were recruited. A lung ultrasound was performed at first 12 h of life and followed till their discharge. Main outcomes need for surfactant treatment. Results: Sixty preterm infants (median gestational age: 29 weeks) were recruited. Newborn in the surfactant group requiring ultrasound and intervention was significantly higher than in no surfactant group (p<0.0001). In 15 newborns who received surfactant, the first dose was administered at a median age of 4.5 h. In 13 of these 15 newborns, the lung ultrasound scan was subsequently repeated an average of 2 h (Standard deviation or SD: 2) On average, the second dose of surfactant was administered at 24 h of life (SD: 9). Conclusion: Early lung ultrasound in preterm infants with respiratory distress appears to be a useful tool with no adverse effects for the patient. It allows a better assessment of respiratory distress by detecting patients with a greater risk of requiring surfactant or mechanical ventilation, even before oxygenation criteria.

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Utility of lung ultrasound scanning in neonatology

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314538 ◽

2018 ◽

Vol 104 (9) ◽

pp. 909-915 ◽

Cited By ~ 6

Author(s):

Patricia Lee Woods

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Point Of Care ◽

Current Evidence ◽

Clinical Question ◽

Important Research ◽

Ultrasound Scanning ◽

Observational Tool ◽

Research Questions

The utility of point-of-care lung ultrasound in neonatology is rapidly expanding. This review summarises current evidence of a diagnostic, procedural and observational tool valuable in the management of newborns requiring intensive care. Approaching a patient, probe in-hand with focused clinical question is essential, and barriers to implication together with important research questions are explored.

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Point-of-care lung ultrasound in intensive care during the COVID-19 pandemic

Clinical Radiology ◽

10.1016/j.crad.2020.05.001 ◽

2020 ◽

Vol 75 (9) ◽

pp. 710.e1-710.e4 ◽

Cited By ~ 9

Author(s):

S. Kulkarni ◽

B. Down ◽

S. Jha

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Point Of Care

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Role of Lung Ultrasound in the Diagnosis of Neonatal Respiratory Disorders

QJM ◽

10.1093/qjmed/hcab113.055 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nehal M El Raggal ◽

laila A Hegazy ◽

Hossam M Sakr ◽

Yasmin A Farid ◽

Osama A Eldafrawy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Cross Sectional ◽

X Ray ◽

Chest X Ray

Abstract lung ultrasound (LUS) was used traditionally in the assessment of pleural effusions and masses but LUS has moved towards the imaging of the pulmonary parenchyma, mainly as a point-of-care technique. Objective To assess the agreement between LUS and CXR for the diagnosis of RD in neonates. Methods This prospective cross sectional study was conducted on 100 neonates presents with RD in the first 24 hours of life in the neonatal intensive care unit (NICU) of the Ain Shams University. All enrolled neonates underwent LUS and CXR initially and on day 7. Neonatologists were blind to the LUS diagnosis and the clinical decisions were driven by CXR findings. Lung score was applied to describe lung aeration, interstitial, alveolar, or consolidation patterns for each lung area. Results 125 different diagnoses were reported in 100 patients. The total agreement between LUS and CXR diagnosis was 96% (95% CI 88–98%) with a κ statistic of 0.94 (95% CI 0.86– 1.00). The agreement for RDS, Pneumonia, TTN, MAS, CDH, PE, Pnumothorax and atelectasis were 99%, 96%,98%, 99%,100%,100%,98% and 98% consequently. Conclusion LUS is a safe, low coast, easy to operate and has high agreement with CXR for the diagnosis of RD in neonates in the first week of life. Key words Neonatal intensive care, Point-of-care ultrasound, Chest X-ray Abbreviations: NICU: Neonatal Intensive Care Unit, LUS: Lung ultrasound, CXR: Chest X ray, RDS: respiratory distress syndrome, TTN: Transient Tachypnea of Newborn, MAS: Meconium Aspiration, PE: pleural effusion, CDH: cong. diaphragmatic hernia.

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S68 National COVID point of care lung ultrasound evaluation (society for acute medicine with the intensive care society)

10.1136/thorax-2021-btsabstracts.74 ◽

2021 ◽

Author(s):

T Knight ◽

P Parulekar ◽

G Rudge ◽

F Lesser ◽

M Dachsel ◽

...

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Point Of Care ◽

Intensive Care Society ◽

Care Society ◽

Acute Medicine ◽

Ultrasound Evaluation

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Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care?

Children ◽

10.3390/children8121098 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1098

Author(s):

J. Lauren Ruoss ◽

Catalina Bazacliu ◽

Nicole Cacho ◽

Daniele De Luca

Keyword(s):

Intensive Care ◽

Neonatal Intensive Care ◽

Lung Ultrasound ◽

Point Of Care ◽

Clinical Care ◽

Neonatal Intensive Care Units ◽

Point Of Care Ultrasound ◽

Predictive Tool ◽

Neonatal Lung ◽

Respiratory Conditions

A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.

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Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

The Ultrasound Journal ◽

10.1186/s13089-021-00231-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Andrew W. Kirkpatrick ◽

Jessica L. McKee ◽

John M. Conly

Keyword(s):

At Risk ◽

Lung Ultrasound ◽

Point Of Care ◽

Human Life ◽

Vital Signs ◽

Home Monitoring ◽

Cost Effective ◽

Care Providers ◽

Vital Signs Monitoring ◽

Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

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