Feasibility of machine integrated point of care lung ultrasound automatic B-lines tool in the Corona-virus 2019 critical care unit

Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a pointof-care investigation.

Download Full-text

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽

10.24908/pocus.v3i1.13310 ◽

2018 ◽

Vol 3 (1) ◽

pp. 13-14

Author(s):

Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽

Maryam Al Ali, MBBS

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Critical Care Unit ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

Download Full-text

Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066620988831 ◽

2021 ◽

Vol 36 (3) ◽

pp. 334-342 ◽

Cited By ~ 1

Author(s):

Kosuke Yasukawa ◽

Taro Minami ◽

David R. Boulware ◽

Ayako Shimada ◽

Ernest A. Fischer

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Prognostic Value ◽

Lung Ultrasound ◽

Point Of Care ◽

Respiratory Support ◽

Point Of Care Ultrasound ◽

Bilateral Involvement ◽

Ultrasound Score ◽

B Lines

Background: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward. Method: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death. Results: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001). Conclusions: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

Download Full-text

Are Lung Ultrasound Findings in COVID-19 Pneumonia Typical or Specific?

Praxis ◽

10.1024/1661-8157/a003696 ◽

2021 ◽

Vol 110 (8) ◽

pp. 421-425

Author(s):

Giovanni Volpicelli ◽

Luciano Cardinale ◽

Thomas Fraccalini

Keyword(s):

Health Systems ◽

Lung Ultrasound ◽

Clinical Phenotype ◽

Virus Disease ◽

Point Of Care ◽

High Sensitivity ◽

Diagnosis And Management ◽

Corona Virus ◽

Ultrasound Findings ◽

First Diagnosis

Abstract. The application of point-of-care lung ultrasound (LUS) in the first diagnosis and management of Corona Virus Disease 2019 (COVID-19) has gained a great interest during a pandemic that is undermining even the most advanced health systems. LUS demonstrated high sensitivity in the visualization of the interstitial signs of the typical pneumonia complicating the infection. However, although this disease gives typical lung alterations, the same LUS signs observed in COVID-19 pneumonia can be detected in other common pulmonary conditions. While being non-specific when considered separately, the analysis of the distribution of the sonographic typical signs allows the assignment of 4 LUS patterns of probability for COVID-19 pneumonia when the whole chest is examined and attention is paid to the presence of other atypical signs. Moreover, the combination of LUS likelihood with the clinical phenotype at presentation increases the accuracy. This mini-review will analyze the LUS signs of COVID-19 pneumonia and how they can be combined in patterns of probability in the first approach to suspected cases.

Download Full-text

Case Report: POCUS to FOCUS

POCUS Journal ◽

10.24908/pocus.v3i1.13311 ◽

2018 ◽

Vol 3 (1) ◽

pp. 15-17

Author(s):

Maryam Al Ali, MBBS ◽

Abeeha Gardezi, MBBsch ◽

Michael Jalal, MBBS ◽

Shihab Al Sheikh, MB.ChB. CABS. MRCS.

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Critical Care Unit ◽

Single Case ◽

Point Of Care ◽

Point Of Care Ultrasound

Point of care ultrasound (POCUS) plays an important role in the Emergency Department or in any Critical Care Unit. In our case, we present how a POCUS mnemonic guided us in diagnosing two fatal conditions in a single case.

Download Full-text

Implementation of a Handheld Electronic Point-of-Care Billing System Improved Efficiency in the Critical Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066607307531 ◽

2007 ◽

Vol 22 (6) ◽

pp. 374-380 ◽

Cited By ~ 4

Author(s):

Brenda G. Fahy ◽

Jonathan T. Ketzler

Keyword(s):

Critical Care ◽

Critical Care Unit ◽

Point Of Care ◽

Billing System

Download Full-text

Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era

Journal of Medical Ultrasonics ◽

10.1007/s10396-020-01074-y ◽

2021 ◽

Vol 48 (1) ◽

pp. 31-43

Author(s):

Toru Kameda ◽

Yoshihiro Mizuma ◽

Hayato Taniguchi ◽

Masato Fujita ◽

Nobuyuki Taniguchi

Keyword(s):

Prospective Studies ◽

Lung Ultrasound ◽

Imaging Modality ◽

Point Of Care ◽

Case Reports ◽

Adult Patients ◽

Clinical Markers ◽

Consistent Finding ◽

Short Period ◽

B Lines

AbstractIn the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.

Download Full-text

Comparison of Lung Ultrasound versus Chest X-ray for Detection of Pulmonary Infiltrates in COVID-19

Diagnostics ◽

10.3390/diagnostics11020373 ◽

2021 ◽

Vol 11 (2) ◽

pp. 373

Author(s):

María Mateos González ◽

Gonzalo García de Casasola Sánchez ◽

Francisco Javier Teigell Muñoz ◽

Kevin Proud ◽

Davide Lourdo ◽

...

Keyword(s):

Prospective Observational Study ◽

Lung Ultrasound ◽

Point Of Care ◽

Kappa Statistic ◽

Attractive Alternative ◽

X Ray ◽

Pulmonary Infiltrates ◽

Chest X Ray ◽

Polymerase Chain ◽

B Lines

Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.

Download Full-text

Fluid Volume Status Assessment by Lung Ultrasonography in Patients with Kidney Disease.

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd40354 ◽

2021 ◽

Vol 4 (03) ◽

Author(s):

Navid Saigal

Keyword(s):

Critical Care ◽

Kidney Disease ◽

Physical Examination ◽

Lung Ultrasound ◽

Point Of Care ◽

Fluid Management ◽

Point Of Care Ultrasound ◽

Lung Ultrasonography ◽

Lung Water ◽

Status Assessment

Point-of-care ultrasound (POCUS) has become firmly established in acute and critical care settings and has now emerged as an important tool in the assessment of the Extra Vascular Lung Water (EVLW). Lung ultrasound (LUS) can be performed quickly and easily in critically ill patients. It has a higher diagnostic accuracy than physical examination and chest radiography combined. It enhances safety by avoiding ionizing radiation and the need for potentially dangerous transfers within the hospital. LUS can also be used to guide fluid management.

Download Full-text

Challenges and opportunities in point-of-care ultrasound: A qualitative exploration of respiratory physiotherapists’ experiences of lung ultrasound training and its adoption in critical care

Ultrasound ◽

10.1177/1742271x211034199 ◽

2021 ◽

pp. 1742271X2110341

Author(s):

Simon Hayward ◽

Sue Innes ◽

Mike Smith

Keyword(s):

Critical Care ◽

Clinical Practice ◽

Lung Ultrasound ◽

Imaging Modality ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Online Appendix ◽

Adoption And Implementation ◽

Patient Pathways ◽

Challenges And Opportunities

Introduction Diagnostic lung ultrasound (LUS) is gaining popularity among respiratory physiotherapists as an imaging modality to aid pulmonary assessments, guide intervention selection, and monitor the efficacy of chosen interventions. The ability of respiratory physiotherapists to incorporate LUS into their clinical practice is influenced by multiple factors to adoption and implementation. The aim of this study was to explore the experiences of senior respiratory physiotherapists who have attempted to adopt and implement LUS into their clinical practice in critical care. It is hoped these experiences will inform the development of educational and adoption strategies for the future implementation of LUS. Methods Following a national call out, eight senior critical care respiratory physiotherapists were purposively selected to be interviewed using semi-structured questions exploring their varied experiences of LUS adoption into clinical practice in critical care. The transcribed data were thematically analysed. Results Five main themes emerged from the participants’ responses: (i) support for physiotherapists using LUS, (ii) knowledge and understanding of LUS evidence, (iii) governance, (iv) physiotherapists’ motivation to use LUS, and (v) resources. Quotes for each of the five themes are given as exemplars. Conclusion Participants reported a range of factors that influenced their ability to adopt and implement LUS into practice several were enabling, and others were barriers to progress. Online Appendix 1 contains recommendations from the authors to help guide managers and clinicians wishing to adopt LUS into respiratory physiotherapy services and patient pathways.

Download Full-text