AB087. SOH21AS044. Use of point of care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome

Respiratory distress is a common presentation in an emergency and critical care setting. Acute respiratory distress syndrome (ARDS) is an acute onset condition where the lungs cannot provide the patient's vital organs with enough oxygen. ARDS can occur as a result of several underlying triggers. It is important that veterinary nurses know what to look out for in these patients, and how to appropriately nurse them to ensure they are not compromised further.

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Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-240891 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240891

Author(s):

Chris Lock ◽

Catherine M Nix

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Point Of Care ◽

Correct Diagnosis ◽

Chest Drain ◽

X Ray ◽

Broad Bandwidth ◽

Chest X Ray

A 64-year-old man was intubated and ventilated for COVID-19-associated acute respiratory distress syndrome. He had a background history of chronic obstructive pulmonary disease and ischaemic heart disease. His oxygen saturations dropped rapidly to 80% on day 9 of ICU admission. Chest auscultation revealed absent breath sounds over the left upper chest which raised suspicions for pneumothorax, of which a small stable left apical pneumothorax was documented on a recent CT scan of the thorax. Point-of-care ultrasonography was performed prior to attempting chest drain insertion which demonstrated sliding pleura on the left side (GE Healthcare model: Vscan Extend—display: 5 inches, 720×1280 pixels resolution, sector probe—broad bandwidth: 1.7–3.8 MHz, 24 cm penetration and linear probe—broad bandwidth: 3.3–8 MHz, 8 cm penetration). A portable chest X-ray was obtained which demonstrated left upper lobe collapse secondary to mucus plugging. The mucus plug was successfully suctioned from the patient’s airway using bedside bronchoscopy subsequently improving the patient’s oxygen saturation. A follow-up chest X-ray and CT scan of the thorax demonstrated interval resolution of the left upper lobe collapse. While expansion of his existing pneumothorax was first on the list of differential diagnoses, the use of ultrasonography early in the patient’s assessment ensured it was ruled out prior to attempting chest drain insertion, thus prompting the acquisition of the chest X-ray which subsequently demonstrated the left upper lobe collapse as the correct diagnosis.

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Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study

Thrombosis Journal ◽

10.1186/s12959-021-00293-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Johannes Herrmann ◽

Quirin Notz ◽

Tobias Schlesinger ◽

Jan Stumpner ◽

Markus Kredel ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Observational Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Platelet Function ◽

Distress Syndrome ◽

Point Of Care ◽

Retrospective Observational Study ◽

Bleeding Complications ◽

Thromboembolic Events

Abstract Background Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT. Methods This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020. Results Median age was 61 years (IQR: 51–69). Median PaO2/FiO2 on admission was 122 mmHg (IQR: 87–189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3–10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications. Conclusions Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..

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