Lung ultrasound guided pulmonary recruitment during mechanical ventilation in neonates: A case series

BACKGROUND: Recently, the first report of lung ultrasound (LUS) guided recruitment during open lung ventilation in neonates has been published. LUS guided recruitment can change the approach to open lung ventilation, which is currently performed without any measure of lung function/lung expansion in the neonatal population. METHODS: We included all the newborn infants that underwent a LUS-guided recruitment maneuver during mechanical ventilation as a rescue attempt for an extremely severe respiratory condition with oxygen saturation/fraction of inspired oxygen (SpO2/FIO2) ratio below 130 or the inability to wean off mechanical ventilation. RESULTS: We report a case series describing 4 LUS guided recruitment maneuvers, underlying crucial aspects of this technique that can improve the effectiveness of the procedure. In particular, we describe a novel pattern (the S-pattern) that allows us to distinguish the recruitable from the unrecruitable lung and guide the pressure titration phase. Additionally, we describe the optimal LUS-guided patient positioning. CONCLUSIONS: We believe that the inclusion of specifications regarding patient positioning and the S-pattern in the LUS-guided protocol may be beneficial for the success of the procedure.

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Correlation Analysis between Mechanical Power and Lung Ultrasound Score and Their Evaluation of Severity and Prognosis in ARDS Patients

BioMed Research International ◽

10.1155/2021/4156162 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Yongpeng Xie ◽

Suxia Liu ◽

Zhifang Mou ◽

Yanli Wang ◽

Xiaomin Li

Keyword(s):

Mechanical Ventilation ◽

Correlation Analysis ◽

Lung Ultrasound ◽

Lung Ventilation ◽

Mechanical Power ◽

Apache Ii Score ◽

Survival Group ◽

Time Points ◽

Death Group ◽

Time Point

Background and Objective. During mechanical ventilation, the energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). It describes the combined effects of several mechanical factors, including tidal volume, driving pressure, transpulmonary pressure, flow rate, positive end-expiratory pressure, and respiratory rate on lung ventilation. As such, MP may be useful for evaluating the severity and prognosis of acute respiratory distress syndrome (ARDS), as improvements in pulmonary ventilation directly affect a patient’s prognosis. Recent advances in lung ultrasound technology make it possible to evaluate lung ventilation at the bedside. In this study, MP was monitored in ARDS patients, and its correlation with lung ultrasound scores (LUS) was evaluated. Further analysis also explored the value of MP in evaluating the severity and prognosis of ARDS. Methods. A total of 121 patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from June 2017 to April 2020 and treated with invasive mechanical ventilation were sequentially included in this study. Their general information was collected, and MP was recorded at 0 h, 24 h, 48 h, and 72 h after admission to the ICU. Professionally trained researchers performed the LUS assessments. Patients were divided into the death and survival groups according to their 28-day prognosis. The trend of MP and LUS at the four time points was analyzed. A receiver operating characteristic curve (ROC) was used to analyze the predictive value of MP and LUS scores at 0 h and 72 h for the prognosis (28-day mortality rate) of patients with moderate to severe ARDS. Results. 121 patients were included in the analysis, of which 73 were male and 48 were female. When patients entered the ICU, their oxygenation index ( t : 30885, P < 0.01 ), APACHE II score ( t : 2.105, P < 0.05 ), and SOFA score ( t : 4.134, P < 0.001 ) were higher in the death group than the survival group. The death group had significantly higher MP and LUS at each time point (0 h, 24 h, 48 h, and 72 h) compared to the survival group (all P < 0.05 ). There was a significant upward trend over time in the MP and LUS of the death group, contrasting to a significant downward trend in the survival group (all P < 0.05 ). The Pearson correlation analysis showed that MP and LUS were significantly positively correlated at each time point ( r values: 0 h: 0.3027; 24 h: 0.3705; 48 h: 0.3902; 72 h: 0.5916; all P < 0.01 ). The ROC curves showed that MP and LUS at 72 h were of significant value in predicting the prognosis of ARDS patients, with areas under the curve of 0.866 ± 0.032 and 0.839 ± 0.037 , respectively. Conclusion. There was a significant correlation between the MP and LUS of ARDS patients at four time points from 0 to 72 h, which has a clinical value in evaluating severity and prognosis.

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Utility of Combined Echocardiography and Lung Ultrasound for Coronavirus Disease-19 Intensive Care Unit Patients: Case Series

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5382 ◽

2020 ◽

Vol 8 (T1) ◽

pp. 408-410

Author(s):

Marijan Bosevski ◽

Filip Janusevski ◽

Kosta Kapsarov

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Lung Ultrasound ◽

Case Series ◽

Accurate Method ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Ultrasound Evaluation

BACKGROUND: A little evidence existed for ultrasound evaluation of coronavirus disease (COVID)-19 patients. AIM: We aimed to present combined transthoracic echocardiography and lung ultrasound in 17 COVID-19 patients in the intensive care unit (ICU). METHODS: Patients were on age 57 + 14 years, 9 on mechanical ventilation and 8 on oxygen support, with average 1.2 comorbidities per patient. Ultrasound was performed by a single experienced sonographer and an assistant. RESULTS: Impaired left ventricular ejection fraction (EF) was found in 2 patients (pts) of them (11.8%) and diastolic dysfunction in 7 (41.2%), which was significantly higher in those ones with comorbidities. In 2 pts (11.8%), the presence of pulmonary hypertension with enlarged right ventricle was found. Later one pulmonary thromboembolism was confirmed in them with computed tomography angio. B-lines were found in 8 pts (47.1%), finding that was significantly higher in pts on mechanical ventilation, but not in relation with decreased EF. In one pt (0.6%), pleural effusion was found, but in none of them lung consolidation. CONCLUSIONS: Our findings revealed that combined echocardiography and lung ultrasound in COVID-19 ICU pts have been an accurate method for diagnosing right and left ventricular function and should be a useful one for guiding of their treatment and prognosis.

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Role of Lung Ultrasound in Weaning From Mechanical Ventilation in Postoperative Neurosurgical ICU Patients

Case Medical Research ◽

10.31525/ct1-nct03921112 ◽

2019 ◽

Author(s):

Keyword(s):

Mechanical Ventilation ◽

Lung Ultrasound ◽

Weaning From Mechanical Ventilation ◽

Icu Patients

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G206(P) Neonatal lung ultrasound in respiratory distress: a case series

10.1136/archdischild-2019-rcpch.201 ◽

2019 ◽

Author(s):

I Premadeva ◽

F Seregni ◽

F Bailey ◽

P Chandershakar

Keyword(s):

Respiratory Distress ◽

Lung Ultrasound ◽

Case Series ◽

Neonatal Lung

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375. COVID 19 infection in a Massachusetts community hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.570 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S257-S258

Author(s):

Raul Davaro ◽

alwyn rapose

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Essential Hypertension ◽

Severe Acute Respiratory Syndrome ◽

High Mortality ◽

Case Series ◽

World Health ◽

Minimal Risk ◽

The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

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Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

Scientific Reports ◽

10.1038/s41598-021-81377-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ser Hon Puah ◽

◽

Barnaby Edward Young ◽

Po Ying Chia ◽

Vui Kian Ho ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Features ◽

Operating Characteristic ◽

Characteristic Curve ◽

Case Series ◽

Plateau Pressure ◽

Apache Ii Score ◽

Multivariable Logistic Regression Model ◽

Reactive Protein ◽

Ventilatory Management

AbstractWe aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.

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Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series

Molecular Medicine ◽

10.1186/s10020-020-00215-w ◽

2020 ◽

Vol 26 (1) ◽

Cited By ~ 2

Author(s):

Andrew G. Weber ◽

Alice S. Chau ◽

Mikala Egeblad ◽

Betsy J. Barnes ◽

Tobias Janowitz

Keyword(s):

Case Series ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Dornase Alfa ◽

Extracellular Traps ◽

Dnase 1 ◽

Fraction Of Inspired Oxygen ◽

Oxygen Requirements ◽

Inspired Oxygen ◽

Ventilated Patients

Abstract Background Mechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed. Results The fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drug-associated toxicities were identified. Conclusions Results suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered.

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Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

Journal of Clinical Medicine ◽

10.3390/jcm10061288 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1288

Author(s):

Riccardo Senter ◽

Federico Capone ◽

Stefano Pasqualin ◽

Lorenzo Cerruti ◽

Leonardo Molinari ◽

...

Keyword(s):

Lung Ultrasound ◽

Clinical Laboratory ◽

Imaging Modality ◽

Case Series ◽

Severity Index ◽

Disease Stage ◽

Retrospective Case ◽

North East ◽

High Flow Oxygen ◽

B Lines

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

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