scholarly journals Coinciding Changes in B Lines Patterns, Haemoglobin and Hematocrit Values Can Predict Outcomes of Weaning from Mechanical Ventilation

2019 ◽  
Vol 7 (23) ◽  
pp. 4010-4014 ◽  
Author(s):  
Samir El Hadidy ◽  
Mohamed Saad ◽  
Rania El Hossany ◽  
Tarek El Gohary ◽  
Mohamed El Ghobashy
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hemodynamic Monitoring ◽  
Lung Ultrasound ◽  
Spontaneous Breathing Trial ◽  
Invasive Mechanical Ventilation ◽  
P Value ◽  
Weaning From Mechanical Ventilation ◽  
Before And After ◽  
B Lines

BACKGROUND: Weaning from invasive mechanical ventilation (MV) is considered as a daily challenging practice in the management of critically ill patients. The use of lung ultrasound and change in haemoglobin and hematocrit during weaning may help to predict weaning outcomes. AIM: We aimed in our study to make a focused view over the changes occurred in lungs during weaning from MV which were detected by lung ultrasound through increase in B lines with the occurrence of weaning induced pulmonary oedema (WIPE), coinciding with this changes the occurrence of hemoconcentration was detected through increase in Hb and HCT values after SBT. PATIENTS AND METHODS: Sixty patients who fulfilled readiness criteria for weaning from MV. Spontaneous breathing trial (SBT) on T-piece for 120 minutes was performed under close hemodynamic monitoring. Lung ultrasound was performed using eight lung zones protocol to detect both the presence and the trend of change in B lines before and after SBT. For all the studied patients, haemoglobin and hematocrit values were checked just before and at the end of SBT. RESULTS: Patient who failed to pass SBT showed significant increase in lung segments showing B pattern, haemoglobin and hematocrit levels (p-value < 0.001 for all) also those patients had significantly higher duration of ICU stay (p-value < 0.001) Despite mortality rate was higher among patients who failed SBT yet it was statistically insignificant (p-value 0.104). CONCLUSION: lung ultrasound and both haemoglobin and hematocrit levels correlate with weaning outcomes.

scholarly journals THE IDEAL PROFILE (INCREASE IN B-LINES/DELTA B-LINES) ON LUNG ULTRASOUND FOR DIAGNOSING WEANING INDUCED PULMONARY EDEMA IN VENTILATED PATIENTS

2022 ◽  
Vol 71 (6) ◽  
pp. 2220-23
Author(s):  
Ghulam Rasheed ◽  
Zahid Siddique Shad ◽  
Tooba Mehreen ◽  
Nusrat Kharadi ◽  
Moazma Ramzan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Edema ◽  
Spontaneous Breathing ◽  
Lung Ultrasound ◽  
Weaning Failure ◽  
Before And After ◽  
Spontaneous Breathing Trials ◽  
B Lines ◽  
Ventilated Patients ◽  
The Ideal

Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020. Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound. Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines ≥6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines ≥6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%. Conclusion: The study indicates that Delta-B-lines ≥6 diagnosed the weaning induced pulmonary edema with the best accuracy.

scholarly journals Lung ultrasound score before and after extubation for predicting weaning outcome

2019 ◽  
Vol 9 (4) ◽  
pp. 15-17
Author(s):  
Manoj Kumar Yadav ◽  
Anusmriti Pal ◽  
Chiranjibi Pant ◽  
Bishow Kumar Shrestha
Keyword(s):  
Lung Ultrasound ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
Mean Difference ◽  
P Value ◽  
Lung Pathology ◽  
Mechanically Ventilated ◽  
Before And After ◽  
High Degree ◽  
Weaning Outcome

Background: Lung ultrasound (LUS) is an emerging, essential, safe and easily repeatable bed­side tool being used for the management of critically ill patients in ICUs. Weaning off the ventilator and decide to extubate require right decision and appropriate timing to avoid ex­tubation failure. The study aimed to perform LUS in planned extubation patients who passed SBT, for the assessment of lungs, before and after extubation. Methods: A single-centre, observational study at medical ICU of a tertiary level hospital in Nepal was conducted on invasive mechanically ventilated patients. LUS was performed be­fore extubation on those who were planned to extubate and repeat scan done after 24 hours of extubation. LUS scores were calculated at both times. p-value 0.05 was considered statisti­cally significant. Results: Twenty-eight patients were included after passing spontaneous breathing trial (SBT), one patient had extubation failure. Mean LUS score before and after extubation came to be 16.15 ± 7.00 and 13.15 ± 4.59 respectively with high degree of correlation (Pearson’s r = 0.896, P <0.001). The mean difference in LUS scores before and after extubation was signifi­cant (Mean difference: 3.00 ± 3.54, t = 4.402, p < 0.001). Conclusions: Lung ultrasound is very useful additive tool in predicting extubation failure eas­ily and timely. Its use after extubation also helps in early prediction of post-extubation failure by assessing aeration changes and other lung pathology.

Comparison of lung bedside ultrasound and BNP in the diagnosis of acute heart failure in the emergency department

2020 ◽  
Vol 8 (1) ◽  
pp. 50-50
Author(s):  
Seyed Hossein Ojaghi Haghighi ◽  
Neda Hamed ◽  
Shiva Ebrahimi ◽  
Jafar Ghobadi ◽  
Hoorolnesa Ameli
Keyword(s):  
Heart Failure ◽  
Emergency Room ◽  
Pulmonary Edema ◽  
Acute Heart Failure ◽  
Lung Ultrasound ◽  
P Value ◽  
Ultrasound Evaluation ◽  
Ultrasound Findings ◽  
Medical Advances ◽  
B Lines

Introduction: Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP. Methods: This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure. Results: Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001). Conclusion: The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.

Lung Ultrasound to Monitor Disease Severity and Aid Prognostication in COVID-19 Pneumonia: A Retrospective Analysis of Serial Lung Ultrasound Assessments

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 109-116
Author(s):  
Matthew Llewelyn Gibbins ◽  
Quentin Otto ◽  
Paul Adrian Clarke ◽  
Stefan Gurney
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Analysis ◽  
Disease Severity ◽  
Scoring System ◽  
Lung Ultrasound ◽  
Weaning From Mechanical Ventilation ◽  
Icu Discharge ◽  
Successful Weaning ◽  
Ultrasound Assessment ◽  
Disease Free

Background: The aim of this retrospective analysis was to assess if serial lung ultrasound assessments in patients with COVID-19 pneumonia, including a novel simplified scoring system, correlate with PaO2:FiO2 ratio, as a marker of disease severity, and patient outcomes. Methods: Patients treated for COVID-19 pneumonia in a tertiary intensive care unit who had a lung ultrasound assessment were included. Standardised assessments of anterior and lateral lung regions were prospectively recorded. A validated lung ultrasound score-of-aeration and a simplified scoring system based on the number of disease-free lung regions were correlated with: PaO2:FiO2 ratio,  successful weaning from mechanical ventilation, and status (alive or dead) at discharge.  MedCalc© statistical software was used for statistical analysis. Results: 28 patients (109 assessments) were included. Correlation was seen between score-of-aeration and PaO2:FiO2 ratio (r = -0.61, p<0.0001) and between the simplified scoring system and PaO2:FiO2 ratio (r = 0.52 p<0.0001). Achieving a score-of-aeration of ≤9/24 or ≥2 disease-free regions was associated with successful weaning from mechanical ventilation and survival to ICU discharge (accuracy of 94% and 97% respectively). Conclusion: Retrospective analysis from this small cohort of patients demonstrates that scores-of-aeration and a simplified scoring system based on the number of disease-free antero-lateral regions from serial LUS assessments correlate with PaO2:FiO2 ratio as a marker of disease severity in patients with COVID-19 pneumonia. In addition, lung ultrasound may help identify patients who will have favourable outcomes. 

scholarly journals Clinical characteristics of Chilean patients with rheumatic diseases and COVID-19: data from the Covid-19 Global Rheumatology Alliance physician-reported registry

2021 ◽  
Author(s):  
Oriela Martínez ◽  
Francisca Valenzuela ◽  
Sebastián Ibáñez
Keyword(s):  
Rheumatoid Arthritis ◽  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
List Type ◽  
Non Invasive ◽  
Rheumatic Patients

AbstractObjectiveThe coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has registered more than 234 million confirmed cases and more than 4.7 million deaths throughout the world until October 2, 2021. During the last few months, a significant number of reports of COVID-19 in patients with rheumatic diseases have been published. In this study the objective is to report the clinical characteristics of Chilean patients with rheumatic diseases and COVID-19 reported in the “Global Rheumatology Alliance” (GRA) physician registration platform.MethodsChilean patients with rheumatic diseases and COVID-19 were included in the Covid-19 GRA physician-reported registry.Results54 patients were included. The most common primary rheumatic disease was rheumatoid arthritis (RA) with 28 cases (51.9%). 30 patients (55.6%) used corticosteroids, of which 20 (66.7%) used a dose of 10 mg or less. 33 patients (61.1%) only used conventional DMARDs, 4 (7.4%) only biological, and 6 (11.1%) the combination. A total of 35 patients (64.8%) had to be hospitalized. 2 patients (3.7%) died. 26 patients of the 35 hospitalized (74.2%) required some type of ventilatory support, of which 5 (19.2%) required non-invasive and 8 (30.8%) invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO).DiscussionMost of included Chilean rheumatic patients were hospitalized, with a low mortality rate but with a high percentage of patients requiring at least non-invasive mechanical ventilation.Key Points-The most common primary rheumatic disease was rheumatoid arthritis (RA) followed by lupus (LES)-Most of the included Chilean rheumatic patients were hospitalized, with a high percentage of patients requiring at least non-invasive mechanical ventilation, but with a low mortality rate.-Worsening of arthralgias or activation of the rheumatic disease was not reported.

scholarly journals Open Tracheostomy for Critically Ill Patients with COVID-19

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Estefanía Hernández-García ◽  
Mar Martínez-RuizCoello ◽  
Andrés Navarro Mediano ◽  
Nuria Pérez-Martín ◽  
Victoria García-Peces ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Admissions ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Epidemiological Data ◽  
Orotracheal Intubation ◽  
Safe Procedure ◽  
Before And After ◽  
A Prospective Study ◽  
Mean Time

Background. COVID-19 is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy can shorten ICU length of stay and help weaning. Aims/Objectives. To describe the long-term evolution of the critically patient with COVID-19 and the need for invasive mechanical ventilation and orotracheal intubation (OTI), with or without tracheostomy. Material and Methods. A prospective study was performed including all patients admitted to the ICU due to COVID-19 from 10th March to 30th April 2020. Epidemiological data, performing a tracheostomy or not, mean time of invasive mechanical ventilation until tracheotomy, mean time from tracheotomy to weaning, and final outcome after one month of minimum follow-up were recorded. The Otolaryngology team was tested for COVID-19 before and after the procedures. Results. Out of a total of 1612 hospital admissions for COVID-19, only 5.8% (93 patients) required ICU admission and IOT. Twenty-seven patients (29%) underwent a tracheostomy. After three months, within the group of tracheotomized patients, 29.6% died and 48.15% were extubated in a mean time of 28.53 days. In the nontracheostomized patients, the mortality was 42.4%. Conclusions. Tracheostomy is a safe procedure for COVID-19 and helps weaning of prolonged OTI. Mortality after tracheostomy was less common than in nontracheostomized patients.

scholarly journals Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Luigi Vetrugno ◽  
Francesco Mojoli ◽  
Andrea Cortegiani ◽  
Elena Giovanna Bignami ◽  
Mariachiara Ippolito ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Working Group ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Italian Society ◽  
Expert Consensus ◽  
Consensus Statements

Abstract Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

scholarly journals Prognostic value of bedside lung ultrasound score in patients with COVID-19

2020 ◽  
Author(s):  
Li Ji ◽  
Chunyan Cao ◽  
Ying Gao ◽  
Wen Zhang ◽  
Yuji Xie ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Troponin I ◽  
Lung Ultrasound ◽  
Invasive Mechanical Ventilation ◽  
Continuous Variable ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Pleural Line ◽  
Specificity And Sensitivity ◽  
B Lines

Abstract Background: Bedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.Methods: The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.Results: Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC =286; C-index = 0.866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.Conclusions: The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

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