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

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.

scholarly journals Point-of-care ultrasound for COVID-19 pneumonia patients in the ICU

2020 ◽  
Author(s):  
zouheir bitar ◽  
Mohammed Shamsah ◽  
Omar Bamasood ◽  
Ossama Maadrani ◽  
Huda Al foudri
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Left Ventricular ◽  
Circulatory Failure ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Point Of Care Ultrasound ◽  
Rt Pcr ◽  
Ventricular Ejection Fraction ◽  
Hemodynamic Assessment

Abstract BackgroundPoint-of-care ultrasound (POCUS) has a major role in the management of patients with acute hypoxic respiratory and circulatory failure and guides hemodynamic management. There is scarce literature on POCUS assessment characteristics in COVID-19 pneumonia with hypoxic respiratory failure.MethodsThe study is an observational, prospective, single‐center study conducted in the intensive care unit of Adan General Hospital from May 1st, 2020, to June 25, 2020. The study included adults suspected to have COVID-19 transferred to the intensive care unit (ICU) with fever or suspected respiratory infection. Patients were transferred to the ICU directly from the ED or general medical wards after reverse transcriptase-polymerase chain reaction (RT-PCR) testing. A certified intensivist in critical care ultrasound who was blinded to the RT-PCR results, if available at the time of examination, performed the lung ultrasound and echocardiology within 12 hours of the patient’s admission to the ICU. We calculated the E/e’, E/A ratio, left ventricular ejection fraction EF, IVC diameter, RV size and systolic function. We performed ultrasound in 12 chest areas.ResultsOf 92 patients with suspected COVID-19 pneumonia, 77 (84%) cases were confirmed. The median age of the patients was 53 (82-36) years, and 71 (77%) were men.In the group of patients with confirmed COVID-19 pneumonia, echocardiographic findings showed normal E/e’, deceleration time (DT), and transmittal E/A ratio in comparison to the non-COVID19 patients (P .001 for both). The IVC diameter was <2 cm with > 50% collapsibility in 62 (81%) patients with COVID-19 pneumonia; a diameter of > 2 cm and < 50% collapsibility in all patients, with a P value of 0.001, was detected among those with non-COVID-19 pneumonia. There were 3 cases of myocarditis with poor EF (5.5%), severe RV dysfunction was seen in 9 cases (11.6%), and 3 cases showed RV thrombus.Chest US revealed four signs suggestive of COVID-19 pneumonia in 77 patients (98.6%) (sensitivity 96.9%, CI 85%‐99.5%) when compared with RT-PCR results.ConclusionPOCUS plays an important role in bedside diagnosis, hemodynamic assessment and management of patients with acute hypoxic respiratory and circulatory failure in patients with COVID-19 pneumonia.

scholarly journals Hyperdynamic left ventricular ejection fraction in the intensive care unit

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Joseph R. Paonessa ◽  
Thomas Brennan ◽  
Marco Pimentel ◽  
Daniel Steinhaus ◽  
Mengling Feng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Fuzzy Modeling to Predict Severely Depressed Left Ventricular Ejection Fraction following Admission to the Intensive Care Unit Using Clinical Physiology

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Rúben Duarte M. A. Pereira ◽  
Cátia M. Salgado ◽  
Andre Dejam ◽  
Shane R. Reti ◽  
Susana M. Vieira ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Fuzzy Model ◽  
Predictive Performance ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Left ventricular ejection fraction (LVEF) constitutes an important physiological parameter for the assessment of cardiac function, particularly in the settings of coronary artery disease and heart failure. This study explores the use of routinely and easily acquired variables in the intensive care unit (ICU) to predict severely depressed LVEF following ICU admission. A retrospective study was conducted. We extracted clinical physiological variables derived from ICU monitoring and available within the MIMIC II database and developed a fuzzy model using sequential feature selection and compared it with the conventional logistic regression (LR) model. Maximum predictive performance was observed using easily acquired ICU variables within 6 hours after admission and satisfactory predictive performance was achieved using variables acquired as early as one hour after admission. The fuzzy model is able to predict LVEF ≤ 25% with an AUC of 0.71 ± 0.07, outperforming the LR model, with an AUC of 0.67 ± 0.07. To the best of the authors’ knowledge, this is the first study predicting severely impaired LVEF using multivariate analysis of routinely collected data in the ICU. We recommend inclusion of these findings into triaged management plans that balance urgency with resources and clinical status, particularly for reducing the time of echocardiographic examination.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

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

scholarly journals Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study

2019 ◽  
Vol 19 (4) ◽  
pp. 310-319 ◽  
Author(s):  
Shining Cai ◽  
Jos M Latour ◽  
Ying Lin ◽  
Wenyan Pan ◽  
Jili Zheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiac Function ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Classification ◽  
New York Heart Association

Background: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. Aims: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. Methods: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. Results: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01–1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27–4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95–1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09–7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. Conclusion: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.

scholarly journals Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series

2020 ◽  
Author(s):  
Anne M Hause ◽  
Lakshmi Panagiotakopoulos ◽  
Eric S Weintraub ◽  
Lina S Sy ◽  
Sungching C Glenn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Syncytial Virus ◽  
Respiratory Failure ◽  
Virus Infection ◽  
Respiratory Syncytial Virus Infection ◽  
Case Series ◽  
Adverse Outcomes ◽  
Syncytial Virus

Abstract We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.

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