scholarly journals Lung Ultrasound in the Critically Ill

2017 ◽  
Vol 32 (4) ◽  
pp. 356-358
Author(s):  
Jin Sun Cho
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Micah L. A. Heldeweg ◽  
Jorge E. Lopez Matta ◽  
Mark E. Haaksma ◽  
Jasper M. Smit ◽  
Carlos V. Elzo Kraemer ◽  
...  

Abstract Background Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients. Methods Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints. Results We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging − 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor. Conclusions Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days. Trial registration: NTR, NL8584. Registered 01 May 2020—retrospectively registered, https://www.trialregister.nl/trial/8584


Breathe ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 100-111 ◽  
Author(s):  
Daniel Lichtenstein

This review article is an update of what should be known for practicing basic lung ultrasound in the critically ill (LUCI) and is also of interest for less critical disciplines (e.g. pulmonology). It pinpoints on the necessity of a professional machine (not necessarily a sophisticated one) and probe. It lists the 10 main signs of LUCI and some of the main protocols made possible using LUCI: the BLUE protocol for a respiratory failure, the FALLS protocol for a circulatory failure, the SESAME protocol for a cardiac arrest and the investigation of a ventilated acute respiratory distress syndrome patient, etc. It shows how the field has been fully standardised to avoid confusion.Key pointsA simple ultrasonography unit is fully adequate, with minimal filters, and provides a unique probe for integrating the lung into a holistic, whole-body approach to the critically ill.Interstitial syndrome is strictly defined. Its clinical relevance in the critically ill is standardised for defining haemodynamic pulmonary oedema, pneumonia and pulmonary embolism.Pneumothorax is strictly and sequentially defined by the A′-profile (at the anterior wall in a supine or semirecumbent patient, abolished lung siding plus the A-line sign) and then the lung point.The BLUE protocol integrates lung and venous ultrasound findings for expediting the diagnosis of acute respiratory failure, following pathophysiology, allowing prompt diagnosis of pneumonia, haemodynamic pulmonary oedema, exacerbated chronic obstructive pulmonary disease or asthma, pulmonary embolism or pneumothorax, even in clinically challenging presentations.Educational aimsTo understand that the use of lung ultrasound, although long standardised, still needs educational efforts for its best use, a suitable machine, a suitable universal probe and an appropriate culture.To be able to use a terminology that has been fully standardised to avoid any confusion of useless wording.To understand the logic of the BLUE points, three points of interest enabling expedition of a lung ultrasound examination in acute respiratory failure.To be able to cite, in the correct hierarchy, the seven criteria of the B-line, then those of interstitial syndrome.To understand the sequential thinking when making ultrasound diagnosis of pneumothorax.To be able to use the BLUE protocol for building profiles of pneumonia (or acute respiratory distress syndrome) and understand their limitations.To understand that lung ultrasound can be used for the direct analysis of an acute respiratory failure (the BLUE protocol), an acute circulatory failure (the FALLS protocol) and even a cardiac arrest (SESAME protocol), following a pathophysiological approach.To understand that the first sequential target in the SESAME protocol (search first for pneumothorax in cardiac arrest) can also be used in countless more quiet settings of countless disciplines, making lung ultrasound in the critically ill cost-, time- and radiation-saving.To be able to perform a BLUE protocol in challenging patients, understanding how the best lung ultrasound can be obtained from bariatric or agitated, dyspnoeic patients.


2013 ◽  
Vol 40 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Nektaria Xirouchaki ◽  
Eumorfia Kondili ◽  
George Prinianakis ◽  
Polychronis Malliotakis ◽  
Dimitrios Georgopoulos

2010 ◽  
Vol 111 (3) ◽  
pp. 687-692 ◽  
Author(s):  
Adriano Peris ◽  
Lorenzo Tutino ◽  
Giovanni Zagli ◽  
Stefano Batacchi ◽  
Giovanni Cianchi ◽  
...  

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