Application of POCUS in patients with COVID-19 for acute respiratory distress syndrome management: a narrative review

Gao, Xianhui; Zou, Xiaojing; Li, Ruiting; Shu, Huaqing; Yuan, Yu; Yang, Xiaobo; Shang, You

doi:10.1186/s12890-022-01841-2

Cited by 10 publications

(11 citation statements)

References 78 publications

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“…Shortly after, the patient suffered clinical deterioration with hypotension (90/40 mmHg), decrease of the oxygen saturation up to 80% with tachycardia and tachypnea requiring respiratory support with a face mask connected to the mechanical ventilator and vasopressors. Considering these sudden changes in patients hemodynamic status and taking into account COVID-19, increased thromboembolic risk [ 8 ], besides SARS CoV2 highly contagious nature which may limit patients access to diagnostic imaging due to hemodynamic instability or transfer difficulties [ 9 ]; an emergency focused transthoracic ultrasound echocardiography (FATE) was done, as one of multiple protocols of point-of-care ultrasound (POCUS), starting at the subcostal fourth chamber view and followed by the parasternal long-axis view [ 10 ]. The ultrasonographic remarkable findings were an impairment of the global systolic function with dilatation of the right ventricle and the presence of gas bubbles moving between right and left heart chambers (Additional file 1 : Video S1, Additional file 2 : Video S2, Additional file 3 : Video S3, Additional file 4 : Video S4, Additional file 5 : Video S5, Additional file 6 : Video S6).…”

Section: Case Reportmentioning

confidence: 99%

Paradoxical venous air embolism detected with point-of-care ultrasound: a case report

2022

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Venous air embolism (VAE) is an uncommon event consistent in the entrainment of air from any communication between the environment and the venous vasculature that could occur during central venous catheter (CVC) manipulation, and might trigger circulatory shock within minutes depending on the amount of air embolized. We present a case of a critical care patient who presented sudden clinical hemodynamic deterioration after the removal of central venous catheter. Hemodynamic evaluation with point-of-care ultrasound (POCUS) showed bubbles in both right and left heart cavities wherewith air embolism facilitated by heart septal defect was suspected. Therefore, the patient was reintubated, supported with vasopressors and a new CVC was inserted to proceed with air aspiration. Shortly after, the patient’s hemodynamic status improved in terms of vital signs stabilization. 6 h after the event with optimal perfusion markers and diminished sedation, the patient showed left hemiparesis therefore a cerebral magnetic resonance (MRI) was also performed showing hyperintensity in the right precentral gyrus, so ischemic stroke without hemorrhagic transformation diagnosis was made, because of paradoxical embolism. This case report demonstrates the value of POCUS application as a diagnostic tool in the hemodynamically unstable patient.

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Section: Case Reportmentioning

confidence: 99%

Paradoxical venous air embolism detected with point-of-care ultrasound: a case report

2022

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“…These findings add to the body of evidence in favor of the value of POCUS in assessing and managing patients with COVID-19 [ 17 - 20 ]. Among the several arguments for performing lung ultrasonography in the setting of COVID-19 infection, one is that lung ultrasound is performed at the bedside, by the treating clinician, without the need to move a potentially critically ill patient to the radiology suite [ 21 ].…”

Section: Discussionmentioning

confidence: 61%

Lung Ultrasound Findings in COVID-19: A Descriptive Retrospective Study

Omer¹,

Cousins²,

Lynch³

et al. 2022

Cureus

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Background Point-of-care ultrasound (POCUS) is an indispensable tool in emergency medicine. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a need for improved diagnostic capabilities and prognostic indicators for patients who are symptomatic for COVID-19 has become apparent. POCUS has been demonstrated to be a useful diagnostic and prognostic tool in the emergency department (ED) in assessing other lung complications. Still, limited data regarding its utility in assessing COVID-19 are available. This study sought to evaluate whether POCUS findings in the ED were correlated with vital signs or laboratory abnormalities typically seen among patients with COVID-19. Methods A retrospective study was conducted that included 39 patients who presented with COVID-19 and systemic inflammatory response syndrome (SIRS) to a large, urban tertiary care ED. The study population was limited to adults aged 18 and above who came to the ED with the primary complaint of respiratory symptoms, met SIRS criteria on admission, and had images of at least one anterior and one posterior intercostal space per lung and a minimum of four intercostal spaces. POCUS images were obtained by trained operators in the ED using portable ultrasound machines, recorded in an image database, and reviewed by ultrasound fellowship-trained emergency physicians. Clinical data (e.g., acute phase reactants and vital signs) were obtained through a chart review of patients’ electronic medical records. Results Both the percentage of intercostal spaces with B-lines and the percentage of merging B-lines were correlated with decreased oxygen saturation on presentation. No other statistically significant correlations were observed between these sonographic findings and other vital signs or acute phase reactants, nor between these clinical data and the percentage of intercostal spaces that were positive for the shred sign. Conclusions With the emergence of the COVID-19 pandemic, emergency medicine physicians are on the frontline of identifying and caring for patients affected by the virus. This study found that sonographic findings associated with interstitial pneumonitis, notably merging B-lines, and the overall percentage of intercostal spaces with B-lines, were clearly associated with worsening oxygen saturation, now thought to be one of the driving causes of morbidity and mortality in COVID-19. As ultrasound has become a ubiquitous and indispensable tool in the ED, this study demonstrated its utility in assessing and managing patients with COVID-19. Bedside ultrasound is a cheap, fast, and non-invasive tool that healthcare providers can use as an essential adjunct in addition to laboratory markers and other imaging modalities for the diagnosis and prognosis of COVID-19.

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“…Furthermore, we also provided the experience of using POCUS to manage COVID-19-related ARDS. [2] Significant progress in device technology and in the management of critically ill patients have allowed an international expansion of the use of VA ECMO. [3] However, short-term mortality remains high, with an overall survival rate of 40%, mainly due to the very high incidence of complications, among which infections are predominant.…”

Section: Introductionmentioning

confidence: 99%

POCUS and Fluid Responsiveness on Venoarterial ECMO

Garg

Kapoor

2023

JCCC

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VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.

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Application of POCUS in patients with COVID-19 for acute respiratory distress syndrome management: a narrative review

Cited by 10 publications

References 78 publications

Paradoxical venous air embolism detected with point-of-care ultrasound: a case report

Paradoxical venous air embolism detected with point-of-care ultrasound: a case report

Lung Ultrasound Findings in COVID-19: A Descriptive Retrospective Study

POCUS and Fluid Responsiveness on Venoarterial ECMO

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