Case Report: Lung Ultrasound for the Guidance of Adjunctive Therapies in Two Invasively Ventilated Patients with COVID-19

Pierrakos, Charalampos; Attou, Rachid; Iesu, Enrica; Baelongandi, Hugues; Honoré, Patrick M.; Bos, Lieuwe D. J.; Schultz, Marcus J.; Bels, David De

doi:10.4269/ajtmh.20-0538

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Dynamic changes in LUS scores should be studied further as monitoring tool for reaeration of lung tissue. 50 Additional studies should focus on LUS because it is an excellent technique to use in a resource-limited setting as alternative for chest radiography or chest CT. 51…”

Section: Discussionmentioning

confidence: 99%

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

Pierrakos

Lieveld

Pisani

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Lung ultrasound (LUS) can be used to assess loss of aeration, which is associated with outcome in patients with coronavirus disease 2019 (COVID-19) presenting to the emergency department. We hypothesized that LUS scores are associated with outcome in critically ill COVID-19 patients receiving invasive ventilation. This retrospective international multicenter study evaluated patients with COVID-19–related acute respiratory distress syndrome (ARDS) with at least one LUS study within 5 days after invasive mechanical ventilation initiation. The global LUS score was calculated by summing the 12 regional scores (range 0–36). Pleural line abnormalities and subpleural consolidations were also scored. The outcomes were successful liberation from the ventilator and intensive care mortality within 28 days, analyzed with multistate, competing risk proportional hazard models. One hundred thirty-seven patients with COVID-19–related ARDS were included in our study. The global LUS score was associated with successful liberation from mechanical ventilation (hazard ratio [HR]: 0.91 95% confidence interval [CI] 0.87–0.96; P = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97–1.08; P = 0.36). Subpleural consolidation and pleural line abnormalities did not add to the prognostic value of the global LUS score. Examinations within 24 hours of intubation showed no prognostic value. To conclude, a lower global LUS score 24 hours after invasive ventilation initiation is associated with increased probability of liberation from the mechanical ventilator COVID–19 ARDS patients, independently of the ARDS severity.

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Section: Discussionmentioning

confidence: 99%

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

Pierrakos

Lieveld

Pisani

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…The latter is described by Lock and Nix [ 39 ] in which a sudden drop in oxygenation in combination of loss of pleural sliding was caused by partial collapse of the lung. Furthermore, there are some cases in which the indication of recruitment was made by finding dorso-basal atelectasis [ 40 , 41 ].…”

Section: Volumes and Aerationmentioning

confidence: 99%

Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome

Somhorst

Gommers

Endeman

2021

Current Opinion in Critical Care

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Purpose of review To summarize the current knowledge about the application of advanced monitoring techniques in coronavirus disease 2019 (COVID-19). Recent findings Due to the heterogeneity between patients, management of COVID-19 requires daily monitoring of and/or aeration and inspiratory effort. Electrical impedance tomography can be used to optimize positive end-expiratory pressure, monitor the response to changes in treatment or body position and assess pulmonary perfusion and ventilation/perfusion matching. Lung ultrasound is more readily available and can be used to measure and monitor recruitment, provide an indication of diaphragm function and pulmonary perfusion disturbances. Esophageal pressure measurements enable the calculation of the transpulmonary pressure and inspiratory effort in order to prevent excessive stress on the lung. While esophageal pressure measurements are the golden standard in determining inspiratory effort, alternatives like P 0.1 , negative pressure swing during a single airway occlusion and change in central venous pressure are more readily available and capable of diagnosing extreme inspiratory efforts. Summary Although there is little data on the effectiveness of advanced monitoring techniques in COVID-19, regular monitoring should be a central part of the management of COVID-19-related acute respiratory distress syndrome (C-ARDS).

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“…Depending on LUS findings, early after initiation of invasive ventilation, invasive ventilation can be planned. 47 It is clear that diagnosis and follow-up of consolidations, atelectasis, interstitial and alveolar edema, pneumothorax, and pleural effusion can be evaluated by LUS. Numerous protocols were recommended for this purpose.…”

Section: Of Lus In Covid-19 Pneumoniamentioning

confidence: 99%

The role of lung ultrasonography in evaluation of COVID-19 pneumonia

2021

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After a few months it emerged in Wuhan (China), Coronavirus Disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) was declared as a pandemic by the World Health Organization (WHO). Diagnosis of the disease is mainly based on real time polymerase chain reaction (PCR) test by nasopharyngeal swab. However, due to excess of numbers of false-negative PCR test results, chest computed tomography (CT) is commonly used as a supplementary modality. However, CT has some disadvantages. Firstly, a normal chest CT scan does not exclude the diagnosis of COVID-19 pneumonia. Additionally, the radiation exposure and a weak diagnostic value are other challenges. When the infection is limited to upper respiratory system or performed in the early stage, false-negative results may be obtained on CT scan. Recently lung ultrasonography (LUS) has emerged as a easy-to-use, cost-effective and radiation-free tool in diagnosis, management and follow-up of COVID-19 pneumonia. In this narrative review, our aim is to clarify the utility of LUS in COVID-19 pneumonia with its advantages and disadvantages. We also aimed to guide clinicians to use LUS as a practical tool.

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Case Report: Lung Ultrasound for the Guidance of Adjunctive Therapies in Two Invasively Ventilated Patients with COVID-19

Cited by 6 publications

References 17 publications

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome

The role of lung ultrasonography in evaluation of COVID-19 pneumonia

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