Utility of point-of-care lung ultrasound for initial assessment of acute respiratory distress syndrome patients in the emergency department

Sanjan, A; Krishnan, S Vimal; Abraham, Siju V; Palatty, Babu Urumese

doi:10.4103/jets.jets_47_19

Cited by 9 publications

(2 citation statements)

References 21 publications

(22 reference statements)

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“…Third, LUS was performed by different first-line clinical doctors with different levels of experience, which may have produced differences in the detection results since the detection standards are difficult to control. 23 In conclusion, LUS has a greater diagnostic accuracy and sensitivity in COVID-19 patients with ARDS than the portable chest X-ray. The obtained results suggest that LUS can be used as the primary imaging technique to detect COVID-19 patients and can improve bedside decision-making.…”

Section: Discussionmentioning

confidence: 88%

“…Second, the enrolled COVID‐19 patients were already screened for ARDS, which may have affected the results of the ROC analyses for LUS and chest X‐ray. Third, LUS was performed by different first‐line clinical doctors with different levels of experience, which may have produced differences in the detection results since the detection standards are difficult to control 23 …”

Section: Discussionmentioning

confidence: 99%

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Lung ultrasound assessment of acute respiratory distress syndrome caused by coronavirus disease 2019: An observational study

Liu

et al. 2020

Hong Kong Journal of Emergency Medicine

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Background: An outbreak of coronavirus disease 2019 (COVID-19) took place in Wuhan, China, by the end of 2019, and the disease continues to spread all over the world. The number of patients is increasing rapidly, a large number of infected patients is critically ill, and the mortality is high. However, information on COVID-19 patients is limited, and its clinical characteristics have not been fully studied. Objectives: To compare the performances of point-of-care lung ultrasound (LUS) and bedside chest X-ray in assessing the condition of COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods: This observational study enrolled 42 COVID-19 patients with ARDS who were admitted to the Department of Critical Care Medicine of the Wuhan Union Hospital from February to April 2020. The point-of-care LUS characteristics of the COVID-19 patients with ARDS were summarized, and the performances of LUS and bedside chest X-ray in assessing the patient’s condition were compared. Results: Most of the 42 patients were elderly individuals with chronic clinical diseases. The proportion of patients older than 60 years old was 85.7%. All patients were given invasive mechanical ventilation; eight (19.0%) of them received venovenous extracorporeal membrane oxygenation support. LUS has evident advantages in detecting lung consolidation, patchy shadows, and pleural thickening, and pleural line changes in particular. The receiver operating characteristic analysis indicated that the sensitivity, Youden index, and kappa value for detecting COVID-19 patients with ARDS were higher for LUS than the chest X-ray. Conclusion: LUS has better diagnostic accuracy and sensitivity in COVID-19 patients with ARDS than the chest X-ray.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Lung ultrasound assessment of acute respiratory distress syndrome caused by coronavirus disease 2019: An observational study

Liu

et al. 2020

Hong Kong Journal of Emergency Medicine

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Lung Ultrasound for Identification of Patients Requiring Invasive Mechanical Ventilation in COVID‐19

Seiler

Klingberg

Hårdstedt

2021

J of Ultrasound Medicine

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Objectives Indication for invasive mechanical ventilation in COVID‐19 pneumonia has been a major challenge. This study aimed to evaluate if lung ultrasound (LUS) can assist identification of requirement of invasive mechanical ventilation in moderate to severe COVID‐19 pneumonia. Materials and Methods Between April 23 and November 12, 2020, hospitalized patients with moderate to severe COVID‐19 (oxygen demand ≥4 L/min) were included consecutively. Lung ultrasound was performed daily until invasive mechanical ventilation (IMV‐group) or spontaneous recovery (non‐IMV‐group). Clinical parameters and lung ultrasound findings were compared between groups, at intubation (IMV‐group) and highest oxygen demand (non‐IMV‐group). A reference group with oxygen demand <4 L/min was examined at hospital admission. Results Altogether 72 patients were included: 50 study patients (IMV‐group, n = 23; non‐IMV‐group, n = 27) and 22 reference patients. LUS‐score correlated to oxygen demand (SpO 2 /FiO 2 ‐ratio) (r = 0.728; p < 0.0001) and was higher in the IMV‐group compared to the non‐IMV‐group (20.0 versus 18.0; p = 0.026). Based on receiver operating characteristic analysis, a LUS‐score of 19.5 was identified as cut‐off for requirement of invasive mechanical ventilation (area under the curve 0.68; sensitivity 56%, specificity 74%). In 6 patients, LUS identified critical coexisting conditions. Respiratory rate and oxygenation index ((SpO 2 /FiO 2 )/respiratory rate) ≥4.88 identified no requirement of invasive mechanical ventilation with a positive predictive value of 87% and negative predictive value of 100%. Conclusions LUS‐score had only a moderate diagnostic value for requirement of invasive mechanical ventilation in moderate to severe COVID‐19. However, LUS proved valuable as complement to respiratory parameters in guidance of disease severity and identifying critical coexisting conditions.

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Pulmonary aspergilloma on transthoracic ultrasound

et al. 2021

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Purpose Pulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis. Methods and Results We report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable. Conclusions The sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.

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Utility of point-of-care lung ultrasound for initial assessment of acute respiratory distress syndrome patients in the emergency department

Cited by 9 publications

References 21 publications

Lung ultrasound assessment of acute respiratory distress syndrome caused by coronavirus disease 2019: An observational study

Lung ultrasound assessment of acute respiratory distress syndrome caused by coronavirus disease 2019: An observational study

Lung Ultrasound for Identification of Patients Requiring Invasive Mechanical Ventilation in COVID‐19

Pulmonary aspergilloma on transthoracic ultrasound

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