Pulmonary Ultrasound Scoring System for Intubated Critically Ill Patients and Its Association with Clinical Metrics and Mortality

Background: Preliminary research has shown that pulmonary ultrasonography (PU) has become a vital tool for quickly diagnosing the cause of acute respiratory failure (ARF), as well as monitoring therapy progress in critically sick patients. The aim of the present study is to examine the relationship between the PU grading system and clinical metrics to identify the etiology of ARF with assessment of treatment response. Patients and methods: A prospective cohort study of 50 ARF patients was recruited from Benha University Hospital's respiratory, general, and coronary critical care units. PU examinations were performed at 3 time points during a patient’s ICU stay at intubation, 48 hours after intubation and after extubation. Results: The research comprised 28 men and 22 women. The average age of participants was 58 years old. COVID-19 was the most common diagnosis (46%). Average intubation was 6.42 days, with a P/F ratio of 172.14 and average length of stay in the ICU 10.06 days. The average length of stay in the hospital was 12.6 days, with death rate 68%. Mean first US score was 18.1 and second US score 17.54. The first total US score had a substantial positive association with mortality rate. The initial total US score had also a substantial positive link with the length of ICU stay and ventilation days (p<0.001), whereas the P/F ratio had a negative correlation with the total lung score (p<0.001). Conclusion: First-to-total US score had positive connection with mortality, length of hospital stay, length of ICU stays, ventilation days, and negative connection with P/F ratio. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.

Lung Ultrasound for Patients with COVID-19 Pneumonia in the Intensive Care Unit

Purpose. To assess the possibility of diagnosing lung changes in patients with Covid-19 pneumonia using ultrasound in the intensive care unit, as well as to determine the diagnostic significance of lung ultrasound. Materials and methods. A retrospective study of 40 patients was carried out. All patients had pneumonia associated with Covid-19, of varying severity according to computed tomography. Of these, 27 had severe respiratory failure, which required the use of mechanical ventilation (lung ventilation), 2 patients were oxygenated by the operation of the ECMO (extracorporeal membrane oxygenation) machine, 9 people were on respiratory support using high-flow nasal cannulas Hi Flow (HFNC), 2 patients received humidified oxygen insufflation with nasal cannulas. Results. We found that in 24 patients (60%), according to CT data, pathological changes were determined in both lungs and had predominantly subpleural localization. Two patients (5%) had a total 100% lesion of the lungs according to the results of CT, with a syndrome of hepatization of the lung tissue according to ultrasound. Changes in the lung as subpleural "frosted glass" detected by CT, in 38 (97.5%) cases, were determined by ultrasound as subpleural consolidations. In the same patient in different areas of the lungs, it is possible to simultaneously determine various ultrasound signs, depending on the degree of involvement of the lung tissue in the pathological process. In 12 patients with ultrasound diagnostics, pneumothorax was reliably and accurately determined, in 28 – hydrothorax. The sensitivity of the method was 89–94%. The specificity of ultrasound varied from 58.3% to 91.3%. Conclusions. Our sensitivity and specificity results of LUS show the high possibilities of ultrasound diagnostics of inflammatory respiratory diseases caused by the SARS-CoV-2 virus. This allows us to attribute ultrasound to an alternative screening procedure for evaluating pneumonia. Lung sonography can be used to diagnose a number of emergency conditions in patients with severe lung pathology, as well as to dynamically assess the state of the lungs in intensive care patients. It is necessary to introduce the method into wide clinical practice. © 2022, Professionalnye Izdaniya. All rights reserved.

Pulmonary Ultrasound in the Diagnosis and Monitoring of Coronavirus Disease (COVID-19): A Systematic Review.

The goal of this review was to systematize the evidence on pulmonary ultrasound (PU) use in diagnosis, monitorization or hospital discharge criteria for patients with coronavirus disease 2019 (COVID-19). Evidence on the use of PU for diagnosis and monitorization of or as hospital discharge criteria for COVID-19 patients confirmed to have COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) between December 1, 2019 and July 5, 2020 was compared with evidence obtained with thoracic radiography (TR), chest computed tomography (CT) and RT-PCR. The type of study, motives for use of PU, population, type of transducer and protocol, results of PU and quantitative or qualitative correlation with TR and/or chest CT and/or RT-PCR were evaluated. A total of 28 articles comprising 418 patients were involved. The average age was 50 y (standard deviation: 25.1 y), and there were 395 adults and 23 children. One hundred forty-three were women, 13 of whom were pregnant. The most frequent result was diffuse, coalescent and confluent B-lines. The plural line was irregular, interrupted or thickened. The presence of subpleural consolidation was noduliform, lobar or multilobar. There was good qualitative correlation between TR and chest CT and a quantitative correlation with chest CT of r = 0.65 (p < 0.001). Forty-four patients were evaluated only with PU. PU is a useful tool for diagnosis and monitorization and as criteria for hospital discharge for patients with COVID-19.

A Case of Covid-19 Diagnosed at Home With Portable Ultrasound and Confirmed With Home Serology Test.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and health care providers, limit use of finite hospital resources, and enable better social distancing and isolation practices. CASE REPORT: We report a case of an otherwise healthy emergency physician diagnosed with COVID-19 at home using portable ultrasound, pulse oximetry, and antibody testing. Her clinical picture and typical lung findings of COVID-19 on ultrasound, combined with a normal echocardiogram and negative deep vein thrombosis study, helped inform her diagnosis. She then monitored her clinical course using pulse oximetry, was able to self-isolate for 4 weeks, and had an uneventful recovery. Her diagnosis was confirmed with a positive IgG antibody test after 3 weeks. CONCLUSIONS: Novel times call for novel solutions and our case demonstrates one possible path for home diagnosis and monitoring of COVID-19. The tools used, namely ultrasound and pulse oximetry, should be familiar to most emergency physicians. Ultrasound in particular was helpful in eliminating other potential diagnoses, such as pulmonary embolus.