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1.
Rev. Col. Bras. Cir ; 49: e20223202, 2022. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1760016

ABSTRACT

ABSTRACT Percutaneous tracheostomy has been considered the standard method today, the bronchoscopy-guided technique being the most frequently performed. A safe alternative is ultrasound-guided percutaneous tracheostomy, which can be carried out by the surgeon, avoiding the logistical difficulties of having a specialist in bronchoscopy. Studies prove that the efficacy and safety of the ultrasound-guided technique are similar when compared to the bronchoscopy-guided one. Thus, it is of paramount importance that surgeons have ultrasound-guided percutaneous tracheostomy as a viable and beneficial alternative to the open procedure. In this article, we describe eight main steps in performing ultrasound-guided percutaneous tracheostomy, highlighting essential technical points that can reduce the risk of complications from the procedure. Furthermore, we detail some precautions that one must observe to reduce the risk of aerosolization and contamination of the team when percutaneous tracheostomy is indicated in patients with COVID-19.


RESUMO A traqueostomia percutânea tem sido considerada o método padrão atualmente, sendo a técnica guiada por broncoscopia a mais realizada. Uma alternativa segura é a traqueostomia percutânea guiada por ultrassonografia, que pode ser feita pelo próprio cirurgião, evitando-se as dificuldades logísticas de disponibilidade de um especialista em broncoscopia. Estudos comprovam que a eficácia e a segurança da técnica guiada por ultrassonografia, comparada à guiada por broncoscopia, são semelhantes. Assim, é de suma importância que os cirurgiões tenham a traqueostomia percutânea guiada por ultrassonografia como alternativa viável e benéfica em relação ao procedimento aberto. Neste artigo, descrevemos oito passos principais da realização da traqueostomia percutânea ecoguiada, destacando pontos técnicos essenciais que podem reduzir o risco de complicações do procedimento. Ainda, detalhamos alguns cuidados que devem ser observados, com o intuito de reduzir o risco de aerolização e contaminação da equipe, quando a traqueostomia percutânea é indicada no paciente com COVID-19.


Subject(s)
Humans , Tracheostomy/methods , COVID-19 , Bronchoscopy/methods , Ultrasonography , Ultrasonography, Interventional/methods
2.
Med Intensiva (Engl Ed) ; 44(9): 551-565, 2020 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1243085

ABSTRACT

The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS) and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with an adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.


Subject(s)
COVID-19/diagnostic imaging , SARS-CoV-2 , Ultrasonography, Interventional/methods , Blood Vessels/diagnostic imaging , COVID-19/complications , Critical Care , Critical Illness , Echocardiography , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Heart Ventricles/diagnostic imaging , Humans , Hypertension, Pulmonary/diagnostic imaging , Intensive Care Units , Intubation, Intratracheal/methods , Lung/diagnostic imaging , Organ Size , Pleura/diagnostic imaging , Pleural Effusion/diagnostic imaging , Pneumothorax/diagnostic imaging , Pulmonary Heart Disease/diagnostic imaging , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Shock/diagnostic imaging , Transducers
3.
J Intensive Care Med ; 36(3): 373-375, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1067076

ABSTRACT

BACKGROUND: In the setting of the COVID pandemic, many patients falling ill with acute respiratory distress syndrome eventually require prone positioning for gas exchange. Traditionally, central venous catheters are inserted with patient in the supine or Trendelenburg position. However, when a patient cannot tolerate supine position and the need for central venous access is urgent, catheter placement may be considered with the patient in the prone position. CASE SUMMARY: A 69-year-old male with rapidly declining respiratory status secondary to COVID pneumonia quickly developed acute respiratory distress syndrome, was rapidly intubated, and then placed in the prone position. Patient could not tolerate the supine position even briefly and required a central venous catheter insertion for continuous renal replacement therapy. We kept the patient in the prone position and successfully inserted a central venous catheter in such position with real-time ultrasound guidance and using micropuncture technique. CONCLUSION: In the setting of the COVID pandemic, many cases of acute respiratory distress syndrome require patients to be prone in order to improve gas exchange. In the most severe situations, these patients would not be able to tolerate rotating back to the supine position but would still require central venous catheter insertion urgently. We demonstrated feasibility of central venous catheter insertion in the prone position in these severely ill patients.


Subject(s)
COVID-19/therapy , Catheterization, Central Venous/methods , Patient Positioning/methods , Prone Position , Respiratory Distress Syndrome/therapy , Ultrasonography, Interventional/methods , Aged , Humans , Intubation, Intratracheal , Male , Punctures , SARS-CoV-2
4.
J Thromb Thrombolysis ; 51(4): 978-984, 2021 May.
Article in English | MEDLINE | ID: covidwho-1002140

ABSTRACT

Disordered coagulation, endothelial dysfunction, dehydration and immobility contribute to a substantially elevated risk of deep venous thrombosis, pulmonary embolism (PE) and systemic thrombosis in coronavirus disease 2019 (Covid-19). We evaluated the prevalence of pulmonary thrombosis and reported RV (right ventricular) dilatation/dysfunction associated with Covid-19 in a tertiary referral Covid-19 centre. Of 370 patients, positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 39 patients (mean age 62.3 ± 15 years, 56% male) underwent computed tomography pulmonary angiography (CTPA), due to increasing oxygen requirements or refractory hypoxia, not improving on oxygen, very elevated D-dimer or tachycardia disproportionate to clinical condition. Thrombosis in the pulmonary vasculature was found in 18 (46.2%) patients. However, pulmonary thrombosis did not predict survival (46.2% survivors vs 41.7% non-survivors, p = 0.796), but RV dilatation was less frequent among survivors (11.5% survivors vs 58.3% non-survivors, p = 0.002). Over the following month, we observed four Covid-19 patients, who were admitted with high and intermediate-high risk PE, and we treated them with UACTD (ultrasound-assisted catheter-directed thrombolysis), and four further patients, who were admitted with PE up to 4 weeks after recovery from Covid-19. Finally, we observed a case of RV dysfunction and pre-capillary pulmonary hypertension, associated with Covid-19 extensive lung disease. We demonstrated that pulmonary thrombosis is common in association with Covid-19. Also, the thrombotic risk in the pulmonary vasculature is present before and during hospital admission, and continues at least up to four weeks after discharge, and we present UACTD for high and intermediate-high risk PE management in Covid-19 patients.


Subject(s)
COVID-19 , Heart Ventricles , Pulmonary Embolism , Thrombolytic Therapy/methods , Ventricular Dysfunction, Right , COVID-19/blood , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , Computed Tomography Angiography/methods , Female , Fibrin Fibrinogen Degradation Products/analysis , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Humans , Hypoxia/etiology , Hypoxia/therapy , Male , Middle Aged , Organ Size , Outcome and Process Assessment, Health Care , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Risk Assessment , Risk Factors , SARS-CoV-2 , Ultrasonography, Interventional/methods , United Kingdom , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/physiopathology
5.
West J Emerg Med ; 21(5): 1042-1045, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-792170

ABSTRACT

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/methods , Pneumonia, Viral/therapy , Point-of-Care Systems , Ultrasonography, Interventional/methods , Algorithms , COVID-19 , Clinical Decision-Making/methods , Coronavirus Infections/diagnostic imaging , Humans , Pandemics , Pneumonia, Viral/diagnostic imaging , SARS-CoV-2
6.
Abdom Radiol (NY) ; 46(3): 1263-1271, 2021 03.
Article in English | MEDLINE | ID: covidwho-774406

ABSTRACT

OBJECTIVES: To determine the feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients. METHODS: 60 patients who expired between 04/22/2020-05/06/2020 due to COVID-19 were considered for inclusion in the study, based on availability of study staff. Minimally invasive ultrasound-guided autopsy was performed with 14G core biopsies through a 13G coaxial needle. The protocol required 20 cores of the liver, 30 of lung, 12 of spleen, 20 of heart, 20 of kidney, 4 of breast, 4 of testis, 2 of skeletal muscle, and 4 of fat with total of 112 cores per patient. Quality of the samples was evaluated by number, size, histology, immunohistochemistry, and in situ hybridization for COVID-19 and PCR-measured viral loads for SARS-CoV-2. RESULTS: Five (5/60, 8%) patients were included. All approached families gave their consent for the minimally invasive autopsy. All organs for biopsy were successfully targeted with ultrasound guidance obtaining all required samples, apart from 2 patients where renal samples were not obtained due to atrophic kidneys. The number, size, and weight of the tissue cores met expectation of the research group and tissue histology quality was excellent. Pathology findings were concordant with previously reported autopsy findings for COVID-19. Highest SARS-CoV-2 viral load was detected in the lung, liver, and spleen that had small to moderate amount, and low viral load in was detected in the heart in 2/5 (40%). No virus was detected in the kidney (0/3, 0%). CONCLUSIONS: Ultrasound-guided percutaneous post-mortem core biopsies can safely provide adequate tissue. Highest SARS-CoV-2 viral load was seen in the lung, followed by liver and spleen with small amount in the myocardium.


Subject(s)
Autopsy/methods , COVID-19/pathology , Ultrasonography, Interventional/methods , Aged , Aged, 80 and over , Biopsy , Feasibility Studies , Female , Humans , Male , Middle Aged , SARS-CoV-2
11.
J Laryngol Otol ; 134(8): 680-683, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-604803

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.


Subject(s)
Coronavirus Infections/transmission , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/pathology , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Pneumonia, Viral/transmission , Aerosols , Betacoronavirus/isolation & purification , Biopsy, Fine-Needle/instrumentation , COVID-19 , Clinical Protocols , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Delayed Diagnosis/prevention & control , Feasibility Studies , Head and Neck Neoplasms/surgery , Humans , London/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Positron Emission Tomography Computed Tomography/methods , Referral and Consultation , Risk Assessment , SARS-CoV-2 , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Ultrasonography, Interventional/methods
13.
Crit Care ; 24(1): 334, 2020 06 12.
Article in English | MEDLINE | ID: covidwho-594759

ABSTRACT

The handheld ultrasound demonstrates clinical and economic value in combating COVID-19 based on interviews with frontline ultrasound physician and cardiologist as well as a national expert in medical ultrasound.


Subject(s)
Betacoronavirus , Computers, Handheld/standards , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Ultrasonography, Interventional/instrumentation , Attitude of Health Personnel , COVID-19 , Coronavirus Infections/therapy , Diagnosis, Computer-Assisted/instrumentation , Humans , Pandemics , Pneumonia, Viral/therapy , Point-of-Care Systems , SARS-CoV-2 , Ultrasonography, Interventional/methods
16.
BMC Cardiovasc Disord ; 20(1): 314, 2020 Jul 01.
Article in English | MEDLINE | ID: covidwho-620066

ABSTRACT

BACKGROUND: Coronary artery aneurysm (CAA) is a potential cause of infarction. During the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability. Here, we report a case of sudden acute myocardial infarction caused by large CAA during the home isolation. CASE PRESENTATION: During the outbreak of coronavirus disease 2019 (COVID-19),a 16-year-old man with no cardiac history was admitted to CCU of Tang du hospital because of severe chest pain for 8 h. The patient reached the hospital its own, his electrocardiogram showed typical features of anterior wall infarction, echocardiography was performed and revealed local anterior wall dysfunction, but left ventricle ejection fraction was normal, initial high-sensitivity troponin level was 7.51 ng/mL (<1.0 ng/mL). The patient received loading dose of aspirin and clopidogrel bisulfate and a total occlusion of the LAD was observed in the emergency coronary angiography (CAG). After repeated aspiration of the thrombus, TIMI blood flow reached level 3. Coronary artery aneurysm was visualized in the last angiography. No stent was implanted. Intravascular ultrasound (IVUS) was performed and the diagnosis of coronary artery aneurysm was further confirmed. The patient was discharged with a better health condition. CONCLUSIONS: Coronary artery aneurysm is a potential reason of infarction, CAG and IVUS are valuable tools in diagnosis in such cases, during the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability, and activities at home should be increased in the high-risk patients.


Subject(s)
Anterior Wall Myocardial Infarction , Coronary Aneurysm , Coronary Angiography/methods , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Thrombectomy/methods , Ultrasonography, Interventional/methods , Adolescent , Anterior Wall Myocardial Infarction/diagnosis , Anterior Wall Myocardial Infarction/etiology , Anterior Wall Myocardial Infarction/physiopathology , Anterior Wall Myocardial Infarction/surgery , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Coronary Aneurysm/complications , Coronary Aneurysm/diagnostic imaging , Echocardiography/methods , Electrocardiography/methods , Humans , Male , Pandemics , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome
18.
J Cardiothorac Vasc Anesth ; 34(7): 1727-1732, 2020 07.
Article in English | MEDLINE | ID: covidwho-45999

ABSTRACT

The COVID-19 pandemic is spreading globally. COVID-19 has an effect on the systemic state, cardiopulmonary function and primary disease of patients undergoing surgery. COVID-19's high contagiousness makes anesthesia and intraoperative management more difficult. This expert consensus aims to comprehensively introduce the application of perioperative ultrasound in COVID-19 patients, including pulmonary ultrasound and anesthesia management, ultrasound and airway management, ultrasound-guided regional anesthesia and echocardiography for COVID-19 patients.


Subject(s)
Anesthesia/methods , Betacoronavirus , Coronavirus Infections/diagnostic imaging , Perioperative Care/methods , Pneumonia, Viral/diagnostic imaging , Ultrasonography/methods , Airway Management/methods , Anesthesia, Conduction/methods , COVID-19 , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnostic imaging , Coronavirus Infections/complications , Coronavirus Infections/transmission , Echocardiography/methods , Hemodynamics , Humans , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Lung Diseases/microbiology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , SARS-CoV-2 , Tracheotomy/methods , Ultrasonography, Interventional/methods , Ventilator Weaning/methods
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