Objectives To perform a prospective longitudinal analysis of lung ultrasound findings in critically ill patients with coronavirus disease 2019 (COVID‐19). Methods Eighty‐nine intensive care unit (ICU) patients with confirmed COVID‐19 were prospectively enrolled and tracked. Point‐of‐care ultrasound (POCUS) examinations were performed with phased array, convex, and linear transducers using portable machines. The thorax was scanned in 12 lung areas: anterior, lateral, and posterior (superior/inferior) bilaterally. Lower limbs were scanned for deep venous thrombosis and chest computed tomographic angiography was performed to exclude suspected pulmonary embolism (PE). Follow‐up POCUS was performed weekly and before hospital discharge. Results Patients were predominantly male (84.2%), with a median age of 43 years. The median duration of mechanical ventilation was 17 (interquartile range, 10–22) days; the ICU length of stay was 22 (interquartile range, 20.2–25.2) days; and the 28‐day mortality rate was 28.1%. On ICU admission, POCUS detected bilateral irregular pleural lines (78.6%) with accompanying confluent and separate B‐lines (100%), variable consolidations (61.7%), and pleural and cardiac effusions (22.4% and 13.4%, respectively). These findings appeared to signify a late stage of COVID‐19 pneumonia. Deep venous thrombosis was identified in 16.8% of patients, whereas chest computed tomographic angiography confirmed PE in 24.7% of patients. Five to six weeks after ICU admission, follow‐up POCUS examinations detected significantly lower rates ( P < .05) of lung abnormalities in survivors. Conclusions Point‐of‐care ultrasound depicted B‐lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings were significantly decreased by ICU discharge, suggesting persistent but slow resolution of at least some COVID‐19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20% of patients at the bedside, nearly one‐fourth of all patients were found to have computed tomography–proven PE.
Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia.Objective-We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization.Methods-We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2-4 MHz), convex (2-6 MHz) and linear (10-15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computedtomography to exclude interstitial lung disease (ILD) in symptomatic survivors.Results-Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68-0.96, p = .048), increased lactate (HR: 1.17, 95% CI: 0.94-1.46, p = 0.049), and D-dimers (HR: 1.21, 95% CI: 1.03-1.44, p = .03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < .05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76-0.89) and specificity of 0.91 (95% CI: 0.94-0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. Conclusion-POCUSshowed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.
Background: During the COVID-19 pandemic, enormous pressure on health care services resulted in a significant shift of work force from different departments of the hospital to the intensive care unit. Objective: To study the impact of redeployment on doctors and to focus on the factors affecting their satisfaction levels. Study Design: Cross-sectional study Place and Duration of Study: Riyadh First Health from 1st April 2021 to 30th September 2021. Methods: Sixty-six respondents were included. Results: Most physicians (59.1%) had no choice before being redeployed to the ICU. The proportion of happy and very happy doctors was 45.5%. A total of seven participants felt very unhappy when they were deployed to the ICU, six of them had no choice and only one had the option to redeploy. Prior to redeploy to the ICU, 37 (56.1%) doctors received orientation, among them 54.05% found it useful. Thirteen participants indicated that they were unclear about their role and 8 (61.5%) of them did not attend the orientation course. 68.2% of doctors worked more than 36 hours a week and 63.6% complained that the number of hours was greater than that of the previous department. 69.7% of doctors found their deployment useful for patient care, while 22.7% were neutral. 62.1 % doctors felt the deployment was beneficial for them and 59.1% felt satisfaction in fulfilling their role and 27.3% were neutral. Forty two (50%) were satisfied with their ICU redeployment and 33.3 % was neutral. Conclusion: By opting few measures, satisfaction levels of redeployed doctors can be boosted. This includes adequate administrative support, a well-organized orientation that clarifies the role of physicians and helps to elevate their morale. Before redeployment physicians should be given a choice so that they can freely join the ICU.
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