Lung Ultrasound in Emergency and Critically Ill Patients

Arbelot, Charlotte; Neto, Felippe Leopoldo Dexheimer; Gao, Ya; Brisson, Hélène; Wang, Chun-Yao; Lv, Jie; Barbas, Carmen Sílvia Valente; Parratte, Sébastien; Caltabellotta, Fabiola Prior; Deransy, Romain; Lima, Emidio J. S.; Cebey, Andres; Monsel, Antoine; Neves, Júlio Leal Bandeira; Zhang, Mao; Du, Bin; An, Youzhong; Malbouisson, Luis Marcelo; Salluh, Jorge I.; Constantin, Jean-Michel; Rouby, Jean-Jacques

doi:10.1097/aln.0000000000003096

Cited by 67 publications

(53 citation statements)

References 27 publications

(49 reference statements)

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“…Secondly, the application of point-of-care ultrasound is operator-dependent, and requires basic training. Even so, learners have found that it is not difficult to acquire basic lung ultrasound skills over a short period of time, with a minimum required number of 25 supervised scans ( 28 ) .…”

Section: Discussion and Brief Review Of Current Literaturementioning

confidence: 99%

Lung ultrasound in a Singapore COVID-19 intensive care unit patient and a review of its potential clinical utility in pandemic

et al. 2020

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Background Point-of-care bedside lung ultrasound is a diagnostic adjunct in the management of respiratory diseases. We describe the clinical progress and lung ultrasound findings of a Singaporean COVID-19 intensive care unit patient who was diagnosed with COVID-19 infection. Methods The clinical course of one COVID-19 patient managed in the intensive care unit was traced. The patient was diagnosed with COVID-19 virus infection and intubated after developing respiratory failure. Serial point-of-care bedside lung ultrasound was performed by the managing intensivist daily, and correlated with the clinical progress and chest X-ray imaging done for the patient. Results The patient exhibited lung ultrasound findings consistent with that described for viral pneumonias. This included numerous B-lines and subpleural consolidations with disrupted pleural lines distributed symmetrically, predominantly in bilateral upper BLUE points, and lower BLUE points bilaterally. Coalescing B-lines leading on to the development of bilateral “white lung” were associated with worsening acute respiratory distress syndrome. An increased density or reduction of the B-lines was associated with clinical improvement or deterioration, respectively. Conclusions Trained clinicians, who are familiar with point-of-care lung ultrasonography, may consider point-of-care bedside ultrasound as an important adjunct to history and physical examination for the diagnosis and management of COVID-19 when advanced imaging is not available because of logistical reasons or infectious control. This applies in particular to cases where resources are limited, and patient transfers to facilities offering such services may prove hazardous.

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Section: Discussion and Brief Review Of Current Literaturementioning

confidence: 99%

Lung ultrasound in a Singapore COVID-19 intensive care unit patient and a review of its potential clinical utility in pandemic

et al. 2020

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“…The basics can be learned in under two hours. [37][38][39] Limitations/bias Our study has some important limitations. First, this was an observational study; no blinding, randomization or power calculation was performed.…”

Section: Strengthsmentioning

confidence: 96%

Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study

et al. 2020

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BackgroundIn this COVID-19 pandemic, fast and accurate testing is needed to profile patients at the emergency department (ED) and efficiently allocate resources. Chest imaging has been considered in COVID-19 workup, but evidence on lung ultrasound (LUS) is sparse. We therefore aimed to assess and compare the diagnostic accuracy of LUS and computed tomography (CT) in suspected COVID-19 patients.MethodsThis multi-centre, prospective, observational study included adult patients with suspected COVID-19 referred to internal medicine at the ED. We calculated diagnostic accuracy measures for LUS and CT using both PCR and multi-disciplinary team (MDT) diagnosis as reference. We also assessed agreement between LUS and CT, and between sonographers.ResultsBetween March 19 and May 4, 2020, 187 patients were included. Area under the receiver operating characteristic (AUROC) was 0.81 (CI 0.75–0.88) for LUS and 0.89 (CI 0.84–0.94) for CT. Sensitivity and specificity for LUS were 91.9% (CI 84.0–96.7) and 71.0% (CI 61.1–79.6), versus 88.4% (CI 79.7–94.3) and 82.0% (CI 73.1–89.0) for CT. Negative likelihood ratio was 0.1 (CI 0.06–0.24) for LUS and 0.14 (0.08–0.3) for CT. No patient with a false negative LUS, required supplemental oxygen or admission. LUS specificity increased to 80% (CI 69.9–87.9) compared to MDT diagnosis, with an AUROC of 0.85 (CI 0.79–0.91). Agreement between LUS and CT was 0.65. Inter-observer agreement for LUS was good: 0.89 (CI 0.83–0.93).ConclusionLUS and CT have comparable diagnostic accuracy for COVID-19 pneumonia. LUS can safely exclude clinically relevant COVID-19 pneumonia and may aid COVID-19 diagnosis in high prevalence situations.

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“…Thus, we imaged the posterior areas behind the posterior axillary line rather than in the paravertebral areas to avoid turning completely the patient [20]. LUS examinations were performed by emergency physicians or intensivists in charge of the patient [21,22]. The skill of the operators was rated as follows [21]:…”

Section: Lus and Chest Ct Examinationmentioning

confidence: 99%

“…LUS examinations were performed by emergency physicians or intensivists in charge of the patient [21,22]. The skill of the operators was rated as follows [21]:…”

Section: Lus and Chest Ct Examinationmentioning

confidence: 99%

Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Markarian²,

et al. 2020

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The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO 2)/fractional inspired oxygen (FiO 2) ratio. Methods: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. Results: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO 2 /FiO 2 ratio below 357. Conclusion: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.

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Lung Ultrasound in Emergency and Critically Ill Patients

Cited by 67 publications

References 27 publications

Lung ultrasound in a Singapore COVID-19 intensive care unit patient and a review of its potential clinical utility in pandemic

Lung ultrasound in a Singapore COVID-19 intensive care unit patient and a review of its potential clinical utility in pandemic

Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study

Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

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