Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study

Abstract

IntroductionPatients with severe malaria or sepsis are at risk of developing life-threatening acute respiratory distress syndrome (ARDS). The objective of this study was to evaluate point-of-care lung ultrasound as a novel tool to determine the prevalence and early signs of ARDS in a resource-limited setting among patients with severe malaria or sepsis.Materials and methodsSerial point-of-care lung ultrasound studies were performed on four consecutive days in a planned sub study of an observational cohort of patients with malaria or sepsis in Bangladesh. We quantified aeration patterns across 12 lung regions. ARDS was defined according to the Kigali Modification of the Berlin Definition.ResultsOf 102 patients enrolled, 71 had sepsis and 31 had malaria. Normal lung ultrasound findings were observed in 44 patients on enrolment and associated with 7% case fatality. ARDS was detected in 10 patients on enrolment and associated with 90% case fatality. All patients with ARDS had sepsis, 4 had underlying pneumonia. Two patients developing ARDS during hospitalisation already had reduced aeration patterns on enrolment. The SpO2/FiO2 ratio combined with the number of regions with reduced aeration was a strong prognosticator for mortality in patients with sepsis (AUROC 91.5% (95% Confidence Interval: 84.6%-98.4%)).ConclusionsThis study demonstrates the potential usefulness of point-of-care lung ultrasound to detect lung abnormalities in patients with malaria or sepsis in a resource-constrained hospital setting. LUS was highly feasible and allowed to accurately identify patients at risk of death in a resource limited setting.

Early Lessons on the Importance of Lung Imaging in Novel Coronavirus Disease (COVID-19)

“…Also, chest X-rays in low-resource settings are often of poor quality, with a much lower sensitivity than LUS to detect pleural or parenchymal abnormalities. 6 This information supports more extensive deployment of point-of-care LUS in COVID-19 patients, in particular in settings where resources are limited. The COVID-19 case presented by Chaisith describes LUS abnormalities observed at the 12th day of hospital admission.…”

Lung Ultrasound for Detection of Pulmonary Complications in Critically Ill Obstetric Patients in a Resource-Limited Setting

“…27,31 Pulmonary complications were significantly associated with poorer outcome, confirming findings in non-obstetric patients in Africa 12 and Asia. 32 This does not imply a causal relationship with mortality, as parturients largely die of direct obstetric complications such as hemorrhage, eclampsia, and sepsis. 3,33 Yet, pulmonary complications led to frequent escalation of care.…”

Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries

“…Malaria is responsible for 500 million infections and one million deaths each year [ 27 ]. A common cause of death in these patients is malaria-associated acute respiratory distress syndrome (ARDS) [ 28 ]. ARDS carries a higher mortality rate in middle-income countries compared to high-income countries [ 29 ].…”