Lung Ultrasound Examination Research Articles

Lung ultrasound-guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis.

Pulmonary edema is a leading cause of hospital admissions, morbidity, and mortality in heart failure (HF) patients. A point-of-care lung ultrasound (LUS) is a useful tool to detect subclinical pulmonary edema.We performed a comprehensive literature search of multiple databases for studies that evaluated the clinical utility of LUS-guided management versus standard care for HF patients in the outpatient setting. The primary outcome of interest was HF hospitalization. The secondary outcomes were all-cause mortality, urgent visits for HF worsening, acute kidney injury (AKI), and hypokalemia rates. Pooled risk ratio (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using random-effect model meta-analysis.A total of 3 randomized controlled trials including 493 HF patients managed in the outpatient setting (251 managed with LUS plus physical examination (PE)-guided therapy vs. 242 managed with PE-guided therapy alone) were included in the final analysis. The mean follow-up period was 5 months. There was no significant difference in HF hospitalization rate between the two groups (RR 0.65; 95% CI 0.34-1.22; P = 0.18). Similarly, there was no significant difference in all-cause mortality (RR 1.39; 95% CI 0.68-2.82; P = 0.37), AKI (RR 1.27; 95% CI 0.60-2.69; P = 0.52), and hypokalemia (RR 0.72; 95% CI 0.21-2.44; P = 0.59). However, LUS-guided therapy was associated with a lower rate for urgent care visits (RR 0.32; 95% CI 0.18-0.59; P = 0.0002).Our study demonstrated that outpatient LUS-guided diuretic therapy of pulmonary congestion reduces urgent visits for worsening symptoms of HF. Further studies are needed to evaluate LUS utility in the outpatient treatment of HF.

Delayed pneumothorax after transbronchial lung biopsy

A 56-year-old woman underwent a bronchoscopy with transbronchial biopsy for work up of interstitial lung disease. The procedure was uneventful and preprocedure and immediately postprocedure lung ultrasound examinations demonstrated no...

Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study.

PurposeTo analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history.MethodsThis is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed.ResultsWe studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23–91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55–91.65%) that was higher in the mild phenotype (94.4%; CI 90.0–97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6–6.7, p < 0.0001).ConclusionCombining LUS patterns of probability with clinical phenotypes at presentation can rapidly identify those patients with or without COVID-19 pneumonia at bedside. This approach could support and expedite patients’ management during a pandemic surge.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-021-06373-7.

Serial lung ultrasounds in pediatric pneumonia in Mozambique and Pakistan

Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing and managing pneumonia. We sought to explore serial LUS examinations in children with chest-indrawing pneumonia in resource-constrained settings and compare their clinical and LUS imaging courses longitudinally. We conducted a prospective, observational study among children aged 2 through 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at 2 district hospitals in Mozambique and Pakistan. We assessed serial LUS at enrollment, 2, 6, and 14 days, and performed a secondary analysis of enrolled children’s longitudinal clinical and imaging courses. By Day 14, the majority of children with chest-indrawing pneumonia and consolidation on enrollment LUS showed improvement on follow-up LUS (100% in Mozambique, 85.4% in Pakistan) and were clinically cured (100% in Mozambique, 78.0% in Pakistan). In our cohort of children with chest-indrawing pneumonia, LUS imaging often reflected the clinical course; however, it is unclear how serial LUS would inform the routine management of non-severe chest-indrawing pneumonia.

Combined lung and cardiac ultrasound in COVID-related acute respiratory distress syndrome.

BackgroundLung ultrasound (LU) is a useful tool for monitoring lung involvement in novel coronavirus (COVID) disease, while information on echocardiographic findings in COVID disease is to date scarce and heterogeneous. We hypothesized that lung and cardiac ultrasound examinations, serially and simultaneously performed, could monitor disease severity in COVID-related ARDS.MethodsWe enrolled 47 consecutive patients with COVID-related ARDS (1st March–31st May 2020). Lung and cardiac ultrasounds were performed on admission, at discharged and when clinically needed.ResultsMost patients were mechanically ventilated (75%) and veno-venous extracorporeal membrane oxygenation was needed in ten patients (21.2%). The in-ICU mortality rate was 27%%. On admission, not survivors showed a higher LUS score (p = 0.006) and a higher incidence of consolidations (p = 0.003), lower values of LVEF (p = 0.027) and a higher RV/LV ratio (0.008). At discharge, a significant reduction in the incidence of subpleural consolidations (p < 0.001) and, thus, in LUS score (p < 0.001) and an increase in patter A findings (p < 0.001) together with reduced systolic pulmonary arterial pressures were detectable. In not survivors at final examination, an increased in LUS score (p < 0.001), and in RV/LV ratio (p < 0.001) associated with a reduction in TAPSE (p = 0.013) were observed. A significant correlation was observed between LUS and systolic pulmonary arterial pressure (p = 0.04). LUS and RV/LV resulted independent predictors of in-ICU death.ConclusionsIn COVID-related ARDS, the combined lung and cardiac ultrasound proved to be an useful clinical tool in monitoring disease progression and in identifying parameters (LU score and RV/LV ratio) able to risk stratifying these patients.

Sonographic Diagnosis of COVID-19: A Review of Image Processing for Lung Ultrasound

The sustained increase in new cases of COVID-19 across the world and potential for subsequent outbreaks call for new tools to assist health professionals with early diagnosis and patient monitoring. Growing evidence around the world is showing that lung ultrasound examination can detect manifestations of COVID-19 infection. Ultrasound imaging has several characteristics that make it ideally suited for routine use: small hand-held systems can be contained inside a protective sheath, making it easier to disinfect than X-ray or computed tomography equipment; lung ultrasound allows triage of patients in long term care homes, tents or other areas outside of the hospital where other imaging modalities are not available; and it can determine lung involvement during the early phases of the disease and monitor affected patients at bedside on a daily basis. However, some challenges still remain with routine use of lung ultrasound. Namely, current examination practices and image interpretation are quite challenging, especially for unspecialized personnel. This paper reviews how lung ultrasound (LUS) imaging can be used for COVID-19 diagnosis and explores different image processing methods that have the potential to detect manifestations of COVID-19 in LUS images. Then, the paper reviews how general lung ultrasound examinations are performed before addressing how COVID-19 manifests itself in the images. This will provide the basis to study contemporary methods for both segmentation and classification of lung ultrasound images. The paper concludes with a discussion regarding practical considerations of lung ultrasound image processing use and draws parallels between different methods to allow researchers to decide which particular method may be best considering their needs. With the deficit of trained sonographers who are working to diagnose the thousands of people afflicted by COVID-19, a partially or totally automated lung ultrasound detection and diagnosis tool would be a major asset to fight the pandemic at the front lines.

The Predictive Value of Lung Ultrasound Scores in Developing Bronchopulmonary Dysplasia: A Prospective Multicenter Diagnostic Accuracy Study

Different lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous. What is the diagnostic accuracy of the LUS score to predict moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy? This was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point. Eight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve [AUC] 95%CI, 0.68-0.85 vs0.68-0.85; P= .97), seventh DOL (AUC 95%CI, 0.74-0.85 vs0.74-0.84; P= .26), and 21st DOL (AUC 95%CI, 0.72-0.86 vs0.74-0.88; P= .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95%CI, 0.69-0.83 vs0.66-0.80; P= .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95%CI, 0.77-0.88 vs0.80-0.91 (P= .52). The LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.

Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia.

Background and Objectives: The potential role of lung ultrasound (LUS) in characterizing lung involvement in Coronavirus disease 2019 (COVID-19) is still debated. The aim of the study was to estimate sensitivity of admission LUS for the detection of SARS-CoV-2 lung involvement using Chest-CT (Computed Tomography) as reference standard in order to assess LUS usefulness in ruling out COVID-19 pneumonia in the Emergency Department (ED). Methods: Eighty-two patients with confirmed COVID-19 and signs of lung involvement on Chest-CT were consecutively admitted to our hospital and recruited in the study. Chest-CT and LUS examination were concurrently performed within the first 6–12h from admission. Sensitivity of LUS was calculated using CT findings as a reference standard. Results: Global LUS sensitivity in detecting COVID-19 pulmonary lesions was 52%. LUS sensitivity ranged from 8% in case of focal and sporadic ground-glass opacities (mild disease), to 52% for a crazy-paving pattern (moderate disease) and up to 100% in case of extensive subpleural consolidations (severe disease), although LUS was not always able to detect all the consolidations assessed at Chest-CT. LUS sensitivity was higher in detecting a typical Chest-CT pattern (60%) and abnormalities showing a middle-lower zone predominance (79%). Conclusions: As admission LUS may result falsely negative in most cases, it should not be considered as a reliable imaging tool in ruling out COVID-19 pneumonia in patients presenting in ED. It may at least represent an expanded clinical evaluation that needs integration with other diagnostic tests (e.g., nasopharyngeal swab, Chest-CT).

Simplified 8-site lung ultrasound examination to assess fluid overload in children on haemodialysis.

Simplified 8-site lung ultrasound examination to assess fluid overload in children on haemodialysis.

Point of Care Ultrasonography Findings and Clinical Outcomes in Hospitalized Patients with SARS-CoV-2

Introduction: Point-of-care ultrasound (POCUS) can detect the cardiopulmonary manifestations of COVID-19 and may predict patient outcomes in an expedient and cost-effective manner.Methods: We conducted a prospective cohort study at four medical centers from 3/2020 to 9/2020 to evaluate the relationship between POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received lung ultrasound (LUS) examinations at the bedside with a 12-zone protocol. All images were interpreted by at least two reviewers who were blinded to clinical outcomes.Results: N=99 patients met inclusion criteria. The median time from ED triage to LUS was 0.9 days (IQR: 0.1-2.9). LUS was rarely normal (11% of patients), with B-lines (90%) and subpleural consolidations (62%) representing the most prevalent findings. Findings associated with ICU admission included anterior B-lines (OR: 3.1 [95% CI: 1.2-9.7]), anterior consolidations (OR: 3.1 [95% CI: 1.1-9.9]) and lateral consolidations (OR: 4.1 [95% CI: 1.3-15.5]), while a normal scan was strongly protective against ICU admission (OR 0.08 [95% CI: 0.00-0.68]). LUS findings remained stable over a period of 28 days from symptom onset.Discussion: Anterior and/or lateral lung involvement on POCUS may portend a three to four-fold risk of critical illness among COVID-19 patients. The location, rather than the absolute appearance of POCUS findings, may be important harbingers of severe disease. POCUS findings did not change over a 28-day scanning period, suggesting that their detection at any time point may be clinically important.Funding Statement: None to declareDeclaration of Interests: None to declare. Ethics Approval Statement: This study was approved by the Institutional Review Boards of Stanford University and the University of California, San Francisco. A waiver of consent was obtained by both institutions.

Nanobubble Lung Ultrasound Application in the Treatment of Neonatal Pneumonia.

This article studies the effect of pulmonary ultrasound in the diagnosis and treatment of neonatal pneumonia. In this experiment, 33 children with pneumonia diagnosed and treated in the hospital were selected as the research objects, and all were performed by X-ray examination and lung ultrasound. After the test was completed, the diagnostic accuracy of the two examination methods was analyzed, the performance of the chest X-rays of the children were observed, and the lung ultrasound examination was recorded at the same time. The results showed that the diagnostic accuracy of lung ultrasound examination was 93.00%, which was higher than 75.00% of X-ray examination, and the difference was statistically significant (P < 0.05). In the experiment, the paired chi-square test was performed on the results of LUS and bedside CXR diagnosis of IPN, and the value was 0.687. The two have a good consistency in the diagnosis of IPN in NICU. The Pearson correlation test results of LUS score and neonatal pneumonia case score showed that there was a significant negative correlation between LUS score and neonatal pneumonia case score. The LUS scores between the control group, non-risk recombination, and risk recombination were tested by rank sum test of multiple independent samples. The results showed that the LUS scores of the three groups were statistically significant (P < 0.05). The LUS scores of the risk recombination were significantly higher than the non-risk recombination. Two independent sample rank sum tests were performed between each two groups. After Bonferroni correction of P value, the difference between each group was statistically significant. In the end, we have concluded that for the diagnosis of neonatal pneumonia, pulmonary ultrasound can be used for diagnosis. Combining pulmonary ultrasound with X-rays can improve the diagnosis accuracy of pneumonia. During the treatment, ultrasound is used for dynamic monitoring. By observing the pleural line and pulmonary consolidation it can be used to clarify the treatment effect of children. LUS and bedside CXR have a good agreement for the diagnosis of IPN. The LUS score can effectively assess the severity of IPN. The greater the severity of the disease in children with IPN, the higher the LUS score.

Scientific effort in combating COVID-19 in obstetrics and gynecology.

Scientific effort in combating COVID-19 in obstetrics and gynecology.

Lung ultrasound and BNP to detect hidden pulmonary congestion in euvolemic hemodialysis patients: a single centre experience

BackgroundDry weight assessment in hemodialysis (HD) remains a challenge. The aim of the study was to investigate the prevalence of subclinical pulmonary congestion using lung ultrasound (LUS) in maintenance HD patients with no clinical or bioimpedance signs of hyperhydration. The correlation between B-lines Score (BLS) and brain natriuretic peptide (BNP) was also evaluated.MethodsTwenty-four HD patients underwent LUS and BNP dosage at the end of the mid-week HD session, monthly for 6 months . LUS was considered as positive when BLS was >15. Hospitalizations and cardiovascular events were also evaluated in relation to the BLS.ResultsLUS+ patients at baseline were 16 (67%), whereas 11 (46%) showed LUS + in at least 50% of the measurements (rLUS+ patients). Only the rLUS+ patients had a higher number of cardiovascular events [p=0.019, OR: 7.4 (CI 95%. 1.32-39.8)] and hospitalizations [p=0.034, OR 5.5 (CI 95% 1.22- 24.89)]. A BNP level of 165 pg/ml was identified as cut-off value for predicting pulmonary congestion, defined by BLS >15.ConclusionPrevalence of pulmonary congestion as assessed by LUS and persistent or recurrent BLS >15 were quite prevalent findings in euvolemic HD patients. In the patients defined as rLUS+, a higher rate of cardiovascular events and hospital admissions was registered. BNP serum levels > 165 pg/ml resulted predictive of pulmonary congestion at LUS. In the dialysis care, regular LUS examination should be reasonably included among the methods useful to detect subclinical lung congestion and to adjust patients’ dry weight.

Is E-Learning Education Effective in Increasing the Ability of Nonphysician Medical Flight Crewmembers to Accurately Interpret Point-of-Care Lung and Cardiac Ultrasound Examinations?

ObjectivePatients suffering from severe injury or illness can benefit from the care and transport of helicopter emergency medical services (HEMS). This may be due to the speed of transport, level of care, expertise of flight crews, and access to specialized equipment and tools. One such tool is point-of-care ultrasound (POCUS). POCUS-based lung and cardiac evaluations can positively influence the assessment and care provided to critically ill HEMS patients, but how these procedures can best be learned by nonphysician flight crewmembers has not been fully explored. MethodsIn this prospective, interventional study, 26 flight crewmembers were evaluated before and after a succinct, guided educational intervention focused on the use of free open-access medical education material intended to help them acquire the knowledge needed to accurately identify and interpret POCUS assessments. ResultsAfter completing the educational intervention, participants had a statistically significant improvement in their postintervention scores. ConclusionThis study supports the use of free open-access medical education material in improving the knowledge needed for nonphysician flight crewmembers to interpret basic lung and cardiac ultrasound images. Integrating this information into educational programs may contribute to increased comfort and proficiency and serve to accelerate the adoption of this tool in the air medical environment.

Point-of-care lung ultrasound patterns in late third-trimester gravidas with and without preeclampsia

Transthoracic point-of-care ultrasonography of the lungs has become a standard technique in critical care medicine for the evaluation of patients with respiratory signs or symptoms but has not been well studied in pregnancy. To compare lung ultrasound patterns in third-trimester gravidas with and without preeclampsia and assess interobserver agreement between 3 obstetrical providers and a physician expert in critical care lung ultrasound. This is a prospective observational study of 262 women with singleton pregnancies between 32 0/7 and 41 6/7 weeks' gestation. Lung ultrasound examinations were performed and interpreted by a team of obstetrical care providers and then interpreted by an expert in point-of-care lung ultrasound. The number of B-lines in each of the 4 lung fields, indicating the accumulation of fluid in the interstitial space and the alveoli, was evaluated. The primary outcome was a positive study for pulmonary interstitial edema, defined as an ultrasound study with 3 or more B-lines in 2 or more bilateral lung fields. The secondary outcome was a lung ultrasound study with 1 or 2 B-lines in 1 or more lung fields or 3 B-lines in 1 lung field. Interobserver agreement in lung ultrasound interpretation between obstetrical care providers and an expert in critical care point-of-care ultrasonography of the lung was assessed. Among healthy gravidas, no subject had a lung ultrasound examination positive for pulmonary interstitial edema. Notably, 2 patients with preeclampsia had positive lung ultrasound studies, and both had respiratory symptoms or signs of pulmonary edema. One or 2 B-lines or 3 B-lines in 1 lung field were identified in 11.4% of healthy gravidas and 18.6% of patients with preeclampsia. There was no difference in lung ultrasound patterns between healthy gravidas and those with preeclampsia. The obstetrical care providers and the lung ultrasound expert had a high proportion of agreement regarding the interpretation of negative lung ultrasound examinations. The 2 patients with clinical signs of pulmonary edema were judged to have positive studies by both the obstetrical team and the expert; however, the obstetrical team classified more studies as positive. Lung ultrasound patterns in women with preeclampsia without respiratory symptoms or clinical signs of pulmonary edema are similar to the lung ultrasound patterns of healthy gravidas. Point-of-care lung ultrasound can be used to evaluate third-trimester gravidas with preeclampsia and respiratory complaints or signs concerning for pulmonary edema. Formal training is important before the widespread adoption of point-of-care lung ultrasound by obstetrical healthcare providers.

Lung ultrasound may be a valuable aid in decision making for patients admitted with COVID-19 disease

ABSTRACT INTRODUCTION: COVID-19 is associated with a risk of severe pneumonia and acute respiratory distress syndrome (ARDS), requiring treatment at an intensive care unit (ICU). Since clinical deterioration may occur rapidly, a simple, fast, bedside, non-invasive method for assessment of lung changes is warranted. The primary aim of this study was to investigate whether lung ultrasound (LUS) findings within 72 hours of admission were predictive of clinical deterioration in hospitalized patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). METHODS: Patients admitted to a dedicated COVID-19 unit were subject to daily LUS examinations. Number of present consolidations and pleural effusions were registered and a Mongodi score was calculated. These findings were correlated with initial chest x-ray and clinical deterioration, defined as ICU-admission, ARDS diagnosis, death. RESULTS: In total, 29 of 83 patients had LUS performed during admission, 18 within 72 h of admission. Of these, four patients died during admission, six were transferred to the ICU and 13 were diagnosed with ARDS. Initial Mongodi-score did not differ significantly between patients with and without clinical deterioration (p = 0.95). Agreement between initial LUS and chest x-ray findings were fair with Cohen’s Kappa at 0.21. CONCLUSION: LUS performed within 72 h in patients admitted to a dedicated COVID-19 unit could not predict ARDS, ICU admission or death. However, consecutive investigations may be of value, as sudden substantial changes may herald disease progression, enabling earlier supplementary diagnostics and treatment initiation.

MAIN PREDICTORS OF CORONAVIRUS DISEASE SEVERITY PROGNOSIS

Coronavirus disease can have a variety of clinical symptoms, ranged from asymptomatic to severe and even critical ones. To date, an information on the epidemiology, clinical features, prevention and treatment of this disease is insufficient, which requires a further study of the problem. To personalize the treatment, it is important to determine the leading clinical and laboratory predictors to forecast the severity of COVID−19. The algorithm of examination of a patient includes the assessment of all complaints, data of the anamnesis of the disease, epidemiological anamnesis. The combination of clinical examination to determine the severity of the patient's condition includes physical examination, the one of diagnostic material using methods of nucleic acid amplification and / or enzyme−linked immunosorbent assay, pulse oximetry. Laboratory, etiological diagnostics, tests and antibodies play an important role. In case of hospitalization of the patients with moderate, severe and extremely severe infection, clinical studies are required such as: general (clinical) and biochemical blood test, coagulogram, diagnosis of disseminated intravascular coagulation syndrome, as well as identification of risk factors. Instrumental and radiological diagnostics include: pulse oximetry with measurement of SpO2 level, computed tomography and ultrasound examination of lungs and pleural cavities, electrocardiography. Comprehensive evaluation of clinical and laboratory data of patients allows to determine a clinically confirmed COVID−19, to route the patient and to start complex therapy in time. A promising direction is the introduction of the method of quantitative diagnostics by polymerase chain reaction on SARS−CoV−2 RNA in the activity of laboratories of Ukraine, which will help to individualize the degree of viral load in patients, improve treatment control. Key words: COVID−19, predictors of course severity, methods of laboratory diagnostics, quantitative polymerase chain reaction.

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

.Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15–28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7–14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.

Lung Ultrasound in the Emergency Department for Early Identification of COVID-19 Pneumonia

Background: Coronavirus disease 2019 (COVID-19) is a pandemic overwhelming the health care systems worldwide. Lung ultrasound (LUS) use has been proposed to identify suspected COVID-19 patients and direct them to the isolation area in the emergency department (ED) or to discharge them for outpatient treatment. Objective: Our aim was to retrospectively investigate the use of LUS in the ED to identify COVID-19 pneumonia (CP). Methods: We performed a retrospective single-center study including all patients accessing the ED who underwent LUS examination for suspicion of COVID-19 during the initial outbreak. Demographics, clinical parameters, laboratory values, imaging features, and outcome variables were collected. The receiver operating characteristic (ROC) curve was used to evaluate diagnostic accuracy. Results: A total of 41% patients were COVID-19-positive; 67% of them were diagnosed with CP. The ROC curve of the LUS score showed an area under the curve of 0.837 (95% CI 0.75–0.92) and with a cutoff value ≥3 identified 28 of 31 patients with CP and 11 of 15 without (sensitivity 90%, 95% CI 74–97%; specificity 75%, 95% CI 56–76%). LUS in combination with nasopharyngeal swab has a sensitivity of 100% (95% CI 74–97%) and a specificity of 61% (95% CI 44–67%). Conclusions: LUS is a promising technique for early identification of CP in patients who accessed the ED in an active epidemic time. The LUS score shows a sensitivity of 90% for CP, allowing to quickly direct patients with COVID-19 to the ED isolation area or to discharge them for outpatient treatment.

Chinese recommendations for the implementation of bedside echocardiography and remote consultation in patients with coronavirus disease 2019.

Chinese recommendations for the implementation of bedside echocardiography and remote consultation in patients with coronavirus disease 2019.