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Zhang B, Cong H, Shen Y, Sun M. Visual Perception and Convolutional Neural Network-Based Robotic Autonomous Lung Ultrasound Scanning Localization System. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:961-974. [PMID: 37015119 DOI: 10.1109/tuffc.2023.3263514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Under the situation of severe COVID-19 epidemic, lung ultrasound (LUS) has been proved to be an effective and convenient method to diagnose and evaluate the extent of respiratory disease. However, the traditional clinical ultrasound (US) scanning requires doctors not only to be in close contact with patients but also to have rich experience. In order to alleviate the shortage of medical resources and reduce the work stress and risk of infection for doctors, we propose a visual perception and convolutional neural network (CNN)-based robotic autonomous LUS scanning localization system to realize scanned target recognition, probe pose solution and movement, and the acquisition of US images. The LUS scanned targets are identified through the target segmentation and localization algorithm based on the improved CNN, which is using the depth camera to collect the image information; furthermore, the method based on multiscale compensation normal vector is used to solve the attitude of the probe; finally, a position control strategy based on force feedback is designed to optimize the position and attitude of the probe, which can not only obtain high-quality US images but also ensure the safety of patients and the system. The results of human LUS scanning experiment verify the accuracy and feasibility of the system. The positioning accuracy of the scanned targets is 15.63 ± 0.18 mm, and the distance accuracy and rotation angle accuracy of the probe position calculation are 6.38 ± 0.25 mm and 8.60° ±2.29° , respectively. More importantly, the obtained high-quality US images can clearly capture the main pathological features of the lung. The system is expected to be applied in clinical practice.
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2
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Maino C, Franco PN, Talei Franzesi C, Giandola T, Ragusi M, Corso R, Ippolito D. Role of Imaging in the Management of Patients with SARS-CoV-2 Lung Involvement Admitted to the Emergency Department: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13111856. [PMID: 37296708 DOI: 10.3390/diagnostics13111856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
During the waves of the coronavirus disease (COVID-19) pandemic, emergency departments were overflowing with patients suffering with suspected medical or surgical issues. In these settings, healthcare staff should be able to deal with different medical and surgical scenarios while protecting themselves against the risk of contamination. Various strategies were used to overcome the most critical issues and guarantee quick and efficient diagnostic and therapeutic charts. The use of saliva and nasopharyngeal swab Nucleic Acid Amplification Tests (NAAT) in the diagnosis of COVID-19 was one of the most adopted worldwide. However, NAAT results were slow to report and could sometimes create significant delays in patient management, especially during pandemic peaks. On these bases, radiology has played and continues to play an essential role in detecting COVID-19 patients and solving differential diagnosis between different medical conditions. This systematic review aims to summarize the role of radiology in the management of COVID-19 patients admitted to emergency departments by using chest X-rays (CXR), computed tomography (CT), lung ultrasounds (LUS), and artificial intelligence (AI).
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Affiliation(s)
- Cesare Maino
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Paolo Niccolò Franco
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Maria Ragusi
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090 Monza, Italy
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3
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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Blazic I, Cogliati C, Flor N, Frija G, Kawooya M, Umbrello M, Ali S, Baranne ML, Cho YJ, Pitcher R, Vollmer I, van Deventer E, del Rosario Perez M. The use of lung ultrasound in COVID-19. ERJ Open Res 2023; 9:00196-2022. [PMID: 36628270 PMCID: PMC9548241 DOI: 10.1183/23120541.00196-2022] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
This review article addresses the role of lung ultrasound in patients with coronavirus disease 2019 (COVID-19) for diagnosis and disease management. As a simple imaging procedure, lung ultrasound contributes to the early identification of patients with clinical conditions suggestive of COVID-19, supports decisions about hospital admission and informs therapeutic strategy. It can be performed in various clinical settings (primary care facilities, emergency departments, hospital wards, intensive care units), but also in outpatient settings using portable devices. The article describes typical lung ultrasound findings for COVID-19 pneumonia (interstitial pattern, pleural abnormalities and consolidations), as one component of COVID-19 diagnostic workup that otherwise includes clinical and laboratory evaluation. Advantages and limitations of lung ultrasound use in COVID-19 are described, along with equipment requirements and training needs. To infer on the use of lung ultrasound in different regions, a literature search was performed using key words "COVID-19", "lung ultrasound" and "imaging". Lung ultrasound is a noninvasive, rapid and reproducible procedure; can be performed at the point of care; requires simple sterilisation; and involves non-ionising radiation, allowing repeated exams on the same patient, with special benefit in children and pregnant women. However, physical proximity between the patient and the ultrasound operator is a limitation in the current pandemic context, emphasising the need to implement specific infection prevention and control measures. Availability of qualified staff adequately trained to perform lung ultrasound remains a major barrier to lung ultrasound utilisation. Training, advocacy and awareness rising can help build up capacities of local providers to facilitate lung ultrasound use for COVID-19 management, in particular in low- and middle-income countries.
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Affiliation(s)
- Ivana Blazic
- Radiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Chiara Cogliati
- Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Nicola Flor
- Unità Operativa di Radiologia, Luigi Sacco University Hospital, Milan, Italy
| | - Guy Frija
- Université de Paris, International Society of Radiology, Paris, France
| | - Michael Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milan, Italy
| | - Sam Ali
- ECUREI, Mengo Hospital, Kampala, Uganda
| | - Marie-Laure Baranne
- Assistance Publique – Hôpitaux de Paris, Paris Institute for Clinical Ultrasound, Paris, France
| | - Young-Jae Cho
- South Korea/Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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5
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Jari R, Alfuraih AM, McLaughlan JR. The diagnostic performance of lung ultrasound for detecting COVID-19 in emergency departments: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:618-627. [PMID: 35261033 PMCID: PMC9088324 DOI: 10.1002/jcu.23184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 05/05/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of published literature investigating the use of lung ultrasound (LUS) on COVID-19 patients, in emergency point of care settings, and to determine its diagnostic value compared with lung computed tomography (LCT) diagnostic performance. Whilst using the real-time polymerase chain reaction test as the 'gold standard'. METHODS Literature searches were performed on MEDLINE, Embase, Web of Science, and PubMed databases for eligible studies. The LUS and LCT pooled diagnostic performance were measured using DerSimonian-Laird random effect method. RESULT Out of a total of 158 studies, 16 met the eligibility criteria and were included in this review. The pooled sensitivity, specificity, positive and negative likelihood ratios were 86.9%, 62.4%, 2.4 and 0.19, respectively for LUS and 93.5%, 72.6%, 3.3 and 0.05, respectively for LCT. CONCLUSION The lung ultrasound (LUS) demonstrated acceptable sensitivity but poor specificity when used independently to diagnose COVID-19 pneumonia patients in emergency departments, while the lung computed tomography showed higher performance. Thus, LUS can be used to supplement existing diagnostic tools and possibly for the triage of patients.
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Affiliation(s)
- Reem Jari
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Chapel Allerton HospitalUniversity of LeedsLeedsUK
| | - Abdulrahman M. Alfuraih
- Radiology and Medical Imaging Department, College of Applied Medical SciencesPrince Sattam bin Abdulaziz UniversityAl‐KharjSaudi Arabia
| | - James R. McLaughlan
- Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical EngineeringUniversity of LeedsLeedsUK
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6
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Zaky S, Fathelbab HK, Elbadry M, El-Raey F, Abd-Elsalam SM, Makhlouf HA, Makhlouf NA, Metwally MA, Ali-Eldin F, Hasan AA, Alboraie M, Yousef AM, Shata HM, Eid A, Asem N, Khalaf A, Elnady MA, Elbahnasawy M, Abdelaziz A, Shaltout SW, Elshemy EE, Wahdan A, Hegazi MS, Abdel Baki A, Hassany M. Egyptian Consensus on the Role of Lung Ultrasonography During the Coronavirus Disease 2019 Pandemic. Infect Drug Resist 2022; 15:1995-2013. [PMID: 36176457 PMCID: PMC9513721 DOI: 10.2147/idr.s353283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background & Aims Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.
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Affiliation(s)
- Samy Zaky
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Elbadry
- Department of Endemic Medicine, Helwan University, Cairo, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Sherief M Abd-Elsalam
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
- Correspondence: Sherief M Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta, Egypt, Tel +201063319696, Email
| | | | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Mohamed A Metwally
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Benha University, Benha, Egypt
| | - Fatma Ali-Eldin
- Department of Tropical medicine; Ain Shams University, Cairo, Egypt
| | | | - Mohamed Alboraie
- Department of Internal Medicine; Al-Azhar University, Cairo, Egypt
| | - Ahmed M Yousef
- Department of Community and Industrial Medicine, Damietta, Al-Azhar University, Damietta, Egypt
| | - Hanan M Shata
- Department of Chest Medicine; Mansoura University, Mansoura, Egypt
| | - Alshaimaa Eid
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University and Ministry of Health and Population, Cairo, Egypt
| | - Asmaa Khalaf
- Department of Radiology, Minia University, Minia, Egypt
| | - Mohamed A Elnady
- Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elbahnasawy
- Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt
| | - Ahmed Abdelaziz
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Shaker W Shaltout
- Department of Tropical Medicine, Port Said University, Port Said, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Atef Wahdan
- Department of Chest Diseases, Damietta, Al-Azhar University, Damietta, Egypt
| | - Mohamed S Hegazi
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Amin Abdel Baki
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
| | - Mohamed Hassany
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
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7
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Vulasala SSR, Gopireddy DR, Bhosale P, Virarkar MK. Comments on "Review of the role of diagnostic modalities and imaging findings in the COVID-19 pandemic". World J Radiol 2022; 14:50-54. [PMID: 35317243 PMCID: PMC8891646 DOI: 10.4329/wjr.v14.i2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/11/2021] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
The present letter to the editor corresponds to the article entitled "Comprehensive literature review on the radiographic findings, imaging modalities, and the role of radiology in the coronavirus disease 2019 (COVID-19) pandemic" by Pal et al, published in World J Radiol. 2021; 13(9): 258-282. With zero to unknown prevalence, COVID-19 has created a heterogeneous and unforeseen situation across the world. Healthcare providers encountered new challenges in image interpretation, characterization, and prognostication of the disease. Pal et al delineated the radiological findings, which would guide the radiologists to identify the early signs of severe infection.
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Affiliation(s)
- Sai Swarupa R Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| | - Dheeraj R Gopireddy
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| | - Priya Bhosale
- Department of Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
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8
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Toraskar K, Zore RR, Gupta GA, Gondse B, Pundpal G, Kadam S, Pawaskar S, Setia MS. Utility and diagnostic test properties of pulmonary and cardiovascular point of care ultra-sonography (POCUS) in COVID-19 patients admitted to critical care unit. Eur J Radiol Open 2022; 9:100451. [PMID: 36345320 PMCID: PMC9630137 DOI: 10.1016/j.ejro.2022.100451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background We conducted this study to assess the diagnostic test properties of point of care ultrasonography (POCUS) of lung and cardiovascular system in prediction of mortality in COVID-19 patients. Methods This is a cross-sectional study of 178 Covid-19 patients; POCUS was performed within one hour of admission to the ICU. We estimated sensitivity, specificity, positive predictive value, negative predictive value for prediction of mortality. Results The mean (SD) age of these patients was 57.3 (12.8) years. The findings were on cardiac ultrasonography were: mild pericardial effusion (45%), chamber dilatation (15%), hypokinesia (11%), and low ejection fraction (8%). In our study, 30 patients (17%) had died. A cut-off score of > to 13 (for lung ultrasound score [LUS]) had high sensitivity for mortality (93.3%, 95% CI: 77.9–99.2%). However, low ejection fraction (92.3%, 95% CI: 86,6–96.1%), and thrombosis in either vein (96.5%, 95% CI: 92.0–98.9%) were specific for mortality. A combination of LUS > =13 or low ejection fraction or thrombosis or spontaneous echo contrast (slow flow) improved sensitivity for mortality to 96.7% (95% CI: 82.8–99.9%). The agreement between LUS of > =13 and CT score of moderate/severe was 85.7% (95% CI: 62.8–100%). The interrater agreement between these two parameters was 0.82 (95% CI: 0.68, 0.97). Conclusions Multi-organ POCUS is effective in diagnosis, prognosis, and management of COVID-19 patients. Rather than just lung ultrasound, clinicians should use multiorgan POCUS for early identification of severe lung involvement and thrombotic changes; it may help reduce mortality in these patients.
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Affiliation(s)
- Kedar Toraskar
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Ravindra R. Zore
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Gaurav A. Gupta
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Bhooshan Gondse
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Gurudas Pundpal
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Shirishkumar Kadam
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Sachin Pawaskar
- Critical Care Department, Wockhardt Hospital, Mumbai Central, Mumbai 400011, India
| | - Maninder Singh Setia
- MGM Institute of Health Sciences, Kamothe, Navi Mumbai 410209, India
- Corresponding author.
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9
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Chardoli M, Sabbaghan Kermani S, Abdollahzade Manqoutaei S, Loesche MA, Duggan NM, Schulwolf S, Tofighi R, Yadegari S, Shokoohi H. Lung ultrasound in predicting COVID-19 clinical outcomes: A prospective observational study. J Am Coll Emerg Physicians Open 2021; 2:e12575. [PMID: 34755148 PMCID: PMC8560933 DOI: 10.1002/emp2.12575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVE We sought to determine the ability of lung point-of-care ultrasound (POCUS) to predict mechanical ventilation and in-hospital mortality in patients with coronavirus disease 2019 (COVID-19). METHODS This was a prospective observational study of a convenience sample of patients with confirmed COVID-19 presenting to 2 tertiary hospital emergency departments (EDs) in Iran between March and April 2020. An emergency physician attending sonographer performed a 12-zone bilateral lung ultrasound in all patients. Research associates followed the patients on their clinical course. We determined the frequency of positive POCUS findings, the geographic distribution of lung involvement, and lung severity scores. We used multivariable logistic regression to associate lung POCUS findings with clinical outcomes. RESULTS A total of 125 patients with COVID-like symptoms were included, including 109 with confirmed COVID-19. Among the included patients, 33 (30.3%) patients were intubated, and in-hospital mortality was reported in 19 (17.4%). Lung POCUS findings included pleural thickening 95.4%, B-lines 90.8%, subpleural consolidation 86.2%, consolidation 46.8%, effusions 19.3%, and atelectasis 18.3%. Multivariable logistic regression incorporating binary and scored POCUS findings were able to identify those at highest risk for need of mechanical ventilation (area under the curve 0.80) and in-hospital mortality (area under the curve 0.87). In the binary model ultrasound (US) findings in the anterior lung fields were significantly associated with a need for intubation and mechanical ventilation (odds ratio [OR] 3.67; 0.62-21.6). There was an inverse relationship between mortality and posterior lung field involvement (OR 0.05; 0.01-0.23; and scored OR of 0.57; 0.40-0.82). Anterior lung field involvement was not associated with mortality. CONCLUSIONS In patients with COVID-19, the anatomic distribution of findings on lung ultrasound is associated with outcomes. Lung POCUS-based models may help clinicians to identify those patients with COVID-19 at risk for clinical deterioration.Key Words: COVID-19; Lung Ultrasound; Mechanical ventilation; Prediction; ICU admission; Mortality; Clinical outcome; Risk stratification; Diagnostic accuracy.
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Affiliation(s)
- Mojtaba Chardoli
- Department of Emergency MedicineFirouzgar General HospitalIran University of Medical SciencesTehranIran
| | | | | | - Michael A. Loesche
- Harvard Affiliated Emergency Medicine Residency Program‐Harvard Medical SchoolBostonMassachusettsUSA
| | - Nicole M. Duggan
- Harvard Affiliated Emergency Medicine Residency Program‐Harvard Medical SchoolBostonMassachusettsUSA
| | - Sara Schulwolf
- Division of Emergency UltrasoundDepartment of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | | | | | - Hamid Shokoohi
- Department of Emergency MedicineHarvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA
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10
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Torres-Macho J, Sánchez-Fernández M, Arnanz-González I, Tung-Chen Y, Franco-Moreno AI, Duffort-Falcó M, Beltrán-Romero L, Rodríguez-Suaréz S, Bernabeu-Wittel M, Urbano E, Méndez-Bailon M, Roque-Rojas F, García-Guijarro E, García-Casasola G. Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study). J Clin Med 2021; 10:jcm10214818. [PMID: 34768337 PMCID: PMC8584928 DOI: 10.3390/jcm10214818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/16/2021] [Indexed: 12/23/2022] Open
Abstract
The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0–48 h and 72–96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer–Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0–11 points, 12–24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58–0.85) vs. 0.61 (0.52–0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66–0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
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Affiliation(s)
- Juan Torres-Macho
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Correspondence:
| | | | - Irene Arnanz-González
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Emergency Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain
| | - Yale Tung-Chen
- Emergency Department, La Paz University Hospital, 28046 Madrid, Spain;
- Enfermera Isabel Zendal Emergency Hospital, 28055 Madrid, Spain
| | - Ana Isabel Franco-Moreno
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
| | - Mercedes Duffort-Falcó
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
| | - Luis Beltrán-Romero
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Santiago Rodríguez-Suaréz
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Máximo Bernabeu-Wittel
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Elena Urbano
- Internal Medicine Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Manuel Méndez-Bailon
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Internal Medicine Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Fernando Roque-Rojas
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
| | - Elena García-Guijarro
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
| | - Gonzalo García-Casasola
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
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11
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Salzmann C, Schmidt C, Sauvigny D, Janneck M, Lock G. [Lung Ultrasound on Admission to a Covid Decision Unit - Helpful in Differential Diagnosis or a Waste of Time?]. Pneumologie 2021; 75:856-863. [PMID: 34255339 DOI: 10.1055/a-1502-8844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In patients with Covid-19, typical and often severe lung lesions have been reported. In addition to the use of chest CT, the diagnostic benefit of lung ultrasound has been advocated.This trial investigates if in patients presenting with symptoms compatible with Covid-19, lung ultrasound is of use in the early differential diagnosis. METHODS This study includes 46 patients of the first wave of the Covid-19 pandemic (23 with confirmed infection, 23 controls with later on excluded infection), who were initially admitted to the Covid Decision Unit of an academic teaching hospital under the clinical suspicion of SARS-CoV-2 infection. All patients were examined by pulmonary ultrasound shortly after admission. The final diagnosis of infection was made or ruled out by means of - sometimes repeated - PCR of nasal/pharyngeal swabs.Findings of SARS-CoV-2 patients and controls were compared and analyzed for significant differences in chest sonographic parameters. RESULTS There were significant differences in the lung ultrasound findings of both groups. In the Covid group there were significantly fewer A-lines, more pathological B-lines (increased or confluent) and more consolidations. Pleural effusions were significantly more frequent in the control group. The calculated lung ultrasound score (LUS) was higher in the Covid group than in the control group. However, a reliable differentiation between the two groups was not possible due to the wide range and overlap. CONCLUSION: In a clinical setting, lung ultrasound reveals more frequent and different lesions in SARS-CoV-2 infected patients than in patients in whom the initial clinical suspicion was not confirmed. However, due to the overlap of findings between the two groups, lung ultrasound was not suitable to differentiate with sufficient certainty between SARS-CoV-2 infected and non-infected patients.
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Affiliation(s)
| | | | | | | | - Guntram Lock
- Klink für Innere Medizin, Albertinen-Krankenhaus, Hamburg
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12
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Deana C, Rovida S, Orso D, Bove T, Bassi F, De Monte A, Vetrugno L. Learning from the Italian experience during COVID-19 pandemic waves: be prepared and mind some crucial aspects. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021097. [PMID: 33988143 PMCID: PMC8182622 DOI: 10.23750/abm.v92i2.11159] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic.
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Affiliation(s)
| | - Serena Rovida
- 2Department of Anesthesia and Intensive Care Unit, Saint Bartholomew's Hospital, Barts NHS Trust, London, UK..
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Amato De Monte
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy..
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13
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Is lung ultrasound score a useful tool to monitoring and handling moderate and severe COVID-19 patients in the general ward? An observational pilot study. J Clin Monit Comput 2021; 36:785-793. [PMID: 33948780 PMCID: PMC8096129 DOI: 10.1007/s10877-021-00709-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/14/2021] [Indexed: 12/11/2022]
Abstract
Lung ultrasound is a well-established diagnostic tool in acute respiratory failure, and it has been shown to be particularly suited for the management of COVID-19-associated respiratory failure. We present exploratory analyses on the diagnostic and prognostic performance of lung ultrasound score (LUS) in general ward patients with moderate-to-severe COVID-19 pneumonia receiving O2 supplementation and/or noninvasive ventilation. From March 10 through May 1, 2020, 103 lung ultrasound exams were performed by our Forward Intensive Care Team (FICT) on 26 patients (18 males and 8 females), aged 62 (54 - 76) and with a Body Mass Index (BMI) of 30.9 (28.7 - 31.5), a median 6 (5 - 9) days after admission to the COVID-19 medical unit of the University Hospital of Parma, Italy. All patients underwent chest computed tomography (CT) the day of admission. The initial LUS was 16 (11 - 21), which did not significantly correlate with initial CT scans, probably due to rapid progression of the disease and time between CT scan on admission and first FICT evaluation; conversely, LUS was significantly correlated with PaO2/FiO2 ratio throughout patient follow-up [R = - 4.82 (- 6.84 to - 2.80; p < 0.001)]. The area under the receiving operating characteristics curve of LUS for the diagnosis of moderate-severe disease (PaO2/FiO2 ratio ≤ 200 mmHg) was 0.73, with an optimal cutoff value of 11 (positive predictive value: 0.98; negative predictive value: 0.29). Patients who eventually needed invasive ventilation and/or died during admission had significantly higher LUS throughout their stay.
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14
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Yau O, Gin K, Luong C, Jue J, Abolmaesumi P, Tsang M, Nair P, Tsang TSM. Point-of-care ultrasound in the COVID-19 era: A scoping review. Echocardiography 2021; 38:329-342. [PMID: 33332638 DOI: 10.1111/echo.14951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
In the midst of the COVID-19 pandemic, unprecedented pressure has been added to healthcare systems around the globe. Imaging is a crucial component in the management of COVID-19 patients. Point-of-care ultrasound (POCUS) such as hand-carried ultrasound emerges in the COVID-19 era as a tool that can simplify the imaging process of COVID-19 patients, and potentially reduce the strain on healthcare providers and healthcare resources. The preliminary evidence available suggests an increasing role of POCUS in diagnosing, monitoring, and risk-stratifying COVID-19 patients. This scoping review aims to delineate the challenges in imaging COVID-19 patients, discuss the cardiopulmonary complications of COVID-19 and their respective sonographic findings, and summarize the current data and recommendations available. There is currently a critical gap in knowledge in the role of POCUS in the COVID-19 era. Nonetheless, it is crucial to summarize the current preliminary data available in order to help fill this gap in knowledge for future studies.
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Affiliation(s)
- Olivia Yau
- Faculty of Medicine, Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC, Canada
| | - Ken Gin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christina Luong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Jue
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Purang Abolmaesumi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Michael Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Parvathy Nair
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa S M Tsang
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Dwivedi D, Bhan S, Paul D, Hooda B. Point-of-care lung ultrasound and early detection of pneumothorax in a COVID-19–positive patient undergoing noninvasive ventilation therapy. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2021. [DOI: 10.4103/ijam.ijam_168_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Boero E, Schreiber A, Rovida S, Vetrugno L, Blaivas M. The role of lung ultrasonography in COVID-19 disease management. J Am Coll Emerg Physicians Open 2020; 1:1357-1363. [PMID: 32838389 PMCID: PMC7404352 DOI: 10.1002/emp2.12194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has created unprecedented disruption for global healthcare systems. Offices and emergency departments (EDs) were the first responders to the pandemic, followed by medical wards and intensive care unit (ICUs). Worldwide efforts sprouted to coordinate proper response by increasing surge capacity and optimizing diagnosis and containment. Within the complex scenario of the outbreak, the medical community shared scientific research and implemented best-guess imaging strategies in order to save time and additional staff exposures. Early publications showed agreement between chest computed tomography (CT) and lung sonography: widespread ground-glass findings resembling acute respiratory distress syndrome (ARDS) on CT of COVID-19 patients matched lung ultrasound signs and patterns. Well-established accuracy of bedside sonography for lung conditions and its advantages (such as no ionizing radiation; low-cost, real-time bedside imaging; and easier disinfection steps) prompted a wider adoption of lung ultrasound for daily assessment and monitoring of COVID-19 patients. Growing literature, webinars, online materials, and international networks are promoting lung ultrasound for the same purpose. We propose 11 lung ultrasound roles for different medical settings during the pandemic, starting from the out-of-hospital setting, where lung ultrasound has ergonomic and infection control advantages. Then we describe how medical wards and ICUs can safely integrate lung ultrasound into COVID-19 care pathways. Finally, we present outpatient use of lung ultrasound to aid follow-up of positive case contacts and of those discharged from the hospital.
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Affiliation(s)
- Enrico Boero
- Anesthesia and Intensive Care UnitSan Giovanni Bosco HospitalTurinItaly
| | - Annia Schreiber
- Interdepartmental Division of Critical Care MedicineUnity Health Toronto (St. Michael's Hospital)TorontoCanada
| | - Serena Rovida
- Department of Anesthesia and Intensive Care UnitSaint Bartholomew's HospitalBarts NHS TrustLondonUK
| | - Luigi Vetrugno
- Anesthesia and Intensive Care Unit, Department of MedicineUniversity of UdineUdineItaly
| | - Michael Blaivas
- Department of Medicine. Department of Emergency MedicineSt. Francis Hospital, University of South Carolina School of MedicineColumbusGeorgiaUSA
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