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Berry L, Rehnberg L, Groves P, Knight M, Stewart M, Dushianthan A. Lung Ultrasound in Critical Care: A Narrative Review. Diagnostics (Basel) 2025; 15:755. [PMID: 40150097 PMCID: PMC11941729 DOI: 10.3390/diagnostics15060755] [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: 01/21/2025] [Revised: 03/04/2025] [Accepted: 03/13/2025] [Indexed: 03/29/2025] Open
Abstract
Lung ultrasound (LUS) has become a crucial part of the investigative tools available in the management of critically ill patients, both within the intensive care unit setting and in prehospital medicine. The increase in its application, in part driven by the COVID-19 pandemic, along with the easy access and use of mobile and handheld devices, allows for immediate access to information, reducing the need for other radiological investigations. LUS allows for the rapid and accurate diagnosis and grading of respiratory pathology, optimisation of ventilation, assessment of weaning, and monitoring of the efficacy of surfactant therapies. This, however, must occur within the framework of accreditation to ensure patient safety and prevent misinterpretation and misdiagnosis. This narrative review aims to outline the current uses of LUS within the context of published protocols, associated pathologies, LUS scoring systems, and their applications, whilst exploring more novel uses.
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Affiliation(s)
- Lee Berry
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- School of Health Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Lucas Rehnberg
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
| | - Paul Groves
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Shackleton Department of Anaesthetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Martin Knight
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Shackleton Department of Anaesthetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Michael Stewart
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Shackleton Department of Anaesthetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (L.R.); (P.G.); (M.K.); (M.S.)
- Perioperative and Critical Care Theme, NIHR Biomedical Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Musolino AM, Tei M, De Rose C, Buonsenso D, Supino MC, Zampogna S, Staiano A, Raponi M, Amendolea A, Colacino V, Gori L, Manganaro A, Ricci R, D'Inzeo V, Grosso S, Villani A, Agostiniani R. Pediatric ultrasound practice in Italy: an exploratory survey. Ital J Pediatr 2024; 50:114. [PMID: 38853266 PMCID: PMC11163714 DOI: 10.1186/s13052-024-01680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide. METHODS A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022. RESULTS There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%). CONCLUSIONS Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.
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Affiliation(s)
- Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Monica Tei
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Stefania Zampogna
- Department Pediatrics, Hospital of Crotone President of SIMEUP (Italian Society of Pediatric Emergency Medicine Urgency), Crotone, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", President of SIP (Italian Society of Pediatric), Naples, Italy
| | - Massimiliano Raponi
- Management and Diagnostic Innovations and Clinical Pathways Research Area, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | | | | | - Laura Gori
- Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, 56100, Italy
| | - Alessandro Manganaro
- Pathology and Neonatal and Pediatric Intensive Care Unit, University Hospital G. Martino, Messina, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Victoria D'Inzeo
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Rino Agostiniani
- Department of Pediatrics and Neonatology, San Jacopo Hospital, Via Ciliegiole 97, 51100, Pistoia, Italy
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A survey of barriers and facilitators to ultrasound use in low- and middle-income countries. Sci Rep 2023; 13:3322. [PMID: 36849625 PMCID: PMC9969046 DOI: 10.1038/s41598-023-30454-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
Point-of-care ultrasound has the potential to help inform assessment, diagnosis, and management of illness in low- and middle-income countries (LMIC). To better understand current ultrasound use, barriers and facilitators to use, and perceptions and practices in LMIC, we conducted an anonymous online global survey targeting healthcare providers training and using ultrasound in LMIC. A total of 241 respondents representing 62 countries participated and most were physicians working in publicly-funded urban tertiary hospitals in LMIC. Most had received ultrasound training (78%), reported expertise (65%) and confidence (90%) in ultrasound use, and had access to ultrasound (88%), utilizing ultrasound most commonly for procedures and for evaluations of lungs, heart, and trauma. Access to an ultrasound machine was reported as both the top barrier (17%) and top facilitator (53%); other common barriers included access to education and training, cost, and competition for use and other common facilitators included access to a probe, gel, and electricity, and acceptance by healthcare providers, administrators, and patients. Most (80%) noted ultrasound access was important and 96% agreed that ultrasound improves quality of care and patient outcomes. Improving access to low-cost ultrasound equipment is critical to increasing ultrasound use among those who are trained.
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Vetrugno L, Mojoli F, Boero E, Berchialla P, Bignami EG, Orso D, Cortegiani A, Forfori F, Corradi F, Cammarota G, De Robertis E, Mongodi S, Chiumello D, Poole D, Ippolito M, Biasucci DG, Persona P, Bove T, Ball L, Pelosi P, Navalesi P, Antonelli M, Corcione A, Giarratano A, Petrini F. Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:464-472. [PMID: 34734405 PMCID: PMC9534595 DOI: 10.1055/a-1634-4710] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. MATERIALS AND METHODS The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. RESULTS 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001). CONCLUSION This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Italy
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Correspondence Dr. Luigi Vetrugno Department of Medicine, University of UdineVia Colugna 5033100 UdineItaly+39/4 32/55 95 01
| | - Francesco Mojoli
- Anesthesiology, Intensive Care and Pain Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- Anesthesia and Intensive Care, University Hospital of Pavia, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care, Hospital Saint-Giovanni Bosco Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin Faculty of Medicine and Surgery, Torino, Italy
| | - Elena Giovanna Bignami
- Department of Medicine and Surgery, University of Parma Department of Medicine and Surgery, Parma, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia Department of Medicine, Perugia, Italy
| | - Silvia Mongodi
- Anesthesiology and Intensive Care, University Hospital of Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
| | - Davide Chiumello
- Department of Anesthesiology and Intensive Care, University of Milan, Milano, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, Hospital Saint-Martinus, Belluno, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Paolo Persona
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Antonio Corcione
- Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Italy, Naples, Italy
| | - Antonino Giarratano
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Flavia Petrini
- Anesthesia, Intensive Care and Pain Management, President Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), Rome Italy, Rome, Italy
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Vetrugno L, Meroi F, Orso D, D’Andrea N, Marin M, Cammarota G, Mattuzzi L, Delrio S, Furlan D, Foschiani J, Valent F, Bove T. Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study. Healthcare (Basel) 2022; 10:healthcare10030568. [PMID: 35327046 PMCID: PMC8955357 DOI: 10.3390/healthcare10030568] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival.
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Affiliation(s)
- Luigi Vetrugno
- Dipartimento di Scienze, Orali e Biotecnologiche, Università degli Studi “G. d’Annunzio”, 66100 Chieti, Italy;
| | - Francesco Meroi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
- Correspondence:
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Natascia D’Andrea
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Matteo Marin
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Gianmaria Cammarota
- Division of Anesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Lisa Mattuzzi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Silvia Delrio
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Davide Furlan
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Jonathan Foschiani
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Francesca Valent
- Clinical and Evaluational Epidemiologic Service, Department of Governance, Local Health Authority, 38123 Trento, Italy;
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
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Di Gioia CC, Artusi N, Xotta G, Bonsano M, Sisto UG, Tecchiolli M, Orso D, Cominotto F, Amore G, Meduri S, Copetti R. Lung ultrasound in ruling out COVID-19 pneumonia in the ED: a multicentre prospective sensitivity study. Emerg Med J 2022; 39:199-205. [PMID: 34937709 PMCID: PMC8704061 DOI: 10.1136/emermed-2020-210973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/13/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Early diagnosis of COVID-19 has a crucial role in confining the spread among the population. Lung ultrasound (LUS) was included in the diagnostic pathway for its high sensitivity, low costs, non-invasiveness and safety. We aimed to test the sensitivity of LUS to rule out COVID-19 pneumonia (COVIDp) in a population of patients with suggestive symptoms. METHODS Multicentre prospective observational study in three EDs in Northeastern Italy during the first COVID-19 outbreak. A convenience sample of 235 patients admitted to the ED for symptoms suggestive COVIDp (fever, cough or shortness of breath) from 17 March 2020 to 26 April 2020 was enrolled. All patients underwent a sequential assessment involving: clinical examination, LUS, CXR and arterial blood gas. The index test under investigation was a standardised protocol of LUS compared with a pragmatic composite reference standard constituted by: clinical gestalt, real-time PCR test, radiological and blood gas results. Of the 235 enrolled patients, 90 were diagnosed with COVIDp according to the reference standard. RESULTS Among the patients with suspected COVIDp, the prevalence of SARS-CoV-2 was 38.3%. The sensitivity of LUS for diagnosing COVIDp was 85.6% (95% CI 76.6% to 92.1%); the specificity was 91.7% (95% CI 86.0% to 95.7%). The positive predictive value and the negative predictive value were 86.5% (95%CI 78.8% to 91.7%) and 91.1% (95% CI 86.1% to 94.4%) respectively. The diagnostic accuracy of LUS for COVIDp was 89.4% (95% CI 84.7% to 93.0%). The positive likelihood ratio was 10.3 (95% CI 6.0 to 17.9), and the negative likelihood ratio was 0.16 (95% CI 0.1 to 0.3). CONCLUSION In a population with high SARS-CoV-2 prevalence, LUS has a high sensitivity (and negative predictive value) enough to rule out COVIDp in patients with suggestive symptoms. The role of LUS in diagnosing patients with COVIDp is perhaps even more promising. Nevertheless, further research with adequately powered studies is needed. TRIAL REGISTRATION NUMBER NCT04370275.
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Affiliation(s)
- Carmine Cristiano Di Gioia
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Nicola Artusi
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Giovanni Xotta
- Department of Emergency Medicine, University of Verona, Verona, Veneto, Italy
| | - Marco Bonsano
- Department of Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Ugo Giulio Sisto
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Marzia Tecchiolli
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Friuli-Venezia Giulia, Italy
| | - Franco Cominotto
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Giulia Amore
- Department of Emergency Medicine, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
| | - Stefano Meduri
- Department of Radiology, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
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7
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Pal A, Ali A, Young TR, Oostenbrink J, Prabhakar A, Prabhakar A, Deacon N, Arnold A, Eltayeb A, Yap C, Young DM, Tang A, Lakshmanan S, Lim YY, Pokarowski M, Kakodkar P. Comprehensive literature review on the radiographic findings, imaging modalities, and the role of radiology in the COVID-19 pandemic. World J Radiol 2021; 13:258-282. [PMID: 34630913 PMCID: PMC8473437 DOI: 10.4329/wjr.v13.i9.258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/28/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, over 103214008 cases have been reported, with more than 2231158 deaths as of January 31, 2021. Although the gold standard for diagnosis of this disease remains the reverse-transcription polymerase chain reaction of nasopharyngeal and oropharyngeal swabs, its false-negative rates have ignited the use of medical imaging as an important adjunct or alternative. Medical imaging assists in identifying the pathogenesis, the degree of pulmonary damage, and the characteristic features in each imaging modality. This literature review collates the characteristic radiographic findings of COVID-19 in various imaging modalities while keeping the preliminary focus on chest radiography, computed tomography (CT), and ultrasound scans. Given the higher sensitivity and greater proficiency in detecting characteristic findings during the early stages, CT scans are more reliable in diagnosis and serve as a practical method in following up the disease time course. As research rapidly expands, we have emphasized the CO-RADS classification system as a tool to aid in communicating the likelihood of COVID-19 suspicion among healthcare workers. Additionally, the utilization of other scoring systems such as MuLBSTA, Radiological Assessment of Lung Edema, and Brixia in this pandemic are reviewed as they integrate the radiographic findings into an objective scoring system to risk stratify the patients and predict the severity of disease. Furthermore, current progress in the utilization of artificial intelligence via radiomics is evaluated. Lastly, the lesson from the first wave and preparation for the second wave from the point of view of radiology are summarized.
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Affiliation(s)
- Aman Pal
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Abulhassan Ali
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Timothy R Young
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Juan Oostenbrink
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Akul Prabhakar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Amogh Prabhakar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Nina Deacon
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Amar Arnold
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Ahmed Eltayeb
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Charles Yap
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - David M Young
- Department of Computer Science, Yale University, New Haven, CO 06520, United States
| | - Alan Tang
- Department of Health Science, Duke University, Durham, NC 27708, United States
| | - Subramanian Lakshmanan
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Ying Yi Lim
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Martha Pokarowski
- The Hospital for Sick Kids, University of Toronto, Toronto M5S, Ontario, Canada
| | - Pramath Kakodkar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
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8
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Pantazopoulos I, Tsikrika S, Kolokytha S, Manos E, Porpodis K. Management of COVID-19 Patients in the Emergency Department. J Pers Med 2021; 11:jpm11100961. [PMID: 34683102 PMCID: PMC8537207 DOI: 10.3390/jpm11100961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is an emerging disease of global public health concern. As the pandemic overwhelmed emergency departments (EDs), a restructuring of emergency care delivery became necessary in many hospitals. Furthermore, with more than 2000 papers being published each week, keeping up with ever-changing information has proven to be difficult for emergency physicians. The aim of the present review is to provide emergency physician with a summary of the current literature regarding the management of COVID-19 patients in the emergency department.
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Affiliation(s)
- Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, Biopolis, 415 00 Larissa, Greece
- Correspondence: ; Tel.: +30-694-566-1525
| | - Stamatoula Tsikrika
- Emergency Department, Thoracic Diseases COVID-19 Referral Hospital “SOTIRIA”, 115 27 Athens, Greece;
| | - Stavroula Kolokytha
- Department of Emergency Medicine, Sismanoglio Hospital, 151 26 Athens, Greece;
| | - Emmanouil Manos
- Pulmonary Clinic, General Hospital of Lamia, 351 00 Lamia, Greece;
| | - Konstantinos Porpodis
- Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, 570 10 Thessaloniki, Greece;
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9
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Zhanna Davidovna K, Fuad Safarova A, Cabello Montoya FE, Vatsik-Gorodetskaya MV, Yulia Leonidovna K, Olga Tairovna Z, Olga Valeryevna A, Rajan R, Al Jarallah M, Brady PA, Al-Zakwani I. A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era. Multidiscip Respir Med 2021; 16:766. [PMID: 34345428 PMCID: PMC8314678 DOI: 10.4081/mrm.2021.766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022] Open
Abstract
Background Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection. Methods This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies. Results All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4). Conclusion When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.
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Affiliation(s)
- Kobalava Zhanna Davidovna
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ayten Fuad Safarova
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.,Clinical Hospital named after V.V. Vinogradov Moscow, Moscow, Russia
| | - Flora Elisa Cabello Montoya
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | | | - Karaulova Yulia Leonidovna
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Zorya Olga Tairovna
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Arutina Olga Valeryevna
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Rajesh Rajan
- Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.,Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Kuwait
| | | | - Peter A Brady
- Department of Cardiology, Illinois Masonic Medical Center, Chicago IL, USA
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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10
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Lieveld AWE, Kok B, Azijli K, Schuit FH, van de Ven PM, de Korte CL, Nijveldt R, van den Heuvel FMA, Teunissen BP, Hoefsloot W, Nanayakkara PWB, Bosch FH. Assessing COVID-19 pneumonia-Clinical extension and risk with point-of-care ultrasound: A multicenter, prospective, observational study. J Am Coll Emerg Physicians Open 2021; 2:e12429. [PMID: 33969350 PMCID: PMC8087918 DOI: 10.1002/emp2.12429] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Assessing the extent of lung involvement is important for the triage and care of COVID-19 pneumonia. We sought to determine the utility of point-of-care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID-19 pneumonia. METHODS This multicenter, prospective, observational study included patients with COVID-19 who received 12-zone lung ultrasound and chest computed tomography (CT) scanning in the emergency department (ED). We defined lung disease severity using the lung ultrasound score (LUS) and chest CT severity score (CTSS). We assessed the association between the LUS and poor outcome (ICU admission or 30-day all-cause mortality). We also assessed the association between the LUS and hospital length of stay. We examined the ability of the LUS to differentiate between disease severity groups. Lastly, we estimated the correlation between the LUS and CTSS and the interrater agreement for the LUS. We handled missing data by multiple imputation with chained equations and predictive mean matching. RESULTS We included 114 patients treated between March 19, 2020, and May 4, 2020. An LUS ≥12 was associated with a poor outcome within 30 days (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.26-24.80; P = 0.02). Admission duration was shorter in patients with an LUS <12 (adjusted HR, 2.24; 95% CI, 1.47-3.40; P < 0.001). Mean LUS differed between disease severity groups: no admission, 6.3 (standard deviation [SD], 4.4); hospital/ward, 13.1 (SD, 6.4); and ICU, 18.0 (SD, 5.0). The LUS was able to discriminate between ED discharge and hospital admission excellently, with an area under the curve of 0.83 (95% CI, 0.75-0.91). Interrater agreement for the LUS was strong: κ = 0.88 (95% CI, 0.77-0.95). Correlation between the LUS and CTSS was strong: κ = 0.60 (95% CI, 0.48-0.71). CONCLUSIONS We showed that baseline lung ultrasound - is associated with poor outcomes, admission duration, and disease severity. The LUS also correlates well with CTSS. Point-of-care lung ultrasound may aid the risk stratification and triage of patients with COVID-19 at the ED.
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Affiliation(s)
- Arthur W. E. Lieveld
- Section General and Acute Internal MedicineDepartment of Internal MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Bram Kok
- Section Acute Internal Medicine, Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Kaoutar Azijli
- Section Emergency MedicineEmergency DepartmentAmsterdam Public Health Research Institute, Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Frederik H. Schuit
- Section General and Acute Internal MedicineDepartment of Internal MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Data ScienceAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Chris L. de Korte
- Medical UltraSound Imaging CenterDepartment of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Robin Nijveldt
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Bernd P. Teunissen
- Department of Radiology & Nuclear MedicineAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Wouter Hoefsloot
- Radboudumc Center for Infectious DiseasesDepartment of Pulmonary DiseasesRadboud University Medical CenterNijmegenThe Netherlands
| | - Prabath W. B. Nanayakkara
- Section General and Acute Internal MedicineDepartment of Internal MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Frank H. Bosch
- Section Acute Internal Medicine, Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
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11
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Karp J, Burke K, Daubaras SM, McDermott C. The role of PoCUS in the assessment of COVID-19 patients. J Ultrasound 2021; 25:207-215. [PMID: 33870480 PMCID: PMC8053566 DOI: 10.1007/s40477-021-00586-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/08/2021] [Indexed: 01/14/2023] Open
Abstract
The Coronavirus disease 19 (COVID-19) pandemic has increased the burden of stress on the global healthcare system in 2020. Point of care ultrasound (PoCUS) is used effectively in the management of pulmonary, cardiac and vascular pathologies. POCUS is the use of traditional ultrasound imaging techniques in a focused binary manner to answer a specific set of clinical questions. This is an imaging technique that delivers no radiation, is inexpensive, ultraportable and provides results instantaneously to the physician operator at the bedside. In regard to the pandemic, PoCUS has played a significant adjunctive role in the diagnosis and management of co-morbidities associated with COVID-19. PoCUS also offers an alternative method to image obstetric patients and the pediatric population safely in accordance with the ALARA principle. Finally, there have been numerous PoCUS protocols describing the effective use of this technology during the COVID-19 pandemic.
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Affiliation(s)
- John Karp
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Karina Burke
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Cian McDermott
- Emergency Department and Emergency Ultrasound Education, Mater University Hospital, Dublin, Ireland
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12
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Akbari M, Carriere J, Meyer T, Sloboda R, Husain S, Usmani N, Tavakoli M. Robotic Ultrasound Scanning With Real-Time Image-Based Force Adjustment: Quick Response for Enabling Physical Distancing During the COVID-19 Pandemic. Front Robot AI 2021; 8:645424. [PMID: 33829043 PMCID: PMC8019797 DOI: 10.3389/frobt.2021.645424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
During an ultrasound (US) scan, the sonographer is in close contact with the patient, which puts them at risk of COVID-19 transmission. In this paper, we propose a robot-assisted system that automatically scans tissue, increasing sonographer/patient distance and decreasing contact duration between them. This method is developed as a quick response to the COVID-19 pandemic. It considers the preferences of the sonographers in terms of how US scanning is done and can be trained quickly for different applications. Our proposed system automatically scans the tissue using a dexterous robot arm that holds US probe. The system assesses the quality of the acquired US images in real-time. This US image feedback will be used to automatically adjust the US probe contact force based on the quality of the image frame. The quality assessment algorithm is based on three US image features: correlation, compression and noise characteristics. These US image features are input to the SVM classifier, and the robot arm will adjust the US scanning force based on the SVM output. The proposed system enables the sonographer to maintain a distance from the patient because the sonographer does not have to be holding the probe and pressing against the patient's body for any prolonged time. The SVM was trained using bovine and porcine biological tissue, the system was then tested experimentally on plastisol phantom tissue. The result of the experiments shows us that our proposed quality assessment algorithm successfully maintains US image quality and is fast enough for use in a robotic control loop.
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Affiliation(s)
- Mojtaba Akbari
- Telerobotic and Biorobotic System Group, Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Jay Carriere
- Telerobotic and Biorobotic System Group, Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Tyler Meyer
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Ron Sloboda
- Department of Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Siraj Husain
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Nawaid Usmani
- Department of Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Telerobotic and Biorobotic System Group, Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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