Lung Ultrasound

Point-of-care lung ultrasound in the assessment of COVID-19: results of a UK multicentre service evaluation

Original Articles, Volume 21, Issue 3, Pages 121-164 (2022)

Background: Coronavirus disease 2019 has had a dramatic impact on the delivery of acute care globally. Accurate risk stratification is fundamental to the efficient organisation of care. Point-of-care lung ultrasound offers practical advantages over conventional imaging with potential to improve the operational performance of acute care pathways during periods of high demand.
The Society for Acute Medicine and the Intensive Care Society undertook a collaborative evaluation of point-of-care imaging in the UK to describe the scope of current practice and explore performance during real-world application.
Methods: A retrospective service evaluation was undertaken of the use of point-of-care lung ultrasound during the initial wave of coronavirus infection in the UK. We report an evaluation of all imaging studies performed outside the intensive care unit.
An ordinal scale was used to measure the severity of loss of lung aeration. The relationship between lung ultrasound, polymerase chain reaction for SARS-CoV-2 and 30-day outcomes were described using logistic regression models.
Results: Data were collected from 7 hospitals between February and September 2020. In total, 297 ultrasound examinations from 295 patients were recorded. Nasopharyngeal swab samples were positive in 145 patients (49.2% 95%CI 43.5-54.8). A multivariate model combining three ultrasound variables showed reasonable discrimination in relation to the polymerase chain reaction reference (AUC 0.77 95%CI 0.71-0.82).
The composite outcome of death or intensive care admission at 30 days occurred in 83 (28.1%, 95%CI 23.3-33.5). Lung ultrasound was able to discriminate the composite outcome with a reasonable level of accuracy (AUC 0.76 95%CI 0.69-0.83) in univariate analysis. The relationship remained statistically significant in a multivariate model controlled for age, sex and the time interval from admission to scan
Conclusion: Point-of-care lung ultrasound is able to discriminate patients at increased risk of deterioration allowing more informed clinical decision making.

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‘Just another asthma attack?’ – point of care ultrasound as a game changer in respiratory failure

Case Reports, Volume 21, Issue 2, Pages 65-120 (2022)

Wheeze and shortness of breath are a common reason for admission to hospital but the cause of which is not always immediately apparent. We present a case of a patient with respiratory distress, wheeze and chest tightness on a background of well controlled asthma and androgen deprivation therapy for prostate cancer. The patient was provisionally treated as an asthma exacerbation but point of care ultrasound (POCUS) performed soon after admission revealed severe LV impairment and ‘wet lungs’ in keeping with acute decompensated heart failure. The case highlights the importance of POCUS to differentiate between different causes of wheeze in the acute setting and we discuss the diagnostic approach to the patient with suspected heart failure.

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Triage Into the Community for COVID-19 (TICC-19) Patients Pathway – Service evaluation of the virtual monitoring of patients with COVID pneumonia

Original Articles, Special Article, Volume 19, Issue 4, Pages 173 – 252 (2020)

Introduction: COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand.

Methods: We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a ‘Virtual Ward’ for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care ‘Hot Hub’. This allowed the safe and managed readmission of those patients who deteriorated at home.

Results: During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month.

Conclusion: It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.

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The Use of Lung Ultrasound in Acute Medicine

Original Articles, Volume 18, Issue 4, Pages 205 – 264 (2019)

POCUS (Point of Care Ultrasound) refers to ultrasound performed by clinicians as part of their initial patient evaluation, often with the aim of answering a specific question as opposed to being a comprehensive assessment. Such ultrasound is noninvasive, involves no radiation and can be rapidly performed at the bedside. It is also widely practiced in emergency and intensive care medicine leading to earlier and more accurate diagnoses for a wide range of presentations such as shock, renal failure and dyspnoea. POCUS has evolved from cardiological or radiological studies, reduced in complexity and scoped for clinician use. Lung ultrasound (LUS) has been largely developed by acute care clinicians and is a more recent addition to POCUS. Procedural LUS is widely recommended to improve the safety profile of pleural catheter placement (referring to BTS guidelines) but in the UK diagnostic LUS is not widely practiced despite good evidence and guideline support for its use. In this article we briefly review and describe the role of diagnostic LUS as applied to acute medicine. Potential advantages of LUS include a decreased time to diagnosis, improved diagnostic accuracy, a reduction in radiation exposure and unnecessary expensive tests. Studies have shown that at least one diagnosis was missed in around a fifth of patients with acute respiratory symptoms, resulting in increased length of stay and mortality in a third of patients.

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