FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3046566051> ?p ?o ?g. }

• W3046566051 endingPage "e235" @default.
• W3046566051 startingPage "e234" @default.
• W3046566051 abstract "In their article, Anile et al1 provide a novel and creative framework for the use of ultrasound to evaluate critically ill coronavirus disease 2019 (COVID-19) patients. We agree that ultrasound offers key advantages over other imaging modalities during the current pandemic, and it may be the preferred method for the routine assessment of these patients.2 New handheld ultrasound devices may be particularly useful for this proposed application because they incorporate sophisticated imaging technology while offering portability, affordability, and ease of decontamination3 to reduce the spread of infection. Some of the latest ultrasound devices offer additional features such as video tutorials and teleguidance, in which a remote expert can guide a novice user in performing an ultrasound examination or procedure.4 With these advances, ultrasound is becoming increasingly accessible to health care providers across all specialties and training levels. The authors highlight the versatility of ultrasound in evaluating not only the lungs (ie, presence of B-lines and lung sliding) and heart (ie, global size and function, pericardial effusion), but also to assess airway anatomy, endotracheal tube placement, end-organ perfusion, intravascular volume status, and peripheral vasculature for evidence of thrombosis. By considering the manifestations of COVID-19 on multiple organ systems, Anile et al1 offer a holistic approach to clinical management. We applaud the authors for highlighting several less conventional but very useful applications of critical care ultrasound, all of which can be performed by a single bedside provider, thus limiting infectious exposure to additional staff members. Their clever mnemonic, C-O-V-I-D, will also serve as a useful cognitive aid to the clinician performing these examinations. In our intensive care units, bedside ultrasound has become a standard tool for assessing and optimizing the management of critically ill COVID-19 patients (Table). Markers of volume status evaluated by bedside ultrasound, such as inferior vena cava (IVC) collapsibility, stroke volume variation, and evaluation of diastolic dysfunction, can help to avoid over diuresis and consequent renal injury in patients undergoing conservative fluid management. We employ ultrasound to monitor response to interventions, including the titration of positive end-expiratory pressure (PEEP) or the administration of pulmonary vasodilators such as nitric oxide, which can have profound hemodynamic effects due to changes in right ventricular (RV) afterload. For patients with refractory hypoxemia for whom ventilation management is challenging, our institution has a dedicated team that performs a trifecta of transthoracic echocardiography, esophageal balloon placement, and electrical impedance tomography to provide physiologic data that can be used to optimize ventilation settings.5,6 We believe that the ability to monitor cardiac function and titrate ventilatory and hemodynamic parameters using bedside ultrasound may lead to improved outcomes. Table 1. - Indications for Ultrasound Evaluation in the Management of Critically Ill Patients With COVID-19 Infection Potential Indications for Ultrasound Evaluation in the Management of Critically Ill Patients With COVID-19 Infection Optimize fluid management (eg, LVOT VTI variation, IVC collapsibility/distensibility index, evaluation of diastolic dysfunction) Determine the presence of intracardiac shunting as a cause of hypoxemia and need for intervention (ie, PFO closure device) Guide PEEP optimization while monitoring RV function Quantitative assessment of RV function to guide titration and weaning of pulmonary vasodilators, inotropic support, and mechanical circulatory support Assess for the presence of pulmonary hypertension and response to interventions Workup for pulmonary embolus and guide resource utilization (ie, CT scan) Determine the presence of other cardiac causes of hypoxemia (eg, ruptured papillary muscle, postmyocardial infarction VSD) Assess for left ventricular diastolic dysfunction as an etiology of difficulty weaning from mechanical ventilation Guide the need for diuresis using diastology to assess left atrial pressures Assist in determining the cause of undifferentiated shock Assess for major valvular abnormalities to guide hemodynamic optimization and potential need for valve repair Workup for consideration of mechanical circulatory support including the need for venoarterial ECMO versus venovenous ECMO, ventricular assist devices, and to exclude contraindications to mechanical circulatory support (ie, severe aortic insufficiency in peripheral ECMO) Abbreviations: ARDS, acute respiratory distress syndrome; COVID-19, coronavirus disease 2019; CT, computed tomography; ECMO, extracorporeal membrane oxygenation; IVC, inferior vena cava; LVOT VTI, left ventricular outflow tract velocity time integral; PEEP, positive end-expiratory pressure; PFO, patent foramen ovale; RV, right ventricular; VSD, ventricular septal defect. We also use focused echocardiography to screen for myocardial injury such as from myocarditis, which may prompt administration of steroids, intracardiac shunting, stress cardiomyopathy, valvulopathies, and the need for mechanical circulatory support such as venoarterial instead of venovenous extracorporeal membrane oxygenation in severe illness. Diastolic dysfunction may contribute to failure to wean from mechanical ventilation and can be evaluated with ultrasound. All of these assessments can be performed rapidly at the bedside, including in the prone position,7 thus minimizing disruption and infectious exposures to additional staff members. The use of ultrasound in airway management is becoming increasingly utilized among clinicians, particularly for confirmation of endotracheal tube placement and ventilation by lung sliding. Tracheal ultrasound can rapidly identify esophageal intubation before ventilation, thus providing the opportunity to avoid insufflation as required for confirmation by auscultation. We have also found ultrasound to be useful in assessing gastric volume to evaluate the risk of aspiration and the need for rapid sequence induction before endotracheal intubation. In summary, we thank the authors for providing a valuable framework for the use of ultrasound during the current pandemic. These efforts will serve to improve the clinical care of COVID-19 patients worldwide. Lauren E. Gibson, MDDavid Convissar, MDLorenzo Berra, MDEdward A. Bittner, MD, PhDMarvin G. Chang, MD, PhDDivision of Cardiac Anesthesia and Critical CareDepartment of Anesthesiology, Pain Medicine,and Critical CareThe Massachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts[email protected]" @default.
• W3046566051 created "2020-08-07" @default.
• W3046566051 creator A5020930761 @default.
• W3046566051 creator A5033813700 @default.
• W3046566051 creator A5047669228 @default.
• W3046566051 creator A5056086689 @default.
• W3046566051 creator A5079746187 @default.
• W3046566051 date "2020-07-21" @default.
• W3046566051 modified "2023-09-27" @default.
• W3046566051 title "In Response" @default.
• W3046566051 cites W2999537057 @default.
• W3046566051 cites W3004566376 @default.
• W3046566051 cites W3023622151 @default.
• W3046566051 cites W3033527303 @default.
• W3046566051 cites W3034305325 @default.
• W3046566051 cites W3046434675 @default.
• W3046566051 cites W3048760041 @default.
• W3046566051 doi "https://doi.org/10.1213/ane.0000000000005144" @default.
• W3046566051 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7389936" @default.
• W3046566051 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/33094984" @default.
• W3046566051 hasPublicationYear "2020" @default.
• W3046566051 type Work @default.
• W3046566051 sameAs 3046566051 @default.
• W3046566051 citedByCount "1" @default.
• W3046566051 countsByYear W30465660512020 @default.
• W3046566051 crossrefType "journal-article" @default.
• W3046566051 hasAuthorship W3046566051A5020930761 @default.
• W3046566051 hasAuthorship W3046566051A5033813700 @default.
• W3046566051 hasAuthorship W3046566051A5047669228 @default.
• W3046566051 hasAuthorship W3046566051A5056086689 @default.
• W3046566051 hasAuthorship W3046566051A5079746187 @default.
• W3046566051 hasBestOaLocation W30465660511 @default.
• W3046566051 hasConcept C126838900 @default.
• W3046566051 hasConcept C143753070 @default.
• W3046566051 hasConcept C144024400 @default.
• W3046566051 hasConcept C154945302 @default.
• W3046566051 hasConcept C177713679 @default.
• W3046566051 hasConcept C19527891 @default.
• W3046566051 hasConcept C195646399 @default.
• W3046566051 hasConcept C2779903281 @default.
• W3046566051 hasConcept C2780226545 @default.
• W3046566051 hasConcept C36289849 @default.
• W3046566051 hasConcept C41008148 @default.
• W3046566051 hasConcept C545542383 @default.
• W3046566051 hasConcept C71924100 @default.
• W3046566051 hasConcept C84393581 @default.
• W3046566051 hasConceptScore W3046566051C126838900 @default.
• W3046566051 hasConceptScore W3046566051C143753070 @default.
• W3046566051 hasConceptScore W3046566051C144024400 @default.
• W3046566051 hasConceptScore W3046566051C154945302 @default.
• W3046566051 hasConceptScore W3046566051C177713679 @default.
• W3046566051 hasConceptScore W3046566051C19527891 @default.
• W3046566051 hasConceptScore W3046566051C195646399 @default.
• W3046566051 hasConceptScore W3046566051C2779903281 @default.
• W3046566051 hasConceptScore W3046566051C2780226545 @default.
• W3046566051 hasConceptScore W3046566051C36289849 @default.
• W3046566051 hasConceptScore W3046566051C41008148 @default.
• W3046566051 hasConceptScore W3046566051C545542383 @default.
• W3046566051 hasConceptScore W3046566051C71924100 @default.
• W3046566051 hasConceptScore W3046566051C84393581 @default.
• W3046566051 hasIssue "5" @default.
• W3046566051 hasLocation W30465660511 @default.
• W3046566051 hasLocation W30465660512 @default.
• W3046566051 hasLocation W30465660513 @default.
• W3046566051 hasLocation W30465660514 @default.
• W3046566051 hasOpenAccess W3046566051 @default.
• W3046566051 hasPrimaryLocation W30465660511 @default.
• W3046566051 hasRelatedWork W1588495630 @default.
• W3046566051 hasRelatedWork W1966026626 @default.
• W3046566051 hasRelatedWork W2000993829 @default.
• W3046566051 hasRelatedWork W2010345321 @default.
• W3046566051 hasRelatedWork W2034850138 @default.
• W3046566051 hasRelatedWork W2150941474 @default.
• W3046566051 hasRelatedWork W2159395257 @default.
• W3046566051 hasRelatedWork W2889349946 @default.
• W3046566051 hasRelatedWork W3135777254 @default.
• W3046566051 hasRelatedWork W3107208611 @default.
• W3046566051 hasVolume "131" @default.
• W3046566051 isParatext "false" @default.
• W3046566051 isRetracted "false" @default.
• W3046566051 magId "3046566051" @default.
• W3046566051 workType "article" @default.