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• W4387248869 abstract "SESSION TITLE: Imaging Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Point of care ultrasound has evolved as an important, quick, and reliable diagnostic modality in supplementing the bedside judgement of physical status of patients, which in turn allows treating physicians to make appropriate decisions regarding management. Different sonographic findings of clinical significance include reduced wall motion abnormalities, left ventricle ejection fraction (LVEF), dilatation of right ventricle (RV) and presence of intramural clots. This analysis was conducted to judge the importance of bedside cardiac ultrasound in predicting the 30-day mortality of patients admitted to the ICU with COVID-19 infection. METHODS: PubMed, Cochrane and EMBASE databases were queried using the following keywords: “Point of care Ultrasound” OR “Ultrasonography”, AND “Cardiac” AND “COVID Pneumonia” OR “COVID Infection” AND “Intensive Care” OR “Critical Care”. 417 manuscripts resulted. Primary and secondary screening resulted in 70 studies which were relevant to the topic, of which 6 were full length manuscripts and included for the final analysis. RESULTS: A total of 418 patients were included in the analysis, of which 363 were males. Mean age was 62.91 years. Smoking status was reported in 3 studies with a mean of 10.2 pack year history. 234 patients had hypertension, 153 had diabetes, 62 patients were obese, and 44 patients had history of congestive cardiac failure. All patients received cardiac bedside ultrasound either alone or in combination with lung ultrasound and/or distal extremity ultrasound. A lung ultrasound score (LUS) was devised based upon the findings of presence of pleural lesions, B line density and pleural effusions in 4 different lung regions. A cut off value of 13 on LUS was demonstrated to have a sensitivity of 93.3% in predicting 30-day mortality, while low ejection fraction and venous thrombosis had a specificity of 92.3% and 96.5% respectively. Combining LUS score, low LVEF and/or presence of intramural thrombus improved the sensitivity for 30-day mortality to 96.7%. Similarly, it was demonstrated that all patients with RV dilatation had bilateral B lines and pleural irregularities, which was an independent predictor of mortality in 30 days (independent of hypertension, diabetes, or age [OR:12.0, p-value of 0.048]). Amongst the patients who died, post-mortem examination demonstrated more than 50% of the patients having RV dilatation had pulmonary artery thrombi, whereas amongst those who survived, RV dilatation was found to have positive correlation with oxygen requirements regardless of evidence of pulmonary embolism (PE) on pulmonary artery CT scan. CONCLUSIONS: Presence of RV dilatation on cardiac ultrasound is a reliable predictor of 30-day mortality, regardless of the presence of detectable pulmonary embolism. Combining the lung ultrasound score and cardiac findings of reduction in LVEF and/or presence of intramural thrombi can serve as a very sensitive marker of 30-days mortality. CLINICAL IMPLICATIONS: Bedside ultrasound assessment can be a crucial marker of prognosis in COVID-19 patients. Sonographers and intensivists should rely on multi-organ ultrasound including heart, lungs, and distal vasculature to predict prognosis in short term. Moreover, there is need to device a numeric score based on ultrasound findings that can help predict risk of mortality based on clinical and ultrasonographic findings. DISCLOSURES: No relevant relationships by Ramsha Abbas No relevant relationships by Jonathan Ariyaratnam No relevant relationships by Salman Ashfaq No relevant relationships by Robert Foronjy No relevant relationships by Allison Foster No relevant relationships by Muhammad Haseeb-ul-Rasool No relevant relationships by Haris Iqbal No relevant relationships by Avish Parikh No relevant relationships by Riki Ranat No relevant relationships by Jasmine Sandhu No relevant relationships by Theo Trandafirescu No relevant relationships by Zaryab Umar" @default.
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• W4387248869 date "2023-10-01" @default.
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• W4387248869 title "UTILITY OF CARDIAC POINT-OF-CARE ULTRASOUND (POCUS) IN INTENSIVE CARE UNIT (ICU) SETTING FOR COVID-19 PATIENTS" @default.
• W4387248869 doi "https://doi.org/10.1016/j.chest.2023.07.2601" @default.
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