This study examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care... Visual COVID-19–Related Critical Illness In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity chan... Background: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. Objective: To describe the epidemiology of COVID-19–related critical illness, incl...

Introduction: In low-resource settings it is not always possible to acquire the information required to diagnose acute respiratory distress syndrome (ARDS). Ultrasound and pulse oximetry, however, may be available in these settings. This study was designed to test whether pulmonary ultrasound and pulse oximetry could be used in place of traditional radiographic and oxygenation evaluation for ARDS. Methods: This study was a prospective, single-center study in the ICU of Harborview Medical Center, a referral hospital in Seattle, Washington, USA. Bedside pulmonary ultrasound was performed on ICU patients receiving invasive mechanical ventilation. Pulse oximetric oxygen saturation (SpO₂), partial pressure of oxygen (PaO₂), fraction of inspired oxygen (FiO₂), provider diagnoses, and chest radiograph closest to time of ultrasound were recorded or interpreted. Results: One hundred and twenty three ultrasound assessments were performed on 77 consecutively enrolled patients with respiratory failure. Oxygenation and radiographic criteria for ARDS were met in 35 assessments. Where SpO₂ ≤ 97 %, the Spearman rank correlation coefficient between SpO₂/FiO₂ and PaO₂/FiO₂ was 0.83, p < 0.0001. The sensitivity and specificity of the previously reported threshold of SpO₂/FiO₂ ≤ 315 for PaO₂/FiO₂ ≤ 300 was 83 % (95 % confidence interval (CI) 68–93), and 50 % (95 % CI 1–99), respectively. Sensitivity and specificity of SpO₂/FiO₂ ≤ 235 for PaO₂/FiO₂ ≤ 200 was 70 % (95 % CI 47–87), and 90 % (95 % CI 68–99), respectively. For pulmonary ultrasound assessments interpreted by the study physician, the sensitivity and specificity of ultrasound interstitial syndrome bilaterally and involving at least three lung fields were 80 % (95 % CI 63–92) and 62 % (95 % CI 49–74) for radiographic criteria for ARDS. Combining SpO₂/FiO₂ with ultrasound to determine oxygenation and radiographic criteria for ARDS, the sensitivity was 83 % (95 % CI 52–98) and specificity was 62 % (95 % CI 38–82). For moderate–severe ARDS criteria (PaO₂/FiO₂ ≤ 200), sensitivity was 64 % (95 % CI 31–89) and specificity was 86 % (95 % CI 65–97). Excluding repeat assessments and independent interpretation of ultrasound images did not significantly alter the sensitivity measures. Conclusions: Pulse oximetry and pulmonary ultrasound may be useful tools to screen for, or rule out, impaired oxygenation or lung abnormalities consistent with ARDS in under-resourced settings where arterial blood gas testing and chest radiography are not readily available.

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.

Lung ultrasound in acute respiratory distress syndrome and beyond

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