Browsing by Author "Andrew P. Walden"

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    Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study
    (2018-12-01) Stije J. Leopold; Aniruddha Ghose; Katherine A. Plewes; Subash Mazumder; Luigi Pisani; Hugh W.F. Kingston; Sujat Paul; Anupam Barua; M. Abdus Sattar; Michaëla A.M. Huson; Andrew P. Walden; Patricia C. Henwood; Elisabeth D. Riviello; Marcus J. Schultz; Nicholas P.J. Day; Asok Kumar Dutta; Nicholas J. White; Arjen M. Dondorp; Brigham and Women's Hospital; Mahidol University; Chittagong Medical College Hospital; Nuffield Department of Clinical Medicine; Royal Berkshire Hospital; Harvard Medical School; Amsterdam UMC - University of Amsterdam
    © 2018 Leopold et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Patients with severe malaria or sepsis are at risk of developing life-threatening acute respiratory distress syndrome (ARDS). The objective of this study was to evaluate point-of-care lung ultrasound as a novel tool to determine the prevalence and early signs of ARDS in a resource-limited setting among patients with severe malaria or sepsis. Materials and methods Serial point-of-care lung ultrasound studies were performed on four consecutive days in a planned sub study of an observational cohort of patients with malaria or sepsis in Bangladesh. We quantified aeration patterns across 12 lung regions. ARDS was defined according to the Kigali Modification of the Berlin Definition. Results Of 102 patients enrolled, 71 had sepsis and 31 had malaria. Normal lung ultrasound findings were observed in 44 patients on enrolment and associated with 7% case fatality. ARDS was detected in 10 patients on enrolment and associated with 90% case fatality. All patients with ARDS had sepsis, 4 had underlying pneumonia. Two patients developing ARDS during hospitalisation already had reduced aeration patterns on enrolment. The SpO 2 /FiO 2 ratio combined with the number of regions with reduced aeration was a strong prognosticator for mortality in patients with sepsis (AUROC 91.5% (95% Confidence Interval: 84.6%-98.4%)). Conclusions This study demonstrates the potential usefulness of point-of-care lung ultrasound to detect lung abnormalities in patients with malaria or sepsis in a resource-constrained hospital setting. LUS was highly feasible and allowed to accurately identify patients at risk of death in a resource limited setting.
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    Ultrasound versus Computed Tomography Assessment of Focal Lung Aeration in Invasively Ventilated ICU Patients
    (2021-09-01) Marry R. Smit; Luigi Pisani; Eva J.E. de Bock; Ferdinand van der Heijden; Frederique Paulus; Ludo F.M. Beenen; Stije J. Leopold; Michaëla A.M. Huson; Patricia C. Henwood; Elisabeth D. Riviello; Andrew P. Walden; Arjen M. Dondorp; Marcus J. Schultz; Lieuwe D.J. Bos; Erasmus MC; Universiteit Twente; Brigham and Women's Hospital; Mahidol University; Nuffield Department of Medicine; Royal Berkshire Hospital; Harvard Medical School; Amsterdam UMC - University of Amsterdam
    It is unknown whether and to what extent the penetration depth of lung ultrasound (LUS) influences the accuracy of LUS findings. The current study evaluated and compared the LUS aeration score and two frequently used B-line scores with focal lung aeration assessed by chest computed tomography (CT) at different levels of depth in invasively ventilated intensive care unit (ICU) patients. In this prospective observational study, patients with a clinical indication for chest CT underwent a 12-region LUS examination shortly before CT scanning. LUS images were compared with corresponding regions on the chest CT scan at different subpleural depths. For each LUS image, the LUS aeration score was calculated. LUS images with B-lines were scored as the number of separately spaced B-lines (B-line count score) and the percentage of the screen covered by B-lines divided by 10 (B-line percentage score). The fixed-effect correlation coefficient (β) was presented per 100 Hounsfield units. A total of 40 patients were included, and 372 regions were analyzed. The best association between the LUS aeration score and CT was found at a subpleural depth of 5 cm for all LUS patterns (β = 0.30, p < 0.001), 1 cm for A- and B1-patterns (β = 0.10, p < 0.001), 6 cm for B1- and B2-patterns (β = 0.11, p < 0.001) and 4 cm for B2- and C-patterns (β = 0.07, p = 0.001). The B-line percentage score was associated with CT (β = 0.46, p = 0.001), while the B-line count score was not (β = 0.07, p = 0.305). In conclusion, the subpleural penetration depth of ultrasound increased with decreased aeration reflected by the LUS pattern. The LUS aeration score and the B-line percentage score accurately reflect lung aeration in ICU patients, but should be interpreted while accounting for the subpleural penetration depth of ultrasound.