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Article ; Online: Validation of New Quantitative Lung Ultrasound Protocol and Comparison With Lung Ultrasound Score in Patients With COVID-19.

Heldeweg, Micah L A / Lieveld, Arthur W E / Mousa, Amne / Pisani, Luigi / Tuinman, Pieter R

2023 Volume 164, Issue 6, Page(s) 1512–1515

MeSH term(s)	Humans ; COVID-19 ; Ultrasonography ; Lung/diagnostic imaging
Language	English
Publishing date	2023-07-27
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.07.022
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Article ; Online: Authors' response: "Lung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients: A prospective study in pilot and confirmation cohorts".

Heldeweg, Micah L A / Mousa, Amne / Lieveld, Arthur W E / Smit, J M / Haaksma, M E / Tuinman, Pieter Roel

Journal of critical care

2023 Volume 77, Page(s) 154321

MeSH term(s)	Humans ; Prospective Studies ; Prone Position/physiology ; COVID-19 ; Lung/diagnostic imaging ; Respiration, Artificial ; Pulmonary Gas Exchange/physiology
Language	English
Publishing date	2023-05-01
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2023.154321
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Zs.A 2152: Show issues

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Article ; Online: Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections.

Azijli, Kaoutar / Minderhoud, Tanca C / de Gans, Carlijn J / Lieveld, Arthur W E / Nanayakkara, Prabath W B

Journal of the American College of Emergency Physicians open

2022 Volume 3, Issue 3, Page(s) e12621

Abstract: Objective: During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and ... ...

Abstract	Objective: During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin. Methods: This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included. Results: A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80-0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 μg/L had a sensitivity of 100% (95% CI 63.1-100) and specificity of 81.2% (95% CI 75.1-86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 μg/L showed a sensitivity of 87.2% (95% CI 72.6-95.7) and specificity of 64.1 % (95% CI 58.3-69.6). Conclusion: In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 μg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low.
Language	English
Publishing date	2022-05-19
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12621
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Article ; Online: Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT?

Lieveld, Arthur W E / Heldeweg, Micah L A / Schouwenburg, Jasper / Veldhuis, Lars / Haaksma, Mark E / van Haaften, Rutger M / Teunissen, Berend P / Smit, Jasper M / Twisk, Jos / Heunks, Leo / Nanayakkara, Prabath W B / Tuinman, Pieter Roel

The ultrasound journal

2023 Volume 15, Issue 1, Page(s) 11

Abstract: Background: It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In ... ...

Abstract	Background: It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints. Methods: This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models. Results: 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31-0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73-0.95), 0.94 (95% CI 0.90-0.96), and 0.84 (95% CI 0.65-0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC. Conclusions: LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool.
Language	English
Publishing date	2023-02-26
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2965029-X
ISSN	2524-8987 ; 2036-3176
ISSN (online)	2524-8987
ISSN	2036-3176
DOI	10.1186/s13089-022-00299-x
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Article ; Online: Determining the optimal number of lung ultrasound zones to monitor COVID-19 patients: can we keep it ultra-short and ultra-simple?

Heldeweg, Micah L A / Lieveld, Arthur W E / de Grooth, Harm J / Heunks, Leo M A / Tuinman, Pieter R

Intensive care medicine

2021 Volume 47, Issue 9, Page(s) 1041–1043

MeSH term(s)	COVID-19 ; Humans ; Lung/diagnostic imaging ; Point-of-Care Systems ; SARS-CoV-2 ; Ultrasonography
Language	English
Publishing date	2021-06-26
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-021-06463-6
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Article: Correlation between Serum Biomarkers and Lung Ultrasound in COVID-19: An Observational Study.

Diagnostics (Basel, Switzerland)

2024 Volume 14, Issue 4

Abstract: Serum biomarkers and lung ultrasound are important measures for prognostication and treatment allocation in patients with COVID-19. Currently, there is a paucity of studies investigating relationships between serum biomarkers and ultrasonographic ... ...

Abstract	Serum biomarkers and lung ultrasound are important measures for prognostication and treatment allocation in patients with COVID-19. Currently, there is a paucity of studies investigating relationships between serum biomarkers and ultrasonographic biomarkers derived from lung ultrasound. This study aims to assess correlations between serum biomarkers and lung ultrasound findings. This study is a secondary analysis of four prospective observational studies in adult patients with COVID-19. Serum biomarkers included markers of epithelial injury, endothelial dysfunction and immune activation. The primary outcome was the correlation between biomarker concentrations and lung ultrasound score assessed with Pearson's (r) or Spearman's (r
Language	English
Publishing date	2024-02-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics14040421
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Article ; Online: Longechografie bij patiënten met symptomen van covid-19.

Assman, Natascha L / Kok, Bram / van Laarhoven, Arjan / Lieveld, Arthur W E / Schuit, Frederik H / Bosch, Frank H

Nederlands tijdschrift voor geneeskunde

2021 Volume 165

Abstract: The SARS-CoV-2 pandemic presents a challenge for healthcare worldwide. In this context, rapid, correct diagnosis and early isolation of infected persons is of great importance. Pneumonia as an expression of COVID-19 is responsible for the most part of ... ...

Title translation	Lung ultrasound in patients with symptoms of covid-19.
Abstract	The SARS-CoV-2 pandemic presents a challenge for healthcare worldwide. In this context, rapid, correct diagnosis and early isolation of infected persons is of great importance. Pneumonia as an expression of COVID-19 is responsible for the most part of morbidity and mortality. Lung ultrasound can provide valuable information about the diagnosis of a COVID-19 pneumonia in daily practice. A normal ultrasound excludes COVID-19 pneumonia. Conversely, finding abnormalities matching with a COVID-19 pneumonia can be useful for isolation policy. Follow up lung ultrasound visualizes the development of the pneumonia and a possible alternative diagnosis can thereby be determined in the event of a deviating clinical course.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; Humans ; Lung/diagnostic imaging ; Pandemics ; SARS-CoV-2 ; Ultrasonography/methods
Language	Dutch
Publishing date	2021-04-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients - A diagnostic accuracy study.

Lieveld, Arthur / Heldeweg, M L A / Smit, J M / Haaksma, M E / Veldhuis, L / Walburgh-Schmidt, R S / Twisk, J / Nanayakkara, P W B / Heunks, L / Tuinman, P R

Journal of critical care

2022 Volume 69, Page(s) 153992

Abstract: Purpose: Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time- ...

Abstract	Purpose: Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis. Materials & methods: This prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination. Results: 70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7]). Conclusions: Multi-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA. Registration: www.trialregister.nl: NL8540.
MeSH term(s)	Adult ; COVID-19/complications ; COVID-19/diagnostic imaging ; Critical Illness ; Humans ; Point-of-Care Systems ; Prospective Studies ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/etiology ; Venous Thrombosis/diagnostic imaging
Language	English
Publishing date	2022-02-02
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2022.153992
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Article ; Online: Assessing COVID-19 pneumonia-Clinical extension and risk with point-of-care ultrasound: A multicenter, prospective, observational study.

Lieveld, Arthur W E / Kok, Bram / Azijli, Kaoutar / Schuit, Frederik H / van de Ven, Peter M / de Korte, Chris L / Nijveldt, Robin / van den Heuvel, Frederik M A / Teunissen, Bernd P / Hoefsloot, Wouter / Nanayakkara, Prabath W B / Bosch, Frank H

Journal of the American College of Emergency Physicians open

2021 Volume 2, Issue 3, Page(s) e12429

Abstract: Background: Assessing the extent of lung involvement is important for the triage and care of COVID-19 pneumonia. We sought to determine the utility of point-of-care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk ... ...

Abstract	Background: Assessing the extent of lung involvement is important for the triage and care of COVID-19 pneumonia. We sought to determine the utility of point-of-care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID-19 pneumonia. Methods: This multicenter, prospective, observational study included patients with COVID-19 who received 12-zone lung ultrasound and chest computed tomography (CT) scanning in the emergency department (ED). We defined lung disease severity using the lung ultrasound score (LUS) and chest CT severity score (CTSS). We assessed the association between the LUS and poor outcome (ICU admission or 30-day all-cause mortality). We also assessed the association between the LUS and hospital length of stay. We examined the ability of the LUS to differentiate between disease severity groups. Lastly, we estimated the correlation between the LUS and CTSS and the interrater agreement for the LUS. We handled missing data by multiple imputation with chained equations and predictive mean matching. Results: We included 114 patients treated between March 19, 2020, and May 4, 2020. An LUS ≥12 was associated with a poor outcome within 30 days (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.26-24.80; Conclusions: We showed that baseline lung ultrasound - is associated with poor outcomes, admission duration, and disease severity. The LUS also correlates well with CTSS. Point-of-care lung ultrasound may aid the risk stratification and triage of patients with COVID-19 at the ED.
Language	English
Publishing date	2021-05-01
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12429
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Article: Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound

Lieveld, Arthur W E / Kok, Bram / Schuit, Frederik H / Azijli, Kaoutar / Heijmans, Jarom / van Laarhoven, Arjan / Assman, Natascha L / Kootte, Ruud S / Olgers, Tycho J / Nanayakkara, Prabath W B / Bosch, Frank H

ERJ open research

2020 Volume 6, Issue 4

Abstract: Background: In this coronavirus disease 2019 (COVID-19) pandemic, fast and accurate testing is needed to profile patients at the emergency department (ED) and efficiently allocate resources. Chest imaging has been considered in COVID-19 workup, but ... ...

Abstract	Background: In this coronavirus disease 2019 (COVID-19) pandemic, fast and accurate testing is needed to profile patients at the emergency department (ED) and efficiently allocate resources. Chest imaging has been considered in COVID-19 workup, but evidence on lung ultrasound (LUS) is sparse. We therefore aimed to assess and compare the diagnostic accuracy of LUS and computed tomography (CT) in suspected COVID-19 patients. Methods: This multicentre, prospective, observational study included adult patients with suspected COVID-19 referred to internal medicine at the ED. We calculated diagnostic accuracy measures for LUS and CT using both PCR and multidisciplinary team (MDT) diagnosis as reference. We also assessed agreement between LUS and CT, and between sonographers. Results: One hundred and eighty-seven patients were recruited between March 19 and May 4, 2020. Area under the receiver operating characteristic (AUROC) was 0.81 (95% CI 0.75-0.88) for LUS and 0.89 (95% CI 0.84-0.94) for CT. Sensitivity and specificity for LUS were 91.9% (95% CI 84.0-96.7) and 71.0% (95% CI 61.1-79.6), respectively, Conclusion: LUS and CT have comparable diagnostic accuracy for COVID-19 pneumonia. LUS can safely exclude clinically relevant COVID-19 pneumonia and may aid COVID-19 diagnosis in high prevalence situations.
Language	English
Publishing date	2020-12-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2827830-6
ISSN	2312-0541
ISSN	2312-0541
DOI	10.1183/23120541.00539-2020
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