Research

10 pages, 988 KiB

Open AccessArticle

Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19

by Alice Nova, Emanuele Rezoagli, Nilde Eronia, Annalisa Benini, Andrea Scognamiglio, Giuseppe Foti and Giacomo Bellani

Diagnostics 2023, 13(7), 1361; https://doi.org/10.3390/diagnostics13071361 - 06 Apr 2023

Viewed by 1433

Abstract

Background: Noninvasive ventilation, mainly helmet CPAP, was widely used during the COVID-19 pandemic, even outside of intensive care units. Both the ROX index and the LUS score (LUSS) have been proposed as tools to predict negative outcomes in patients with hypoxemia treated with [...] Read more.

Background: Noninvasive ventilation, mainly helmet CPAP, was widely used during the COVID-19 pandemic, even outside of intensive care units. Both the ROX index and the LUS score (LUSS) have been proposed as tools to predict negative outcomes in patients with hypoxemia treated with noninvasive ventilation (NIV) outside of ICUs. We aim to evaluate whether the combination of LUSS with the ROX index improves the predictive performance of these indices in patients with hypoxemia due to COVID-19 pneumonia, treated with NIV outside of ICUs. Methods: This is a monocentric prospective observational study conducted at the university teaching hospital Fondazione IRCCS San Gerardo dei Tintori (Monza, Italy) from February to April 2021. LUSS and ROX were collected at the same time in noninvasively ventilated patients outside of the ICU. An LUS exam was performed by 3 emergency medicine attending physicians with at least 5 years’ experience in point-of-care ultrasonography using a 12-zone system. To evaluate the accuracy of the prognostic indices in predicting a composite outcome (endotracheal intubation and mortality), ROC curves were used. A logistic multivariable model was used to explore the predictors of the composite outcome of endotracheal intubation and in-hospital mortality. An unadjusted Kaplan–Meier analysis was used to explore the association with the composite outcome of survival without invasive mechanical ventilation at the 30-day follow-up by stratifying the 3 indices by their best cut-offs. Results: A total of 79 patients were included in the statistical analysis and stratified into 2 groups based on the presence of a negative outcome, which was reported in 24 patients out of 79 (30%). A great proportion of patients (66 patients—84%) were treated with helmet CPAP. All three indices (LUSS, ROX and LUSS/ROX) were independently associated with negative outcomes in the multivariable analyses. Although the comparison between the AUROC of LUSS or ROX versus LUSS/ROX did not reveal a statistically significant difference, we observed a trend toward a higher accuracy for predicting negative outcomes using the LUSS/ROX index as compared to using LUSS. With the Kaplan–Maier approach, all three indices stratified by the best cut-off reported a significant association with the outcome of 30-day survival without mechanical ventilation. Conclusions: A multimodal noninvasive approach that combines ultrasound (i.e., LUSS) and a bedside clinical evaluation (i.e., the ROX index) may help clinicians to predict outcomes and to identify patients who would benefit the most from invasive respiratory support. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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11 pages, 2054 KiB

Open AccessArticle

Incidence of Air Leaks in Critically Ill Patients with Acute Hypoxemic Respiratory Failure Due to COVID-19

by Robin L. Goossen, Mariëlle Verboom, Mariëlle Blacha, Illaa Smesseim, Ludo F. M. Beenen, David M. P. van Meenen, Frederique Paulus, Marcus J. Schultz and on behalf of the PRoVENT–COVID and PRoAcT–COVID Investigators

Diagnostics 2023, 13(6), 1156; https://doi.org/10.3390/diagnostics13061156 - 17 Mar 2023

Viewed by 1096

Abstract

Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory [...] Read more.

Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2–5) chest radiographs and a median of one (1–2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2–21) days after arrival in the ICU and 18 (9–22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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9 pages, 1290 KiB

Open AccessArticle

Accuracy of Modified Blue-Dye Testing in Predicting Dysphagia in Tracheotomized Critically Ill Patients

by Manuel Muñoz-Garach, Olga Moreno-Romero, Rosario Ramirez-Puerta, Eugenia Yuste-Ossorio, Francisca Quintana-Luque, Manuel Muñoz-Torres and Manuel Colmenero

Diagnostics 2023, 13(4), 616; https://doi.org/10.3390/diagnostics13040616 - 07 Feb 2023

Cited by 2 | Viewed by 3019

Abstract

(1) Background: Diagnosis of dysphagia in critically ill patients with a tracheostomy is important to avoid aspiration pneumonia. The objective of this study was to analyze the validity of the modified blue-dye test (MBDT) on the diagnosis of dysphagia in these patients; (2) [...] Read more.

(1) Background: Diagnosis of dysphagia in critically ill patients with a tracheostomy is important to avoid aspiration pneumonia. The objective of this study was to analyze the validity of the modified blue-dye test (MBDT) on the diagnosis of dysphagia in these patients; (2) Methods: Comparative diagnostic test accuracy study. Tracheostomized patients admitted to the Intensive Care Unit (ICU) were studied with two tests for dysphagia diagnosis: MBDT and fiberoptic endoscopic evaluation of swallowing (FEES) as the reference standard. Comparing the results of both methods, all diagnostic measures were calculated, including the area under the receiver-operating-characteristic curve (AUC); (3) Results: 41 patients, 30 males and 11 females, mean age 61 ± 13.9 years. The prevalence of dysphagia was 70.7% (29 patients) using FEES as the reference test. Using MBDT, 24 patients were diagnosed with dysphagia (80.7%). The sensitivity and specificity of the MBDT were 0.79 (CI95%: 0.60–0.92) and 0.91 (CI95%: 0.61–0.99), respectively. Positive and negative predictive values were 0.95 (CI95%: 0.77–0.99) and 0.64 (CI95%: 0.46–0.79). AUC was 0.85 (CI95%: 0.72–0.98); (4) Conclusions: MBDT should be considered for the diagnosis of dysphagia in critically ill tracheostomized patients. Caution should be taken when using it as a screening test, but its use could avoid the need for an invasive procedure. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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12 pages, 1576 KiB

Open AccessArticle

Ultrasound Versus Computed Tomography for Diaphragmatic Thickness and Skeletal Muscle Index during Mechanical Ventilation

by Stefano Gatti, Chiara Abbruzzese, Davide Ippolito, Sophie Lombardi, Andrea De Vito, Davide Gandola, Veronica Meroni, Vittoria Ludovica Sala, Sandro Sironi, Antonio Pesenti, Giuseppe Foti, Emanuele Rezoagli and Giacomo Bellani

Diagnostics 2022, 12(11), 2890; https://doi.org/10.3390/diagnostics12112890 - 21 Nov 2022

Cited by 4 | Viewed by 1706

Abstract

Background: Diaphragmatic alterations occurring during mechanical ventilation (MV) can be monitored using ultrasound (US). The performance of computed tomography (CT) to evaluate diaphragmatic thickness is limited. Further, the association between muscle mass and outcome is increasingly recognized. However, no data are available on [...] Read more.

Background: Diaphragmatic alterations occurring during mechanical ventilation (MV) can be monitored using ultrasound (US). The performance of computed tomography (CT) to evaluate diaphragmatic thickness is limited. Further, the association between muscle mass and outcome is increasingly recognized. However, no data are available on its correlation with diaphragmatic thickness. We aimed to determine correlation and agreement of diaphragmatic thickness between CT and US; and its association with muscle mass and MV parameters. Methods: Prospective observational study. US measurements of the diaphragmatic thickness were collected in patients undergoing MV within 12 h before or after performing a CT scan of the thorax and/or upper abdomen. Data on skeletal muscle index (SMI), baseline, and ventilatory data were recorded and correlated with US and CT measures of diaphragmatic thickness. Agreement was explored between US and CT data. Results: Twenty-nine patients were enrolled and the diaphragm measured by CT resulted overall thicker than US-based measurement of the right hemidiaphragm. The US thickness showed the strongest correlation with the left posterior pillar at CT (r = 0.49, p = 0.008). The duration of the controlled MV was negatively correlated with US thickness (r = −0.45, p = 0.017), the thickness of the right anterior pillar (r = −0.41, p = 0.029), and splenic dome by CT (r = −0.43, p = 0.023). SMI was positively correlated with US diaphragmatic thickness (r = 0.50, p = 0.007) and inversely correlated with the duration of MV before enrollment (r = −0.426, p = 0.027). Conclusions: CT scan of the left posterior pillar can estimate diaphragmatic thickness and is moderately correlated with US measurements. Both techniques show that diaphragm thickness decreases with MV duration. The diaphragmatic thickness by US showed a good correlation with SMI. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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7 pages, 1327 KiB

Open AccessArticle

Safety of Bedside Portable Low-Field Brain MRI in ECMO Patients Supported on Intra-Aortic Balloon Pump

by Christopher Wilcox, Matthew Acton, Hannah Rando, Steven Keller, Haris I. Sair, Ifeanyi Chinedozi, John Pitts, Bo Soo Kim, Glenn Whitman and Sung Min Cho

Diagnostics 2022, 12(11), 2871; https://doi.org/10.3390/diagnostics12112871 - 19 Nov 2022

Cited by 4 | Viewed by 3470

Abstract

(1) Background: Fifty percent of patients supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are concurrently supported with an intra-aortic balloon pump (IABP). Acute brain injury (ABI) is a devastating complication related to ECMO and IABP use. The standard of care for ABI diagnosis [...] Read more.

(1) Background: Fifty percent of patients supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are concurrently supported with an intra-aortic balloon pump (IABP). Acute brain injury (ABI) is a devastating complication related to ECMO and IABP use. The standard of care for ABI diagnosis requires transport to a head CT (HCT) scanner. Recent data suggest that point-of-care (POC) magnetic resonance imaging (MRI) is safe and may be effective in diagnosing ABI in ECMO patients; however, no data exist in patients supported on ECMO with an IABP. We report pre-clinical safety data and a case series to evaluate the safety and feasibility of POC brain MRI in ECMO patients supported with IABP. (2) Methods: Prior to patient use, ex vivo testing with an IABP catheter within the Swoop^® Portable MRI (0.064 T) System™ was conducted. After IRB approval, clinical testing was performed for the safety and feasibility of early ABI detection. (3) Results: No deflection force was measured with a 7.5 French Maquet Linear IABP within the 0.064 T field. Three adult ECMO patients (average age: 40 years; 67% female) supported with IABP completed four POC brain MRI exams (median exam time: 30 min). Multiple signal abnormalities were detected on the POC brain MRI, corresponding to HCT results. (4) Conclusions: Our preliminary results suggest that adult VA-ECMO patients with IABP support can be safely imaged with low-field POC brain MRI in the intensive care unit, allowing for the early and bedside imaging of patients. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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12 pages, 1223 KiB

Open AccessArticle

Prone Positioning Decreases Inhomogeneity and Improves Dorsal Compliance in Invasively Ventilated Spontaneously Breathing COVID-19 Patients—A Study Using Electrical Impedance Tomography

by Charalampos Pierrakos, Fleur L. I. M. van der Ven, Marry R. Smit, Laura A. Hagens, Frederique Paulus, Marcus J. Schultz and Lieuwe D. J. Bos

Diagnostics 2022, 12(10), 2281; https://doi.org/10.3390/diagnostics12102281 - 21 Sep 2022

Cited by 2 | Viewed by 1756

Abstract

Background: We studied prone positioning effects on lung aeration in spontaneously breathing invasively ventilated patients with coronavirus disease 2019 (COVID-19). Methods: changes in lung aeration were studied prospectively by electrical impedance tomography (EIT) from before to after placing the patient prone, and back [...] Read more.

Background: We studied prone positioning effects on lung aeration in spontaneously breathing invasively ventilated patients with coronavirus disease 2019 (COVID-19). Methods: changes in lung aeration were studied prospectively by electrical impedance tomography (EIT) from before to after placing the patient prone, and back to supine. Mixed effect models with a random intercept and only fixed effects were used to evaluate changes in lung aeration. Results: fifteen spontaneously breathing invasively ventilated patients were enrolled, and remained prone for a median of 19 [17 to 21] hours. At 16 h the global inhomogeneity index was lower. At 2 h, there were neither changes in dorsal nor in ventral compliance; after 16 h, only dorsal compliance (βFe +18.9 [95% Confidence interval (CI): 9.1 to 28.8]) and dorsal end-expiratory lung impedance (EELI) were increased (βFe, +252 [95% CI: 13 to 496]); at 2 and 16 h, dorsal silent spaces was unchanged (βFe, –4.6 [95% CI: –12.3 to +3.2]). The observed changes induced by prone positioning disappeared after turning patients back to supine. Conclusions: in this cohort of spontaneously breathing invasively ventilated COVID-19 patients, prone positioning decreased inhomogeneity, increased lung volumes, and improved dorsal compliance. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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13 pages, 1507 KiB

Open AccessArticle

The RALE Score Versus the CT Severity Score in Invasively Ventilated COVID-19 Patients—A Retrospective Study Comparing Their Prognostic Capacities

by Christel M. Valk, Claudio Zimatore, Guido Mazzinari, Charalampos Pierrakos, Chaisith Sivakorn, Jutamas Dechsanga, Salvatore Grasso, Ludo Beenen, Lieuwe D. J. Bos, Frederique Paulus, Marcus J. Schultz and Luigi Pisani

Diagnostics 2022, 12(9), 2072; https://doi.org/10.3390/diagnostics12092072 - 26 Aug 2022

Cited by 6 | Viewed by 1502

Abstract

Background: Quantitative radiological scores for the extent and severity of pulmonary infiltrates based on chest radiography (CXR) and computed tomography (CT) scan are increasingly used in critically ill invasively ventilated patients. This study aimed to determine and compare the prognostic capacity of the [...] Read more.

Background: Quantitative radiological scores for the extent and severity of pulmonary infiltrates based on chest radiography (CXR) and computed tomography (CT) scan are increasingly used in critically ill invasively ventilated patients. This study aimed to determine and compare the prognostic capacity of the Radiographic Assessment of Lung Edema (RALE) score and the chest CT Severity Score (CTSS) in a cohort of invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to COVID-19. Methods: Two-center retrospective observational study, including consecutive invasively ventilated COVID-19 patients. Trained scorers calculated the RALE score of first available CXR and the CTSS of the first available CT scan. The primary outcome was ICU mortality; secondary outcomes were duration of ventilation in survivors, length of stay in ICU, and hospital-, 28-, and 90-day mortality. Prognostic accuracy for ICU death was expressed using odds ratios and Area Under the Receiver Operating Characteristic curves (AUROC). Results: A total of 82 patients were enrolled. The median RALE score (22 [15–37] vs. 26 [20–39]; p = 0.34) and the median CTSS (18 [16–21] vs. 21 [18–23]; p = 0.022) were both lower in ICU survivors compared to ICU non-survivors, although only the difference in CTSS reached statistical significance. While no association was observed between ICU mortality and RALE score (OR 1.35 [95%CI 0.64–2.84]; p = 0.417; AUC 0.50 [0.44–0.56], this was noticed with the CTSS (OR, 2.31 [1.22–4.38]; p = 0.010) although with poor prognostic capacity (AUC 0.64 [0.57–0.69]). The correlation between the RALE score and CTSS was weak (r² = 0.075; p = 0.012). Conclusions: Despite poor prognostic capacity, only CTSS was associated with ICU mortality in our cohort of COVID-19 patients. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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Review

Jump to: Research, Other

22 pages, 8484 KiB

Open AccessReview

Endocardial Fibroelastosis as an Independent Predictor of Atrioventricular Valve Rupture in Maternal Autoimmune Antibody Exposed Fetus: A Systematic Review with Clinicopathologic Analysis

by Monika Kantilal Kotecha, Khurshid Merchant, Charmaine Jiahui Chan, Jonathan Tze Liang Choo, Krishna Revanna Gopagondanahalli, Dyan Zhewei Zhang, Teng Hong Tan and Sreekanthan Sundararaghavan

Diagnostics 2023, 13(8), 1481; https://doi.org/10.3390/diagnostics13081481 - 20 Apr 2023

Viewed by 1500

Abstract

Background: Neonatal lupus (NL) is a clinical syndrome that develops in the fetus as a result of maternal autoimmune antibodies. Congenital complete heart block (CHB) is the most common manifestation, while extranodal cardiac manifestations of NL, such as endocardial fibroelastosis (EFE) and myocarditis, [...] Read more.

Background: Neonatal lupus (NL) is a clinical syndrome that develops in the fetus as a result of maternal autoimmune antibodies. Congenital complete heart block (CHB) is the most common manifestation, while extranodal cardiac manifestations of NL, such as endocardial fibroelastosis (EFE) and myocarditis, are rare but more serious. Less is known about this atrioventricular valve rupture due to valvulitis as a consequence of maternal autoantibodies. We have described a case of cardiac neonatal lupus with an antenatally detected CHB patient who developed mitral and tricuspid valve chordal rupture at 45 days of age. We compared the cardiac histopathology and the fetal cardiac echocardiographic findings of this case with another fetus that was aborted after being antenatally diagnosed with CHB but without valvar rupture. A narrative analysis after a systematic review of the literature regarding atrioventricular valve apparatus rupture due to autoimmune etiology along with maternal characteristics, presentation, treatment, and outcome have been discussed in this article. Objectives: To describe published data on atrioventricular valve rupture in neonatal lupus, including clinical presentation, diagnostic evaluation, management, and outcomes. Methods: We conducted a PRISMA-compliant descriptive systematic examination of case reports that included accounts of lupus during pregnancy or in the newborn period that resulted in an atrioventricular valve rupture. We gathered information on the patient’s demographics, the details of the valve rupture and other comorbidities, the maternal therapy, the clinical course, and the results. We also used a standardized method to evaluate the cases’ quality. A total of 12 cases were investigated, with 11 cases drawn from 10 case reports or case series and 1 from our own experience. Results: Tricuspid valve rupture (50%) is more common than mitral valve rupture (17%). Unlike mitral valve rupture, which occurs postnatally, the timing of tricuspid valve rupture is perinatal. A total of 33% of the patients had concomitant complete heart block, while 75% of the patients had endocardial fibroelastosis on an antenatal ultrasound. Antenatal changes pertaining to endocardial fibroelastosis can be seen as early as 19 weeks of gestation. Patients with both valve ruptures generally have a poor prognosis, especially if they occur at close intervals. Conclusion: Atrioventricular valve rupture in neonatal lupus is rare. A majority of patients with valve rupture had antenatally detected endocardial fibroelastosis in the valvar apparatus. Appropriate and expedited surgical repair of ruptured atrioventricular valves is feasible and has a low mortality risk. Rupture of both atrioventricular valves occurring at close intervals carries a high mortality risk. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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19 pages, 2267 KiB

Open AccessReview

Update on Lean Body Mass Diagnostic Assessment in Critical Illness

by Silvia De Rosa, Michele Umbrello, Paolo Pelosi and Denise Battaglini

Diagnostics 2023, 13(5), 888; https://doi.org/10.3390/diagnostics13050888 - 26 Feb 2023

Cited by 6 | Viewed by 2977

Abstract

Acute critical illnesses can alter vital functions with profound biological, biochemical, metabolic, and functional modifications. Despite etiology, patient’s nutritional status is pivotal to guide metabolic support. The assessment of nutritional status remains complex and not completely elucidated. Loss of lean body mass is [...] Read more.

Acute critical illnesses can alter vital functions with profound biological, biochemical, metabolic, and functional modifications. Despite etiology, patient’s nutritional status is pivotal to guide metabolic support. The assessment of nutritional status remains complex and not completely elucidated. Loss of lean body mass is a clear marker of malnutrition; however, the question of how to investigate it still remains unanswered. Several tools have been implemented to measure lean body mass, including a computed tomography scan, ultrasound, and bioelectrical impedance analysis, although such methods unfortunately require validation. A lack of uniform bedside measurement tools could impact the nutrition outcome. Metabolic assessment, nutritional status, and nutritional risk have a pivotal role in critical care. Therefore, knowledge about the methods used to assess lean body mass in critical illnesses is increasingly required. The aim of the present review is to update the scientific evidence regarding lean body mass diagnostic assessment in critical illness to provide the diagnostic key points for metabolic and nutritional support. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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16 pages, 1806 KiB

Open AccessReview

Echocardiography as a Tool to Assess Cardiac Function in Critical Care—A Review

by Marius Keller, Harry Magunia, Peter Rosenberger and Michael Koeppen

Diagnostics 2023, 13(5), 839; https://doi.org/10.3390/diagnostics13050839 - 22 Feb 2023

Cited by 4 | Viewed by 5085

Abstract

In critically ill patients, hemodynamic disturbances are common and often lead to a detrimental outcome. Frequently, invasive hemodynamic monitoring is required for patients who are hemodynamically unstable. Although the pulmonary artery catheter enables a comprehensive assessment of the hemodynamic profile, this technique carries [...] Read more.

In critically ill patients, hemodynamic disturbances are common and often lead to a detrimental outcome. Frequently, invasive hemodynamic monitoring is required for patients who are hemodynamically unstable. Although the pulmonary artery catheter enables a comprehensive assessment of the hemodynamic profile, this technique carries a substantial inherent risk of complications. Other less invasive techniques do not offer a full range of results to guide detailed hemodynamic therapies. An alternative with a lower risk profile is transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). After training, intensivists can obtain similar parameters on the hemodynamic profile using echocardiography, such as stroke volume and ejection fraction of the right and left ventricles, an estimate of the pulmonary artery wedge pressure, and cardiac output. Here, we will review individual echocardiography techniques that will help the intensivist obtain a comprehensive assessment of the hemodynamic profile using echocardiography. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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31 pages, 2275 KiB

Open AccessReview

Heart Failure and Cardiomyopathies: CT and MR from Basics to Advanced Imaging

by Pierpaolo Palumbo, Ester Cannizzaro, Maria Michela Palumbo, Annamaria Di Cesare, Federico Bruno, Chiara Acanfora, Antonella Arceri, Laura Evangelista, Francesco Arrigoni, Francesca Grassi, Roberta Grassi, Silvia Pradella, Vittorio Miele, Andrea Giovagnoni, Alessandra Splendiani, Antonio Barile, Carlo Masciocchi and Ernesto Di Cesare

Diagnostics 2022, 12(10), 2298; https://doi.org/10.3390/diagnostics12102298 - 23 Sep 2022

Cited by 3 | Viewed by 2183

Abstract

Since 1997, heart failure (HF) has been designated as a new epidemic. However, it is not easy to find a proper definition since different descriptors are used in clinical practice. Moreover, HF is not a single clinical entity, and there is a close [...] Read more.

Since 1997, heart failure (HF) has been designated as a new epidemic. However, it is not easy to find a proper definition since different descriptors are used in clinical practice. Moreover, HF is not a single clinical entity, and there is a close relationship between HF and all cardiomyopathies (CMs). This leads us to also consider accuracy in the characterization of CMs, which is essential to define the therapeutic process of HF patients. This narrative review aims to describe the main mechanisms leading to HF in different CMs, as well as the current diagnostic and prognostic advantages deriving from advanced imaging in the cardiac field. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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Other

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7 pages, 1784 KiB

Open AccessCase Report

Radiologic Imaging of the In Vivo Position of the New Supraglottic Airway Device Spritztube^® in an Adult Patient—A Case Report

by Silvia De Rosa, Massimiliano Sorbello, Alessandro Rigobello, Lucia Cattin, Giuseppe Iannucci, Paolo Gennaro, Vinicio Danzi and Stefano Checcacci Carboni

Diagnostics 2022, 12(12), 2907; https://doi.org/10.3390/diagnostics12122907 - 22 Nov 2022

Viewed by 1339

Abstract

Spritztube^® is a new supraglottic airway device that allows either extraglottic ventilation or orotracheal intubation with the same device. The aim of the present report is to provide the first radiologic images of the Spritztube in situ in a living human and [...] Read more.

Spritztube^® is a new supraglottic airway device that allows either extraglottic ventilation or orotracheal intubation with the same device. The aim of the present report is to provide the first radiologic images of the Spritztube in situ in a living human and to assess the depth of insertion and its anatomical relationships in vivo. We present the case of a 55-year-old man who was admitted to our centre to perform an interventional neuroradiological procedure. We obtained and analysed radiologic images of the head and neck of an adult patient to ascertain the position of the cuffs of the Spritztube relative to different anatomic structures. The insertion and depth of the device, correct tip positioning, effects of the distal and proximal cuffs on adjacent soft tissues, and the position of the pharyngeal cuff from the cranial to the hyoid bone were evaluated. Our report shows that Spritztube could be helpful in maintaining an adequate airway during radiologic procedures. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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6 pages, 1039 KiB

Open AccessCase Report

Testosterone Therapy and Diaphragm Performance in a Male Patient with COVID-19: A Case Report

by Gloria Martins, Juan Carlos Rosso Verdeal, Helio Tostes, Alice Ramos Oliveira da Silva, Bernardo Tessarollo, Nazareth Novaes Rocha, Patricia Rieken Macedo Rocco and Pedro Leme Silva

Diagnostics 2022, 12(2), 535; https://doi.org/10.3390/diagnostics12020535 - 19 Feb 2022

Cited by 2 | Viewed by 1867

Abstract

Low levels of testosterone may lead to reduced diaphragm excursion and inspiratory time during COVID-19 infection. We report the case of a 38-year-old man with a positive result on a reverse transcriptase-polymerase chain reaction test for SARS-CoV-2, admitted to the intensive care unit [...] Read more.

Low levels of testosterone may lead to reduced diaphragm excursion and inspiratory time during COVID-19 infection. We report the case of a 38-year-old man with a positive result on a reverse transcriptase-polymerase chain reaction test for SARS-CoV-2, admitted to the intensive care unit with acute respiratory failure. After several days on mechanical ventilation and use of rescue therapies, during the weaning phase, the patient presented dyspnea associated with low diaphragm performance (diaphragm thickness fraction, amplitude, and the excursion-time index during inspiration were 37%, 1.7 cm, and 2.6 cm/s, respectively) by ultrasonography and reduced testosterone levels (total testosterone, bioavailable testosterone and sex hormone binding globulin (SHBG) levels were 9.3 ng/dL, 5.8 ng/dL, and 10.5 nmol/L, respectively). Testosterone was administered three times 2 weeks apart (testosterone undecanoate 1000 mg/4 mL intramuscularly). Diaphragm performance improved significantly (diaphragm thickness fraction, amplitude, and the excursion-time index during inspiration were 70%, 2.4 cm, and 3.0 cm/s, respectively) 45 and 75 days after the first dose of testosterone. No adverse events were observed, although monitoring was required after testosterone administration. Testosterone replacement therapy led to good diaphragm performance in a male patient with COVID-19. This should be interpreted with caution due to the exploratory nature of the study. Full article

(This article belongs to the Special Issue Critical Care Imaging)

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