Soins palliatifs et médecine

Abstrait

Application of LUS to Treat Acute Respiratory Distress Syndrome (ARDS) in a Critically Ill Patient with Severe COVID-19

Sarah Ziane

Background: Rapid development and a high death rate characterise the acute respiratory distress syndrome (ARDS), a condition that is highly frequent in intensive care units (ICUs). Infections brought on by the novel SARSCoV-2 coronavirus can quickly proceed in individuals who are already critically unwell to ARDS. It's crucial to diagnose patients quickly and accurately, and to check for ARDS while they're being treated. Computed tomography (CT) examination is not always feasible due to the special characteristics of COVID-19 patients, and chest radiographs have a low sensitivity and specificity for the detection of lung illnesses. As a result, bedside lung ultrasonography (LUS) can be utilised as a novel method for ARDS diagnosis in COVID-19 patients. Bilateral non-uniform B lines can be seen in the pulmonary field that is not gravity-dependent. The B lines are denser and even present as "white lung" in the dorsal pulmonary area. Areas of consolidation with a static or dynamic air bronchogram sign are often observed in the dorsal pulmonary field, particularly in the basilar section. The "lung slip" typically lessens or vanishes in the fused B-line region. The pleural line is rough, thicker, uneven, and contains numerous tiny consolidations. Both primary and secondary ARDS had identical pulmonary ultrasonography results.

Case description: In the setting described above, we provide our experience with treating a significant COVID-19 case and a literature evaluation. An 81-year-old man patient with COVID-19-related ARDS. LUS was used to direct the implementation of prone ventilation, and we discovered that the pulmonary edoema in the gravity-dependent region did lessen over time. The posterior consolidation started to open after nine hours of prone breathing. The transition from fragment sign to B line is visible on LUS. The B-line was reduced after 16 hours, showing that the pulmonary edoema was becoming better. Improved oxygenation could be possible. Pulmonary ultrasonography allows for visual monitoring of prone ventilation. The patient was also given mechanical breathing, high-flow nasal oxygen, oseltamivir, lopinavir/ritonavir, abidol, and cefoperazone-sulbactam treatment at the same time.

Conclusion: The success of this case's therapy was largely due to LUS-guided care.