Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI).

INTRODUCTION: Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS: The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS: A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS: This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.

Ecografía multiórgano en infección por SARS-COV-2 / Multi-organ ultrasound for SARS-COV-2 disease

Aim: There is growing evidence regarding the imaging ultrasound findings of coronavirus disease 2019 COVID-19. Multi-organ ultrasoundhas played a significant role in the diagnosis and follow-up of thesepatients. The aim of this study was to describe the ultrasound findingsat pulmonary, cardiac and deep venous system of the lower extremities in patients with SARS-COV-2 infection.Material and method: Prospective, cross-sectional, observationalstudy was conducted in patients with confirmed COVID-19 who underwent a multi-organ point-of-care ultrasound (POCUS) examinationduring hospitalization.Results: A total of 107 patients were enrolled. Lung involvement waspresent in 100% of the patients, 93.4% bilaterally involvement. Themost affected lung area was the posteroinferior (94.39%) followed bythe lateral (89.72%). Subpleural consolidations were present in 71%of patients and consolidations larger than 1 cm in 25%. More echographic lung involvement is relational with the degree of respiratoryinsufficiency. Only two patients had proximal deep vein thrombosisin the lower extremities, 27 angiography tomography scan were performed and pulmonary thromboembolism was confirmed in 14 patients. The most frequent echocardiographic findings were impairedleft ventricular relaxation and left ventricular hypertrophy. All patientswith thromboembolic disease had severe or critical echocardiographicpulmonary involvement.Conclusions: Multi-organ POCUS ultrasound may be useful for themanifestations of COVID-19. The degree of lung ultrasound involvement was related to the degree of respiratory failure and to the presence of VTED. The relationship between DVT and PTE was lower thanexpected. Cardiac involvement has little relevance in our series. (AU)

Objetivo: Existe una creciente evidencia con respecto a los hallazgosecográficos y la COVID-19, destacando la ecografía multiórgano parael diagnóstico y el seguimiento de estos pacientes. El objetivo fuedescribir los hallazgos ecográficos a nivel pulmonar, cardiaco y delsistema venoso profundo de extremidades inferiores en pacientes coninfección por SARS-COV-2.Material y Métodos: Estudio prospectivo, transversal y observacionalrealizado en pacientes con COVID-19 confirmado a los que se lesrealizó una ecografía multiórgano en el punto de atención durante lahospitalización.Resultados: Un total de 107 pacientes se inscribieron. El 100% delos pacientes tenían afectación pulmonar (93,4% bilateral). Las zonaspulmonares más afectadas fueron la posteroinferior (94,39%) y la lateral (89,72%). Se observó consolidaciones subpleurales en el 71%de los pacientes y consolidaciones mayores de 1 cm en el 25%. Amayor afectación pulmonar ecográfica, mayor grado de insuficienciarespiratoria. 2 pacientes presentaron TVP proximal en extremidadesinferiores. Se realizaron 27 Angiotomografía computarizada confirmándose tromboembolismo pulmonar en 14 pacientes. Los hallazgosecocardiográficos más frecuentes fueron: alteración de la relajacióndel ventrículo izquierdo e hipertrofia ventricular izquierda. Todos lospacientes con enfermedad tromboembólica tenían una afectación pulmonar ecográfica grave o crítica.Conclusión: la ecografia multiórgano puede ser útil para lasmanifestaciones de la COVID-19. El grado de afectación ecográficapulmonar se relacionó con el grado de insuficiencia respiratoria y conla presencia de ETEV. La relación entre TVP y TEP fue más baja de loesperado. La afectación cardiaca fue poco relevante en nuestra serie. (AU)

Usefulness of Multi-Organ Point-of-Care Ultrasound as a Complement to the Decision-Making Process in Internal Medicine.

Accumulated data show the utility of diagnostic multi-organ point-of-care ultrasound (PoCUS) in the assessment of patients admitted to an internal medicine ward. We assessed whether multi-organ PoCUS (lung, cardiac, and abdomen) provides relevant diagnostic and/or therapeutic information in patients admitted for any reason to an internal medicine ward. We conducted a prospective, observational, and single-center study, at a secondary hospital. Multi-organ PoCUS was performed during the first 24 h of admission. The sonographer had access to the patients' medical history, physical examination, and basic complementary tests performed in the Emergency Department (laboratory, X-ray, electrocardiogram). We considered a relevant ultrasound finding if it implied a significant diagnostic and/or therapeutic change. In the second semester of 2019, we enrolled 310 patients, 48.7% were male and the mean age was 70.5 years. Relevant ultrasound findings were detected in 86 patients (27.7%) and in 60 (19.3%) triggered a therapeutic change. These findings were associated with an older age (Mantel−Haenszel χ2 = 25.6; p < 0.001) and higher degree of dependency (Mantel−Haenszel χ2 = 5.7; p = 0.017). Multi-organ PoCUS provides relevant diagnostic information, complementing traditional physical examination, and facilitates therapy adjustment, regardless of the cause of admission. Multi-organ PoCUS to be useful need to be systematically integrated into the decision-making process in internal medicine.

Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort.

Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE × US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation-SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE × US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE × US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE × US score, should be further studied before expanding its use in AHF patients.

Usefulness of lung ultrasound in the early identification of severe COVID-19: results from a prospective study.

AIM: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS); however, its role in predicting the prognosis has yet to be explored. The aim of the study was to assess the relationship between lung ultrasound findings with the degree of respiratory failure measured by the PaO2/FiO2 ratio (PaFi) andthe prognosis of these patients: need for non-invasive mechanical ventilation (NIMV), admission to the Intensive Care Unit (ICU) and mortality. MATERIAL AND METHOD: Prospective, longitudinal and observational study performed in patients with confirmed COVID-19 underwent a LUS examination and laboratory tests. RESULTS: A total of 107 patients were enrolled: 93.4% with bilateral involvement and 73.83% presented at least one consolidation. A good inverse correlation (Rho Spearman coefficient -0.897) between the ultrasound score and PaFi was obtained. The AUC for identification of patients with more severe respiratory failure, a moderate and severe ARDS, was 0.97 (CI 95%: 0.95-1) and a cut-off score of 34.5 showed a sensitivity of 0.94 and a specificity of 0.91. The Kappa index showed a high concordance (0.83) of the classification by ultrasound lunginvolvement and ARDS. CONCLUSIONS: The combination of the ultrasound score and the presence of respiratory failure can easily identify patients with a higher risk to present complications.

Comparison of Lung Ultrasound versus Chest X-ray for Detection of Pulmonary Infiltrates in COVID-19.

Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.

Lung ultrasound monitoring in patients with COVID-19 on home isolation.

Many patients with COVID-19, the clinical illness caused by SARS-CoV-2 infection, exhibit mild symptoms and do not require hospitalization. Instead, these patients are often referred for 14-days of home isolation as symptoms resolve. Lung ultrasound is well-established as an important means of evaluating lung pathology in patients in the emergency department and in intensive care units. Ultrasound is also being used to assess admitted patients with COVID-19. However, data on the progression of sonographic findings in patients with COVID-19 on home isolation is lacking. Here we present a case series of a group of physician patients with COVID-19 who monitored themselves daily while in home isolation using lung point-of-care ultrasound (POCUS). Lung POCUS findings corresponded with symptom onset and resolution in all 3 patients with confirmed COVID-19 during the 14-day isolation period. Lung POCUS may offer a feasible means of monitoring patients with COVID-19 who are on home isolation. Further studies correlating sonographic findings to disease progression and prognosis will be valuable.

Documento de consenso de SEMI, semFYC, SEN y SEC sobre ecocardioscopia en España / Consensus document of the SEMI, semFYC, SEN, and SEC on focused cardiac ultrasound in Spain

En el presente documento se sintetizan el concepto de ecocardioscopia, los aspectos técnicos fundamentales relacionados con esta técnica y sus objetivos diagnósticos. Además, se define cómo deben ser la formación y la capacitación en ecocardioscopia. Todo ello, avalado por la Sociedad Española de Medicina Interna (SEMI), la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Sociedad Española de Neurología (SEN) y la Sociedad Española de Cardiología (SEC)

This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC)

Consensus Document of the SEMI, semFYC, SEN, and SEC on Focused Cardiac Ultrasound in Spain.

This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC).

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