Publications by authors named "Jasper M Smit"

11 Publications

  • Page 1 of 1

Extended Lung Ultrasound to Differentiate Between Pneumonia and Atelectasis in Critically Ill Patients: A Diagnostic Accuracy Study.

Crit Care Med 2021 Sep 27. Epub 2021 Sep 27.

Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands. Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com), Amsterdam, The Netherlands. Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.

Objectives: To determine the diagnostic accuracy of extended lung ultrasonographic assessment, including evaluation of dynamic air bronchograms and color Doppler imaging to differentiate pneumonia and atelectasis in patients with consolidation on chest radiograph. Compare this approach to the Simplified Clinical Pulmonary Infection Score, Lung Ultrasound Clinical Pulmonary Infection Score, and the Bedside Lung Ultrasound in Emergency protocol.

Design: Prospective diagnostic accuracy study.

Setting: Adult ICU applying selective digestive decontamination.

Patients: Adult patients that underwent a chest radiograph for any indication at any time during admission. Patients with acute respiratory distress syndrome, coronavirus disease 2019, severe thoracic trauma, and infectious isolation measures were excluded.

Interventions: None.

Measurements And Main Results: Lung ultrasound was performed within 24 hours of chest radiograph. Consolidated tissue was assessed for presence of dynamic air bronchograms and with color Doppler imaging for presence of flow. Clinical data were recorded after ultrasonographic assessment. The primary outcome was diagnostic accuracy of dynamic air bronchogram and color Doppler imaging alone and within a decision tree to differentiate pneumonia from atelectasis. Of 120 patients included, 51 (42.5%) were diagnosed with pneumonia. The dynamic air bronchogram had a 45% (95% CI, 31-60%) sensitivity and 99% (95% CI, 92-100%) specificity. Color Doppler imaging had a 90% (95% CI, 79-97%) sensitivity and 68% (95% CI, 56-79%) specificity. The combined decision tree had an 86% (95% CI, 74-94%) sensitivity and an 86% (95% CI, 75-93%) specificity. The Bedside Lung Ultrasound in Emergency protocol had a 100% (95% CI, 93-100%) sensitivity and 0% (95% CI, 0-5%) specificity, while the Simplified Clinical Pulmonary Infection Score and Lung Ultrasound Clinical Pulmonary Infection Score had a 41% (95% CI, 28-56%) sensitivity, 84% (95% CI, 73-92%) specificity and 68% (95% CI, 54-81%) sensitivity, 81% (95% CI, 70-90%) specificity, respectively.

Conclusions: In critically ill patients with pulmonary consolidation on chest radiograph, an extended lung ultrasound protocol is an accurate and directly bedside available tool to differentiate pneumonia from atelectasis. It outperforms standard lung ultrasound and clinical scores.
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http://dx.doi.org/10.1097/CCM.0000000000005303DOI Listing
September 2021

Lung ultrasound in a tertiary intensive care unit population: a diagnostic accuracy study.

Crit Care 2021 09 17;25(1):339. Epub 2021 Sep 17.

Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands.

Background: Evidence from previous studies comparing lung ultrasound to thoracic computed tomography (CT) in intensive care unit (ICU) patients is limited due to multiple methodologic weaknesses. While addressing methodologic weaknesses of previous studies, the primary aim of this study is to investigate the diagnostic accuracy of lung ultrasound in a tertiary ICU population.

Methods: This is a single-center, prospective diagnostic accuracy study conducted at a tertiary ICU in the Netherlands. Critically ill patients undergoing thoracic CT for any clinical indication were included. Patients were excluded if time between the index and reference test was over eight hours. Index test and reference test consisted of 6-zone lung ultrasound and thoracic CT, respectively. Hemithoraces were classified by the index and reference test as follows: consolidation, interstitial syndrome, pneumothorax and pleural effusion. Sensitivity, specificity, positive and negative likelihood ratio were estimated.

Results: In total, 87 patients were included of which eight exceeded the time limit and were subsequently excluded. In total, there were 147 respiratory conditions in 79 patients. The estimated sensitivity and specificity to detect consolidation were 0.76 (95%CI: 0.68 to 0.82) and 0.92 (0.87 to 0.96), respectively. For interstitial syndrome they were 0.60 (95%CI: 0.48 to 0.71) and 0.69 (95%CI: 0.58 to 0.79). For pneumothorax they were 0.59 (95%CI: 0.33 to 0.82) and 0.97 (95%CI: 0.93 to 0.99). For pleural effusion they were 0.85 (95%CI: 0.77 to 0.91) and 0.77 (95%CI: 0.62 to 0.88).

Conclusions: In conclusion, lung ultrasound is an adequate diagnostic modality in a tertiary ICU population to detect consolidations, interstitial syndrome, pneumothorax and pleural effusion. Moreover, one should be careful not to interpret lung ultrasound results in deterministic fashion as multiple respiratory conditions can be present in one patient. Trial registration This study was retrospectively registered at Netherlands Trial Register on March 17, 2021, with registration number NL9344.
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http://dx.doi.org/10.1186/s13054-021-03759-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447620PMC
September 2021

Venous thromboembolism is not a risk factor for the development of bloodstream infections in critically ill COVID-19 patients.

Thromb Res 2021 10 25;206:128-130. Epub 2021 Aug 25.

Department of Intensive Care, OLVG Hospital, Amsterdam, the Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

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http://dx.doi.org/10.1016/j.thromres.2021.08.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384728PMC
October 2021

Holistic Ultrasound to Predict Extubation Failure in Clinical Practice.

Respir Care 2021 Jun 13;66(6):994-1003. Epub 2021 Apr 13.

Department of Intensive Care Medicine, Amsterdam University Medical Centers VUmc, Amsterdam, The Netherlands.

Background: A weaning trial can be considered a stress test of the cardiorespiratory system; it increases oxygen demand and thus warrants a higher cardiac index and elevated breathing effort. We hypothesized that the combination of easily performed ultrasound measurements of heart, lungs, and diaphragm would yield good diagnostic accuracy to predict extubation failure.

Methods: Adult subjects ventilated for > 72 h with a successful spontaneous breathing trial were included. Ultrasound measurements of heart (left ventricular function), lungs (number of B-lines), and diaphragm thickening fraction were performed during a spontaneous breathing trial. The primary outcomes were sensitivity, specificity, and area under the receiver operating characteristic curve of a holistic ultrasound approach for extubation failure. Re-intubation within 48 h was considered extubation failure.

Results: Eighty-three subjects were included, of whom 15 (18%) were re-intubated within 48 h. The sensitivity and specificity of a holistic approach were 100% (78.2-100%) and 7.7% (2.5-17.1%), respectively, with an area under the receiver operating characteristic curve of 0.54. The sensitivity and specificity of diaphragm thickening fraction, using a cutoff value of < 30% for extubation failure were 86.7% (59.5-98.3%) and 25.4% (15.5-37.5%), respectively, with an area under the receiver operating characteristic curve of 0.61.

Conclusions: In subjects ventilated for > 72 h who had a successful spontaneous breathing trial, holistic ultrasound was a weak predictor for extubation failure. (ClinicalTrials.gov registration NCT04196361).
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http://dx.doi.org/10.4187/respcare.08679DOI Listing
June 2021

Effects of Lung Ultrasonography-Guided Management on Cumulative Fluid Balance and Other Clinical Outcomes: A Systematic Review.

Ultrasound Med Biol 2021 05 23;47(5):1163-1171. Epub 2021 Feb 23.

Department of Intensive Care, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands; Amsterdam Leiden IC Focused Echography, Amsterdam, The Netherlands.

Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung ultrasonography-guided management has an effect on cumulative fluid balances and other clinical outcomes remains unclear. In this systematic review, we included 12 studies using ultrasonography guided-management with a total of 2290 patients. Four in-patient studies found a reduced cumulative fluid balance (ranging from -0.3 L to -2.4 L), whereas three out-patient studies found reduction in dialysis dry weight (ranging from -2.6 kg to -0.2 kg) compared with conventionally managed patients. None of the studies found adverse effects related to hypoperfusion. The use of lung ultrasonography-guided management was not associated with other clinical outcomes. This systematic review shows that lung ultrasonography-guided management, exclusively or in concert with other diagnostic modalities, is associated with a reduced cumulative fluid balance. Studies thus far have not shown a consistent effect on clinical outcomes.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2021.01.024DOI Listing
May 2021

Coronavirus disease 2019 is associated with catheter-related thrombosis in critically ill patients: A multicenter case-control study.

Thromb Res 2021 04 26;200:87-90. Epub 2021 Jan 26.

Department of Intensive Care Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Leiden Intensive care Focused Echography (ALIFE, www.alifeofpocus.com), the Netherlands.

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http://dx.doi.org/10.1016/j.thromres.2021.01.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835604PMC
April 2021

Lung ultrasound and computed tomography to monitor COVID-19 pneumonia in critically ill patients: a two-center prospective cohort study.

Intensive Care Med Exp 2021 Jan 25;9(1). Epub 2021 Jan 25.

Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.

Background: Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients.

Methods: Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints.

Results: We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging - 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor.

Conclusions: Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days.

Trial Registration: NTR, NL8584. Registered 01 May 2020-retrospectively registered, https://www.trialregister.nl/trial/8584.
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http://dx.doi.org/10.1186/s40635-020-00367-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829056PMC
January 2021

Lung ultrasound findings in patients with novel SARS-CoV-2.

ERJ Open Res 2020 Oct 16;6(4). Epub 2020 Nov 16.

Dept of Intensive Care Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands.

Background: Over 2 million people worldwide have been infected with severe acute respiratory distress syndrome-coronavirus-2 (SARS CoV-2). Lung ultrasound has been proposed to diagnose and monitor it, despite the fact that little is known about the ultrasound appearance due to the novelty of the illness. The aim of this manuscript is to characterise the lung ultrasonographic appearance of critically ill patients with SARS-CoV-2 pneumonia, with particular emphasis on its relationship with the time course of the illness and clinical parameters.

Methods: Adult patients from the intensive care unit of two academic hospitals who tested positive for SARS-CoV-2 were included. Images were analysed using internationally recognised techniques which included assessment of the pleura, number of B-lines, pathology in the PLAPS (posterolateral alveolar and/or pleural syndrome) point, bedside lung ultrasound in emergency profiles, and the lung ultrasound score. The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) durations of symptoms and their correlation with clinical parameters.

Results: In this pilot observational study, 61 patients were included with 76 examinations available for analysis. 26% of patients had no anterior lung abnormalities, while the most prevalent pathological ultrasound findings were thickening of the pleura (42%), ≥3 B-lines per view (38%) and presence of PLAPS (74%). Patients with "long" duration of symptoms presented more frequently with a thickened and irregular pleura (32 (21%) 11 (9%)), C-profile (18 (47%) 8 (25%)) and pleural effusion (14 (19%) 3 (5%)), compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with arterial oxygen tension/inspiratory oxygen fraction ratio, fluid balance or dynamic compliance.

Conclusion: SARS-CoV-2 results in significant, but not specific, ultrasound changes, with decreased lung sliding, thickening of the pleura and a B-profile being the most commonly observed. With time, a thickened and irregular pleura, C-profile and pleural effusion become more common findings. When screening patients, a comprehensive ultrasound protocol might be necessary.
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http://dx.doi.org/10.1183/23120541.00238-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548922PMC
October 2020

Ultrasound to Detect Central Venous Catheter Placement Associated Complications: A Multicenter Diagnostic Accuracy Study.

Anesthesiology 2020 04;132(4):781-794

From the Department of Intensive Care Medicine, Research VU University Medical Center (VUmc) Intensive Care, Amsterdam Cardiovascular Sciences, and Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands (J.M.S., M.E.H., E.H.T.L., T.S.S., H.R.W.T., A.R.J.G., L.M.A.H., P.R.T.) the Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands (M.J.B., F.H.B.) the Department of Intensive Care Medicine, Groene Hart Hospital, Gouda, The Netherlands (M.P., B.V.).

Background: Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax.

Methods: This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen's κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound.

Results: In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen's κ-coefficient of 0.50 (95% CI, 0.19 to 0.80).

Conclusions: This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax.
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http://dx.doi.org/10.1097/ALN.0000000000003126DOI Listing
April 2020

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis.

Crit Care 2018 Mar 13;22(1):65. Epub 2018 Mar 13.

Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.

Background: Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US).

Methods: This is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool.

Results: We included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8-99.5) and sensitivity of 68.2 (95% CI: 54.4-79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77-2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6-36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate.

Conclusions: US is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed.
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http://dx.doi.org/10.1186/s13054-018-1989-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851097PMC
March 2018

Necessary additional steps in ultrasound guided central venous catheter placement: getting to the heart of the matter.

Crit Care 2017 12 19;21(1):307. Epub 2017 Dec 19.

Department of Intensive Care Medicine VUmc, Department of Intensive Care Medicine, Room ZH - 7B-90, De Boelelaan 1117, PO Box 7057, 1007MB, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1186/s13054-017-1900-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735926PMC
December 2017
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