AB191. SOH22ABS007. Use of point-of-care ultrasonography in the critical care setting to individualise care in a critically ill patient with post coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome
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AB191. SOH22ABS007. Use of point-of-care ultrasonography in the critical care setting to individualise care in a critically ill patient with post coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome

Cathriona Murphy1, Kim O’Brien1, John Kennedy1, Catherine Nix1, Aidan O’Brien2, Owais Rahman2, Siobhan Gallagher3

1Department of Anaesthesiology, Critical Care & Pain Medicine, University Hospital Limerick, Limerick, Ireland; 2Department of Medicine, University Hospital Limerick, Limerick, Ireland; 3Department of Paediatrics, University Hospital Limerick, Limerick, Ireland

Background: An 18-year-old woman with a background of thalassemia minor presented to the emergency department with a one-week history of sore throat, dyspnoea, a non-blanching abdominal rash, diarrhoea and vomiting. She had tested PCR positive on a nasopharyngeal swab for coronavirus disease 2019 (COVID-19) four weeks prior to her presentation. Despite fluid resuscitation, the patient was hypotensive, tachycardic and hypothermic on admission to the Intensive Care Unit (ICU). A noradrenaline infusion was commenced. She was in respiratory distress with an FiO2 of 0.4 via venturi face mask and was unable to complete full sentences. Her inflammatory markers were elevated and her haemoglobin was 6.7 g/dL.

Methods: Point-of-care-ultrasonography (POCUS) of the patient’s lungs revealed bilateral B-lines in the midzones and signs consistent with bilateral basal consolidations (GE Venue). Broad spectrum antimicrobials were commenced. The patient could observe the lung ultrasound findings and as she was a young self-ventilating patient, she was encouraged to cough and to use an incentive spirometer. The importance of chest physiotherapy was emphasised. A portable chest radiograph was obtained which demonstrated rapidly progressing bi-basal pulmonary infiltrates with increased interstitial markings bilaterally congruent with prior COVID pneumonia. A diagnosis of multisystem inflammatory syndrome (MIS-A) complicated by pneumonia was made.

Results: A Focused UltraSound in Intensive Care (FUSIC) Heart scan demonstrated well filled cardiac chambers and a well filled IVC. Intravenous immunoglobulin (IVIG) and methylprednisolone were commenced immediately. The FUSIC Heart scan resulted in the IVIG (6–8 L) being administered over 24 hours to reduce the risk of venous congestion for this 57 kg patient with an estimated 3.5 litre circulating volume (65 mL/kg).

Conclusions: The use of POCUS early in critical care assessment of this patient ensured the patient wasn’t inappropriately volume overloaded and encouraged patient engagement in chest physiotherapy to expedite her recovery.

Keywords: Coronavirus disease 2019 (COVID-19); intensive care; intravenous immunoglobulin (IVIG); multisystem inflammatory syndrome (MIS); ultrasonography

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-22-ab191
Cite this abstract as: Murphy C, O’Brien K, Kennedy J, Nix C, O’Brien A, Rahman O, Gallagher S. AB191. SOH22ABS007. Use of point-of-care ultrasonography in the critical care setting to individualise care in a critically ill patient with post coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome. Mesentery Peritoneum 2022;6:AB191.

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