Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic – A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI)

Abstract

Purpose The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. Materials and Methods The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. Results 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0–6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001). Conclusion This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.

Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study

“…The percentage of daily user intensivists of the LUS score grew from less than 2% to 9%. The majority of the practitioners stated that the LUS influenced their clinical decisions (68%) and patient monitoring (73%) [ 12 ].…”

Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances

“…A specific survey about LUS, named ITALUS, with 807 respondents, showed that LUS was extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy. However, 76.7% of this sample did not undertake any LUS certification [ 9 ].…”

The use of lung ultrasound in COVID-19

“…A recent online survey conducted by the International Society of Radiology showed that the current imaging practice of imaging in COVID-19 differs throughout the world: conventional chest X-ray and CT were the most applied imaging modalities, while LUS was used for bedside imaging and in the ICU, mostly by intensivists, usually using small mobile units for point-of-care ultrasound [67]. A survey conducted in Italy showed that LUS was already extensively used by anesthesiologists and intensivists at the time of the first wave of the COVID-19 pandemic and then, its adoption increased further [68] .…”

“…Machines are robust, mobile, and potentially portable and require relatively little maintenance. Point-of-care ultrasound (POCUS) can assist emergency and critical care in COVID-19 management [68] and allows for utilization in out-of-hospital settings [69]. A low level of awareness of the many advantages of ultrasound technology mentioned above, and a lack of qualified staff adequately trained to perform LUS may be major barriers to its utilization, in particular for LMICs.…”