Point-of-Care Ultrasound for COVID-19 Pneumonia Patients in the ICU

Abstract

BACKGROUND: There is scarce literature on point-of-care ultrasound (POCUS) assessment characteristics in coronavirus disease 2019 (COVID-19) pneumonia with hypoxic respiratory failure. METHODS: This study was an observational, prospective, single-center study, including adults suspected to have COVID-19 who were transferred to the intensive care unit (ICU). An intensivist in critical care ultrasound performed lung ultrasound (LUS) and echocardiology within 12 hours of patients' admission to the ICU. We calculated the trans mitral E/A ratio, E/e′, left ventricular ejection fraction (EF), inferior vena cava (IVC) diameter, right ventricle (RV) size and systolic function. RESULTS: In the group of patients with confirmed COVID-19 pneumonia, echocardiographic findings revealed normal E/e′, deceleration time (DT), and transmittal E/A ratio compared to those in the non-COVID-19 patients (p = 0.001, 0.0001, and 0.0001, respectively). IVC diameter was < 2 cm with > 50% collapsibility in 62 (81%) patients with COVID-19 pneumonia; a diameter of > 2 cm and < 50% collapsibility was detected among those with non-COVID-19 pneumonia (p-value of 0.001). In patients with COVID-19 pneumonia, there were 3 cases of myocarditis (3.9%) with poor EF, severe RV systolic dysfunction was seen in 9 cases (11.6%), and 3 cases exhibited RV thrombus. Lung US revealed 4 signs suggestive of COVID-19 pneumonia in 77 patients (98.6%) (sensitivity 96.9%; confidence interval, 85%-99.5%) when compared with reverse transcriptase-polymerase chain reaction results. CONCLUSIONS: POCUS plays an important role in the bedside diagnosis, hemodynamic assessment and management of patients with acute hypoxic respiratory and circulatory failure with COVID-19 pneumonia.

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

“…29 studies reported data about the prevalence of RVD 14 – 42 , while 7 reported about all-cause mortality according to RVD status 17 , 19 , 20 , 30 , 33 , 35 , 36 . 11 studies were held in Europe 16 , 18 – 21 , 33 – 36 , 38 , 40 , 8 in North America 23 , 25 , 26 , 28 , 29 , 37 , 41 , 42 , 3 in Asia 30 – 32 , and 7 in other geographical locations 14 , 15 , 17 , 22 , 24 , 27 , 39 , including 2 multinational studies 24 , 27 . Cohorts included were quite homogeneous in terms of mean age of the included patients (ranging from 52 years old to 68 years old); among sex, males were generally more represented than females (up to 84%).…”

“… Study Geographical location Incl. criteria Cohort (N) RVD (N) Age (mean) Males (%) ICU (%) HTN (%) T2DM (%) Definition of RVD Outcomes Follow up time (days) Barman (2020) 14 Other COVID-19 patients 90 15 56,4 51 32 35 15 TAPSE ≤ 16 mm Prevalence – Bitar (2021) 15 Other COVID-19 patients admitted to ICU 77 9 53* 83 100 26 32 TAPSE < 16 mm, RV S’ < 9.5 cm/s, RV FAC < 35% Prevalence – Bleakley (2020) 16 Europe COVID-19 patients underwent mechanical ventilation 84 20 52 74 100 36 22 TAPSE < 17 mm Prevalence – Calderon-Esquivel (2020) 17 Other COVID-19 patients admitted to ICU 30 4 59 7 …”

“…The definition of RVD was heterogeneous across studies, both in terms of parameters and cut-offs used to defined RVD. 13 studies used a combination of several parameters 15 , 18 , 19 , 21 , 24 , 28 , 30 , 33 – 35 , 38 , 40 , 42 , 8 studies defined RVD according to TAPSE cut-off 14 , 16 , 22 , 23 , 31 , 32 , 36 , 39 , while other or unclear definitions of RVD was used in 8 studies 17 , 20 , 25 – 27 , 29 , 37 , 41 . In one study, a surrogate of Right Ventricular-Arterial uncoupling, which in turn relates the degree of RVD to the increase of pulmonary pressure, was addressed 20 .…”

Point-of-care ultrasound use in COVID-19: a narrative review

“…In early stages of COVID-19 pneumonia, there are focal B-lines, progressing to confluent and multifocal B-lines with subpleural consolidations as the infection advances ( 20 ). Confluent B-lines have been described as “shining white lung” ( 26 ), “torchlight” sign ( 27 ) and “waterfall” sign ( 28 ).…”

Lung ultrasound as a predictor of mortality of patients with COVID-19

“…(5) Several studies have shown that LUS can detect interstitial disease, subpleural consolidations, and respiratory distress of any aetiology, with sensitivity and specificity superior to chest radiography and comparable to CT. (6)(7)(8) Indeed, LUS has already been recommended in past viral pandemics (9) and growing evidence demonstrates its effectiveness in patients with COVID-19, (10) which allows identifying the degree of lung involvement, its course, and the possible association between the initial lung involvement and its prognosis. (11)(12)(13)(14)(15) Our objective was to evaluate the performance of LUS through the lung ultrasound score (LUS score) to determine the severity of pneumonia and the short-term outcomes of patients with COVID-19 admitted to the intensive care unit. We hypothesize that the Lung Ultrasound Score (LUS) correlates with clinical evolution and predicts mortality in critically ill COVID-19 pneumonia patients.…”