Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution

Gargani, Luna; Soliman-Aboumarie, Hatem; Volpicelli, Giovanni; Corradi, Francesco; Pastore, María; Cameli, Matteo

doi:10.1093/ehjci/jeaa163

Cited by 120 publications

(187 citation statements)

References 30 publications

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“…The most frequent finding in the patients was an elevated PASP, followed by an E/e′ ratio of >14, and RV dilatation and dysfunc- 12 (10)(11)(12)(13)(14) 11 (10)(11)(12)(13)(14) 11 (9)(10)(11)(12)(13)(14) 11 (9)(10)(11)(12)(13) 13 (11)(12)(13)(14)(15) . in patients with ARDS.…”

Section: Discussionmentioning

confidence: 99%

“…The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes severe pneumonia and myocardial injury; however, the hemodynamic and pulmonary consequences are not completely known. 8,9 Patients with COVID-19 tend to have higher requirement for oxygen and ventilator support, as well as rescue ventilation strategies, unlike those who suffered from the formerly known acute respiratory distress syndrome (ARDS). Two phenotypes have been described: a) the type L patients, with low elastance, low ventilation-to-perfusion (V/Q) ratio and low lung recruitability, requiring lower positive end-expiratory pressure (PEEP) levels usually with a normal pulmonary pressure and b) the type H patients high elastance,…”

Section: Introductionmentioning

confidence: 99%

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Critical care ultrasonography during COVID‐19 pandemic: The ORACLE protocol

et al. 2020

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Background Coronavirus disease 2019 (COVID‐19) is characterized by severe lung involvement and hemodynamic alterations. Critical care ultrasonography is vital because it provides real time information for diagnosis and treatment. Suggested protocols for image acquisition and measurements have not yet been evaluated. Methods This cross‐sectional study was conducted at two centers from 1 April 2020 to 30 May 2020 in adult patients with confirmed COVID‐19 infection admitted to the critical care unit. Cardiac and pulmonary evaluations were performed using the ORACLE protocol, specifically designed for this study, to ensure a structured process of image acquisition and limit staff exposure to the infection. Results Eighty‐two consecutively admitted patients were evaluated. Most of the patients were males, with a median age of 56 years, and the most frequent comorbidities were hypertension and type 2 diabetes, and 25% of the patients had severe acute respiratory distress syndrome. The most frequent ultrasonographic findings were elevated pulmonary artery systolic pressure (69.5%), E/e’ ratio > 14 (29.3%), and right ventricular dilatation (28%) and dysfunction (26.8%). A high rate of fluid responsiveness (82.9%) was observed. The median score (19 points) on pulmonary ultrasound did not reveal any variation between the groups. Elevated pulmonary artery systolic pressure was associated with higher in‐hospital mortality. Conclusion The ORACLE protocol was a feasible, rapid, and safe bedside tool for hemodynamic and respiratory evaluation of patients with COVID‐19. Further studies should be performed on the alteration in pulmonary hemodynamics and right ventricular function and its relationship with outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Critical care ultrasonography during COVID‐19 pandemic: The ORACLE protocol

et al. 2020

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“…In addition, POCUS (Point-of-Care Ultrasound) can provide vital information regarding any possible involvement of the cardiovascular system as well being used as echocardiography during the same session (29) . However, the reported sensitivity of this diagnostic tool is controversial, particularly when it is performed by a non-expert sonographist ( 30 , 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran, Iran

et al. 2021

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Rationale and Objectives Real-time polymerase chain reaction (RT-PCR) remains the gold standard for confirmation of Coronavirus disease 2019 (COVID-19) despite having many disadvantages. Here, we investigated the diagnostic performance of chest computed tomography (CT) as an alternative to RT-PCR in patients with clinical suspicion of COVID-19 infection. Methods In this descriptive cross-sectional study, 27824 patients with clinical suspicion of COVID-19 infection who underwent unenhanced low-dose chest CT from 20 February, 2020 to 21 May, 2020 were evaluated. Patients were recruited from seven specifically designated hospitals for patients with COVID-19 infection affiliated to Shahid Beheshti University of Medical Sciences. In each hospital, images were interpreted by two independent radiologists. CT findings were considered as positive/negative for COVID-19 infection based on RSNA diagnostic criteria. Then, the correlation between the number of daily positive chest CT scans and number of daily PCR-confirmed cases and COVID-19-related deaths in Tehran province during this three-month period was assessed. The trends of admission rate and patients with positive CT scans were also evaluated. Results A strong positive correlation between the numbers of daily positive CT scans and daily PCR-confirmed COVID-19 cases (r=0.913, p < 0.001) was observed. Furthermore, in hospitals located in regions with a lower socioeconomic status, the admission rate and number of positive cases within this three-month period was higher as compared to other hospitals. Conclusion Low-dose chest CT is a safe, rapid and reliable alternative to RT-PCR for the diagnosis of COVID-19 in high-prevalence regions. In addition, our study provides further evidence for considering patients’ socioeconomic status as an important risk factor for COVID-19.

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“…For this purpose, beyond basic echocardiographic parameters, additive tools could represent a strong support for clinicians: Firstly, lung ultrasound (LU) offers important information on acute hemodynamic changes in HF, through dynamic signs (ie, homogenous and diffuse B‐lines and bilateral pleural effusion), allowing a quick diagnosis and monitoring of acute pulmonary edema 34 . In this setting, it is important to differentiate between the typical LU signs of pulmonary edema and of COVID‐19 leading to ARDS (ie, congestion, coalescent B‐lines, the so‐called “white lung,” air bronchogram) 35 : Even if clinical presentation are crucial for differential diagnosis, there are some notable differences between cardiogenic and COVID‐19 B‐lines: unlike the first, B‐lines have a patchy and nongravity‐related distribution, are commonly separated and coalescent, and present well‐defined spared areas in COVID‐19 pneumonia 36 . However, sometimes these patients could show overlap patterns; thus, LU results should be taken cautiously 37 …”

Section: Acute Heart Failurementioning

confidence: 99%

Usefulness of echocardiography to detect cardiac involvement in COVID‐19 patients

et al. 2020

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Coronavirus disease 2019 (COVID‐19) outbreak is a current global healthcare burden, leading to the life‐threatening severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, evidence showed that, even if the prevalence of COVID‐19 damage consists in pulmonary lesions and symptoms, it could also affect other organs, such as heart, liver, and spleen. Particularly, some infected patients refer to the emergency department for cardiovascular symptoms, and around 10% of COVID‐19 victims had finally developed heart injury. Therefore, the use of echocardiography, according to the safety local protocols and ensuring the use of personal protective equipment, could be useful firstly to discriminate between primary cardiac disease or COVID‐19–related myocardial damage, and then for assessing and monitoring COVID‐19 cardiovascular complications: acute myocarditis and arrhythmias, acute heart failure, sepsis‐induced myocardial impairment, and right ventricular failure derived from treatment with high‐pressure mechanical ventilation. The present review aims to enlighten the applications of transthoracic echocardiography for the diagnostic and therapeutic management of myocardial damage in COVID‐19 patients.

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Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution

Cited by 120 publications

References 30 publications

Critical care ultrasonography during COVID‐19 pandemic: The ORACLE protocol

Critical care ultrasonography during COVID‐19 pandemic: The ORACLE protocol

Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran, Iran

Usefulness of echocardiography to detect cardiac involvement in COVID‐19 patients

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