POCUS in COVID-19

By Michael Prats

COVID19 graphic

》Make sure you check out the Ultrasound Podcast COVID-19 episode for more discussion of how to use POCUS in this disease!《

This post and podcast refer only to the initial studies on this topic. More recently published articles on POCUS in COVID-19 can be found on the More Articles page.


Background

COVID-19 is the worst pandemic we have seen for a long time. People are using ultrasound at the point-of-care to detect lung findings on these patients. Here are some of the proposed benefits of POCUS:

  • Fast, bedside, no radiation

  • Likely more sensitive than chest xray

  • Easier to disinfect equipment compared to CT scan

  • Lends itself to repeat examinations for monitoring disease course


The Studies

There are two main articles published thus far:

  1. A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel coronavirus pneumonia (COVID-19) February 26, 2020

  2. Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic Intensive Care Medicine March 12, 2020


Summary of Article 1

Retrospectively looked at the lung ultrasounds done on 20 COVID19 patients in Xi’an Chest hospital

All patients had an epidemiologic history, infectious symptoms, and positive blood or respiratory testing. Unclear what made these “non-critical” patients. No exclusion criteria noted


Used a convex array and linear. A protective barrier and 75% alcohol solution were used to protect and disinfect.

Protocol: 12 area examination - Anterior and posterior axillary lines used to make an anterior, lateral, and posterior area, these were further divided into upper and lower zones. Therefore there were 6 zones per lung, total of 12 for the whole exam.

Two physicians with more than 5 years of experience in ultrasound reviewed all of these scans to draw conclusions about the findings.


Findings

Right and left posterior inferior lungs involved in 75% of cases each, Posterior superior was 50%.

  • Discontinuous or continuous/fused B -lines were common → 37.9%

  • Pleural line is unsmooth and rough → 15%

  • Multiple small patchy subpleural consolidations → 22.1%

  • Air bronchograms → 15.4%

  • Local pleural effusions around the lung lesions (10%? Or 18.8%)

  • Pleural thickening 1-2mm (7.9%? Or 14.6%)

  • Poor blood flow in lesions (unlike other findings, not everyone had this assessed, 50/54 → 94.3%)

✳Some numbers were only in abstract


Ultrasound missed lesions that were completely intrapulmonary and apical lesions


Summary of Article 2

Also used 12 zone method

Not nearly as much detail - unclear what hospitals involved but authors were from Changsha and Beijing, China.


Findings

  • Thickening pleural line, irregular pleural line

  • B-lines - focal and confluent

  • Consolidations - including air bronchograms

  • Not that many pleural effusions

  • A-lines when in recovery


Changes Over Time

  • Focal B-lines early and in mild infection

  • Alveolar interstitial syndrome (more consolidation) is in progressive and critically ill patients


Take Home Points

1. POCUS is feasible in COVID-19 and likely can be used to follow disease progression.

2. Findings are commonly bilateral, lower/posterior lung fields, and are similar to other viral pneumonias (B-lines, consolidations, pleural line abnormalities).

3. Research needed to determine how to incorporate POCUS into screening, diagnosis, or management


More Great FOAMed on this Topic

Ultrasound Podcast COVID-19

Internet Book of Critical Care - COVID-19

REBEL EM - COVID-19

St. Emlyn's COVID-19 Podcast from Italy with Roberto Cosentini

EPICA Podcast - COVID-19 US on My Own Lungs

Butterfly Network - Lung Ultrasound Findings in COVID-19 patients

Cite this post as

Michael Prats. POCUS in COVID-19. Ultrasound G.E.L. Podcast Blog. Published on March 17, 2020. Accessed on October 27, 2020. Available at https://www.ultrasoundgel.org/88.
Published on 03/17/20 05:00 AM
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