A.B.C. approach proposal for POCUS in COVID-19 critically ill patients

Abstract

The rapid spread of SARS-CoV-2 (COVID-19) since December 2019 forced Intensive Care Units to face high numbers of patients admitted simultaneously with limited resources. COVID-19 critically ill patients, especially those on mechanical ventilators, demand special attention as they can develop potential complications with critical hemodynamic and respiratory consequences. Point of Care Ultrasound (POCUS) might have important roles in assessing the critically ill SARS-CoV-2 patient. Mostly, lung ultrasound has been presented as having a role in diagnosis and monitoring, but airway examination and hemodynamic evaluation are of interest also. We propose an A.B.C. POCUS approach focusing on A-airway (orotracheal intubation), B-breathing (interstitial syn-dromes, pneumothorax, atelectasis, pneumonia), and C-circulation (cardiac function, pulmonary embolism, volume status, deep veins thrombosis). This A.B.C. approach has emerged during ICU care for 22 adult COVID-19 critically ill patients, along with the analysis of recent papers describing ultrasound in COVID-19 patients including the use of ultrasound that is currently applied in the management of the general critically ill population. This A.B.C- POCUS algorithm parallels the well-established clinical A.B.C. algorithms. There are few extensive ultrasonographic studies in COVID-19 critically ill patients up to now, but techniques extrapolated from non-COVID studies seem reasonable even though comparative studies are not available yet.

Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

“…Ultrasound meets all these requirements, but other methods such as CT, may be evaluated when establishing the diagnosis and the clinical management. Point-of-care ultrasonography (POCUS) has demonstrated to be a ubiquitous and quick way to detect pulmonary changes [ 107 ]. In particularly, the use of lung ultrasonography (LUS) in COVID-19 has received much attention.…”

“…algorithm. It is based on the three step process of cardiac resuscitation protocol: Airway (A), Breathing (B) and Circulation (C) [ 107 ]. The airway evaluation is based on the POCUS examination of no obstruction to patient airflow.…”

Cardiovascular Imaging Evaluation in COVID-19 Heart and Vascular Non-Ischaemic Involvement

“…Point-of-care ultrasonography (POCUS) has demonstrated to be a ubiquitous and quick way to detect pulmonary changes [97]. disease severity quickly and easily.…”

“…algorithm. It is based on the three step process of cardiac resuscitation protocol: Airway (A), Breathing (B), and Circulation (C) [97]. The airway evaluation is based on the POCUS examination of no obstruction to patient airflow.…”

“…Therefore, echocardiography should be performed on admission in patients with COVID-19 disease and should be repeated [97,107] periodically.…”