Best Practice Recommendations for Point-of-Care Lung Ultrasound in Patients with Suspected COVID-19

Abstract

Background: Lung point-of-care ultrasound (POCUS) is a critical tool for evaluating patients with dyspnea in the emergency department (ED), including patients with suspected coronavirus disease (COVID)-19. However, given the threat of nosocomial disease spread, the use of ultrasound is no longer risk free. Objective: Here, we review the lung POCUS findings in patients with COVID-19. In doing so we present a scanning protocol for lung POCUS in COVID-19 that maximizes clinical utility and provider safety. Discussion: In COVID-19 lung, POCUS findings are predominantly located in the posterior and lateral lung zones bilaterally. A six-zone scanning protocol that prioritizes obtaining images in these locations optimizes provider positioning, and minimizes time spent scanning, which can reduce risk to health care workers performing POCUS. Conclusions: Lung POCUS can offer valuable clinical data when evaluating patients with COVID-19. Scanning protocols such as that presented here, which target clinical utility and decreased nosocomial disease spread, must be prioritized.

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

“…Characteristic findings of the COVID-19 syndrome on lung POCUS include a thickened or irregular pleural line, confluent B-lines, and subpleural consolidations [ 19 , 21 – 23 ]. These findings correlate closely with those observed on CT [ 22 ], and demonstrate promise in trending clinical progression from onset to peak to resolution [ 21 , 24 ]. Descriptive studies [ 25 – 31 ] have revealed the potential utility of lung POCUS but are limited by small sample sizes, lack of in-depth statistical analysis, and limited evaluation of patient characteristics that impact the utility of lung POCUS.…”

The role of PoCUS in the assessment of COVID-19 patients

“…It has an overall diagnostic sensitivity and specificity of 90.2% (67.6–99.3%) and 88.8% (81.8–94.4%) in COVID-19 pneumonia when compared to CXR, CT and clinical exam [ 25 ]. Additionally, while COVID-19 has a preference to affect the posterior-basal lung zones, ultrasound provides effective visualization of the lung’s peripheries [ 10 , 26 – 30 ]. LUS is not capable of visualising central lung lesions—these are best seen on cross-sectional CT imaging.…”

Point‐of‐care ultrasound in the COVID‐19 era: A scoping review

“…Their guideline provide detail descriptions of anatomical landmarks, imaging settings, and presented a scoring mechanism. Meanwhile, experts in the US have developed a six‐zone POCUS protocol that prioritize provider safety that optimizes provider positioning and minimizes the time spent scanning 85 . Their protocol mainly focuses on imaging the posterior and lateral lung fields, arguing that scanning anteriorly is not necessary to obtain clinically useful data 85 .…”

“…Meanwhile, experts in the US have developed a six‐zone POCUS protocol that prioritize provider safety that optimizes provider positioning and minimizes the time spent scanning 85 . Their protocol mainly focuses on imaging the posterior and lateral lung fields, arguing that scanning anteriorly is not necessary to obtain clinically useful data 85 . This was supported by a study of 20 COVID‐19 patients where most lung pathology was found primarily in the posterior lung bases 47 …”

“…The introduction of a standardized scoring system for COVID‐19 POCUS findings may help improve POCUS to be a more reliable and observer independent tool for decision‐making in the treatment of COVID‐19 67 . In inexperienced hands, POCUS may lead to misinterpretations 85 . Imaging experts have suggested that basic training in addition to 25 supervised examinations is required to achieved proficiency in imaging COVID‐19 patients 61 .…”