Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Abstract

Background: Lung Ultrasound Evaluation (LUS) is usefully applied in the Emergency Department (ED) to patients with suspected or confirmed COVID-19. Diaphragmatic Ultrasound (DUS) may provide additional insight into ventilatory function. This proof-of-concept study aimed to evaluate the feasibility of LUS and DUS in a third level ED during the COVID-19 pandemic. Methods: Adult patients presenting with COVID-19 symptoms were eligible. After the physical examination, both LUS and DUS (i.e., diaphragmatic motion and thickness) were performed. All patients were followed after 30 days to determine their need for ventilation, admission, and/or a new ED evaluation after discharge. The diagnostic accuracies of diaphragm measurements in assessing the risk of the 30-day outcome were calculated as well as the measurements’ usefulness. Bland–Altman plots were used for comparing bedside and off-line diaphragm measurements. Results: 118 patients were enrolled. Median thickness and motion were 1.7 mm (iqr 0.4) and 1.8 cm (iqr 0.7), respectively, with a mean difference of 0.009 mm (95% CI −0.037–0.056 mm) and −0.051 cm (95% CI −0.108–0.006 cm), respectively. The 30-day outcome was associated with an increase in thickness (OR 5.84, 95% CI 0.96–35.4), and a lower motion (OR 0.49, 95% CI 0.2–1.21). Conclusion: DUS seemed to be feasible and reliable in the ED in a population of patients presenting with symptoms related to COVID-19 infection.

Prognostic Value of Diaphragmatic Ultrasound in Patients Admitted for COVID-19 Pneumonia

“…DUS at emergency department admission due to COVID-19 infection is an easy and reproducible technique, although its findings have not been related to the 30-day prognosis. 32 Our study confirmed the usefulness of this technique and shows its usefulness in the prognosis of patients hospitalized for this disease. TfDi had the best power in predicting poor outcomes in our study, unlike other studies such as the one conducted by Adolf Helmy et al in which the reduction in forced diaphragmatic excursion at ICU admission was a predictor of mortality and the requirement for IMV.…”

Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study

“…Forty-six (81%) patients underwent a trial of non-invasive ventilation (NIV) before intubation (duration: 15 h; IQR 3-36). Median length of invasive ventilation was 14 days (IQR [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Median DTF at weaning start (or at SBT start) was 28.0 (IQR 21.7-38.9).…”

“…7 Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, University of Ferrara, Sant' Anna Hospital, Ferrara, Italy. 8 Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy. 9 Anestesia and Intensive Care Service 2, Azienda Ospedaliera di Perugia, Perugia, Italy.…”

“…Diaphragmatic dysfunction had already been documented before a possible correlation between diaphragmatic dysfunction and weaning failure from mechanical ventilation emerged in patients with COVID-19 pneumonia. Although it is known that diaphragmatic force is mainly preserved or improved in the first phases of COVID-19 infection, some patients have shown early dysfunction in spontaneous breathing [7][8][9]. However, only few studies focused on diaphragmatic function during weaning from mechanical ventilation in these patients.…”

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

“…DTF was found to be inversely correlated with the success of continuous positive airway pressure in COVID-19 patients with respiratory failure ( 115 ). Meanwhile, Pivetta et al reported in their proof-of-concept study that lower motion or excursion of the diaphragm (measured in M-mode) combined with age and LUS achieved a modest AUROC of 0.75 to predict poorer outcomes at 30 days ( 116 ).…”