Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

Abstract

Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used-the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care.

Transthoracic echocardiographic findings in patients admitted with SARS‐CoV‐2 infection

“…Our population represents a high-risk group evident by higher D-dimer and troponin levels than previously reported, Not surprisingly, many had RV dilation (Figure 1), 9…”

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

“…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.…”

“…10 Also, patients with L phenotype may reveal ventricular inter-dependence caused by increased respiratory effort, with the consequent reduction in stroke volume. 11 Furthermore, the high mortality and yet unknown aspects of the clinical course of COVID-19 necessitate evaluation of hemodynamic, cardiac, and respiratory functions. 12 In this study, we proposed an algorithm to perform a quick systemic evaluation using CCU that ensured least exposure of the health care staff to the infection.…”

SARS-CoV-2/Renin–Angiotensin System: Deciphering the Clues for a Couple with Potentially Harmful Effects on Skeletal Muscle

“…The latter is a form of invasive support used in severe forms of COVID-19. The prolonged use of IMV on ICU patients is directly associated with further complications, such as ventilator-associated pneumonia, pneumothorax and pneumomediastinum, and ventilator-induced diaphragmatic dysfunction (VIDD), leading to elevated mortality [68]. of 18 In a recent study with 73 adult patients (median age: 61 years, mostly male (83.6%)), COVID-19 ARDS was associated with prolonged mechanical ventilation (MV) and high short-term mortality, among other factors [67].…”

“…In this context, muscle wasting involving diaphragmatic and lower limb muscles is experienced by 50% of ICU patients, causing severe respiratory and physical complications that might remain for years after hospital discharge [70]. Considering other pathologies similar to COVID-19, a dysfunction in the diaphragm muscle has been seen as a characteristic of severe symptoms, so it is expected that this behavior could be identical in COVID-19 [68,71,72].…”