Narrative review of ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): clinical applications in intensive care medicine

Abstract

The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS), and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with a adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.

A Comparison of Lung Ultrasound and Computed Tomography in the Diagnosis of Patients with COVID-19: A Systematic Review and Meta-Analysis

“…A total of 14 reviews or protocols assessing the use of LUS for the diagnosis of COVID-19 have been published prior to our study, including 12 narrative reviews [29][30][31][32][33][34][35][36][37][38][39][40], one systematic review and meta-analysis [41], and one systematic review proposal [42]. The narrative reviews analyzed the role of LUS in COVID-19 from different perspectives.…”

Acute cor pulmonale in patients with acute respiratory distress syndrome due to COVID-19

“… 7 The estimate of systolic pressure of both the pulmonary artery and the tricuspid annular plane systolic excursion was conducted following public recommendations. 8 Continuous variables were expressed as mean and 95% confidence interval or median (interquartile range) and compared using the Student t test or the Mann–Whitney U test when appropriate. Categorical variables were expressed as number and percentage and compared using the chi square test or Fisher’s exact test.…”