Our Italian experience using lung ultrasound for identification, grading and serial follow‐up of severity of lung involvement for management of patients with COVID‐19

Vetrugno, Luigi; Bove, Tiziana; Orso, Daniele; Barbariol, Federico; Bassi, Flavio; Boero, Enrico; Ferrari, Giovanni; Kong, Robert

doi:10.1111/echo.14664

Cited by 178 publications

(197 citation statements)

References 12 publications

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“… 16 Sonographically, ground-glass opacities are seen as coalescing B-lines, which were identified in 2 of our patients. 6 , 7 Notably, B-lines are a nonspecific reverberation artifact that may be caused by multiple lung pathologies including pneumonia, pneumonitis, atelectasis, pulmonary contusion or infarction, pleural disease, and neoplasia. 17 …”

Section: Review Of the Literaturementioning

confidence: 99%

Lung Point-of-Care Ultrasound in Pediatric COVID-19

et al. 2020

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Lung point-of-care ultrasound (POCUS) has been shown to be useful for identifying pulmonary pathology in adult patients with coronavirus disease 2019 (COVID-19). However, pediatric literature for POCUS in COVID-19 is limited. The objective of this case series was to describe lung POCUS findings in pediatric patients with COVID-19. Three patients with COVID-19 who had lung POCUS performed in a pediatric emergency department were included. Point-of-care ultrasound revealed bilateral abnormalities in all patients, including pleural line irregularities, scattered and coalescing B-lines, consolidations, and pleural effusions. Additional pediatric studies are necessary to gain a broader understanding of COVID-19's sonographic appearance in this age group and to determine whether POCUS may be helpful to facilitate diagnosis and expedite management decisions.

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Section: Review Of the Literaturementioning

confidence: 99%

Lung Point-of-Care Ultrasound in Pediatric COVID-19

et al. 2020

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“…It, therefore, seems premature to be able to affirm definitive data regarding the performance of thoracic ultrasound examinations until results are available on a large population of COVID-19-positive patients. 8…”

mentioning

confidence: 99%

Lung Ultrasound and the COVID‐19 “Pattern”: Not All That Glitters Today Is Gold Tomorrow

Vetrugno

Bove

Orso

et al. 2020

J of Ultrasound Medicine

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“…The lung Point of care Ultrasound (POCUS) is reported to be useful in con rming clinical suspicion of COVID 19 infection in patients who showed negative RT-qPCR. [23] reported that normal lung US shows A (complete or partial) lines that are a repetition of the pleural line at the same distance from skin to the pleural line, indicative of air below the pleural line, corresponding to the parietal pleura, and B lines that arise from the pleural line and move in concert with a sliding lung and described as hyperechoic laser-like artefacts that resemble a "comet tail". In pathological lungs, A lines are generally not present and B lines are associated with an interstitial syndrome and diminished lung aeration.…”

Section: Discussionmentioning

confidence: 99%

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

Simone

Chouillard

Sartelli

et al. 2020

Preprint

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BackgroundSince the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity. The World Society of Emergency Surgery (WSES) conceived this position paper with the purpose of providing recommendations for the management of surgical, infected and non-infected, patients in emergency setting under COVID-19 pandemic in the safety of the patient and health care workers based on available evidences and experienced surgeons’opinion.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P)through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to provide a guide for emergency surgeons to perform safely surgery during this pandemic on the basis of evidence medicine and principles of mass casualty incident management to limit the diffusion of the infection among patients and health care workers. ConclusionsWe recommend screening for COVID-19 infection at emergency department, all surgical patients with clinical and epidemiologic features suspect for COVID-19 disease who are waiting for hospital admission and urgent surgery. The screening provides performing a RT-PCR naso-pharyngeal swab test and a baseline (non-contrast) chest CT or chest X-ray or lungs US, depending on skills and availability.The management of COVID-19 surgical patient is multidiplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every efforts to protect the operating room staff, in the safety of the patient . We recommend not being present during the intubation and extubation maneuvers (1A).To perform a safe surgical procedure, we recommend:-having a trained staff, wearing the necessary personal protective equipments, and an established protocol for the preoperative, peri-operative and postoperative management of the COVID-19 surgical patient;-being careful in the establishment and management of the artificial pneumoperitoneum, in the control of the hemostasis and of incisions to prevent any loss of biological fluids and contamination of the surgical staff;-using of all available devices to remove smoke and aerosol during the operation and a closed suction system for artificial pneumoperitoneum, especially if there is a risk of conversion to laparotomy.If it is not possible to perform surgery in a safe and protected environment, we recommend do not underestimating the highest risk of contamination and infection for health care workers and dissemination of the virus in the hospital and to consider transferring the patient in a COVID HUB hospital for the appropriate management.The administration of prophylactic anticoagulation with LMWH is recommended as soon as possible in COVID-19 patients to reduce thromboembolic risk related to the virus and sepsis, decreasing the mortality rate. We recommend to carefully administrating antibiotics in COVID-19 surgical patients for the high risk of selecting resistant bacteria, especially in patients admitted in ICU for mechanical ventilation. Early empirical antibiotic treatment should be targeted to results from cultures, with de-escalation of treatment as soon as possible. We recommend against empirical antifungal treatment in all surgical COVID-19 patients but to consider it in critically ill patients.

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Our Italian experience using lung ultrasound for identification, grading and serial follow‐up of severity of lung involvement for management of patients with COVID‐19

Abstract: Lung ultrasound (LU)

Cited by 178 publications

References 12 publications

Lung Point-of-Care Ultrasound in Pediatric COVID-19

Lung Point-of-Care Ultrasound in Pediatric COVID-19

Lung Ultrasound and the COVID‐19 “Pattern”: Not All That Glitters Today Is Gold Tomorrow

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

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