Point‐of‐care lung ultrasound in patients with COVID‐19 – a narrative review

Abstract

Summary Ultrasound imaging of the lung and associated tissues may play an important role in the management of patients with COVID‐19–associated lung injury. Compared with other monitoring modalities, such as auscultation or radiographic imaging, we argue lung ultrasound has high diagnostic accuracy, is ergonomically favourable and has fewer infection control implications. By informing the initiation, escalation, titration and weaning of respiratory support, lung ultrasound can be integrated into COVID‐19 care pathways for patients with respiratory failure. Given the unprecedented pressure on healthcare services currently, supporting and educating clinicians is a key enabler of the wider implementation of lung ultrasound. This narrative review provides a summary of evidence and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID‐19–associated lung injury. Mechanisms by which the potential lung ultrasound workforce can be deployed are explored, including a pragmatic approach to training, governance, imaging, interpretation of images and implementation of lung ultrasound into routine clinical practice.

Ultrasonography and SARS-CoV 2 infection: a review of what we know and do not yet know

“…Assessment of the severity of lung damage. For this purpose, combining the number of affected areas with the ultrasound appearance was proposed [10]. The ultrasound aspect defines lung damage as:…”

“…To express the severity of lung damage at a given time and to be able to assess the evolution of the disease, a severity score was imagined. A total of 12 lung areas are evaluated, each of which can receive a maximum of 3 points of severity so that the theoretical maximum score is 36 points [10]. Criteria for awarding points:…”

“…The chest examination in 6 areas is fast and acceptable. Examination in 12 areas is complete for assessing the condition of the lung [10].…”

“…• Prolonged exposure of the examiner to the risk of infection makes it necessary to use protective equipment that, in its turn, makes examination difficult; • The US examination is performed in the COVID section (usually ICU), with on-site available devices and not in the ultrasound laboratory, with high-end machines; • Impossibility of fluid disinfection of the ultrasound keyboard; • Problematic disinfection of the transducers; • The impossibility to keep the device uncontaminated traps the US machine inside the ICU / COV-ID ward; • Interoperator reproducibility of the description of US changes is untested; • There is still no standardization of how to report US changes. There is a need to increase the professional competence of performing chest US of the personnel in the ICU wards, pulmonology departments and others [10] by performing a minimum of 25 supervised lung US examinations [15].…”

Point‐of‐care ultrasound in respiratory and critical care: consolidation and expansion of imaging skills

“…In our article [2], we presented mechanisms by which a sub-set of these skills could be rapidly gained by clinicians with a range of pre-existing ultrasound imaging and/or respiratory and critical care experience.…”