POCUS and COVID: Practical & Clinical Applications. #FOAMed

So I’ve yet to take care of any COVID patients, but we are ramping up, and it’s just a matter of time. In the meantime, practical issues such as where we will cohort patients and how we protect non-COVID patients and HCPs are happening, and one of the challenges in infection control is imaging, which is a staple of severe respiratory illness.

Evidence has been steadily coming out that lung ultrasound is carving itself a pivotal role in the diagnosis and management of COVID infection. Here are some of the things I’ve gathered and I think are worth sharing. I will be adding to this as I collect from others and eventually generate a COVID POCUS database and experience.

a. Lung US is more sensitive than CXR for interstitial patterns, small effusions and subpleural thickening. 

b. COVID seems to have some particular ultrasound features:

from:

Full article: COVID LUS

c. POCUS can be used to detect worsening or improvement of disease – by personal communication of Italian and Chinese ER/ICU docs. No published data yet, but several self-scanning infected physicians corroborate clinical improvement with resolution of POCUS lung findings.

d. POCUS can also detect the usual pathologies!  Pneumothorax is not a rare occurence in ventilated patients, and there may be an increased rate related to the parenchymal damage resulting in the unusually high compliance respiratory failure.

 

COVID POCUS DATA

Here is a good example from Marco Garrone with COVID B line pattern on the left, along with pleural thickening and small sub-pleural consolidations, note also the clustering of B lines, compared to the left, B lines of CHF with a relatively smooth and even pleural line:

This is a great article by Yi et al, a Chinese radiology group, with some great CT/POCUS comparative images:

LUS covid study

 

BOTTOM LINE

This makes it important that all physicians and probably also PAs and nurses pick up basic LUS skills. At our shop we are making sure all first line providers can screen for lung POCUS abnormalities.

 

BASIC LUNG POCUS

Lung ultrasound modules have been made open access at USABCD!

here are some excellent first steps by Jacob Avila:

How I perform the Lung Ultrasound Exam

B Lines

Pneumothorax