Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

Abstract Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.

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LUNG ULTRASOUND B-LINES CORRELATE WITH STATIC COMPLIANCE IN MECHANICALLY VENTILATED PATIENTS

CHEST Journal ◽

10.1016/j.chest.2020.08.552 ◽

2020 ◽

Vol 158 (4) ◽

pp. A584

Author(s):

Andrew Lehr ◽

Vikramjit Mukherjee ◽

Deepak Pradhan ◽

Bishoy Zakhary

Keyword(s):

Lung Ultrasound ◽

Static Compliance ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

B Lines ◽

Ventilated Patients

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COVID-19 phenotypes, lung ultrasound, chest computed tomography, and clinical features in critically ill mechanically ventilated patients

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2021.07.014 ◽

2021 ◽

Author(s):

D Orlandi ◽

D Battaglini ◽

C Robba ◽

M Viganò ◽

G Bergamaschi ◽

...

Keyword(s):

Computed Tomography ◽

Critically Ill ◽

Clinical Features ◽

Lung Ultrasound ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Chest Computed Tomography ◽

Ventilated Patients

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ASSOCIATION OF LUNG ULTRASOUND SCORE WITH LENGTH-OF-STAY AND VENTILATION DAYS IN MECHANICALLY VENTILATED PATIENTS

Respirology ◽

10.1111/resp.13207_107 ◽

2017 ◽

Vol 22 ◽

pp. 124-124

Keyword(s):

Length Of Stay ◽

Lung Ultrasound ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ultrasound Score ◽

Ventilated Patients

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Expert Agreement in the Interpretation of Lung Ultrasound Studies Performed on Mechanically Ventilated Patients

Journal of Ultrasound in Medicine ◽

10.1002/jum.14627 ◽

2018 ◽

Vol 37 (11) ◽

pp. 2659-2665 ◽

Cited By ~ 5

Author(s):

Scott J. Millington ◽

Robert T. Arntfield ◽

Robert Jie Guo ◽

Seth Koenig ◽

Pierre Kory ◽

...

Keyword(s):

Lung Ultrasound ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ultrasound Studies ◽

Ventilated Patients

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Favourable Experience with M-Mode Sonography in the Diagnosis of Pneumothorax in Two Patients with Thoracic Subcutaneous Emphysema

Case Reports in Radiology ◽

10.1155/2014/906127 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

T. Berlet ◽

R. Etter

Keyword(s):

Subcutaneous Emphysema ◽

Tension Pneumothorax ◽

Case Presentation ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Thoracic Ultrasound ◽

Life Threatening ◽

Surgical Emphysema ◽

Lung Sliding ◽

Ventilated Patients

Introduction. Thoracic subcutaneous emphysema may be caused by various pathologies. In mechanically ventilated patients, timely diagnostic workup is particularly important, as the presence of subcutaneous surgical emphysema may indicate pneumothorax, representing a risk factor for the development of life threatening tension pneumothorax. Thoracic ultrasound is of proven value for the detection of pneumothorax but has so far been considered of little value in the context of subcutaeneous emphysema, due to poor visibility of anatomic structures.Case Presentation. We present the successful use of diagnostic M-mode sonography in two mechanically ventilated patients who developed thoracic subcutaneous emphysema. In both cases B-mode sonography was inconclusive.Conclusion. M-mode sonography may be more sensitive than B-mode sonography in the detection of lung sliding and could become a useful diagnostic tool when pneumothorax needs to be ruled in or ruled out and visibility of the pleura is limited.

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Use of Lung Ultrasound for Assessment of Lung Recruitment Maneuvers in Patients with ARDS

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6883 ◽

2021 ◽

Vol 9 (B) ◽

pp. 952-963

Author(s):

Waheed A. Radwan ◽

Mohamed M. Khaled ◽

Ayman G. Salman ◽

Mohmed A. Fakher ◽

Shady Khatab

Keyword(s):

Lung Ultrasound ◽

Lung Recruitment ◽

Positive Pressure ◽

Small Airways ◽

Lung Collapse ◽

Opening Pressure ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ultrasound Group ◽

Ventilated Patients

BACKGROUND: Positive pressure mechanical ventilation is a non-physiological intervention that saves lives but is not free of important side effects. It invariably results in different degrees of collapse of small airways. Recruitment maneuver (RM) aims to resolve lung collapse by a brief and controlled increment in airway pressure while positive end-expiratory pressure (PEEP) afterward keeps the lungs open. Therefore, ideally RM and PEEP selection must be individualized and this can only be done when guided by specific monitoring tools since lung’s opening and closing pressures vary among patients with different lung conditions. AIM: The aim of this study was to explore the clinical value of ultrasonic monitoring in the assessment of pulmonary recruitment and the best PEEP. PATIENTS AND METHODS: This study was conducted on 120 patients, 30 were excluded as in whom lung collapse cannot be confirmed then the rest were 90 patients from whom another 25 patients excluded as they were hemodynamically unstable the rest 65 patients were divided into two groups: Group A: Included 50 mechanically ventilated patients with ARDS, underwent lung recruitment using lung ultrasound and Group B: Included 15 mechanically ventilated patients with ARDS, underwent lung recruitment using oxygenation index. This prospective study was held at many critical care departments around Egypt. RESULTS: We noticed that lung recruitment in both groups significantly increased Pao2/Fio2 ratio immediately after recruitment compared with basal state and also significantly increase dynamic compliance compared with basal state. The increase in PF ratio immediately was significantly more in ultrasound group than in oxygenation group. Furthermore, we noticed that that P/F ratio 12 h after recruitment decreased compared with P/F ratio immediately after recruitment but significantly increased compared with basal state before recruitment and also we found that the increase in P/F ratio 12 h after recruitment was more significantly in lung ultrasound group than in oxygenation group. Furthermore, we noticed that lung recruitment (both lung ultrasound and oxygenation group) significantly increase RV function using TAPSE compared with basal state. Both opening pressure and optimal PEEP were significantly higher in lung ultrasound group than in oxygenation group. In our study, opening pressure was 37.28 ± 1.25 in lung ultrasound group and was 36.67±0.98 in oxygenation group and optimal PEEP was 14.64 ± 1.08 in lung ultrasound group and was 13.13 ± 0.74 in oxygenation group. CONCLUSION: Lung US is an effective mean of evaluating and guiding alveolar recruitment in ARDS. Compared with the maximal oxygenation–guided method, the protocol for reaeration in US-guided lung recruitment achieved a higher opening pressure, resulted in greater improvements in lung aeration, and substantially reduced lung heterogeneity in ARDS.

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