Point-of-care ultrasound has an important role in the management of patients with COVID-19 infection. Because the utility of each application varies by setting, individual institutions should consider how they can best use ultrasound within their specific environments.
In general, procedural guidance and focused echocardiography are high yield. Lung ultrasound has the potential to aid the diagnosis and management of patients with COVID-19 infection. Lower extremity point-of-care ultrasound for deep vein thrombosis may help guide decision making regarding anticoagulation or undifferentiated shock.
It is of the utmost priority that ultrasound not spread infection, so point-of-care ultrasound must be used only when clinically indicated. Institutions should have protocols for machine disinfection.
Background
The highly infectious nature of the SARS-CoV-2 virus via respiratory droplets can lead to contamination of medical and radiologic devices during use.
The concern for nosocomial spread of the virus among healthcare workers and other hospitalized patients has led many societies and medical centers to recommend appropriately limiting exposure and imaging.
Point-of-care ultrasound is increasingly being used to diagnose, monitor, and manage patients in emergency departments and in those admitted to inpatient services.
In patients with COVID-19 infection it is an excellent tool for comprehensive examination given that ultrasound is already commonly used in patient care, handheld ultrasound devices are easy to clean, and the nature of the virus is critical and dynamic.
In this Curbside Consult, we present typical lung ultrasound findings in patients with COVID-19 infection and discuss other uses of point-of-care ultrasound in their care.
We also highlight key points about the disinfection of ultrasound machines and introduce a protocol that minimizes the time needed to assess infected patients for deep vein thrombosis as well as lung and cardiac abnormalities.
Typical findings of COVID-19
Description of findings
Typical lung patterns seen on ultrasonography in patients with COVID-19 infection include the following:
- Pleural irregularity and thickening (early finding)
- Subpleural consolidations
- B lines may be seen, often derived from areas of irregular pleura; these become more confluent and diffuse as the disease progresses.
- Spared areas (a pattern of normal lung interspersed between focal B lines) are usually present early in the disease
- Nonlobar and translobar consolidation with air bronchograms
- Small localized pleural effusions may be seen, but moderate or large basilar pleural effusions are rare
Findings are nonspecific
These lung ultrasound findings are not specific to COVID-19 and are seen in other pneumonias (viral and bacterial) and inflammatory pneumonitis. Severe cases of COVID-19 are similar in appearance to acute respiratory distress syndrome from other etiologies.
The findings differ from cardiogenic pulmonary edema, which is frequently characterized by bilateral lower-lobe-predominant B lines with smooth pleura. Alternatively, lack of lung ultrasound findings consistent with COVID-19 infection in acute respiratory failure may suggest an alternative etiology.