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. 2021 May 21;156(10):477-484.
doi: 10.1016/j.medcli.2020.12.007. Epub 2021 Jan 28.

Point-of-care ultrasonography in the initial characterization of patients with COVID-19

[Article in English, Spanish]
Yale Tung-Chen  1 , Ana Algora-Martín  2 , Rafael Llamas-Fuentes  3 , Pablo Rodríguez-Fuertes  2 , Ana María Martínez Virto  2 , Elena Sanz-Rodríguez  4 , Blanca Alonso-Martínez  5 , Maria Angélica Rivera Núñez  2
Affiliations

Point-of-care ultrasonography in the initial characterization of patients with COVID-19

[Article in English, Spanish]
Yale Tung-Chen et al. Med Clin (Barc). .

Abstract
in English, Spanish

Background: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in chest X-rays and computed tomography scans; however, their availability during this pandemic outbreak might be compromised. Currently, the role of point-of-care ultrasonography (POCUS) has yet to be explored.

Objectives: To describe the POCUS findings of COVID-19 in patients with the disease admitted to the emergency department (ED), correlating them with vital signs, laboratory and radiologic results, therapeutic decisions, and the prognosis.

Methods: Prospective study performed in the ED of 2 academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a lung ultrasonography (lung POCUS), focused cardiac ultrasound (FOCUS), and inferior vena cava (IVC) exam.

Results: Between March and April 2020, 96 patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common findings in the lung POCUS were an irregular pleural line (63.2%), bilateral confluence (55.2%), and isolated B-lines (53.1%), which were associated with a positive RT-PCR (odds ratio 4.327; 95% CI 1.216-15.401; p<.001), and correlated with IL-6 levels (rho=0.622; p=.002). The IVC negatively correlated with levels of expiratory pO2 (rho=-0.539; p=.014) and inspiratory pO2 (rho=-0.527; p=0.017), and expiratory diameter positively correlated with troponin I (rho=0.509; p=.03). After the POCUS exam, almost 20% of the patients had an associated condition that required a change in their treatment or management.

Conclusions: POCUS parameters have the potential to impact the diagnosis, management, and prognosis of patients with confirmed or suspected COVID-19.

Antecedentes: Existe una evidencia creciente con respecto a los hallazgos por imagen de la COVID-19, tanto en radiografías de tórax como en tomografía computarizada; sin embargo, la disponibilidad de estas técnicas durante la pandemia podría verse comprometida.

Objetivos: Describir los hallazgos en la ecografía en el punto de atención (POCUS) en pacientes con COVID-19 que consultaron en el servicio de urgencias (SU), correlacionándolos con signos vitales, resultados analíticos y radiológicos, decisiones terapéuticas y pronóstico.

Métodos: Estudio prospectivo realizado en los SU de dos hospitales académicos. Los pacientes con COVID-19 con alta sospecha o confirmada se sometieron a una ecografía pulmonar (POCUS pulmonar), una ecocardioscopia y una ecografía de la vena cava inferior (VCI).

Resultados: Entre marzo y abril del 2020, se reclutaron 96 pacientes. La edad media fue de 68,2 años (DE 17,5). Los hallazgos más comunes en el POCUS pulmonar fueron la línea pleural irregular (63,2%), las líneas B confluyentes bilateral (55,2%) y aisladas (53,1%), que se vincularon con una RT-PCR (odds ratio 4,327; IC 95% 1,216 a 15,401; p < 0,001), y se asoció con los niveles de interleucina-6 (IL-6) (ρ = 0,622; p = 0,002). La VCI se correlacionó negativamente con los niveles de pO2 espiratorio (ρ = − 0,539; p = 0,014) y pO2 inspiratorio (ρ = − 0,527; p = 0,017), y el diámetro espiratorio se relacionó positivamente con la troponina I (ρ = 0,509; p = 0, 03). Después del examen POCUS, casi el 20% de los pacientes tenían una condición asociada que requería un cambio en el tratamiento o manejo previo.

Conclusiones: Los parámetros POCUS tienen el potencial de afectar el diagnóstico, manejo y pronóstico de pacientes con sospecha o confirmación de COVID-19.

Keywords: Coronavirus disease 2019 (COVID-19); Coronavirus tipo 2 del Síndrome respiratorio agudo grave (SARS-CoV-2); Ecocardioscopia; Ecografía clínica; Enfermedad por coronavirus 2019 (COVID-19); Focused cardiac ultrasonography (FOCUS).; Point-of-care ultrasonography (POCUS); Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Figures

Fig. 1
Fig. 1
Lung ultrasound showing the different signs (white arrow). A-lines: horizontal reverberation artifacts parallel to the pleural line (A); B-lines: hyperechoic vertical artifacts that arise from the pleural line, extending to the bottom of the screen without fading that erases the A-line artifact, that can converge (B) or be well demarcated (C); Irregular pleural line: indented or broken pleural line (D); Consolidations: subpleural hypoechoic areas surrounded by a hyperechoic artifact tail (E); Pleural effusion: anechoic space between the parietal and visceral pleura (F).
Fig. 2
Fig. 2
STROBE flow diagram.
See this image and copyright information in PMC

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