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. 2021 Nov 14;10(22):5291.
doi: 10.3390/jcm10225291.

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department-A Proof-of-Concept Study

Emanuele Pivetta  1 , Irene Cara  2 , Giulia Paglietta  2 , Virginia Scategni  2 , Giulia Labarile  2 , Maria Tizzani  1 , Giulio Porrino  1 , Stefania Locatelli  1 , Gilberto Calzolari  1 , Fulvio Morello  1   3 , Milena Maria Maule  3   4 , Enrico Lupia  1   3
Affiliations

Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department-A Proof-of-Concept Study

Emanuele Pivetta et al. J Clin Med. .

Abstract

Background: Lung Ultrasound Evaluation (LUS) is usefully applied in the Emergency Department (ED) to patients with suspected or confirmed COVID-19. Diaphragmatic Ultrasound (DUS) may provide additional insight into ventilatory function. This proof-of-concept study aimed to evaluate the feasibility of LUS and DUS in a third level ED during the COVID-19 pandemic.

Methods: Adult patients presenting with COVID-19 symptoms were eligible. After the physical examination, both LUS and DUS (i.e., diaphragmatic motion and thickness) were performed. All patients were followed after 30 days to determine their need for ventilation, admission, and/or a new ED evaluation after discharge. The diagnostic accuracies of diaphragm measurements in assessing the risk of the 30-day outcome were calculated as well as the measurements' usefulness. Bland-Altman plots were used for comparing bedside and off-line diaphragm measurements.

Results: 118 patients were enrolled. Median thickness and motion were 1.7 mm (iqr 0.4) and 1.8 cm (iqr 0.7), respectively, with a mean difference of 0.009 mm (95% CI -0.037-0.056 mm) and -0.051 cm (95% CI -0.108-0.006 cm), respectively. The 30-day outcome was associated with an increase in thickness (OR 5.84, 95% CI 0.96-35.4), and a lower motion (OR 0.49, 95% CI 0.2-1.21).

Conclusion: DUS seemed to be feasible and reliable in the ED in a population of patients presenting with symptoms related to COVID-19 infection.

Keywords: COVID-19; diaphragm; point-of-care ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Example of DUS measurements: Panel 1 shows diaphragmatic thickness at end-expiration; Panel 2 shows diaphragmatic motion (the white B in the blue dot is the probe marker).
Figure 2
Figure 2
Bland–Altman plots for agreement between diaphragm thickness and motion measurement bedside and offline (Panel (A) and (B), respectively).
Figure 3
Figure 3
Decision curves for 30-day outcomes for diaphragmatic thickness, motion, and LUS score at ED evaluation.
See this image and copyright information in PMC

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References

    1. Guarracino F., Vetrugno L., Forfori F., Corradi F., Orso D., Bertini P., Ortalda A., Federici N., Copetti R., Bove T. Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach. J. Cardiothorac. Vasc. Anesth. 2021;35:1866–1874. doi: 10.1053/j.jvca.2020.06.013. - DOI - PMC - PubMed
    1. Pivetta E., Goffi A., Tizzani M., Locatelli S.M., Porrino G., Losano I., Leone D., Calzolari G., Vesan M., Steri F., et al. Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department. Ann. Emerg. Med. 2021;77:385–394. doi: 10.1016/j.annemergmed.2020.10.008. - DOI - PMC - PubMed
    1. Peixoto A.O., Costa R.M., Uzun R., Fraga A.M.A., Ribeiro J.D., Marson F.A.L. Applicability of lung ultrasound in COVID-19 diagnosis and evaluation of the disease progression: A systematic review. Pulmonology. 2021;27:529–562. doi: 10.1016/j.pulmoe.2021.02.004. - DOI - PMC - PubMed
    1. Peng Q.Y., Wang X.T., Zhang L.N., Chinese Critical Care Ultrasound Study Group (CCUSG) Findings of lung ultrasonography of novel coronavirus pneumonia during the 2019–2020 epidemic. Intensive Care Med. 2020;46:849–850. doi: 10.1007/s00134-020-05996-6. - DOI - PMC - PubMed
    1. Vetrugno L., Bove T., Orso D., Barbariol F., Bassi F., Boero E., Ferrari G., Kong R. Our Italian experience using lung ultrasound for identification, grading and serial follow-up of severity of lung involvement for management of patients with COVID-19. Echocardiography. 2020;37:625–627. doi: 10.1111/echo.14664. - DOI - PMC - PubMed