tetano
Editor, Senior Moderator
Ultrasound Med Biol
. 2020 May 6;S0301-5629(20)30205-2.
doi: 10.1016/j.ultrasmedbio.2020.04.033. Online ahead of print.
Lung Ultrasound in Patients With Acute Respiratory Failure Reduces Conventional Imaging and Health Care Provider Exposure to COVID-19
Silvia Mongodi[SUP] 1 [/SUP], Anita Orlando[SUP] 2 [/SUP], Eric Arisi[SUP] 2 [/SUP], Guido Tavazzi[SUP] 3 [/SUP], Erminio Santangelo[SUP] 4 [/SUP], Luca Caneva[SUP] 2 [/SUP], Marco Pozzi[SUP] 2 [/SUP], Eleonora Pariani[SUP] 5 [/SUP], Giada Bettini[SUP] 5 [/SUP], Giuseppe Maggio[SUP] 2 [/SUP], Stefano Perlini[SUP] 6 [/SUP], Lorenzo Preda[SUP] 7 [/SUP], Giorgio Antonio Iotti[SUP] 3 [/SUP], Francesco Mojoli[SUP] 3 [/SUP]
Affiliations
Abstract
Lung ultrasound gained a leading position in the last year as an imaging technique for the assessment and management of patients with acute respiratory failure. In coronavirus disease 2019 (COVID-19), its role may be of further importance because it is performed bedside and may limit chest X-ray and the need for transport to radiology for computed tomography (CT) scan. Since February 21, we progressively turned into a coronavirus-dedicated intensive care unit and applied an ultrasound-based approach to avoid traditional imaging and limit contamination as much as possible. We performed a complete daily examination with lung ultrasound score computation and systematic search of complications (pneumothorax, ventilator-associated pneumonia); on-duty physicians were free to perform CT or chest X-ray when deemed indicated. We compared conventional imaging exams performed in the first 4 wk of the COVID-19 epidemic with those in the same time frame in 2019: there were 84 patients in 2020 and 112 in 2019; 64 and 22 (76.2% vs. 19.6%, p < 0.001) had acute respiratory failure, respectively, of which 55 (85.9%) were COVID-19 in 2020. When COVID-19 patients in 2020 were compared with acute respiratory failure patients in 2019, the median number of chest X-rays was 1.0 (1.0-2.0) versus 3.0 (1.0-4.0) (p = 0.0098); 2 patients 2 (3.6%) versus 7 patients (31.8%) had undergone at least one thoracic CT scan (p = 0.001). A self-imposed ultrasound-based approach reduces the number of chest X-rays and thoracic CT scans in COVID-19 patients compared with patients with standard acute respiratory failure, thus reducing the number of health care providers exposed to possible contamination and sparing personal protective equipment.
Keywords: ARDS; COVID-19; Lung monitoring; Lung ultrasound; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
. 2020 May 6;S0301-5629(20)30205-2.
doi: 10.1016/j.ultrasmedbio.2020.04.033. Online ahead of print.
Lung Ultrasound in Patients With Acute Respiratory Failure Reduces Conventional Imaging and Health Care Provider Exposure to COVID-19
Silvia Mongodi[SUP] 1 [/SUP], Anita Orlando[SUP] 2 [/SUP], Eric Arisi[SUP] 2 [/SUP], Guido Tavazzi[SUP] 3 [/SUP], Erminio Santangelo[SUP] 4 [/SUP], Luca Caneva[SUP] 2 [/SUP], Marco Pozzi[SUP] 2 [/SUP], Eleonora Pariani[SUP] 5 [/SUP], Giada Bettini[SUP] 5 [/SUP], Giuseppe Maggio[SUP] 2 [/SUP], Stefano Perlini[SUP] 6 [/SUP], Lorenzo Preda[SUP] 7 [/SUP], Giorgio Antonio Iotti[SUP] 3 [/SUP], Francesco Mojoli[SUP] 3 [/SUP]
Affiliations
- PMID: 32451194
- DOI: 10.1016/j.ultrasmedbio.2020.04.033
Abstract
Lung ultrasound gained a leading position in the last year as an imaging technique for the assessment and management of patients with acute respiratory failure. In coronavirus disease 2019 (COVID-19), its role may be of further importance because it is performed bedside and may limit chest X-ray and the need for transport to radiology for computed tomography (CT) scan. Since February 21, we progressively turned into a coronavirus-dedicated intensive care unit and applied an ultrasound-based approach to avoid traditional imaging and limit contamination as much as possible. We performed a complete daily examination with lung ultrasound score computation and systematic search of complications (pneumothorax, ventilator-associated pneumonia); on-duty physicians were free to perform CT or chest X-ray when deemed indicated. We compared conventional imaging exams performed in the first 4 wk of the COVID-19 epidemic with those in the same time frame in 2019: there were 84 patients in 2020 and 112 in 2019; 64 and 22 (76.2% vs. 19.6%, p < 0.001) had acute respiratory failure, respectively, of which 55 (85.9%) were COVID-19 in 2020. When COVID-19 patients in 2020 were compared with acute respiratory failure patients in 2019, the median number of chest X-rays was 1.0 (1.0-2.0) versus 3.0 (1.0-4.0) (p = 0.0098); 2 patients 2 (3.6%) versus 7 patients (31.8%) had undergone at least one thoracic CT scan (p = 0.001). A self-imposed ultrasound-based approach reduces the number of chest X-rays and thoracic CT scans in COVID-19 patients compared with patients with standard acute respiratory failure, thus reducing the number of health care providers exposed to possible contamination and sparing personal protective equipment.
Keywords: ARDS; COVID-19; Lung monitoring; Lung ultrasound; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).