Esaote releases a clinical resource brochure for and in support of COVID-19 frontliners. MEDEV is the distributor of Esaote ultrasound machines in the Philippines for more than 20 years.
From ESAOTE:
COVID-19 pneumonia is characterized by alveolar edema with prominent proteinaceous exudates, vascular congestion, patchy inflammatory clusters with fibrinoid material, alveolar epithelial hyperplasia, and fibroblastic proliferation. These histopathologic changes provide a particular pattern of findings on lung ultrasound (LUS) that can help to differentiate COVID pneumonia from other causes of acute dyspnea.
LUS allows a bedside examination of patients, even those who are critically ill, without needing to transfer them. Thus, it could represent a valuable approach for the diagnosis and follow-up of lung involvement in COVID patients, minimizing the risk of further infection in healthcare personnel.
In particular, LUS can be used for:
- triage of symptomatic patients at home or in the emergency room
- prognostic stratification and monitoring of patients with COVID pneumonia
- monitoring of ICU patients with ventilation
- monitoring of therapeutic interventions
Since this global emergency needs a unified approach, Italian experts in LUS involved in the management of COVID-19 patients in different areas of Italy (Lucca, Trento, Rome, Pavia, Brescia, Voghera, Lodi) proposed a standardized acquisition protocol and scoring algorithm.
ACQUISITION PROTOCOL (1/2):
- portable US, wireless probe, tablet
- all devices wrapped in single use plastic covers to reduce the risk of contamination and to facilitate the sterilization procedures
- 2 operators – one operator performing the examination, the second with tablet at safe distance from the patient
- convex or linear probes, according to the patient’s body size
- single focal point modality (no multi-focusing), setting the focal point on the pleura line
- low mechanical index (MI) (start from 0.7 and reduce it further if possible), high MIs, if employed for a long observation time, may result in damaging the lung
- avoid saturation phenomena as much as possible by controlling the gain
- avoid the use of cosmetic filters and specific imaging modalities such as Harmonic Imaging, Contrast, Doppler, Compounding
- achieve the highest frame rate possible
- save the data in DICOM format
ACQUISITION PROTOCOL (2/2):
14 standard areas are proposed to be scanned in each patient, using landmarks on chest anatomic lines (see the scheme). In patients able to maintain a sitting position:
- Right basal on paravertebral line above the curtain sign
- Right middle on paravertebral line at the inferior angle of shoulder blade
- Right upper on paravertebral line at spine of shoulder blade
- Left basal on paravertebral line above the curtain sign
- Left middle on paravertebral line at the inferior angle of shoulder blade
- Left upper on paravertebral line at spine of shoulder blade
- Right basal on mid-axillary line below the internipple line
- Right upper on mid-axillary line above the internipple line
- Left basal on mid-axillary line below the internipple line
- Left upper on mid-axillary line above the internipple line
- Right basal on mid-clavicular line below the internipple line
- Right upper on mid-clavicular line above the internipple line
- Left basal on mid-clavicular line below the internipple line
- Left upper on mid-clavicular line above the internipple line
In patients on invasive ventilation and in patients that are not able to maintain a sitting position, the posterior areas might be difficult to be evaluated. In these cases, the operator should try to have a partial view of the posterior basal areas and start echographic assessment from landmark number 7.
* Protocol, schemes, and figures are reproduced by kind permission of the corresponding author of Wiley Global Permission Office
More from the literature: https://www.esaote.com/clinical-solutions/special-covid-19/lung-ultrasound-in-covid-patients/?fbclid=IwAR36l_lIqmuwiFjsp95IsGjkx8fDSauX9Wq74ClY7NZMjuo0ofdyE5pLXmA