LUNG ULTRASOUND IN COVID PATIENTS - MEDEV Medical Devices Corporation

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