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Review
. 2020 Apr 17;S1078-8174(20)30057-2.
doi: 10.1016/j.radi.2020.04.005. Online ahead of print.

Point of Care and Intensive Care Lung Ultrasound: A Reference Guide for Practitioners During COVID-19

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Free PMC article
Review

Point of Care and Intensive Care Lung Ultrasound: A Reference Guide for Practitioners During COVID-19

S Moore et al. Radiography (Lond). .
Free PMC article

Abstract

Objectives: Current events with the recent COVID-19 outbreak are necessitating steep learning curves for the NHS workforce. Ultrasound, although not used in the diagnosis of COVID-19 may be utilised by practitioners at the point of care (POC) or on the intensive care units (ITUs) where rapid assessment of the lung condition may be required. The aim of this article was to review current literature surrounding the use of lung ultrasound in relation to COVID-19 and provide Sonographers with a quick and digestible reference guide for lung pathologies.

Key findings: Ultrasound is being used in Italy and China to help review lung condition during the COVID-19 outbreak however not strictly as a diagnostic tool as Computed Tomography (CT) of the chest and chest radiographs are currently gold standard. Ultrasound is highly sensitive in the detection of multiple lung pathologies which can be demonstrated in conjunction with COVID-19 however to date there are no specific, nor pathognomonic findings which relate to COVID-19 on ultrasound.

Conclusion: Lung ultrasound is highly sensitive and can quickly and accurately review lung condition creating potential to assess for changes or resolution over time, especially in the ITU and POC setting. However it should not be used as a diagnostic tool for COVID-19 due to low specificity in relation to the virus.

Implications for practice: The adoption of lung ultrasound to monitor lung condition during the COVID-19 outbreak may reduce the need for serial exposure to ionising radiation on the wards and in turn reduce the number of radiographers required to attend infected wards and bays, protecting both patients and the workforce.

Keywords: COVID-19; ITU; Intensive care; Lung ultrasound; POCUS; Point of care ultrasound.

Conflict of interest statement

Conflict of interest statement None.

Figures

Figure 1
Figure 1
Windows used in lung ultrasound Anterior axillary line (AAL) Posterior axillary line (PAL).
Figure 2
Figure 2
Normal ultrasound appearances (Red star = Rib, Orange Triangle = Rib shadow, Pink Diamond = Intercostal Muscles, Yellow Arrow = Pleural Line, Blue Rectangle = Subcutaneous Fat, Green Oval = Dermal layers). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 3
Figure 3
Normal Seashore sign on M-mode (Red star = Rib, Orange Triangle = Rib shadow, Pink Diamond = Static Intercostal Muscles on M-mode, Yellow Arrow = Pleural Line, Pink Cross = Normal Sliding Pleura on M-mode). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 4
Figure 4
Normal A-lines seen as parallel lines (Orange arrows) in the intercostal space which descend to the bottom of the screen. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 5
Figure 5
Normal Pleural line = <0.2–0.3 mm (Yellow Arrow = Pleural Line). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 6
Figure 6
Normal B-lines seen in the intercostal space (Red Arrow = Single normal B-line). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 7
Figure 7
>3 B-lines in the intercostal space is suggestive of pulmonary oedema (Red Arrows = Multiple closely associated thick B-lines). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 8
Figure 8
Simple pleural effusion (Blue Circle = Fluid in the pleural space/pleural effusion, Pink Diamond = Liver, Red Arrow = Diaphragm, Green Cross = Lung Tissue). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 9
Figure 9
Thickened and irregular pleura suggestive of interstitial lung disease (Yellow Arrows = Thickened irregular pleura). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 10
Figure 10
Pleural effusion (Blue Circle) with underlying lung consolidation and shredding appearance from an air-bronchogram. (Yellow Arrows = air-bronchogram/shredded appearance, Green Cross – Lung parenchyma, Red Arrow = Diaphragm). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 11
Figure 11
Barcode sign on M-mode. These appearances are suggestive of a pneumothorax (Red Stars = Ribs, Yellow Callipers = Barcode sign). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Figure 12
Figure 12
Flow diagram of Lung Ultrasound Assessment.

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