Standardized protocol for ultrasound diagnosis of the lungs with COVID-19
BACKGROUND. The era of coronavirus disease (COVID-19) set the such task for lung ultrasound (LUS): to identify the presence of COVID-pneumonia, its differential diagnosis with other conditions which characterized by interstitial edema, determining the severity of lung damage and its location, the dynamics of pulmonary changes tissue, the development of complications, as well as to assess the effectiveness of personalized therapy.
OBJECTIVE. To develop a national LUS protocol for COVID-19 based on a balance of completeness of information with the optimal minimum of time and effort for medical staff, who often do not specialize in ultrasound using, with ultrasound equipment of basic and middle classes.
MATERIALS AND METHODS. A total of 1576 patients with COVID-19 were examined. There were 810 women (51.4 %) and 766 men (48.6 %). The age of the examined patients was in the range of 18-83 years, the average age was 52.3±14.6 years. 4710 LUS were performed, of which 1572 were repeated and 3144 – in the dynamics. Polysystemic ultrasound was performed in 275 patients. Ultrasound devices of both domestic and foreign production were used: Soneus P7 (Ultrasine, Ukraine), HandyUsound (Ukraine), Xario, USAP-770A (Toshiba, Japan), GE Venue (General Electric, USA) and TE7 COVID (Mindray, China) with ultrasound probes of convex, linear and microconvex formats.
RESULTS. Summarizing our own experience with patients with COVID-19 in 2020-2021, we have developed a version of the LUS-protocol, which has a convenient form of recording all stages of ultrasound with maximum coverage of the entire volume of both lungs according to a clear algorithm, a graphical form, clear ultrasound semiotics and diagnostic scoring criteria for the severity of lung damage.
CONCLUSIONS. 1. Clinical data indicate the feasibility and effectiveness of using LUS for dynamic monitoring of patients with pneumonia caused by SARS-CoV-2, especially in oxygen-dependent patients at their bedside (POCUS principle). 2. Optimization of the use of radiological diagnostic methods due to ultrasound makes it possible to reduce the radiation dose of the patient.3. The use of LUS allows more adequate decision-making on the need for intensive and interventional therapy, leads to faster diagnosis, improved medical care, reduced length of stay of patients in ICU, as well as reducing the total cost of treatment.4. Ability to reduce the impact of SARS-CoV-2 on healthcare professionals by limiting physical contact with the patient. 5. The standardized Ukrainian protocol of LUS provides availability, efficiency and clear interpretation of the received data at its use by different doctors in different medical institutions. The integration of the protocol in to the ultrasound machine provides optimization of the workflow process.
Pesenti A., Musch G., Lichtenstein D., Mojoli F., Amato M.B.P., Cinnella G. et al. Imaging in acute respiratory distress syndrome. Intensive Care Med. 2016; 42 (5): 686-98.
Lichtenstein D., Axler O. Intensive use of general ultrasound in the intensive care unit. Intensive Care Med. 1993; 19 (6): 353-5. doi.org/10.1007/bf01694712.
Lichtenstein D., Mezière G. The BLUE-points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure. Crit. Ultrasound J. 2011; 3: 109-110.
Lichtenstein D. Lung ultrasound in the critically ill. Ann. Intensive Care. 2014; 4: 1. doi: 10.1186/2110-5820-4-1.
Feshchenko Y.I., Golubovska O.A., Dziublyk A.Y. et al. Pulmonary disease in COVID-19. Ukr. Pulmonol. J. 2021; 1: 5-14.
Peng Q.-Y., Wang X.-T., Zhang L.-N. Findings of lung ultrasonography of novel coronavirus pneumonia during the 2019-2020 epidemic. Intensive Care Med. 2020; 1-2. doi: 10.1007/s00134-020-05996-6.
Stock K., Horn R., Mathis G. Lung Ultrasound (LUS) Protocol. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). Available at: https://efsumb.org/wp-content/uploads/2021/01/Poster-A4-Lungenultraschall-Protokoll_DEGUM_SGUM_OEGM_V3_englisch_100420....pdf.
Huang Y. et al. A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel coronavirus pneumonia (COVID-19). Available at: https://ssrn.com/abstract=3544750.
Dargent A., Chatelain E., Kreitmann L. et al. Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS. PLoS ONE. 2020; 15 (7): e0236312. https://doi.org/ 10.1371/journal.pone.0236312.
Soummer A., Perbet S., Brisson H., Arbelot C., Constantin J.-M., Lu Q. et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit. Care Med. 2012; 40 (7): 2064-72. https://doi.org/10.1097/CCM.0b013e31824e68ae.
Mongodi S., Via G., Girard M., Rouquette I. et al. Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest. 2016; 149 (4): 969-80. https://doi.org/10.1016/j.chest.2015.12.012.
Mitkov V.V., Safonov D.V., Mitkova M.D. et al. Коnsensusnoe zajavlenije RASUDM ob ultrazvukovom issledovanii legkikh v uslovijakh COVID-19 (version 1). Ultrazvukovaja i funkcionaljnaja diagnostika. 2020; 1: 24-45. doi: 10.24835/1607-0771-2020-1-24-45.
Soldati G., Smargiassi A., Inchingolo R. et al. Proposal for international standardization of the use of lung ultrasound for COVID-19 patients; a simple, quantitative, reproducible method. J. Ultrasound Med. 2020. doi:10.1002/jum.15285.
Manivel V., Lesnewski A., Shamim S. et al. CLUE: COVID-19 lung ultrasound in emergency department. Emerg. Med. Australas. 2020 Aug; 32 (4): 694-696. doi: 10.1111/1742-6723.13546.
Soni N., Arntfield R., Kory P. Point-Of-Care Ultrasound. Philadelphia, PA: Elsevier. 2020; 502 p.
Zhu S.-T., Tao F.-Y., Xu J.-H. et al. Utility of point-of-care lung ultrasound for clinical classification of COVID-19. Ultrasound in Medicine and Biology. 2021; 47 (2): 214-221.
Smargiassi A., Soldati G., Borghetti A. et al. Lung ultrasonography for early management of patients with respiratory symptoms during COVID-19 pandemic. J. Ultrasound. 2020; 23 (4): 449-456. doi: 10.1007/s40477-020-00501-7.
EFSUMB Guideline. Christiane M., Nyhsen C., Humphreys H., Koerner R. et al. Infection prevention and control in ultrasound – best practice recommendations from the European Society of Radiology Ultrasound Working Group. Insights Imaging. 2017; 8: 523-535. https://doi.org/10.1007/s13244-017-0580-3.
World Federation for Ultrasound in Medicine and Biology (WFUMB) Safety Committee (Abramowicz J., Akiyama I., Evans D. et al.). World Federation for Ultrasound in Medicine and Biology Position Statement: how to perform a safe ultrasound examination and clean equipment in the context of COVID-19. Ultrasound in Medicine and Biology. 2020; 46 (7): 1821-1826.
Valenko О.О., Volkov О.О., Bessarab А.S. Practychni aspecty vykorystannja urgentnogo sonografichnogo doslidzhennia v dyfferencijnij diagnostyci krytychnykh respiratornykh incidentiv (BLUE-protocol “Bedside Lung Ultrasound in Emergency”). Perioperative Medicine. 2018; 1 (1): 46-59.
Tung-Chen Y., Marti de Garcia M., Diez Tascon A. et al. Correlation between chest computed tomography and lung ultrasonography in patients with coronavirus disease 2019 (COVID-19). Ultrasound in Medicine and Biology. 2020; 46 (11): 2918-2926.
Zieleskiewicz L., Markarian T., Lopez A. et al. Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Med. 2020 Sep; 46 (9): 1707-1713. doi: 10.1007/s00134-020-06186-0.
Mongodi S., Orlando A., Arisi E. et al. Lung ultrasound in patients with acute respiratory failure reduces conventional imaging and health care provider exposure to COVID-19. Ultrasound in Medicine and Biology. 2020; 46 (8): 2090-2093.
Balik M., Plasil P., Waldauf P. et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med. 2006; 32 (2): 318. doi: 10.1007/s00134-005-0024-2.
Pecho-Silva S., Navarro-Solsol A., Taype-Rondan A. et al. Pulmonary ultrasound in the diagnosis and monitoring of coronavirus disease (COVID-19): a systematic review. Ultrasound in Medicine and Biology. V0; 1-9.
Sultan L.R., Sehgal C.M. A review of early experience in lung ultrasound in the diagnosis and management of COVID-19. Ultrasound in Medicine and Biology. 2020; 46 (9): 2530-2545.
This work is licensed under a Creative Commons Attribution 4.0 International License.