What’s new in lung ultrasound during the COVID-19 pandemic

The SARS-CoV-2 pandemic is undermining the ability of many advanced healthcare systems worldwide to provide quality care. COVID-19 is the disease caused by infection with SARS-CoV-2, a virus with specific tropism for the lower respiratory tract in the early disease stage. Computed tomography scans of patients with COVID-19 typically show a diffuse bilateral interstitial pneumonia, with asymmetric, patchy lesions distributed mainly in the periphery of the lung LUS signs The signs seen in the LUS of patients with COVID-19 are similar to those extensively described in patients with other types of pneumonia. These include various forms of B-lines, an irregular or fragmented pleural line, consolidations, pleural effusions and absence of lung sliding The LUS of patients with COVID-19 usually shows an explosion of multiform vertical artifacts and separate and coalescent B-lines. The pleural line may be irregular or fragmented as is commonly observed in ARDS. As stated above none of these signs is pathognomonic to COVID-19 pneumonia and their presence is variable. Conversely, a typical artifact that we named “light beam” is being observed invariably in most patients with pneumonia from COVID-19. This artifact corresponds to the early appearance of “ground glass” alterations typical of the acute disease that may be detected in computed tomography. This broad, lucent, band-shaped, vertical artifact moves rapidly with sliding, at times creating an “on–off” effect as it appears and disappears from the screen. The bright artifact typically arises from an entirely regular pleural line interspersed within areas of normal pattern or with separated B-lines. Hospital flooding of patients with COVID-19 imposes a huge burden on the medical system. This burden can be somewhat mitigated with optimization of patient identification, triage and management. LUS is noninvasive and can be performed very rapidly. LUS may be used in the ED to identify likely COVID-19 patients and to identify those patients with more extensive pulmonary involvement who should probably be referred to the ICU. It may serve to differentiate between patients with acute signs of respiratory failure, patients with mild symptoms and normal respiratory function, patients with preexisting chronic cardiac or pulmonary diseases. In the ICU, LUS may be used to identify areas of poor lung aeration and to monitor the effect of changes in ventilation and recruitment maneuvers on lung aeration. To read more- https://link.springer.com/article/10.1007%2Fs00134-020-06048-9


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