Lung Ultrasound Integration in Assessment of Patients with Noncritical COVID-19.

OBJECTIVES: Performing lung ultrasound during the clinical assessment of patients with suspicion of noncritical COVID-19 may increase the diagnostic rate of pulmonary involvement over other diagnostic techniques used in routine clinical practice. This study aims to compare complications (readmissions, emergency department [ED] visits, and length of outpatient follow-up) in the first 30 days after ED discharge in patients with confirmed COVID-19 who were managed with versus without lung ultrasound. MATERIALS AND METHODS: Prospective, observational, analytical study in noncritical patients with confirmed respiratory disease due to SARS-CoV-2, assessed in the ED of a tertiary Spanish hospital in March and April 2020. We compared 2 cohorts, differentiated by the use of lung ultrasound as a diagnostic tool. Complications were assessed (hospital admissions, ED revisits and days of outpatient follow-up) at 30 days postdischarge. RESULTS: Of the 88 included patients, 31% (n = 27) underwent an initial lung ultrasound, while 61 (68%) did not. In 82.5% of the patients evaluated with ultrasound, the most predominant areas affected were the posterobasal regions, in the form of focalized and confluent B-lines; 70.4% showed pleural irregularity in these same areas. Use of the lung ultrasound was associated with a greater probability of hospital admission (odds ratio 5.63, 95% confidence interval 3.31 to 9.57; p < 0.001). However, it was not significantly associated with mortality or short-term complications. CONCLUSIONS: Lung ultrasound could identify noncritical patients with lung impairment due to SARS-CoV-2, in whom other tests used routinely show no abnormalities. However, it has not shown a prognostic value in these patients and could generate a higher percentage of hospital admissions. More studies are still needed to demonstrate the clear benefit of this use.

Diagnostic yield of point-of-care ultrasound imaging of the lung in patients with COVID-19. / Capacidad diagnóstica de la ecografía clínica pulmonar en pacientes con COVID-19.

OBJECTIVES: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. MATERIAL AND METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive.

OBJETIVO: Evaluar el rendimiento diagnóstico de la ecografía clínica pulmonar en pacientes con sospecha de infección respiratoria no crítica por SARS-CoV-2 sin alteraciones evidentes en la radiografía de tórax. METODO: Estudio de una serie de casos con análisis transversal que incluyó pacientes con sospecha de infección respiratoria por SARS-CoV-2, sintomatología respiratoria leve-moderada y sin hallazgos patológicos concluyentes en la radiografía torácica, que consultaron en un servicio de urgencias durante marzo y abril de 2020. Se realizó una ecografía clínica pulmonar a todos los participantes como parte de la práctica clínica asistencial. Se compararon los hallazgos ecográficos en función del resultado del test SARS-CoV-2. RESULTADOS: Se estudiaron 58 pacientes [mediana de edad 44,5 (RIC 34-67) años; 42 (72,4%) mujeres], 27 (46,5%) con infección por SARS-CoV2 confirmada. Treinta y tres (56,9%) presentaron hallazgos ecográficos de neumonía intersticial por COVID-19, siendo más frecuente en los casos con COVID-19 confirmada (22,2% vs 100%; p < 0,001). Los hallazgos más frecuentes en los casos con COVID-19 confirmada fueron en áreas posterobasales (regiones R1, R2, L1, L2), en forma de líneas B focalizadas y confluentes (85,2%, 77,8%, 88,9% y 88,9%, respectivamente), con irregularidad pleural asociada (70,4%, 70,4%, 81,5% y 85,2%, respectivamente). El diagnóstico del COVID-19 mediante ecografía pulmonar clínica tuvo una sensibilidad de un 92,6% (IC 95%: 75,7-99,1%), una especificidad de un 85,2% (IC 95%: 66,3-95,8%), un valor predictivo positivo fue de un 75,8% (IC 95%: 59,6-91,9%), un valor predictivo negativo de un 92% (IC 95%: 74,0-99,0%), una razón de verosimilitud positiva de un 6,25 (IC 95%: 6,0-6,5) y una negativa de 0,1 (IC 95%: 0,1-0,1). CONCLUSIONES: El uso de la ecografía clínica pulmonar podría ser de ayuda diagnóstica en pacientes con sospecha de infección respiratoria no crítica por SARS-CoV-2 donde la radiografía de tórax no es diagnóstica.

Capacidad diagnóstica de la ecografía clínica pulmonar en pacientes con COVID-19 / Diagnostic yield of point-of-care ultrasound imaging of the lung in patients with COVID-19

OBJETIVO: Evaluar el rendimiento diagnóstico de la ecografía clínica pulmonar en pacientes con sospecha de infección respiratoria no crítica por SARS-CoV-2 sin alteraciones evidentes en la radiografía de tórax. MÉTODO: Estudio de una serie de casos con análisis transversal que incluyó pacientes con sospecha de infección respiratoria por SARS-CoV-2, sintomatología respiratoria leve-moderada y sin hallazgos patológicos concluyentes en la radiografía torácica, que consultaron en un servicio de urgencias durante marzo y abril de 2020. Se realizó una ecografía clínica pulmonar a todos los participantes como parte de la práctica clínica asistencial. Se compararon los hallazgos ecográficos en función del resultado del test SARS-CoV-2. RESULTADOS: Se estudiaron 58 pacientes [mediana de edad 44,5 (RIC 34-67) años; 42 (72,4%) mujeres], 27 (46,5%) con infección por SARS-CoV2 confirmada. Treinta y tres (56,9%) presentaron hallazgos ecográficos de neumonía intersticial por COVID-19, siendo más frecuente en los casos con COVID-19 confirmada (22,2% vs 100%; p < 0,001). Los hallazgos más frecuentes en los casos con COVID-19 confirmada fueron en áreas posterobasales (regiones R1, R2, L1, L2), en forma de líneas B focalizadas y confluentes (85,2%, 77,8%, 88,9% y 88,9%, respectivamente), con irregularidad pleural asociada (70,4%, 70,4%, 81,5% y 85,2%, respectivamente). El diagnóstico del COVID-19 mediante ecografía pulmonar clínica tuvo una sensibilidad de un 92,6% (IC 95%: 75,7-99,1%), una especificidad de un 85,2% (IC 95%: 66,3-95,8%), un valor predictivo positivo fue de un 75,8% (IC 95%: 59,6-91,9%), un valor predictivo negativo de un 92% (IC 95%: 74,0-99,0%), una razón de verosimilitud positiva de un 6,25 (IC 95%: 6,0-6,5) y una negativa de 0,1 (IC 95%: 0,1-0,1). CONCLUSIONES: El uso de la ecografía clínica pulmonar podría ser de ayuda diagnóstica en pacientes con sospecha de infección respiratoria no crítica por SARS-CoV-2 donde la radiografía de tórax no es diagnóstica

OBJECTIVE: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive

Point-of-care ultrasound in cardiopulmonary resuscitation: a concise review.

Point-of-care ultrasound (POCUS) is a widely used tool in critical care areas, allowing for the performance of accurate diagnoses and thus enhancing the decision-making process. Every major organ or system can be safely evaluated with POCUS. In that respect, the utility of POCUS in cardiac arrest is gaining interest. In this article, we will review the actual role of ultrasound in cardiac arrest and the main POCUS protocols focused to this scenario as well as discuss the potential role of POCUS in monitoring the efficacy of the chest compressions.