POCUS Application in COVID-19

Welcome to our page! We compiling a complete set of resources to provide you with a learning home for the essential components of impelenting POCUS in your care of patients with suspected or confirmed COVID-19. Additionally, we are sharing our proposed workflows being utilized by our providers. Click the tiles below to navigate to learning resources.

This site is a work in process and we are editing the site daily to provide the most up to date resources for you, in addition to providing you new content. Keep checking back with us!

Ultrasound fundamentals: machine operation, creating an encounter, protocols, disinfection, etc.

Ultrasound fundamentals: machine operation, creating an encounter, protocols, disinfection, etc.

COVID Cases: Collection of case reports, images, etc. to help with understanding utility of POCUS.

COVID Cases: Collection of case reports, images, etc. to help with understanding utility of POCUS.

Cardiopulmonary POCUS Essentials: A learning toolkit for learning the indications, performing the exam, and integrating finding into patient care.

Cardiopulmonary POCUS Essentials: A learning toolkit for learning the indications, performing the exam, and integrating finding into patient care.

US-Guided Procedures: US-guided line access, thoracentesis, paracentesis, etc.

US-Guided Procedures: US-guided line access, thoracentesis, paracentesis, etc.

Proposed Algorithm for Implementation of POCUS in Care of Patient's with Suspected/Confirmed COVID-19

  • Our group recommends PPE conservation priortization as clinically indicated
  • This below algorithm is a expert-based recommendation and has not been validated.
  • POCUS infection prevention measures here.

Purpose:

With the current COVID-19 pandemic exponentially increasing throughout the world, Point-of-care ultrasound (POCUS) is in a unique position to help providers is the diagnosis, management, and prognostication of this disease. While there is some preliminary evidence that POCUS can help detect consolidate, diagnose pneumonia, and detect ARDS, there is still yet much unknown how it may be of use to clinicians managing the disease. Given concerns that global infection may strain traditional diagnostic resources, such as PCR testing and other traditional imaging modalities, POCUS is uniquely situated in that it can be done in real-time by the caring provider at the bedside. This page is designed to provide resources with providers attempting to use POCUS in the clinical care of patient’s potentially infected with COVID-19.

Evidence

Currently, there is little know about the direct application of POCUS in the care of COVID-19. A small study of 20 patients retrospectively showed characteristic findings of thickening of the pleural line, B-lines, and consolidations, in which they hypothesized that POCUS may be useful in the identification and management of patients with COVID-19.1 These findings are consistent with other viral pneumonias and ARDS. However, current CT studies suggest that the modality has a relatively high sensitivity, and importantly, has generally a peripheral distribution.2–4 This observation is important because POCUS is able to detect peripheral lung pathology as accurately, but frequently may miss central lesions due to a predominance of reflection and scattering at the pleural-air interface.5,6 Given that POCUS has the benefit of being able to be performed in real-time at the bedside, limit radiation, and be potentially used in resource-limited setting, it has potential to be a tool in the initial diagnostic management of patients with COVID-19.7 Furthermore, disinfection is a vital aspect for imaging modalities, and many POCUS devices are relatively easy to clean. Many patients with COVID may need prolonged hospitalization, with many of these patients developing adult respiratory distress syndrome.8 As there is significant potential for medical resources to be potentially strained as the pandemic evolves, it will be critical to identify the clinical course and trajectory of these potential. POCUS offers the ability to provide an objective measurement of lung function, aeration, evaluate for cardiomyopathies, and assess volume status. All of these evaluations are key in evaluating the patient with suspected or confirmed COVID-19. We will need to continue to assess how POCUS findings may integrate with clinician prognostication of which patients may need ongoing hospital resources and which patients may do well with de-escalation of care.9

  1. Peng, Q.-Y., Wang, X.-T., Zhang, L.-N. & Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med. (2020) doi:10.1007/s00134-020-05996-6.
  2. Fang, Y. et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology 200432 (2020) doi:10.1148/radiol.2020200432.
  3. Pan, F. et al. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology 200370 (2020) doi:10.1148/radiol.2020200370.
  4. Bai, H. X. et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 200823 (2020) doi:10.1148/radiol.2020200823.
  5. Mayo, P. H. et al. Thoracic ultrasonography: a narrative review. Intensive Care Med. 45, 1200–1211 (2019).
  6. Nazerian, P. et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am. J. Emerg. Med. 33, 620–625 (2015).
  7. Moore, C. L. & Copel, J. A. Point-of-Care Ultrasonography. N. Engl. J. Med. 364, 749–757 (2011).
  8. Clinical Characteristics of Coronavirus Disease 2019 in China | NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032.
  9. Yin, W. et al. Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome. BMC Pulm. Med. 19, 1 (2019).

Who We Are:

Site Creator

Dr. Kevin Piro (@US_pyro) - please tweet at me to add resources you love, provide us feedback, and to improve the content we provide.

Contributors

Dr. Renee Dversdal (@DRsonosRD)

Dr. Michael Wollenberg

Dr. Michael Northrop (@mikenorthropmd)

Dr. Florian Sattelmacher

Dr. Nikolai Schnittke

Dr. Bryson Hicks