Ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): narrative review

• Published in: Medicina intensiva 2020-12, Vol.44 (9), p.551
• Main Authors: Fraile Gutiérrez, V, Ayuela Azcárate, J M, Pérez-Torres, D, Zapata, L, Rodríguez Yakushev, A, Ochagavía, A
• Format: Article
• Language: Spanish
• Subjects: Blood Vessels - diagnostic imaging; COVID-19 - complications; COVID-19 - diagnostic imaging; Critical Care; Critical Illness; Echocardiography; Heart Diseases - diagnostic imaging; Heart Diseases - etiology; Heart Ventricles - diagnostic imaging; Humans; Hypertension, Pulmonary - diagnostic imaging; Intensive Care Units; Intubation, Intratracheal - methods; Lung - diagnostic imaging; Organ Size; Pleura - diagnostic imaging; Pleural Effusion - diagnostic imaging; Pneumothorax - diagnostic imaging; Pulmonary Heart Disease - diagnostic imaging; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; SARS-CoV-2; Shock - diagnostic imaging; Transducers; Ultrasonography, Interventional - methods
• ISSN: 2173-5727; 2173-5727; 1578-6749
• DOI: 10.1016/j.medin.2020.04.016

The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS) and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with an adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects and shock states.