Citation Information :
Biswas I, Toshkhani D, Muralidharan J. Role of Point-of-care Ultrasound in Management of Critically Ill COVID-19 Patients: A Case Series. J Perioper Echocardiogr 2019; 7 (2):40-43.
Introduction: Hereby, we describe a series of four critically ill COVID-19 patients where point-of-care ultrasound (POCUS) helped in guiding specific management.
Case description: The first case is a 62-year-old COVID-19 positive woman where severe aortic stenosis and severe left ventricular dysfunction were diagnosed by POCUS, which led to the institution of specific medical management leading to resolution of her symptoms and referral to the cardiac surgical department for further surgical management. The second case is a 51-year-old woman admitted with severe hypoxia secondary to COVID-19 infection. She was being considered for tocilizumab therapy. However, POCUS revealed the presence of pericardial effusion, which, on evaluation, was found to be due to tubercular. This led to withholding tocilizumab therapy. Anti-tubercular therapy, instead, was instituted. The third case is a 13-month-old child, who presented with a history of recurrent syncopes and was diagnosed as a case of congenital heart block on electrocardiography (ECG). However, due to his COVID-19 positive status, rescue temporary pacing could not be performed at the catheterization laboratory. Point-of-care ultrasound helped in the successful placement of a temporary pacemaker lead at the bedside, leading to the achievement of optimum heart rate till he got an epicardial pacemaker inserted at a later date. The fourth case is of a 45-year-old man, who had to undergo endotracheal intubation due to refractory COVID-19 related hypoxia. Upon connection to the mechanical ventilator, the peak airway pressure was found to be unusually high. On POCUS, lung sliding on the left side was missing, which led to the diagnosis of right-mainstem endobronchial intubation. Repositioning of the endotracheal tube led to a decrease in peak airway pressures and optimal delivery of mechanical ventilation to the patient.
Conclusion: Point-of-care ultrasound can help diagnose and manage significant underlying diseases, help take/modify decisions on specific therapies, and overcome resource limitations for performing specialized therapeutic procedures in COVID-19 patients.
Laursen CB, Sloth E, Lambrechtsen J, et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2013;144(6):1868–1875. DOI: 10.1378/chest.13-0882.
Oks M, Cleven KL, Cardenas-Garcia J, et al. The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest 2014;146(6):1574–1577. DOI: 10.1378/chest.14-0728.
Volpicelli G, Elbarbary M, Blaivas M, et al. International liaison committee on lung ultrasound (ILC-LUS) for international consensus conference on lung ultrasound (ICC-LUS). international evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38(4):577–591. DOI: 10.1007/s00134-012-2513-4.
Bouzat P, Francony G, Declety P, et al. Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury. Neurosurgery 2011;68(6):1603–1609. DOI: 10.1227/NEU.0b013e31820cd43e.
Troianos CA, Hartman GS, Glas KE, et al. Councils on intraoperative echocardiography and vascular ultrasound of the American Society of Echocardiography. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2011;24(12):1291–1318. DOI: 10.1016/j.echo.2011.09.021.
COVID-19 Map- Johns Hopkins Coronavirus Resource Centre. (2020, October 28). Retrieved from https://coronavirus.jhu.edu/map.html.
Zieleskiewicz L, Muller L, Lakhal K, et al., CAR’Echo and AzuRea Collaborative Networks Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 2015;41(9):1638–1647. DOI: 10.1007/s00134-015-3952-5.
Gray R, Baldwin F, Bruemmer-Smith S. Diagnostic echocardiography in an unstable intensive care patient. Echo Res Pract 2015;2(1):K11–K16. DOI: 10.1530/ERP-14-0040.
Marcelino PA, Marum SM, Fernandes AP, et al. Routine transthoracic echocardiography in a general intensive care unit: an 18 month survey in 704 patients. Eur J Intern Med 2009;20(3):e37–e42. DOI: 10.1016/j.ejim.2008.09.015.
Who should not take Tocilizumab Syringe? (2020, October 28). Retrieved from https://www.webmd.com/drugs/2/drug-165324/tocilizumab-subcutaneous/details/list-contraindications.
Singh Y, Tissot C, Fraga MV, et al. International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS working group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020;24(1):65. DOI: 10.1186/s13054-020-2787-9.
Sjaus A, Fayad A. The use of subcostal echocardiographic views to guide the insertion of a right ventricular temporary transvenous pacemaker-description of the technique. J Cardiothorac Vasc Anesth 2019;33(10):2797–2803. DOI: 10.1053/j.jvca.2019.01.033.
Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100(1):9–15. DOI: 10.1097/00000542-200401000-00006.
Bouhemad B, Brisson H, Le-Guen M, et al. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 2011;183(3):341–347. DOI: 10.1164/rccm.201003-0369OC.
Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 2010;38(1):84–92. DOI: 10.1097/CCM.0b013e3181b08cdb.
Volpicelli G, Melniker LA, Cardinale L, et al. Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid. Radiol Med 2013;118(2):196–205. DOI: 10.1007/s11547-012-0852-4.