Multi-organ Point-of-Care Ultrasound for COVID-19 (PoCUS4COVID)

International Expert Consensus

Arif Hussain; Gabriele Via; Lawrence Melniker; Alberto Goffi; Guido Tavazzi; Luca Neri; Tomas Villen; Richard Hoppmann; Francesco Mojoli; Vicki Noble; Laurent Zieleskiewicz; Pablo Blanco; Irene W. Y. Ma; Mahathar Abd. Wahab; Abdulmohsen Alsaawi; Majid Al Salamah; Martin Balik; Diego Barca; Karim Bendjelid; Belaid Bouhemad; Pablo Bravo-Figueroa; Raoul Breitkreutz; Juan Calderon; Jim Connolly; Roberto Copetti; Francesco Corradi; Anthony J. Dean; Andre Denault; Deepak Govil; Carmela Graci; Young-Rock Ha; Laura Hurtado; Toru Kameda; Michael Lanspa; Christian B. Laursen; Francis Lee; Rachel Liu; Massimiliano Meineri; Miguel Montorfano; Peiman Nazerian; Bret P. Nelson; Aleksandar N. Neskovic; Ramon Nogue; Adi Osman; Jose Pazeli; Elmo Pereira-Junior; Tomislav Petrovic; Emanuele Pivetta; Jan Poelaert; Susanna Price; Gregor Prosen; Shalim Rodriguez; Philippe Rola; Colin Royse; Yale Tung Chen; Mike Wells; Adrian Wong; Wang Xiaoting; Wang Zhen; Yaseen Arabi

Disclosures

Crit Care. 2020;24(702) 

In This Article

Abstract and Introduction

Abstract

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Introduction

Since the first reports from China,[1] SARS-CoV-2 has caused considerable morbidity and mortality from COVID-19 globally.[1] Although respiratory signs and symptoms are the most common manifestations, other systems may be involved.[2] Clinical presentations range from mild (80%) to life-threatening (5%), usually as acute respiratory distress syndrome (ARDS). Paucity of evidence, and urgency to adjust to evolving clinical scenarios have prompted adoption of approaches based on institutional experience,[3] limited evidence, or extrapolation from other conditions.[4,5]

Point-of-care ultrasound (PoCUS) is a rapid, bedside, goal-oriented, diagnostic test that is used to answer specific clinical questions.[6] These distinctive features are appealing and address concerns of environmental contamination and disinfection of larger devices such as chest X-ray (CXR) and computed tomography (CT). Thus, multi-organ PoCUS could enhance the management of COVID-19 (Figure 1).

Figure 1.

Graphical synopsis of potentially useful applications of point-of-care ultrasound (PoCUS) in COVID-19 patients. ABD, abdominal ultrasound; ACP, acute cor pulmonale; AKI, acute kidney injury; DUS, diaphragmatic ultrasound; DVT, ultrasound for deep venous thrombosis screening; ECHO, echocardiography; FoCUS, focused cardiac ultrasound; LUS, lung ultrasound; MUS, parasternal intercostal muscles ultrasound; ONSD, optic nerve sheath diameter; PEEP, positive end expiratory pressure; PoCUS, point-of-care ultrasound; TCD, transcranial Doppler; VASC, ultrasound for venous and arterial access

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