Novel coronavirus 2019-nCoV: What can ultrasound do?

To assist in the fight against the pneumonia epidemic caused by the novel coronavirus infection, Kanda fully guarantees the supply of various medical equipment needed by medical staff on the front line to curb the epidemic, from large imaging equipment such as CT, to mobile X-ray machines that can quickly perform chest imaging diagnosis, and to various portable ultrasound for scanning. Portable ultrasound, with its ability to perform rapid/real-time/repeated testing and its non-radiation characteristics, has quickly gained recognition from numerous experts.

What can ultrasound do?

For this novel coronavirus, especially for the lungs, the lungs were once considered a forbidden zone for ultrasound examination. In recent years, with the deepening understanding of diseases, more and more clinical studies have shown that ultrasound is one of the good imaging methods for examining and diagnosing lung diseases. Especially for critically ill patients, since X-rays and CT cannot monitor the development and changes of the disease in real-time and repeated movement and transfer of patients carries risks, portable ultrasound can provide good supplementary diagnosis.

BLUE Principle

General lung ultrasound examinations follow the BLUE principle, which can quickly determine the cause of respiratory failure with an accuracy rate as high as 90.5%. The examination positions are generally four checkpoints: upper blue point, lower blue point, diaphragm point, and PLAPS point, with a total of eight points for both lungs. In the improved bedside lung ultrasound assessment scheme, the examining doctor needs to add a posterior blue point based on BLUE to target lung consolidation in special areas. At this time, placing the probe in the intercostal space for scanning will show the pleura and lung air artifacts, and the doctor can diagnose lung diseases based on different manifestations.

The image above is a normal sonogram of the lungs.

With changes in breathing, there is relative movement between the visceral pleura and the parietal pleura, forming a pleural sliding sign.

Application and manifestations of ultrasound in pneumonia:

●Bronchogram sign

●Patchy sign

●Pleural inflammatory changes around the lung bases (irregular or thickened pleural line)

●Irregular manifestations at the diaphragm and pleural interface (disruption or thickening, etc.)

●Pleural effusion, ultrasound-guided puncture and drainage

●Pneumonic parenchymal changes, etc.

Ultrasound has a wider range of applications in pneumonia epidemics:

●For lung ultrasound, ultrasound can help differentiate acute respiratory failure in cases of pneumothorax, atelectasis, and pleural effusion.

●Ultrasound can assess ARDS (acute respiratory distress) or other critical lung diseases under mechanical ventilation.

●Ultrasound can help doctors diagnose the cause of fever in respiratory patients, such as venous thrombosis and inflammation.

●For patients on ventilator support, ultrasound can assess diaphragm excursion, help adjust parameters, and evaluate weaning.

●If critically ill shock patients need intubation or puncture, ultrasound can accurately locate and guide, avoiding blind puncture and multiple puncture injuries.

●The heart and lungs are closely related. For pneumonia patients, evaluating cardiac function is particularly important. Automated cardiac function analysis by ultrasound can provide multiple parameters to assist clinical treatment and find evidence of the cause of acute circulatory disorders.

In addition, ultrasound can help doctors find out whether critically ill pneumonia patients have serious complications such as lower extremity venous thrombosis, gastrointestinal bleeding, early bladder urine retention, neurological symptoms (transcranial Doppler, optic nerve diameter, pupillary light reflex), nasogastric tube placement, gastric residual volume, and ileocecal pseudo-obstruction. Ultrasound can also observe the internal diameter and variability of the inferior vena cava, evaluate the effectiveness of treatment, whether fluid input is reasonable; evaluate cardiac function, understand whether cardiogenic shock has improved; measure diaphragm movement to indirectly provide effective information for ventilator extubation.

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