Abstract
BackgroundTo produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit.MethodsA modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging.ResultsA total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%.ConclusionThe Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.
Highlights
The use of lung ultrasound (LUS) in the intensive care setting has increased during the coronavirus disease 2019 (COVID-19) pandemic
Canadian Internal Medicine Ultrasound (CIMUS) experts recently established their recommendations for medical inpatients with COVID-19 [12], consensus guidelines dedicated to COVID-19 intensive care unit (ICU) patients and officially acknowledged by a national intensive care scientific society are lacking
The experts were selected by the project coordinators (LV and FM) based on their clinical and scientific interest in the topic [13] and the opinion of intensivists who are not experts in LUS but who understand the context of critically ill COVID patients, and the potential role of lung ultrasound was invited
Summary
The use of lung ultrasound (LUS) in the intensive care setting has increased during the coronavirus disease 2019 (COVID-19) pandemic. CT remains the reference imaging technique for lung assessment, but it is unsuitable as a monitoring tool due to its use of ionizing radiation It necessitates patient contact with healthcare providers outside the ICU, increasing the opportunity for this highly infectious disease to spread. Canadian Internal Medicine Ultrasound (CIMUS) experts recently established their recommendations for medical inpatients with COVID-19 [12], consensus guidelines dedicated to COVID-19 ICU patients and officially acknowledged by a national intensive care scientific society are lacking. To fill this gap, we aimed to produce an expert consensus on the bedside use of LUS in critically ill COVID-19 patients by a national panel of anesthesiology and intensive care physicians. To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit
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