LUNG ULTRASOUND IN THE SETTING OF COVID-19: A SCOPING LITERATURE REVIEW

Abstract

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In the current climate of the COVID-19 pandemic, there is growing evidence on the use of lung ultrasound (LUS) as an imaging modality, reducing the use of chest x-rays and computerized tomography (CT). LUS provides immediate and reliable information, remains low-cost, and may limit viral transmission. Considering the growing evidence on the use of bedside lung ultrasound (LUS) in evaluating patients with COVID-19 disease, the objective of this scoping review is to better elucidate key LUS findings and compare studies assessing its use in the context of COVID-19. METHODS: Using the PRISMA protocol, seven databases were searched from December 1, 2019 to April 15, 2020 inclusive with no language restriction. Publications were included if they discussed LUS and PoCUS during COVID-19. General COVID-19 treatments and medicine were excluded. A 2-person title and abstract screen was performed, followed by a full-text publication review. The data was extracted using a form designed a priori. Descriptive analysis was performed using a method similar to the Joanna Briggs qualitative assessment. RESULTS: 515 studies were retrieved from the literature. 17 were included in the final review. Studies consistently report similar LUS findings in COVID-19-related lung disease. A-lines are suggestive of the absence of disease or disease recovery. Features of early disease include focal B-lines (vertical artifacts suggestive of increased interstitial density) as well as pleural indentations. Subpleural consolidations, white lung and pleural breaks are commonly described in more severe disease. Initially, the peripheral and posterior lung zones are affected, moving proximally and anteriorly as the disease advances. Various scanning protocols were used, but no evidence-based standard protocol currently exists. Wireless Bluetooth probes have been preferentially used for their transportability and ease of sterilization. Curvilinear and linear probes were equally appropriate, while overall favoring a linear probe for fine lesions. Studies report a moderate to strong correlation between LUS and CT-findings and has been proposed as a diagnostic tool in SARS-CoV-2 PCR negative patients. LUS can aid in the stratification of disease severity, and when performed by the same physician, it allows for quick and easy follow-up of the disease progression and could dictate prognosis. It can also aid general practitioners in the triage of patients. CONCLUSIONS: There is strong agreement in the literature regarding LUS findings at various stages of COVID-19 infection. Its use has been proposed for triage, severity stratification, following disease progression and predicting prognosis. CLINICAL IMPLICATIONS: In the absence of a standardized screening protocol, further study is needed to better understand the test characteristics and clinical impact of bedside US in various COVID-19 related settings. DISCLOSURES: No relevant relationships by Samuel Mamane, source=Web Response No relevant relationships by Kacper Niburski, source=Web Response No relevant relationships by Laura Ran Yan, source=Web Response