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Review
DOI: 10.1016/j.medine.2020.10.002
Available online 2 November 2020
Narrative review of ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): clinical applications in intensive care medicine
Revisión narrativa de la ecografía en el manejo del paciente crítico con infección por SARS-CoV-2(COVID-19): aplicaciones clínicas en medicina intensiva
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V. Fraile Gutiérreza,
Corresponding author
vicky_uvi@yahoo.es

Corresponding author.
, J.M. Ayuela Azcárateb, D. Pérez Torresa, L. Zapatac, A.L. Rodríguez Yakushevd, A. Ochagavía Calvod
a Servicio de Medicina Intensiva, Hospital Universitario Rio Hortega, Valladolid, Spain
b Servicio de Medicina Intensiva, Spain
c Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
d Servicio de Medicina Intensiva, Área de Críticos, Corporación Sanitaria Parc Taulí Sabadell, Barcelona, Spain
Received 27 April 2020. Accepted 28 April 2020
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Table 1. Main applications of the ultrasound during the management of the current COVID-19 pandemic in the Intensive Care Medicine Service (ICMS) setting.
Table 2. Main advantages and disadvantages of pulmonary ultrasound.
Table 3. Indications of echocardiography in patients with COVID-19.
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Abstract

The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS), and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common.

Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with a adapted guide to the intensive care setting.

Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.

Keywords:
COVID-19
Coronavirus
Ultrasound
Echocardiography
Echography
Critically ill
Resumen

La infección por SARS-CoV-2 (COVID-19) se caracteriza por producir en las formas graves, un cuadro de insuficiencia respiratoria que puede evolucionar hacia neumonía y síndrome de distrés respiratorio agudo (SDRA), presentar complicaciones como fenómenos trombóticos y disfunción cardiaca, lo que motiva el ingreso en la Unidad de Cuidados Intensivos (UCI).

La ecografía, convertida en una herramienta de uso habitual en la UCI, puede ser muy útil durante la pandemia COVID-19 ya que la información obtenida por el clínico puede ser interpretada e integrada en la valoración global durante la exploración del paciente. Este documento describe algunas de sus aplicaciones con el objetivo de proporcionar una guía a los médicos responsables adaptado al paciente crítico con COVID-19.

Alguna de sus aplicaciones desde el ingreso en la UCI incluyen confirmar la correcta posición del tubo endotraqueal, facilitar la inserción segura de las vías, e identificar complicaciones y fenómenos trombóticos. Además, la ecografía pleuropulmonar puede ser una alternativa diagnóstica válida que permite evaluar el grado de afectación pulmonar, mediante el análisis de patrones ecográficos específicos, identificación del derrame pleural y del barotrauma. La ecocardiografía proporciona información acerca de la afectación cardíaca, detección del cor pulmonale y estados de shock.

Palabras clave:
COVID-19
Coronavirus
Ecografía
Ultrasonografía
Ecocardiografía
Paciente crítico

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