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The use of lung ultrasound in COVID-19

Ivana Blazic, Chiara Cogliati, Nicola Flor, Guy Frija, Michael Kawooya, Michele Umbrello, Sam Ali, Marie-Laure Baranne, Young-Jae Cho, Richard Pitcher, Ivan Vollmer, Emilie van Deventer, Maria del Rosario Perez
ERJ Open Research 2023 9: 00196-2022; DOI: 10.1183/23120541.00196-2022
Ivana Blazic
1Radiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
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Chiara Cogliati
2Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
3Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Nicola Flor
4Unità Operativa di Radiologia, Luigi Sacco University Hospital, Milan, Italy
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Guy Frija
5Université de Paris, International Society of Radiology, Paris, France
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Michael Kawooya
6Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
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Michele Umbrello
7SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milan, Italy
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Sam Ali
8ECUREI, Mengo Hospital, Kampala, Uganda
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Marie-Laure Baranne
9Assistance Publique – Hôpitaux de Paris, Paris Institute for Clinical Ultrasound, Paris, France
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Young-Jae Cho
10South Korea/Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
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Richard Pitcher
11Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ivan Vollmer
12Hospital Clínic de Barcelona, Barcelona, Spain
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Emilie van Deventer
13World Health Organization, Geneva, Switzerland
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Maria del Rosario Perez
13World Health Organization, Geneva, Switzerland
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  • FIGURE 1
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    FIGURE 1

    Typical lung ultrasound findings in patients with coronavirus disease 2019 (COVID-19) pneumonia. a) Interstitial involvement with separated B-lines (arrows) and irregular pleural line; b) confluent B-lines (asterisks); c, d) consolidations (asterisks); d) air bronchograms.

  • FIGURE 2
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    FIGURE 2

    Geographical distribution of publications on use of lung ultrasound in coronavirus disease 2019 (COVID-19) based on the results of the literature review. a) Distribution of the publications according to the six World Health Organization regional offices for a total of 200 publications on use of lung ultrasound in COVID-19, including 187 national articles and 13 multinational papers. Data presented as “EURO” comprise papers published by one single country in Europe as well as six articles jointly published by more than one European country. The literature review identified seven inter-regional articles (i.e. papers jointly published by authors from countries in different parts of the world) which were not included in any specific region and are therefore presented separately in this figure. b) The 31 countries involved in the literature review are listed together with the number of national articles submitted by each country. The numbers provided between brackets indicate, when appropriate, the number of multinational studies to which a given country has contributed. More detailed information about the reviewed publications is provided in supplementary material S1.

  • FIGURE 3
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    FIGURE 3

    Specific field of application of lung ultrasound in the different studies. COVID-19: coronavirus disease 2019. #: including evaluation of the diagnostic accuracy of lung ultrasound in comparison with lung computed tomography and chest radiography; ¶: screening, contrast-enhanced ultrasound, application of lung ultrasound in nursing homes, “self-ultrasound”, guiding therapy, deciding on intubation, wireless ultrasound, assisting in patient resuscitation, application of lung ultrasound with artificial intelligence and with robotics.

  • FIGURE 4
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    FIGURE 4

    Standardised lung ultrasound examination. a) Anatomical landmarks, topographic regions and b) example of lung ultrasound report form. Each hemithorax is divided into anterior, lateral and posterior regions, according to anatomical landmarks (anterior and posterior axillary lines and internipple line), as follows. R1: right anterior superior; R2: right anterior inferior; R3: right lateral superior; R4: right lateral inferior; R5: right posterior superior; R6: right posterior inferior; L1: left anterior superior; L2: left anterior inferior; L3: left lateral superior; L4: left lateral inferior; L5: left posterior superior; L6: left posterior inferior. The presence or absence of lung sliding and pleural effusion for each region should be noted. A lung ultrasound score ranging from 0 to 3 is assigned according to the degree of aeration loss and the presence of any other pathological sign (extension of findings), allowing calculation of lung ultrasound score for left and right lung and total score. In addition, the lung ultrasound report form may include information about examination quality, mechanical ventilation settings and arterial blood gas results. LUS: lung ultrasound.

  • FIGURE 5
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    FIGURE 5

    Lung ultrasonographic scores and representative ultrasonographic images.

Supplementary Materials

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  • Supplementary Material

    Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

    Appendix A 00196-2022.SUPPLEMENT_S1

    Appendix B 00196-2022.SUPPLEMENT_S2

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The use of lung ultrasound in COVID-19
Ivana Blazic, Chiara Cogliati, Nicola Flor, Guy Frija, Michael Kawooya, Michele Umbrello, Sam Ali, Marie-Laure Baranne, Young-Jae Cho, Richard Pitcher, Ivan Vollmer, Emilie van Deventer, Maria del Rosario Perez
ERJ Open Research Jan 2023, 9 (1) 00196-2022; DOI: 10.1183/23120541.00196-2022

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The use of lung ultrasound in COVID-19
Ivana Blazic, Chiara Cogliati, Nicola Flor, Guy Frija, Michael Kawooya, Michele Umbrello, Sam Ali, Marie-Laure Baranne, Young-Jae Cho, Richard Pitcher, Ivan Vollmer, Emilie van Deventer, Maria del Rosario Perez
ERJ Open Research Jan 2023, 9 (1) 00196-2022; DOI: 10.1183/23120541.00196-2022
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  • Article
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    • Clinical use of lung ultrasound in COVID-19
    • The use of lung ultrasound in COVID-19 in different regions/countries
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    • Infection prevention and control measures when performing lung ultrasound
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