Lung ultrasound monitoring of CPAP effectiveness on SARS-CoV-2 pneumonia: A case report
https://doi.org/10.4081/ecj.2020.9333
Accepted: 6 November 2020
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
SARS-CoV-2 infection is characterized by extremely heterogeneous features, going from cases with few symptoms to severe respiratory failures. Chest Computed Tomography (CT) is currently the gold-standard imaging method, although burdened by the risk of exposure to ionizing radiation and management / organizational concerns. In particular, the critical patient undergoing ventilation (invasive or not) seems to be difficult to monitor by repeated CT scan over time. We report the case of a 55-year-old male patient subjected to Continuous Positive Airway Pressure (CPAP) and prone positioning, in which the use of ultrasound monitoring allowed to verify the effectiveness of the pressure support used in recruiting previously atelectasis lung areas. Lung ultrasound can guide pulmonary recruitment and pronation maneuvers in patients undergoing non-invasive ventilation. Ultrasound can identify atelectatic lung areas, which demonstrate an alveolar re-expansion following the setting of high PEEP values, as underlined by the reappearance of pleural/air interface.
Poggiali E, Dacrema A, Bastoni D, et al. Can lung US help critical care clinicians in the early diagnosis of novel coronavirus (COVID-19) Pneumonia? Radiology 2020;13:200847.
Sofia S, Boccatonda A, Montanari M, et al. Thoracic ultrasound and SARS-COVID-19: a pictorial essay. J Ultrasound 2020;16:1-5.
Huang C. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet 2020;395(10223):497–506.
Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet. 2020 Mar 28;395(10229):1014-1015.
D'Ardes D, Boccatonda A, Rossi I, et al. COVID-19 and RAS: Unravelling an Unclear Relationship. Int J Mol Sci 2020;Apr 24;21(8):E3003.
Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;
Caputo ND, Strayer RJ, Levitan R. Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED's Experience During the COVID-19 Pandemic. Acad Emerg Med 2020;27(5):375-378.
Bastoni D, Poggiali E, Vercelli A, et al. Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department. Emerg Med J 2020;37(9):565-566.
Bouhemad B, Mojoli F, Nowobilski N, et al. Use of combined cardiac and lung ultrasound to predict weaning failure in elderly, high-risk cardiac patients: a pilot study. Intensive Care Med 2020;46, 475–484.
Bao L, Deng W, Huang B, et al. The pathogenicity of SARS-CoV-2 in hACE2 transgenic mice. Nature 2020; May 7.
Reissig A, Copetti R. Lung ultrasound in community acquired pneumonia and in interstitial lung diseases. Respiration 2014;87(3):179–189.
Boccatonda A, Primomo G, Cocco G, et al. Not all abolished lung sliding are pneumothorax: the case of a particular lung atelectasis. J Ultrasound. 2020 Jan 22.
Laursen CB, Sloth E, Lassen AT, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med 2014; 2:638–646.
Boccatonda A, Ianniello E, D'Ardes D et al. Can lung ultrasound be used to screen for pulmonary embolism in patients with SARS-CoV-2 pneumonia? EJCRIM 2020;7
Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovascular Ultrasound 2008.
Mongodi S, Pozzi M, Orlando A, et al. Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience. Intensive Care Med 2018 Jan;44(1):123-124.
Généreux V, Chassé M, Girard F, et al. Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero endexpiratory pressure on atelectasis during open gynaecological surgery as assessed by ultrasonography: a randomised controlled trial. Br J Anaesth 2020;124(1):101–109.
Brambilla AM, Prina E, Ferrari G, et al. Non-invasive Positive Pressure Ventilation in Pneumonia Outside Intensive Care Unit: An Italian Multicenter Observational Study. Eur J Intern Med 2019 59:21-26.
Lari F, Giostra F, Bragagni G, et al. Continuous positive airway pressure in acute pulmonary edema. application in a general medical ward]. Recenti Prog Med 2011;102(3):114-9.
Nava S, Carbone G, Di Battista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med 2003;15;168(12):1432-7.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
