Evidence supporting the use of lung ultrasound in COVID-19 healthcare delivery.
POCUS can improve diagnostic sensitivity for COVID-19 pneumonia, in conjunction with PCR and clinical assessment.Read article
Point-of-care lung ultrasound is more sensitive than CXR for evaluation of COVID-19.Read article
Lung ultrasound offers unprecedented accessibility for frontline healthcare providers.Read article
In 2020 we have learned that there are a number of possible situations where handheld whole-body ultrasound plays a valuable role. Bedside ultrasound has been shown to have a valuable cross-specialty role in informing decisions around COVID-19 across the full spectrum of clinical management.
POCUS is an initial imaging modality for patients presenting to the Emergency Department suspected of COVID-19 infection and pulmonary involvement. This reduces dependencies on CT and CXR, and can impact the ability to risk stratify while maintaining isolation protocols.
Handheld ultrasound setting can be utilized by HCPs in primary care, urgent care, skilled nursing, and home healthcare settings to help decrease the need for patient transport for advanced imaging.
With POCUS, the monitoring of hospitalized patients, particularly in high dependency units such as the ICU, can be done at the bedside. A dedicated handheld ultrasound system can remain with the patient throughout their hospital stay, eliminating the risk of patient-to-patient nosocomial transmission via ultrasound systems. Lung imaging findings have also been shown to support decisions about disease severity, and can help support critical care decisions such as ventilator allocation.
Systematic integration of portable ultrasound imaging in the community, leveraging telemedicine guidance when necessary, could facilitate early detection of imaging features typical of COVID-19. This has the potential to inform clinicians’ decisions around isolation and quarantine of early or asymptomatic cases. Telemedicine also has the ability to support remote clinician exams to keep healthy patients, such as those requiring routine prenatal monitoring, from entering a potentially infected facility or space. Read more here.
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Literature suggests that patients with confirmed COVID-19 demonstrate typical lung imaging features. These include: B-lines, irregular pleural line with sub-pleural consolidation and disease foci predominantly in the lower posterior segments.
Contact us to be part of the movement contributing images to our consolidated COVID-19 gallery.
The Butterfly Education platform provides a diverse video library of instructional content to support our frontline COVID-19 care providers.
Learn the basic technique on how to evaluate the lung surface for sliding and artifacts using your Butterfly iQ.
Comprehensive lung exams assisted by real-time segment-by-segment guidance has been built to help increase rapidity of frontline patient assessment, and potentially reduce viral exposure. Available to Pro and Enterprise members.
This and other videos are offered for demonstration only—always follow your institutions’ protocols for proper use of PPE and cleaning and disinfection protocols.
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Lung ultrasound is used to identify pulmonary complications in suspected and/or confirmed COVID-19 patients and helps risk stratify those for admission and closer observation. It is not diagnostic of COVID-19. The definitive diagnosis is made by real-time RT-polymerase chain reaction (rRT-PCR) detection of the SARS-CoV-2 virus (the virus that causes COVID-19) in respiratory specimens.
Lung ultrasound is a portable, bedside, radiation-free, inexpensive imaging modality that can readily detect many features of COVID-19-associated lung disease. The cost, portability, accuracy, and ability to use in an isolated environment lead to significant potential benefit over chest radiography or computed tomography (CT) imaging. Imaging findings can accelerate disposition decisions while awaiting culture results.
Clinicians are using lung ultrasound to assess and monitor COVID-19 patients with hypoxemia and to assess high risk infected patients to stratify disposition decisions. Lung ultrasound findings can change dynamically through the course of an illness, and monitoring for progression of B-lines and/or consolidation (or for resolution with return of a normal A-line pattern) could provide valuable information to the treatment team. While CT has confirmed value in the evaluation of COVID-19, many patients are too ill to transport or can extend the exposure risk to more health care providers. CT is also more expensive and studies suggest ultrasound may be equally as informative.
The following ultrasound features have been described in patients with COVID-19 infection:
· A fragmented, irregular pleural line
· B-lines (focal, scattered and/or confluent)
· Bilateral involvement
· Posterior and lateral segment involvement
· Lung consolidation (ranging from small to lobar, with or without air bronchograms)
· Rare pleural effusions
· See this study and this study for further details
Serial examinations with lung POCUS can reveal worsening B-lines and/or consolidations, indicating progression of disease. Additionally, return of a normal A-line pattern may indicate signs of recovery. Multiple approaches have been described (6-,8-,12-, 14+ zone protocols) for lung evaluation with POCUS. You may also consider imaging the heart as a baseline measure of ejection fraction. This may be specifically relevant to intensivists caring for severely ill patients with COVID-19.
We’ve expanded our list of chemically compatible cleaners and disinfectants for the iQ with 63 additional products. Clinicians may consider the use of a sterile probe sheath as an additional barrier precaution. View a demonstration video at the link: Compatible cleaners and disinfectants for COVID-19
Many users have reported positive results placing both Butterfly and mobile device in a standard probe sheath. CIVCO has created a unique landing page for sheaths that will work with the iQ. You may also use standard sheaths available from ProTek, Medline, Sheathes and other retailers. For more details, view our COVID-19 cleaning and disinfection page.
We are actively seeking to connect with the medical community, and add to the data available for research, teaching and understanding of COVID-19. Qualified professionals are encouraged to contribute to our library of de-identified positive cases, as well as share care delivery protocols. Contact us at email@example.com for more details.
The images and clips in our COVID-19 gallery originate from clinicians across the world and have been useful to accelerate learning and collaboration throughout our community. Please reach out to us via email at firstname.lastname@example.org, and we will be happy to provide further instructions. We appreciate your contributions to this evolving resource center.