Application of Remote Ultrasound in COVID-19 Isolated Intensive Care Unit

doi:10.37015/AUDT.2020.200037

Abstract

Abstract:

Objective: To investigate the application of remote ultrasound in COVID-19 isolation ward.
Methods: Two patients with suspected COVID-19 were admitted to the isolation ward in critical condition. In the isolation ward, the intensive care unit (ICU) physician used ultrasound to evaluate patients’ heart, lung, abdomen, blood volume, and lower limb veins, guided by an ultrasound expert in remote.
Results: (1) Under the guidance of the ultrasound expert, the ICU physician successfully performed ultrasound examination and gathered clear images. (2) The main manifestations of the patients’ lung lesions were multiple B3-lines in both lungs fused to “white lung” and pulmonary consolidation in the subpleural area. A small amount of effusion was observed in the bilateral costal diaphragmatic angle and left lower extremity vein thrombosis was found in patient No.1. Ultrasound was also used to assess the inner diameter and respiratory variability of the inferior vena cava for adjusting fluid supplementation. Patient No.1’s condition was severe with rapidly progressing pulmonary lesions. After treatment, ultrasound showed improvement in pneumonia and disappearance of pleural effusion and the left lower extremity vein thrombosis. (3) There was a high degree of consistency between ultrasound and chest computerized tomography (CT) findings in two patients.
Conclusion: The application of remote ultrasound can reduce the risk of cross-infection and save the personal protective equipment in the COVID-19 outbreak. Ultrasound experts can also provide real-time guidance for ICU physician to maintain a good quality of patient care and receive high-quality images for accurate diagnosis.

Key words: Remote ultrasound; Intensive care unit; COVID-19; Infectious

Xingxi Lin, MD, Jianqiu Hu, MD, Liuqiong Ren, MD, Yuqing Huang, MD, Dudu Wu, MD, Shiyue Zhao, MD, Yuanyuan Zhao, MD, Jie Liu, MD, Xuan Zhou, MD, Weihua Li, MD, Ming Zhang, MD, Bingqi Zhang, MD, Haidan Lin, MD, Shengzheng Wu, MD, Faqin Lv, MD. Application of Remote Ultrasound in COVID-19 Isolated Intensive Care Unit. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 123-127.

References

[1]	National Health Commission of the people’s Republic of China. Diagnosis and treatment of novel coronavirus pneumonia (trial, the seventh version) [EB/OL]. ( 2020- 03- 03) [2020-03-04]. Available from: http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
[2]	Li M, Lei P, Zeng B, Li Z, Yu P, Fan B, et al. Coronavirus disease (COVID-19): spectrum of ct findings and temporal progression of the disease. Acad Radiol 2020: S1076-6332(20) 30144-6.
[3]	National Health Commission Capacity Building and Continuing Education Center; The War trauma and Emergency Ultrasound Committee of Medical Ultrasound Equipment Society of CAME; Tele- and Mobile- Ultrasound Subcommittee of Medical Ultrasound Equipment Society of CAME. Chinese expert consensus on critical ultrasound application for patients with COVID-19. Chinese Journal of Critical Care Medicine 2020; 3: 185-195. [In Chinese]. Available from: http://111.40.160.75:802/CN/abstract/abstract5262.shtml.
[4]	Liu Y, Huang Y, Lv F, Li T. Progress of tele-ultrasound technology. Chinese Journal Medical Ultrasound (Electronic Edition) 2019; 16:244-246. [In Chinese] DOI: 10.3877/cma.j.issn.1672-6448.2019.04.002.
[5]	Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Mar 16: ciaa272. DOI: 10.1093/cid/ciaa272.
[6]	Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of Epidemiological and Clinical features in older patients with Corona Virus Disease 2019 (COVID-19) out of Wuhan. Clin Infect Dis. 2020 Mar 25: ciaa242. DOI: 10.1093/cid/ciaa242.
[7]	Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020 Mar 25. DOI: 10.1007/s00330-020-06817-6.
[8]	Hishitani T, Fujimoto Y, Saito Y, Sugamoto K, Hoshino K, Ogawa K. Accuracy of telediagnosis of fetal heart disease using ultrasound images transmitted via the Internet. Pediatr Int 2014,56:289-291.
[9]	Dyer D, Cusden J, Turner C, Boyd J, Hall R, Lautner D, et al. The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient. J Trauma 2008, 65:1209-1216.
[10]	Liu Y, Lv F, Li T. The advent of 5G ultrasound: Application and progress of remote ultrasound. Chinese Journal Medical Ultrasound (Electronic Edition) 2019; 16:241-243. [In Chinese]> DOI: 10.3877/cma.j.issn.1672-6448.2019.04.001.

[1]	Jiaojiao Ma, MD, Xinying Jia, MD, Guanghan Li, MD, Dandan Guo, MD, Xuehua Xi, MD, Tongtong Zhou, MD, Ji-Bin Liu, MD, Bo Zhang, MD. Development of 5G-based Remote Ultrasound Education: Current Status and Future Trends [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 197-203.
[2]	Srinivasan S, MD, Neeti Aggarwal, MD, Sushma Makhaik, MD, Anupam Jhobta, MD. Role of Lung Ultrasound in Diagnosing and Differentiating Transient Tachypnea of Newborn and Respiratory Distress Syndrome in Preterm Neonates [J]. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(3): 112-118.
[3]	Victor V Rao, MBBS, DMRD, RDMS, James A DellaValle, MD, MBA, Samantha Forcum, M.Ed, Jasmine Rockett, Hannah Mason, MA, PMP, Dale R. Cyr, MBA, CAE. Role of PCA in Offering Certifications and Other Related Services to POCUS Users Worldwide [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(3): 260-263.
[4]	Yijun Zhang, MD, Jianjian Liu, MD, Qinqin Yan, MD, Nannan Shi, MD, Fei Shan, MD, Yuxin Shi, MD. Analysis of Characteristics of Bedside Chest Radiography in Critically Ill COVID-19 Patients [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 107-111.
[5]	Rong Tan, MD, Nina Li, MD, Ping Liu, MD, Qi Tang, MD, Qizhi Yu, MD. Comparative Study of CT Characteristics in Imported Cases and Indigenous Cases with COVID-19 [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 99-106.
[6]	Jie Chen, MD, Bo Zhang, MD, Mo Yang, MB, Yan Tian, MD, Dandan Guo, MS, Boya Wang, MD, Weidan Lu, MS, Jiaojiao Ma, MS, Cui Zhao, MB, Shuliang Zang, MB, Jianya Wang, MB. Management Strategies of Ultrasound Department in Response to the Epidemic Crisis [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 90-98.
[7]	Xuexia Shan, MD, Yuqing Huang, MD, Haiyan Kou, MD, Yuanyuan Zhao, MD, Keyan Li, MD, Dudu Wu, MD, Shiyue Zhao, MD, Liuqiong Ren, MD, Xingxi Lin, MD, Xianghui Chen, MD, Libo Wang, MD, Shengzheng Wu, MD, Faqin Lv, MD. Suggestions on Prevention and Control of COVID-19 in Ultrasound Department [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 84-89.
[8]	Guorong Lyu, MD, Ying Zhang, MD, Guoliang Tan, MD. Transthoracic Ultrasound Evaluation of Pulmonary Changes in COVID-19 Patients During Treatment Using Modified Protocols [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 79-83.
[9]	Yi Huang, MD, Hua Wang, MD, Wenqi Cui, MD, Yujin Zong, MD, Chuyun Zheng, MD, Yue Liu, MD, Weili Min, MD, Sihan Wang, MD, Mingjun Hu, MD, Yaohui Zhang, MD. Analysis of Ultrasonic Manifestations of Pulmonary Lesions in Patients with COVID-19 [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 73-78.
[10]	Faqin Lv, MD, Jinrui Wang, MD, Xing Yu, MD, Aiping Yang, MD, Ji-Bin Liu, MD, Linxue Qian, MD, Huixiong Xu, MD, Ligang Cui, MD, Mingxing Xie, MD, Xi Liu, MD, Chengzhong Peng, MD, Yi Huang, MD, Haiyan Kou, MD, Shengzheng Wu, MD, Xi Yang, MD, Bin Tu, MD, Huaping Jia, MD, Qingyi Meng, MD, Jie Liu, MD, Ruizhong Ye, MD. Chinese Expert Consensus on Critical Care Ultrasound Applications at COVID-19 Pandemic [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 27-42.
[11]	Xi Liu, MD, Yang Hai, MD, Bin Ma, MD, Weelic Chong, BA, Ji-Bin Liu, MD. Critical Care Ultrasonography and Its Application for COVID-19 [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 43-49.
[12]	Xiaolong Li, MD, Lehang Guo, MD, Liping Sun, MD, PhD. Wenwen Yue, MD, Huixiong Xu, MD, PhD. Teleultrasound for the COVID-19 Pandemic: A Statement from China [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 50-56.
[13]	Heng Xue, MD, Yao Zhang, MD, Ligang Cui, MD, Jing Han, MD. Lung Ultrasonography in Diagnosis and Management of Novel Coronavirus (COVID-19) Pneumonia: Pearls and Pitfalls [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 57-59.
[14]	Haidan Lin, MD, Bingqi Zhang, MD, Haiyan Kou, MD, Yuanyuan Zhao, MD, Keyan Li, MD, Dudu Wu, MD, Shiyue Zhao, MD, Liuqiong Ren, MD, Xingxi Lin, MD, Zihao Zhang, MD, Zhiye Chen, MD, Xuexia Shan, MD, Yuqing Huang, MD, Shengzheng Wu, MD, Faqin Lv, MD. Application Value of Lung Ultrasound in Asymptomatic Patients with Confirmed COVID-19 [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 67-72.
[15]	Jianjian Liu, MD, Xin Ma, MD, Xujuan Pu, MD, Jingjing Huang, MD, Zongguo Yang, MD, Xia Shi, MD, Dou Wu, MD, Liping Sun, MD, Hui Zhang, MD. Lung Ultrasound in Assessment of Patients with COVID-19 [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(2): 112-118.