key: cord-1040854-1bx19fal
authors: Anile, Antonio; Castiglione, Giacomo; Zangara, Chiara; Calabrò, Chiara; Vaccaro, Mauro; Sorbello, Massimiliano
title: COVID: the new ultrasound alphabet in SARS-CoV-2 era.
date: 2020-07-21
journal: Anesth Analg
DOI: 10.1213/ane.0000000000005142
sha: b41db9dbb2ae50867af0a8c734a5728492546be6
doc_id: 1040854
cord_uid: 1bx19fal

nan

We applaud the proposal of Piliego et al 1 to use lung ultrasound as a bedside test for triage of COVID-19 patients and for subsequent management of clinical workload and level of care in the scenario of a hospital overloaded with SARS-CoV-2 pandemic patients 2 . We describe an expanded role for ultrasound (US). Preliminary reports from the Italian outbreak 2 prompted us to adopt some variations on our standard clinical protocols and to implement or upgrade techniques we already use in our critical care practice before SARS-CoV-2 pandemic. We propose the following corona virus disease ultrasound (COVID-US) alphabet (figure 1). In our practice we also use US for pre-intubation airway evaluation, given the aerosolization risk associated with the performance of conventional tests (measuring inter-incisor distance, determining Mallampati score) 8 , intubation confirmation when end-tidal CO2 is not immediately available 2 , diagnosis of intubation-related complications (pneumothorax, pneumomediastinum, airway trauma) and for lung and ventilation assessment 7 .

Finally, evaluation of right cardiac chamber diameters and lung windows, and eventual integration with lower limbs US, is used to monitor thromboembolic phenomena as part of routine coagulative evaluation (thromboelastography/thromboelastometry), given the high thrombotic risk associated with COVID-19 7 .

We believe that our approach has two important novelties. First of all, it is not only lung US, but integrated US, involving cardiac and pulmonary evaluation, fluid repletion status and perfusion, airway evaluation and thrombosis screening. The second point is that COVID-US approach is not only a diagnostic tool, but also an integrated monitoring approach following patient's evolution and a step-by-step clinical and therapeutic decisional support. US applications in COVID-19 patients are promising, though they deserve larger studies and robust data to be validated and adopted in clinical practice. We propose a simple, patient-tailored, bedside approach to COVID-19 patients that reflects the multi-organ involvement of SARS-CoV-2. 

The ultrasound guided triage: a new tool for prehospital management of COVID-19 pandemic

on behalf of The Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva

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