Going live with the @bartspom #covid19pocus meeting

Join an excellent international faculty discussing all things #pocus and #COVID19!
First up are lung ultrasound royalty -
@LunaGargani and @giovolpicelli

Discussing their extensive experience of lung ultrasound in #COVID19 #covid19pocus
Little reminder on technique for lung ultrasound

I love this video from @kyliebaker888

https://www.youtube.com/watch?v=Yvc83U74Z3s

https://www.youtube.com/watch... href="https://twtext.com//hashtag/covid19pocus"> #covid19pocus
Differential diagnosis of B Lines

From this excellent article featuring @hatemsoliman

#covid19pocus
Check out the excellent resource https://www.openlus.com/en/ 

Which">https://www.openlus.com/en/"... contains tutorials, videos and literature- direct from Gio and Luna

#covid19pocus
Now @giovolpicelli discussing his experience

in ED, their LUS use was mainly for triage

LUS is very sensitive (more so than CXR and CT in some studies) but not specific https://www.stemlynsblog.org/combatting-covid19-is-lung-ultrasound-an-option/

However">https://www.stemlynsblog.org/combattin... it is “typical”- which means if PTP is high it’s suggestive.

#covid19pocus
The proper terminology for ultrasound (and arguably all imaging) is to speak in terms of probabilities, and not in terms of diagnosis

Gio is giving us a Bayesian lesson here

(Discuss twitter!)
@giovolpicelli takes this one step further

Combining the imaging with the patient’s presenting “phenotype” as seen below #covid19pocus

This is called “clinical integration” and I think it’s something we sometimes forget to do. It can also be quite hard.
A key point here, which you might here repeated later today...

Lung ultrasound does not predict outcomes in #covid19 patients.

#covid19pocus
Interesting question on subpleural consolidations on lung ultrasound- seeing that they may be small infarcts https://link.springer.com/article/10.1007/s00134-020-06085-4

More">https://link.springer.com/article/1... data is needed… #covid19pocus
Does lung ultrasound still have a role now the pandemic is slowing?

@giovolpicelli reckons it has a role both in the pandemic and in the quiet phase to improve diagnostic accuracy

#covid19pocus
Further discussion on semiotics

We should stop using the term “subpleural consolidation” as all consolidations are subpleural

Gio prefers “peripheral consolidations"
How can we integrate this into our ICU patients?

Useful study from @cardiacACCP et al here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228719/

https://www.ncbi.nlm.nih.gov/pmc/artic... href="https://twtext.com//hashtag/covid19pocus"> #covid19pocus
Annia is suggesting LUS has a role in:
1. Initial diagnosis
2. Selection of therapies
3. EVLW
4. Proning/ECMO
5. Weaning

These are empirical suggestions based on experience, with no data to support this

#covid19pocus
Using a previous score https://pubmed.ncbi.nlm.nih.gov/32396163/ 

And">https://pubmed.ncbi.nlm.nih.gov/32396163/... modifying it by adding lung ultrasound, AUROC improved from 0.73 to 0.78

So lung ultrasound by itself does not predict, but it may be another useful data point
Take home messages:
Lots of potential of Lung ultrasound scoring, but limited data

#covid19pocus
Next up- Enrico Boero on diaphragm monitoring in #COVID19 using ultrasound

Ping @sonophysio

#covid19pocus
Diaphgramatic dysfunction is twice as common as limb weakness following ICU admission

https://www.atsjournals.org/doi/full/10.1164/rccm.201602-0367OC

https://www.atsjournals.org/doi/full/... href="https://twtext.com//hashtag/covid19pocus"> #covid19pocus
Beautiful work from my friend @aron_jonny

Describing the role of advanced echocardiography in managing the #COVID19 patient

Including a huge focus on the right ventricle ping @concernecus
You can follow @iceman_ex.
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