INFECTIOUS DISEASES DEPARTMENT, O.BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE.
OLEXANDRIVSKA CLINICAL HOSPITAL, KYIV, UKRAINE.
Wiad Lek. 2021;74(8):1783-1788.
The aim: To optimize diagnostic of pathological processes in lungs af f ected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings.
Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for conf i rmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinf l ammatory cytokines - IL-6, CRP, procalcitonin, ferritin. Diagnosis was conf i rmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound fi ndings were recorded numerically based on scales.
Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process af f ecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained.
Conclusions: Grading of ultrasonographic findings in the lungs was suf f i cient for both initial assessment with identif ication of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.
旨在优化在资源有限的情况下使用肺部超声对 COVID-19 影响肺部的病理过程进行诊断、动态监测和临床决策。
材料和方法：在大流行开始到 2021 年 1 月之间，Olexandrivska 临床医院大约对 9000 例确诊 COVID-19 患者进行了治疗。对所有住院患者进行评估包括血液学、化学和促炎细胞因子-IL-6、CRP、降钙素原、铁蛋白。通过聚合酶链反应 (PCR) 对 SARS-CoV-2 RNA 进行诊断。所有住院患者均进行胸部 X 线检查，而 CT 仅在住院期间约 30%的情况下可用。对住院至 ICU 和感染科的患者（n=135）主动使用肺部超声来评估肺部损伤的类型和程度，并监测疾病进展。超声检查结果基于量表进行数字记录。
在 COVID-19 背景下，床边肺部超声已迅速被公认为一种诊断和监测肺部损伤性质和程度的工具。肺部超声是一种实时评估，可以帮助确定影响肺部的病理过程的性质。本文比较了床边 LUS、胸部 X 线和计算机断层扫描的准确性，并根据 COVID-19 肺部超声的典型表现对其进行了评估。本文中描述的数据是在处理 COVID-19 的最大设施之一中收集的。所有住院患者均进行胸部 X 线检查，而 CT 仅在住院期间约 30%的情况下可用。本文中的病例表明，在资源有限的医疗环境中使用超声具有潜在优势，尤其是在将患者转运至 CT 的风险超过所获得信息的价值时。
肺部超声检查结果的分级对于初始评估和识别高危患者以及日常常规监测都是足够的。因此，肺部超声可用于预测病情恶化、分层风险和做出临床决策。
