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大流行期间的床旁超声:COVID-19病房实用指南。

Point-of-care ultrasound in a pandemic: Practical guidance in COVID-19 units.

作者信息

Deshwal Himanshu, Pradhan Deepak, Mukherjee Vikramjit

机构信息

Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States.

出版信息

World J Crit Care Med. 2021 Sep 9;10(5):204-219. doi: 10.5492/wjccm.v10.i5.204.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has stretched our healthcare system to the brink, highlighting the importance of efficient resource utilization without compromising healthcare provider safety. While advanced imaging is a great resource for diagnostic purposes, the risk of contamination and infection transmission is high and requires extensive logistical planning for intrahospital patient transport, healthcare provider safety, and post-imaging decontamination. This dilemma has necessitated the transition to more bedside imaging. More so than ever, during the current pandemic, the clinical utility and importance of point-of-care ultrasound (POCUS) cannot be overstressed. It allows for safe and efficient beside procedural guidance and provides front line providers with valuable diagnostic information that can be acted upon in real-time for immediate clinical decision-making. The authors have been routinely using POCUS for the management of COVID-19 patients both in the emergency department and in intensive care units turned into "COVID-units." In this article, we review the nuances of using POCUS in a pandemic situation and maximizing diagnostic output from this bedside technology. Additionally, we review various methods and diagnostic uses of POCUS which can replace conventional imaging and bridge current literature and common clinical practices in critically ill patients. We discuss practical guidance and pertinent review of the literature for the most relevant procedural and diagnostic guidance of respiratory illness, hemodynamic decompensation, renal failure, and gastrointestinal disorders experienced by many patients admitted to COVID-units.

摘要

2019年冠状病毒病(COVID-19)大流行已将我们的医疗系统推向极限,凸显了在不危及医护人员安全的情况下高效利用资源的重要性。虽然先进成像技术是诊断的重要资源,但污染和感染传播风险很高,需要对医院内患者转运、医护人员安全及成像后消毒进行广泛的后勤规划。这一困境促使向更多的床边成像转变。在当前大流行期间,即时超声检查(POCUS)的临床效用和重要性比以往任何时候都更加不容忽视。它能在床边实现安全、高效的操作指导,并为一线医护人员提供有价值的诊断信息,可据此实时做出临床决策。作者一直在急诊科和改造成“新冠病房”的重症监护病房中常规使用POCUS来管理COVID-19患者。在本文中,我们回顾了在大流行情况下使用POCUS的细微差别以及如何最大化利用这项床边技术的诊断产出。此外,我们还回顾了POCUS的各种方法和诊断用途,这些方法可取代传统成像,并衔接当前关于重症患者的文献和常见临床实践。我们讨论了针对COVID病房中许多患者所经历的呼吸系统疾病、血流动力学失代偿、肾衰竭和胃肠道疾病的最相关操作和诊断指导的实用指南及相关文献综述。

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