Lung ultrasonography in COVID-19: a game changer in the stroke unit?,European Journal of Neurology

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Lung ultrasonography in COVID-19: a game changer in the stroke unit?
European Journal of Neurology ( IF 4.5 ) Pub Date : 2020-05-25 , DOI: 10.1111/ene.14352
C Lugnan ₁ , V Tommasini ₁ , G Furlanis ₁ , M Naccarato ₁ , P Caruso ₁ , I Scali ₁ , A Buoite Stella ₁ , M Ajčević _{1,

2} , T Cillotto ₁ , P Manganotti ₁

Affiliation

Dear Editor,

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) is rapidly spreading worldwide, and the World Health Organization declared its pandemic nature on 11 March 2020 [1]. The outbreak has hit Europe and, as of 19 April 2020, Italy has the third largest number of confirmed cases, namely a total of 175 925 cases and 23 227 deaths according to the Johns Hopkins University [2]. This is the largest health and economic emergency of our country since the post‐war period, and many hospitals are now dedicated exclusively to COVID‐19 assistance. Our University Hub Stroke Unit of Cattinara Hospital is in the northeastern Italian region of Friuli Venezia Giulia which has registered 2731 cases and 222 deaths at the time of writing [3]. The health emergency has revolutionized the hospital logistics and, similarly to other parts of the country, a decrease in the number of stroke unit admissions has been experienced [4]. From 9 March 2020 to 12 April 2020 25 patients have been admitted with acute ischaemic or haemorrhagic stroke to our stroke unit. No patients were suspected for COVID‐19 but, previous to admission in our unit, they all underwent nasopharyngeal swab in the emergency department, testing negative. During hospitalization, 16 patients with fever or dyspnoea or elevation in C‐reactive protein/brain natriuretic peptide underwent lung ultrasound and one of them, at fever onset (day 4 of hospitalization), showed signs compatible with interstitial pneumonia (bilateral B‐lines with irregular pleura). The nasopharyngeal swab was repeated on the latter patient, testing positive.

Lung ultrasound has a key role in the clinical management and diagnosis of patients with COVID‐19 associated lung injury [5]. This technique is rapid, cost‐effective and can be performed at the bedside. At the level of the stroke unit, it was decided to use lung ultrasonography in all suspected patients. Patients were studied with an eight‐zone approach, considering each hemithorax divided into anterior (upper and lower) and lateral (upper and lower) areas. For each area, a longitudinal and a cross‐sectional view were obtained. A convex probe was used.

During the pandemic, to reduce the risk of SARS‐CoV‐2 spreading in non‐COVID units (i.e. the stroke unit), a rapid evaluation of suspected patients is fundamental. Moreover, one of the most frequent stroke complications is the onset of bacterial pneumonia and lung ultrasound may help in the differential diagnosis. The aim of this letter is to highlight the importance of lung ultrasound and its use also in neurological departments.

Declaration of ethical standards and acknowledgements

The authors declare that no funding was present for this study. All procedures were conducted according to standard care and retrospective analysis of data was conducted with respect to the ethical committee (CEUR FVG) and the Declaration of Helsinki. A special thanks to Matteo di Franza for editorial assistance.

References

中文翻译：

COVID-19 中的肺超声检查：中风单元的游戏规则改变者？

亲爱的编辑，

严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 正在世界范围内迅速传播，世界卫生组织于 2020 年 3 月 11 日宣布其大流行性质 [ 1 ]。疫情已席卷欧洲，截至 2020 年 4 月 19 日，意大利的确诊病例数量位居第三，根据约翰霍普金斯大学的数据，共有 175 925 例病例和 23 227 例死亡 [ 2 ]。这是战后以来我国最大的健康和经济紧急情况，许多医院现在专门提供 COVID-19 援助。我们的卡蒂纳拉医院大学中心卒中科位于意大利东北部弗留利威尼斯朱利亚地区，截至撰写本文时，该地区已登记 2731 例病例和 222 例死亡 [ 3]。突发卫生事件彻底改变了医院的后勤工作，与该国其他地区类似，中风病房入院人数有所减少 [ 4]。从 2020 年 3 月 9 日到 2020 年 4 月 12 日，25 名急性缺血性或出血性中风患者被我们的中风病房收治。没有患者被怀疑患有 COVID-19，但在入住我们单位之前，他们都在急诊科接受了鼻咽拭子检查，检测结果为阴性。住院期间，16 例发热或呼吸困难或 C 反应蛋白/脑利钠肽升高的患者接受了肺部超声检查，其中 1 例在发热时（住院第 4 天）表现出与间质性肺炎相符的体征（双侧 B 线与不规则胸膜）。对后一名患者重复鼻咽拭子检查，结果呈阳性。

肺部超声在 COVID-19 相关肺损伤患者的临床管理和诊断中具有关键作用 [ 5 ]。这种技术快速、经济有效，可以在床边进行。在卒中单元层面，决定对所有疑似患者进行肺部超声检查。采用八区入路对患者进行研究，将每个半胸分为前部（上部和下部）和侧部（上部和下部）区域。对于每个区域，获得了纵向和横截面视图。使用凸面探针。

在大流行期间，为了降低 SARS-CoV-2 在非 COVID 单位（即中风单位）中传播的风险，对疑似患者进行快速评估至关重要。此外，最常见的中风并发症之一是细菌性肺炎的发作，肺部超声可能有助于鉴别诊断。这封信的目的是强调肺部超声的重要性及其在神经科的应用。