COVID-19 Lung Ultrasound - Course Director Interview: Ultrasound Technology in Long-Term Management

The below comments are attributed to Alistair Royse, University of Melbourne Cardiothoracic Surgeon and Course Director of the COVID-19 Lung Ultrasound course.

Can you please explain how ultrasound technology, such as the Butterfly iQ, is having an impact on the monitoring and management of COVID-19?

Most patients with COVID-19 do not develop significant lung involvement, but some may develop severe pneumonia and need to be ventilated. To be able to differentiate those with and without lung involvement, even when there are no symptoms, is crucial to being able to identify patients early in their disease.

By identifying patients early, any early intervention strategies or novel treatments are more likely to work, and will have more time to work then trying the same strategies when the disease is advanced and the patient is already requiring respiratory support.

Lung US in early stage of COVID-19

pneumoniaInterstitial syndrome with irregular pleural line

Lung ultrasound is an emerging field for most doctors and nurses who traditionally have relied on stethoscope examinations and chest x-rays. Most centres currently do not perform lung ultrasound at the time of screening.

Since lung ultrasound is very sensitive at detecting areas of lung inflammation, it is suggested that this would be introduced more widely. Where lung ultrasound has been used internationally, it has been found to be sensitive to detection of lung inflammation, convenient and time efficient.

There is also evidence internationally that repeated scans are useful for detecting progression of the severity of the disease, as well as the regression, when the patient is recovering. In the intensive care unit, it has been used to assist with decisions about positioning the patient during ventilation.

Findings in late stage of COVID-19
Thickened pleura, confluent B-lines and subpleural consolidation

In addition, the use of small handheld ultrasound devices is rapidly gaining popularity. An individual doctor or nurse can "wear" their own device throughout their shift, and are small enough to fit within a conventional sterile plastic sheath (that are normally used for ultrasound guided sterile procedures), and this allows a physical barrier against the COVID-19 virus.

Is the Australian healthcare industry adopting the use of ultrasound technology as they prepare to manage COVID-19?

There is strong evidence from the ultrasound industry for increased sales of smaller ultrasound devices in recent times, particularly related to new clinical use scenarios such as lung ultrasound to monitor COVID-19.

Hospitals are responding by purchasing ultrasound equipment, although this uptake varies widely between hospitals. Clinical staff who already use lung ultrasound are strong advocates for its expanded use.

There has been tremendous interest shown in the online COVID-19 lung ultrasound course distributed by the University of Melbourne, with almost 4,000 enrolments worldwide within two weeks.

What role do you believe ultrasound technology could have in the longer-term management of COVID-19 in Australia?

COVID-19 is an upper respiratory tract infection that in a proportion of patients also becomes a lower respiratory tract infection. Ultrasound is particularly useful in detecting changes in the lung. We feel that the use of lung ultrasound will find a place in:

  1. The early diagnosis of any lung pathology at or near the time of screening
  2. The repeated scanning of patients over a number of days can monitor the progress and allow early intervention therapies time to work
  3. Use in the advanced stages of respiratory failure before or after ventilation in some cases which may reduce the need to transport patients to the CT scan Department
  4. Use in the recovery phase to ensure there is improvement

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