Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic
Identifieur interne : 000133 ( Pmc/Corpus ); précédent : 000132; suivant : 000134Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic
Auteurs : Qian-Yi Peng ; Xiao-Ting Wang ; Li-Na ZhangSource :
- Intensive Care Medicine [ 0342-4642 ] ; 2020.
Url:
DOI: 10.1007/s00134-020-05996-6
PubMed: 32166346
PubMed Central: 7080149
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic</title><author><name sortKey="Peng, Qian Yi" sort="Peng, Qian Yi" uniqKey="Peng Q" first="Qian-Yi" last="Peng">Qian-Yi Peng</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.216417.7</institution-id><institution-id institution-id-type="ISNI">0000 0001 0379 7164</institution-id><institution>Department of Critical Care Medicine, Xiangya Hospital,</institution><institution>Central South University,</institution></institution-wrap>No. 87 Xiangya Road, Changsha, 410008 Hunan Province China</nlm:aff></affiliation></author><author><name sortKey="Wang, Xiao Ting" sort="Wang, Xiao Ting" uniqKey="Wang X" first="Xiao-Ting" last="Wang">Xiao-Ting Wang</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Critical Care Medicine, Peking Union Medical College Hospital,</institution><institution>Tsinghua University,</institution></institution-wrap>No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730 Beijing China</nlm:aff></affiliation></author><author><name sortKey="Zhang, Li Na" sort="Zhang, Li Na" uniqKey="Zhang L" first="Li-Na" last="Zhang">Li-Na Zhang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.216417.7</institution-id><institution-id institution-id-type="ISNI">0000 0001 0379 7164</institution-id><institution>Department of Critical Care Medicine, Xiangya Hospital,</institution><institution>Central South University,</institution></institution-wrap>No. 87 Xiangya Road, Changsha, 410008 Hunan Province China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32166346</idno><idno type="pmc">7080149</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080149</idno><idno type="RBID">PMC:7080149</idno><idno type="doi">10.1007/s00134-020-05996-6</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000133</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000133</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic</title><author><name sortKey="Peng, Qian Yi" sort="Peng, Qian Yi" uniqKey="Peng Q" first="Qian-Yi" last="Peng">Qian-Yi Peng</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.216417.7</institution-id><institution-id institution-id-type="ISNI">0000 0001 0379 7164</institution-id><institution>Department of Critical Care Medicine, Xiangya Hospital,</institution><institution>Central South University,</institution></institution-wrap>No. 87 Xiangya Road, Changsha, 410008 Hunan Province China</nlm:aff></affiliation></author><author><name sortKey="Wang, Xiao Ting" sort="Wang, Xiao Ting" uniqKey="Wang X" first="Xiao-Ting" last="Wang">Xiao-Ting Wang</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Critical Care Medicine, Peking Union Medical College Hospital,</institution><institution>Tsinghua University,</institution></institution-wrap>No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730 Beijing China</nlm:aff></affiliation></author><author><name sortKey="Zhang, Li Na" sort="Zhang, Li Na" uniqKey="Zhang L" first="Li-Na" last="Zhang">Li-Na Zhang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.216417.7</institution-id><institution-id institution-id-type="ISNI">0000 0001 0379 7164</institution-id><institution>Department of Critical Care Medicine, Xiangya Hospital,</institution><institution>Central South University,</institution></institution-wrap>No. 87 Xiangya Road, Changsha, 410008 Hunan Province China</nlm:aff></affiliation></author></analytic><series><title level="j">Intensive Care Medicine</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mayo, Ph" uniqKey="Mayo P">PH Mayo</name></author><author><name sortKey="Copetti, R" uniqKey="Copetti R">R Copetti</name></author><author><name sortKey="Feller Kopman, D" uniqKey="Feller Kopman D">D Feller-Kopman</name></author><author><name sortKey="Mathis, G" uniqKey="Mathis G">G Mathis</name></author><author><name sortKey="Maury, E" uniqKey="Maury E">E Maury</name></author><author><name sortKey="Mongodi, S" uniqKey="Mongodi S">S Mongodi</name></author><author><name sortKey="Mojoli, F" uniqKey="Mojoli F">F Mojoli</name></author><author><name sortKey="Volpicelli, G" uniqKey="Volpicelli G">G Volpicelli</name></author><author><name sortKey="Zanobetti, M" uniqKey="Zanobetti M">M Zanobetti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soummer, A" uniqKey="Soummer A">A Soummer</name></author><author><name sortKey="Perbet, S" uniqKey="Perbet S">S Perbet</name></author><author><name sortKey="Brisson, H" uniqKey="Brisson H">H Brisson</name></author><author><name sortKey="Arbelot, C" uniqKey="Arbelot C">C Arbelot</name></author><author><name sortKey="Constantin, Jm" uniqKey="Constantin J">JM Constantin</name></author><author><name sortKey="Lu, Q" uniqKey="Lu Q">Q Lu</name></author><author><name sortKey="Rouby, Jj" uniqKey="Rouby J">JJ Rouby</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Intensive Care Med</journal-id><journal-id journal-id-type="iso-abbrev">Intensive Care Med</journal-id><journal-title-group><journal-title>Intensive Care Medicine</journal-title></journal-title-group><issn pub-type="ppub">0342-4642</issn><issn pub-type="epub">1432-1238</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32166346</article-id><article-id pub-id-type="pmc">7080149</article-id><article-id pub-id-type="publisher-id">5996</article-id><article-id pub-id-type="doi">10.1007/s00134-020-05996-6</article-id><article-categories><subj-group subj-group-type="heading"><subject>Letter</subject></subj-group></article-categories><title-group><article-title>Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Peng</surname><given-names>Qian-Yi</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Wang</surname><given-names>Xiao-Ting</given-names></name><address><email>icuting@163.com</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Zhang</surname><given-names>Li-Na</given-names></name><address><email>zln7095@163.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><collab>Chinese Critical Care Ultrasound Study Group (CCUSG)</collab></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.216417.7</institution-id><institution-id institution-id-type="ISNI">0000 0001 0379 7164</institution-id><institution>Department of Critical Care Medicine, Xiangya Hospital,</institution><institution>Central South University,</institution></institution-wrap>No. 87 Xiangya Road, Changsha, 410008 Hunan Province China</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Critical Care Medicine, Peking Union Medical College Hospital,</institution><institution>Tsinghua University,</institution></institution-wrap>No.1 Shuaifuyuan, Wangfujing, Dongcheng District, 100730 Beijing China</aff></contrib-group><pub-date pub-type="epub"><day>12</day><month>3</month><year>2020</year></pub-date><fpage>1</fpage><lpage>2</lpage><history><date date-type="accepted"><day>2</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© Springer-Verlag GmbH Germany, part of Springer Nature 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/501100001809</institution-id><institution>National Natural Science Foundation of China</institution></institution-wrap></funding-source><award-id>81873956</award-id><award-id>81974285</award-id><principal-award-recipient><name><surname>Peng</surname><given-names>Qian-Yi</given-names></name><name><surname>Zhang</surname><given-names>Li-Na</given-names></name></principal-award-recipient></award-group></funding-group></article-meta></front><body><p id="Par1">Dear Editor,</p><p id="Par2">Up to 24 February 2020, there have been 77,269 officially reported confirmed cases of 2019 novel corona virus (SARS-CoV-2) infection in China. As lung abnormalities may develop before clinical manifestations and nucleic acid detection, experts have recommended early chest computerized tomography (CT) for screening suspected patients [<xref ref-type="bibr" rid="CR1">1</xref>]. The high contagiousness of SARS-CoV-2 and the risk of transporting unstable patients with hypoxemia and hemodynamic failure make chest CT a limited option for the patient with suspected or established COVID-19. Lung ultrasonography gives the results that are similar to chest CT and superior to standard chest radiography for evaluation of pneumonia and/or adult respiratory distress syndrome (ARDS) with the added advantage of ease of use at point of care, repeatability, absence of radiation exposure, and low cost [<xref ref-type="bibr" rid="CR2">2</xref>].</p><p id="Par3">In this report, we summarize our early experience with lung ultrasonography for evaluation of SARS-CoV-2 infection in China with the intent of alerting frontline intensivists to the utility of lung ultrasonography for management of COVID-19.</p><sec id="Sec1"><title>Ultrasonographic features of nCoV pneumonia</title><p id="Par4">We performed lung ultrasonography on 20 patients with COVID-19 using a 12-zone method [<xref ref-type="bibr" rid="CR3">3</xref>].</p><p id="Par5">Characteristic findings included the following:<list list-type="order"><list-item><p id="Par6">Thickening of the pleural line with pleural line irregularity;</p></list-item><list-item><p id="Par7">B lines in a variety of patterns including focal, multifocal, and confluent;</p></list-item><list-item><p id="Par8">Consolidations in a variety of patterns including multifocal small, non-translobar, and translobar with occasional mobile air bronchograms;</p></list-item><list-item><p id="Par9">Appearance of A lines during recovery phase;</p></list-item><list-item><p id="Par10">Pleural effusions are uncommon.</p></list-item></list></p><p id="Par11">The observed patterns occurred across a continuum from mild alveolar interstitial pattern, to severe bilateral interstitial pattern, to lung consolidation. Table <xref rid="Tab1" ref-type="table">1</xref> summarizes typical lung ultrasonography finds in patients with COVID-19 respiratory disease in comparison with chest CT findings. Typical lung ultrasonography images are shown in the supplementary material (Supplementary Fig. 1.)<table-wrap id="Tab1"><label>Table 1</label><caption><p>CT and ultrasonographic features of COVID-19 pneumonia</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left">Lung CT</th><th align="left">Lung ultrasound</th></tr></thead><tbody><tr><td align="left">Thickened pleura</td><td align="left">Thickened pleural line</td></tr><tr><td align="left">Ground glass shadow and effusion</td><td align="left">B lines (multifocal, discrete, or confluent)</td></tr><tr><td align="left">Pulmonary infiltrating shadow</td><td align="left">Confluent B lines</td></tr><tr><td align="left">Subpleural consolidation</td><td align="left">Small (centomeric) consolidations)</td></tr><tr><td align="left">Translobar consolidation</td><td align="left">Both non-translobar and translobar consolidation</td></tr><tr><td align="left">Pleural effusion is rare.</td><td align="left">Pleural effusion is rare</td></tr><tr><td align="left">More than two lobes affected</td><td align="left">Multilobar distribution of abnormalities</td></tr><tr><td align="left">Negative or atypical in lung CT images in the super-early stage, then diffuse scattered or ground glass shadow with the progress of the disease, further lung consolidation</td><td align="left">Focal B lines is the main feature in the early stage and in mild infection; alveolar interstitial syndrome is the main feature in the progressive stage and in critically ill patients; A lines can be found in the convalescence; pleural line thickening with uneven B lines can be seen in patients with pulmonary fibrosis</td></tr></tbody></table></table-wrap></p><p id="Par12">The findings of lung ultrasonography features of SARS-CoV-2 pneumonia/ARDS are related to the stage of disease, the severity of lung injury, and comorbidities. The predominant pattern is of varying degrees of interstitial syndrome and alveolar consolidation, the degree of which is correlated with the severity of the lung injury. A recognized limitation of lung ultrasonography is that it cannot detect lesions that are deep within the lung, as aerated lung blocks transmission of ultrasonography, i.e., the abnormality must extend to the pleural surface to be visible with on ultrasonography examination. Chest CT is required to detect pneumonia that does not extend to the pleural surface.</p><p id="Par13">Based upon our experience, we consider that lung ultrasonography has major utility for management of COVID-19 with respiratory involvement due to its safety, repeatability, absence of radiation, low cost and point of care use; chest CT may be reserved for cases where lung ultrasonography is not sufficient to answer the clinical question. We find there is utility of lung ultrasonography for rapid assessment of the severity of SARS-CoV-2 pneumonia/ARDS at presentation, to track the evolution of disease, to monitor lung recruitment maneuvers, to guide response to prone position, the management of extracorporeal membrane therapy, and for making decisions related to weaning the patient form ventilatory support.</p></sec><sec sec-type="supplementary-material"><title>Electronic supplementary material</title><sec id="Sec2"><p>Supplementary Figure 1: Typical lung ultrasonography images of nCoV pneumonia. B lines; B. confluent B lines; C. small consolidations; D. translobar consolidation.<supplementary-material content-type="local-data" id="MOESM1"><media xlink:href="134_2020_5996_MOESM1_ESM.tif"><label>Supplementary Figure 1</label><caption><p>Typical lung ultrasonography images of nCoV pneumonia. A. B lines; B. confluent B lines; C. small consolidations; D. translobar consolidation. (TIFF 34299 kb)</p></caption></media></supplementary-material></p></sec></sec></body><back><fn-group><fn><p><bold>Publisher's Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><notes notes-type="funding-information"><title>Funding</title><p>Funding was provided by National Natural Science Foundation of China (Grant no. 81873956) and National Natural Science Foundation of China (Grant no. 81974285).</p></notes><notes notes-type="ethics"><title>Compliance with ethical standards</title><notes notes-type="COI-statement"><title>Conflicts of interest</title><p id="Par14">On behalf of all authors, the corresponding author states that there is no conflict of interest.</p></notes></notes><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><mixed-citation publication-type="other">National Health Commission of the people’s Republic of China. Diagnosis and treatment of novel coronavirus pneumonia (trial, the fifth version)[EB/OL]. (2020-02-05)[2020-02-06]. <ext-link ext-link-type="uri" xlink:href="http://www.nhc.gov.cn/yzygj/s7653p/202002/3b09b894ac9b4204a79db5b8912d4440.shtml">http://www.nhc.gov.cn/yzygj/s7653p/202002/3b09b894ac9b4204a79db5b8912d4440.shtml</ext-link></mixed-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mayo</surname><given-names>PH</given-names></name><name><surname>Copetti</surname><given-names>R</given-names></name><name><surname>Feller-Kopman</surname><given-names>D</given-names></name><name><surname>Mathis</surname><given-names>G</given-names></name><name><surname>Maury</surname><given-names>E</given-names></name><name><surname>Mongodi</surname><given-names>S</given-names></name><name><surname>Mojoli</surname><given-names>F</given-names></name><name><surname>Volpicelli</surname><given-names>G</given-names></name><name><surname>Zanobetti</surname><given-names>M</given-names></name></person-group><article-title>Thoracic ultrasonography: a narrative review</article-title><source>Intensive Care Med</source><year>2019</year><volume>45</volume><fpage>1200</fpage><lpage>1211</lpage><pub-id pub-id-type="doi">10.1007/s00134-019-05725-8</pub-id><pub-id pub-id-type="pmid">31418060</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soummer</surname><given-names>A</given-names></name><name><surname>Perbet</surname><given-names>S</given-names></name><name><surname>Brisson</surname><given-names>H</given-names></name><name><surname>Arbelot</surname><given-names>C</given-names></name><name><surname>Constantin</surname><given-names>JM</given-names></name><name><surname>Lu</surname><given-names>Q</given-names></name><name><surname>Rouby</surname><given-names>JJ</given-names></name><collab>Lung Ultrasound Study Group</collab></person-group><article-title>Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress</article-title><source>Crit Care Med.</source><year>2012</year><volume>40</volume><issue>7</issue><fpage>2064</fpage><lpage>2072</lpage><pub-id pub-id-type="doi">10.1097/CCM.0b013e31824e68ae</pub-id><pub-id pub-id-type="pmid">22584759</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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