Dr. Sandeep Garg
As of today 7thApril , 2020 more than 1.3 million people are affected worldwide by covid19 virus and about 75000 people lost their life. In Nepal too, we have 9 covid19 positive cases being treated, out of which one was locally transmitted case. We need to prepare our self for any surge in covid9 cases keeping in mid our limited available resources.From the radiology and imaging perspective, CT scan and conventional x-ray of chest has been used to diagnose the severity of the lung disease.However, the recent pandemic experience in China, Italy, USA and other European countries shows Point of Care lung ultrasound (POCUS) is as sensitive as CT chest in covid19 patients and even better than chest x-ray. For CT scan, patient is required to be taken to the CT room and involves many health workers from attendant, nurses, CTtechnologist to radiologist etc which increases their risk of acquiring the disease. The CT room too need to be deeply disinfected after performing the CT scan and hence delays the other non covid19 emergency cases. Sometimes, it is not possible to bring the critically ill or hemodynamically unstable patient with oxygen cylinder to the CT scan room.
Lung ultrasound is a bed side procedure hence reduces many health workers exposure to the infected patient. It can be easily repeated many times during follow up of the course of the disease. The cost of machine is low and can be easily set up in low resource setting. There isabsence of radiation exposure and hence is a great advantage particularly in pregnant women and children.
Many research papers are recently published from China and Italy on advantages of lung ultrasound in covid 19 and all the papers suggest similar sensitivity of ultrasound in diagnosing covid19 as compared to CT chest. Lung ultrasound has been used for long time in critical care in developed countries for diagnosing pneumonia, pleural effusion, pneumothorax etc.
Recently, there is an increased use of small wireless hand held ultrasound machine. It has a small wireless probe and is connected to the smartphone or ipad via Bluetooth. Sonologist can easily bring the smartphone and probe in his or her pocket, cover it with the sterile sheath and perform the ultrasound. Later, he or she disposes of the sheath and clean the probe for the next patient.
In developing countries like Nepal with fewer resources, USG lung can play an important role in our critical care units or ICU for managing covid 19 patients with respiratory problems. Hence, we must have good quality portable ultrasound machines in our critical care units. We must also focus on training more doctors in performing lung ultrasound.
- Dr sandeep
Senior Consultant Radiologist
Chitwan Om Hospital, Chitwan