key: cord-0772943-l8529hu0 authors: Zanforlin, Alessandro; Ferro, Federica; Pretto, Paolo; Fabbro, Loris; Vezzali, Norberto title: Lung Ultrasound During the COVID‐19 Pandemic: Building a Mobile Lung Ultrasound Unit date: 2020-07-04 journal: J Ultrasound Med DOI: 10.1002/jum.15375 sha: 1dfff78d1535a8849f9180b22885f1114082bec4 doc_id: 772943 cord_uid: l8529hu0 nan The role of lung ultrasound (LUS) in diagnosing pneumonia is well known, and many meta-analyses have reported sensitivity and specificity ranging from 85% to 93% and from 86% to 93%, respectively, especially when LUS examinations are performed by experienced operators. [1] [2] [3] [4] [5] As the first reports of computed tomographic (CT) patterns of coronavirus pneumonia showed a typical involvement of peripheral areas of the lung, 6 and the first article described the principal ultrasound (US) features of coronavirus disease 2019 (COVID-19) pneumonia in comparison with CT findings, the possible role of US needed to be taken into consideration in the diagnostic process because of its safety, repeatability, absence of radiation, low cost and point-of-care use. 7 As the epidemic began to spread in Italy, the role of LUS was immediately reported by the first colleagues in northern Italy who were engaged in fighting the epidemic. 8 As recently reported, chest US is largely diffuse in particular amid pulmonologists in the northern area of Italy. 9 The Italian thoracic US community has contributed in reporting and encouraging the use of LUS through journal letters 10-12 and video tutorials. 13 As the pretriage evaluation of patients suspected of having COVID-19 started in the Hospital of Bolzano in South Tyrol, Italy, a diagnostic protocol was established, suggesting the indications for performing CT in patients suspected of having COVID-19 pneumonia with negative chest x-ray results. Unfortunately, the route to the CT scanner was not a "clean", dedicated route, and the potentially contagious patient could pose a high risk of contagion for many other health care workers. Moreover, in the new COVID-19 intensive care unit, the imaging monitoring of patients with COVID-19 had the same difficulties. To solve some of these problems, a pulmonologist with 15 years of experience in LUS was enlisted in the Radiodiagnostic Department to set up the LUS activity in the hospital, where needed and not yet present, becoming a mobile LUS unit. This required 3 phases: organizational, educational and operative. In the organizational phase, to be able to perform LUS examinations in every COVID-19 ward and limit the contamination that could occur by moving US equipment, every COVID-19 ward was equipped with a US machine and the transducers needed for the ward's activity. Predominantly, US machines were provided by redistributing them in the hospital: after a census between all wards, all underused equipment was reassigned temporarily for the epidemic. The purchase of new US machines was limited by general low availability from distributors and long shipment times. In the educational phase, we planned small classes of LUS courses for radiologists, anesthesiologists, and emergency physicians with a theoretical part, a practical demonstration performed through a video conference, and a theoretical and organizational webinar involving all of the hospitals of South Tyrol. During US execution by the mobile LUS unit in the emergency department and intensive care unit, there was also in-field education for other physicians. Consequently, some colleagues progressively became autonomous in performing LUS examinations. In the operative phase, the working day of the mobile LUS unit was organized into a morning session in the intensive care unit, with LUS mapping and US assistance for intensivists, and an afternoon session in the emergency department, with COVID-19 triage and additional LUS support in the diagnostic workup of patients suspected of having COVID-19. This lowered the number of CT scans required for diagnosis, reducing costs and risks related to moving potentially contagious patients through nondedicated pathways. In conclusion, the temporary allocation of personnel with expertise in LUS has permitted the focused and thoughtful supply of US equipment where required without substantial costs. The mobile LUS unit has promoted the implementation of the technique through education of other health care professionals and has provided expert effort to the diagnostic work flow, reducing costs and risks. Except for the limit of the availability of an expert unit, we think that this model, which did not require high costs or additional instrumentation, could be exported to every health care setting and could be easily applied, especially where resources are limited and there is an increasing need to solve a clinical problem. Lung ultrasonography versus chest radiography for the diagnosis of pediatric community acquired pneumonia in emergency department: a meta-analysis Lung ultrasound in diagnosing pneumonia in the emergency department: a systematic review and meta-analysis Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis Accuracy of lung ultrasonography in the diagnosis of pneumonia in adults: systematic review and meta-analysis Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19) Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic Accademia di Ecografia Toracica Facebook group Clinical use and barriers of thoracic ultrasound: a survey of Italian pulmonologists COVID-19 outbreak: less stethoscope, more ultrasound Point-of-care lung ultrasound findings in novel coronavirus disease-19 pneumoniae: a case report and potential applications during COVID-19 outbreak Is there a role for lung ultrasound during the COVID-19 pandemic?