Role of Point-of-care Ultrasound in Management of Critically Ill COVID-19 Patients: A Case Series

Abstract

Ab s t r Ac t Introduction: Hereby, we describe a series of four critically ill COVID-19 patients where point-of-care ultrasound (POCUS) helped in guiding specific management. Case description: The first case is a 62-year-old COVID-19 positive woman where severe aortic stenosis and severe left ventricular dysfunction were diagnosed by POCUS, which led to the institution of specific medical management leading to resolution of her symptoms and referral to the cardiac surgical department for further surgical management. The second case is a 51-year-old woman admitted with severe hypoxia secondary to COVID-19 infection. She was being considered for tocilizumab therapy. However, POCUS revealed the presence of pericardial effusion, which, on evaluation, was found to be due to tubercular. This led to withholding tocilizumab therapy. Anti-tubercular therapy, instead, was instituted. The third case is a 13-month-old child, who presented with a history of recurrent syncopes and was diagnosed as a case of congenital heart block on electrocardiography (ECG). However, due to his COVID-19 positive status, rescue temporary pacing could not be performed at the catheterization laboratory. Point-of-care ultrasound helped in the successful placement of a temporary pacemaker lead at the bedside, leading to the achievement of optimum heart rate till he got an epicardial pacemaker inserted at a later date. The fourth case is of a 45-year-old man, who had to undergo endotracheal intubation due to refractory COVID-19 related hypoxia. Upon connection to the mechanical ventilator, the peak airway pressure was found to be unusually high. On POCUS, lung sliding on the left side was missing, which led to the diagnosis of rightmainstem endobronchial intubation. Repositioning of the endotracheal tube led to a decrease in peak airway pressures and optimal delivery of mechanical ventilation to the patient. Conclusion: Point-of-care ultrasound can help diagnose and manage significant underlying diseases, help take/modify decisions on specific therapies, and overcome resource limitations for performing specialized therapeutic procedures in COVID-19 patients.