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Abstract(s)
Introdução: A ecografia é um método de diagnóstico considerado seguro, de baixo
custo, de fácil e rápido acesso, sendo a ecografia point-of-care, vulgarmente conhecida
como POCUS, um conceito que tem vindo a ser amplamente implementado na prática
clínica.
A pandemia SARS-CoV-2 trouxe novos desafios e barreiras a serem ultrapassadas, como
o distanciamento social, novas infraestruturas hospitalares e sistemas de triagem. Para
tal, a necessidade urgente levou a uma díspar evolução tecnológica e científica
conseguida através de investigações e estudos realizados neste período, que permitiram
um grande impulso e descoberta de novos métodos de diagnóstico e terapêutica, assim
como aperfeiçoamento de protocolos já existentes.
Pela sua eficiência e aparente inocuidade, a POCUS foi rapidamente implementada como
método de diagnóstico e controlo nos doentes com Covid-19 em diversos países como a
China, Estados Unidos da América, Alemanha, entre outros.
Analisando a literatura científica existente até à data, este trabalho tem como objetivo
contextualizar o conceito de POCUS na era da pandemia e analisar o estado da arte dos
protocolos pleuropulmonares implementados nos principais países que desenvolveram
e adaptaram este método durante a pandemia.
Objetivo: Identificar na literatura protocolos de ecografia point-of-care
pleuropulmonar desenvolvidos como método de diagnóstico e controlo de doentes com
Covid-19.
Métodos: Pesquisa bibliográfica de artigos científicos em base de dados científicas,
como a PubMed, com as seguintes combinações de palavras-chave: "Point-of-care
Ultrasonography OR POCUS OR Point-of-Care Ultrasound" AND "Pandemic OR
COVID-19 OR SARS-CoV-2 OR coronavirus" AND "Pleuropulmonar protocol OR
pulmonar protocol”. Após a pesquisa, foram aplicados critérios de inclusão e exclusão
específicos e foram analisados os protocolos implementados e procedeu-se à síntese dos
resultados encontrados. Foram também incluídos artigos considerados pertinentes,
dados pelos orientadores, ou retirados de referências bibliográficas de artigos que
resultaram da pesquisa, desde que cumpram os critérios de inclusão e exclusão e sejam
relevantes no enquadramento desta revisão. Resultados e Conclusões: A POCUS pleuropulmonar é uma ferramenta facilmente
acessível para os clínicos e deve ser considerada uma extensão do exame físico. É erro
dependente do utilizador, sendo a qualidade dos exames ecográficos influenciada dos
conhecimentos e habilidades do operador. A identificação de padrões pleuropulmonares
indicativos de Covid-19 tornou a POCUS numa valiosa ferramenta de diagnóstico e
monitorização, sendo um excelente preditor de prognóstico. Estas alterações podem ser
quantificadas através da ferramenta Lung Ultrasound Score (LUS), que pode permitir
estratificar o risco destes doentes. Esta abordagem pode ainda ajudar a proteger
profissionais e Equipamento Proteção Individual, bem como limitar a exposição a outros
profissionais de saúde e locais.
Assim, é possível concluir que a POCUS pleuropulmonar associada à ferramenta de
quantificação LUS pode apoiar a triagem, diagnóstico e avaliação prognóstica em
doentes com Covid-19 e, portanto, diminuir o tempo de espera para tomada de decisões
clínicas e auxiliar na orientação do doente, dos cuidados e da terapêutica. Pode ser usado
nos serviços de urgência, mas também nas enfermarias e Unidade de Cuidados
Intensivos. Mais estudos e pesquisas são necessários para continuar a definir o papel da
POCUS pleuropulmonar na Covid-19. Mas uma coisa é certa: a POCUS pleuropulmonar
veio para ficar.
Introduction: Ultrasound is a diagnostic method considered safe, inexpensive, easy, and quick to access, and point-of-care ultrasound (POCUS) is a concept that has been widely implemented in clinical practice. SARS-CoV-2 pandemic brought new challenges and barriers to overcome, such as social distancing, the need to create new hospital infrastructure and triage systems. To this end, it led to technological and scientific development, achieved through investigations and studies which allowed a great evolution and discovery of new diagnostic and therapeutic methods, as well as improvement of existing protocols. Due to its efficiency and considered innocuity, POCUS was quickly implemented as a diagnostic and control method in patients with Covid-19 in several countries such as China, the United States of America, Germany, among others. Reviewing the existing scientific literature to date, this work aims to contextualize the concept of POCUS in the Covid-19 pandemic era and explore the state of the art of pleuropulmonary protocols implemented in the main countries that developed and adapted this method during the pandemic. Goal: To identify in the literature point-of-care pleuropulmonary ultrasound protocols developed as a method of diagnosis and control of patients with Covid-19. Methods: Bibliographic search of scientific articles in scientific databases, such as PubMed, with the following keyword combinations: "Point-of-care Ultrasonography OR POCUS OR Point-of-Care Ultrasound" AND "Pandemic OR COVID-19 OR SARS-CoV-2 OR coronavirus" AND "Pleuropulmonary protocol OR pulmonary protocol". After the search, specific inclusion and exclusion criteria were applied and the implemented protocols were analyzed, and the results found were synthesized. Articles considered relevant were also included, given by supervisors, or taken from bibliographic references of articles that resulted from the research, provided they meet the inclusion and exclusion criteria, and were relevant to this review. Results and Conclusions: Pleuropulmonary POCUS is an easily accessible tool for clinicians and should be considered as an extension of the physical examination. It is a user-dependent error, with the quality of ultrasound being dependent on the operator's knowledge and skills. The identification of pleuropulmonary patterns indicative of Covid-19 disease made POCUS a valuable diagnostic and monitoring tool, being an excellent predictor of prognosis. These changes can be quantified using the Lung Ultrasound Score (LUS) tool, which can stratify the risk of these patients. This approach can also help protect clinicians and Personal Protective Equipment, as well as limit exposure to other healthcare workers and locations. Thus, it is possible to conclude that pleuropulmonary POCUS associated with the LUS quantification tool can support screening, diagnosis and prognostic evaluation in patients with Covid-19 and, therefore, decrease the waiting time for clinical decisionmaking and assist in patient orientation, care and treatment. It can be used in emergency department, but also in hospital wards and Intensive Care Units. More studies and research are needed to continue to define the role of pleuropulmonary POCUS in Covid19. But one thing is certain: pleuropulmonary POCUS has come to stay.
Introduction: Ultrasound is a diagnostic method considered safe, inexpensive, easy, and quick to access, and point-of-care ultrasound (POCUS) is a concept that has been widely implemented in clinical practice. SARS-CoV-2 pandemic brought new challenges and barriers to overcome, such as social distancing, the need to create new hospital infrastructure and triage systems. To this end, it led to technological and scientific development, achieved through investigations and studies which allowed a great evolution and discovery of new diagnostic and therapeutic methods, as well as improvement of existing protocols. Due to its efficiency and considered innocuity, POCUS was quickly implemented as a diagnostic and control method in patients with Covid-19 in several countries such as China, the United States of America, Germany, among others. Reviewing the existing scientific literature to date, this work aims to contextualize the concept of POCUS in the Covid-19 pandemic era and explore the state of the art of pleuropulmonary protocols implemented in the main countries that developed and adapted this method during the pandemic. Goal: To identify in the literature point-of-care pleuropulmonary ultrasound protocols developed as a method of diagnosis and control of patients with Covid-19. Methods: Bibliographic search of scientific articles in scientific databases, such as PubMed, with the following keyword combinations: "Point-of-care Ultrasonography OR POCUS OR Point-of-Care Ultrasound" AND "Pandemic OR COVID-19 OR SARS-CoV-2 OR coronavirus" AND "Pleuropulmonary protocol OR pulmonary protocol". After the search, specific inclusion and exclusion criteria were applied and the implemented protocols were analyzed, and the results found were synthesized. Articles considered relevant were also included, given by supervisors, or taken from bibliographic references of articles that resulted from the research, provided they meet the inclusion and exclusion criteria, and were relevant to this review. Results and Conclusions: Pleuropulmonary POCUS is an easily accessible tool for clinicians and should be considered as an extension of the physical examination. It is a user-dependent error, with the quality of ultrasound being dependent on the operator's knowledge and skills. The identification of pleuropulmonary patterns indicative of Covid-19 disease made POCUS a valuable diagnostic and monitoring tool, being an excellent predictor of prognosis. These changes can be quantified using the Lung Ultrasound Score (LUS) tool, which can stratify the risk of these patients. This approach can also help protect clinicians and Personal Protective Equipment, as well as limit exposure to other healthcare workers and locations. Thus, it is possible to conclude that pleuropulmonary POCUS associated with the LUS quantification tool can support screening, diagnosis and prognostic evaluation in patients with Covid-19 and, therefore, decrease the waiting time for clinical decisionmaking and assist in patient orientation, care and treatment. It can be used in emergency department, but also in hospital wards and Intensive Care Units. More studies and research are needed to continue to define the role of pleuropulmonary POCUS in Covid19. But one thing is certain: pleuropulmonary POCUS has come to stay.
Description
Keywords
Covid-19 Ecografia Pocus Point-of-Care Protocolo Pleuropulmonar