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A Surge of FoCUS on COVID-19 POCUS.

In Response In their article, Anile et al 1 provide a novel and creative framework for the use of ultrasound to evaluate critically ill coronavirus disease 2019 (COVID-19) patients. We agree that ultrasound offers key advantages over other imaging modalities during the current pandemic, and it may be the preferred method for the routine assessment of these patients.2 New handheld ultrasound devices may be particularly useful for this proposed application because they incorporate sophisticated imaging technology while offering portability, affordability, and ease of decontamination3 to reduce the spread of infection. Some of the latest ultrasound devices offer additional features such as video tutorials and teleguidance, in which a remote expert can guide a novice user in performing an ultrasound examination or procedure.4 With these advances, ultrasound is becoming increasingly accessible to health care providers across all specialties and training levels. The authors highlight the versatility of ultrasound in evaluating not only the lungs (ie, presence of B-lines and lung sliding) and heart (ie, global size and function, pericardial effusion), but also to assess airway anatomy, endotracheal tube placement, endorgan perfusion, intravascular volume status, and peripheral vasculature for evidence of thrombosis. By considering the manifestations of COVID-19 on multiple organ systems, Anile et al1 offer a holistic approach to clinical management. We applaud the authors for highlighting several less conventional but very useful applications of critical care ultrasound, all of which can be performed by a single bedside provider, thus limiting infectious exposure to additional staff members. Their clever mnemonic, "C-O-V-I-D," will also serve as a useful cognitive aid to the clinician performing these examinations. In our intensive care units, bedside ultrasound has become a standard tool for assessing and optimizing the management of critically ill COVID-19 patients (Table). Markers of volume status evaluated by bedside ultrasound, such as inferior vena cava (IVC) collapsibility, stroke volume variation, and evaluation of diastolic dysfunction, can help to avoid over diuresis and consequent renal injury in patients undergoing conservative fluid management. We employ ultrasound to monitor response to interventions, including the titration of positive end-expiratory pressure (PEEP) or the administration of pulmonary vasodilators such as nitric oxide, which can have profound hemodynamic effects due to changes in right ventricular (RV) afterload. For patients with refractory hypoxemia for whom ventilation management is challenging, our institution has a dedicated team patients are promising, though they deserve larger studies and robust data to be validated and adopted in clinical practice. We propose a simple, patient-tailored, bedside approach to COVID-19 patients that reflects the multiorgan involvement of SARS-CoV-2.