Point-of-care ultrasound findings among dialysis patients with COVID-19

Background: Dialysis patients are vulnerable in the COVID-19 pandemic due to advanced age, comorbidities, and obligate travel with frequent healthcare contacts Pointof- care cardiac and lung ultrasound (US) has been used to enhance the physical exam in dialysis patients and is a potent tool for assessment COVID-19, comparing favorably to computed tomography Here we report findings of focused cardiac and lung US among dialysis patients in an acute care setting Methods: This is a cohort of dialysis patients who presented to our institution in Spring of 2020 with COVID-19 All patients started dialysis prior to the index acute care visit Focused 5-view cardiac assessment and 12-zone lung US were obtained according to published protocols Results: 25 patients were included 88% were African American 64% were female Mean age was 61 96 and body mass index was 25 8 kg/ m2 56% had history of heart failure, 28% lung disease 15 (60%) were discharged with mean length of stay 10 days 36% required invasive mechanical ventilation and 56% intensive care unit admission 23 patients had cardiac US 17 had an ejection fraction (EF) >55%, 3 had EF 30-55%, 1 had EF <30% 23 had inferior vena cava (IVC) assessment, 18 had a normal or collapsed IVC, and 5 had a full, non-collapsing IVC 3 had pericardial effusion 4 had right-ventricular dysfunction 25 completed anterior lung US zones and 12 also had posterior lung US In at least 1 lung zone 16 (64%) had confluent B-lines, 16 (64%) consolidations, 16 (64%) isolated B-lines, and 17 (68%) pleural thickening 8 had pleural effusions (3 bilateral) Conclusions: We showed a high prevalence of thickened pleural lines, subpleural consolidations, and multifocal or confluent B-lines among dialysis patients with COVID-19 Most had a normal or collapsed IVC and intact cardiac function Pleural and pericardial effusions were uncommon More study is needed to determine whether US findings can help guide fluid management in dialysis patients (Figure Presented)