LAUSR

COVID-19 is the name of the disease caused by the new coronavirus. Old age is a well-known risk factor for developing a symptomatic COVID-19 disease [1, 2] and for more severe disease with poor prognosis and high mortality [3, 4]. Available evidence show that COVID-19 mortality sharply increases with age [5–7]. For these reasons, it is extremely important to rapidly identify SARS-CoV2 infection to achieve a point-of-care diagnosis and establish appropriate treatment. Lung ultrasound (LUS) could be invaluable in allowing a quick evaluation of patients with suspected or confirmed COVID-19 disease in different settings, starting from the Emergency Department (ED). First, clinical presentation of SARS-Cov2 infection is different in advanced age compared to the rest of population. In older patients, typical symptoms such as fever or cough [8] might be blunted or even absent [9]. Often atypical symptoms, such as fatigue, anorexia, delirium, falls, and functional decline, might be present [8, 10]. Therefore, the initial diagnosis is more difficult. Moreover, delirium, which is a well-known presenting condition of COVID-19 infection in older subjects [11], might hinder the diagnostic evaluation and treatment. In older patients with delirium or dementia, even a chest X-ray can be difficult to perform, and even more so, exams such as computed tomography (CT) that require patient collaboration. On the other hand, the use of sedative or antipsychotic medications to perform these diagnostic exams may be counterproductive due to the possibility of adverse effects like, for example, prolongation of the QTc interval or impairment of respiration. On the other hand, a longer stay in the ED is associated with negative outcomes in older patients, such as delirium or falls [12]. For this reason, rapid and noninvasive diagnostic strategies are important to make an early diagnosis in the ED. Lung ultrasound fulfills all these requirements. It is well established and validated that the Bedside Lung Ultrasound in Emergency (BLUE) protocol [13] plays a pivotal role in the assessment of all patients presenting with acute respiratory failure (ARF) in emergency/ urgency integrating perfectly with the physical examination [14]. Lung ultrasound could be also valuable to support COVID-19 diagnosis and monitoring in out of hospital settings, i.e., at home or in nursing homes, reducing the need to be admitted to the hospital [15–18]. A recent observational research involving 48 older nursing home residents, aged a mean of 84.1 ± 9.8 years, undergoing LUS examination made within 3 days from the positivity of nasopharyngeal swab test for COVID-19, demonstrated that LUS plays a significant role in predicting mortality in nursing home residents affected by COVID-19. This study underlines the need to use routinely LUS in this scenario instead of other diagnostic techniques available only in the hospital [16]. There are also practical experiences on how it is possible to carry out lung ultrasound at home in patients affected by SARSCoV2 [19]. In non-hospital settings, lung ultrasound allows to carry out a noninvasive instrumental monitoring by visualizing in real-time any modification of lung patterns and consequently providing precious information about patient clinical conditions, evolution and prognosis, allowing to detect deterioration as well as patient improvement [20]. Concerning the approach to perform LUS in older patients with suspected COVID-19, hereafter practical information is provided, on the basis of the available scientific evidence and experience gained at our center [21]. LUS examination can be performed using high-frequency linear or convex transducers, depending on the need to study better the pleural line or to get a panoramic vision of the lung, as well as operator preference [21]. It is advisable to put the probe along the longitudinal axis using an intercostal approach. This conventional position allows to visualize the upper and lower ribs as reference points and to scan * Costantino Caroselli [email protected]