Treating COVID-19 pneumonia with ultrasound
Since a few months, INRiM has been cooperating with Fondazione IRCCS Istituto Neurologico Carlo Besta, providing knowledge and instrumentation to the laboratory for ultrasound therapy of nervous system disorders.
Since the outbreak of COVID-19 pandemic, neurosurgeon Francesco Prada from Istituto Neurologico Carlo Besta and INRiM technologist Giovanni Durando have been working on a therapy to treat interstitial pneumonia that affects some of the patients tested positive for COVID-19. The method is based on low intensity ultrasound treatment of pulmonary pathology.
Dr. Durando, what idea is your proposal based on?
Starting from the synergy between the experience on clinical application of ultrasound for therapy that dr. Prada gained working at the Focused Ultrasound Foundation (USA), and my technical experience, we thought about using ultrasounds to treat patients tested positive for COVID-19.
Specifically, we could treat inflamed lung tissues, which become fibrotic because of the interstitial pneumonia that affects patients. We would like to use the mechanical and thermal principles typical of interaction between ultrasound beam and propagation medium, the same used in physical therapy: pulmonary inflammation would be treated by means of mechanical solicitation induced by the ultrasound beam, with a potential healing action.
An example: after a race or hard training, professional athletes have tired and inflamed muscles, so they get a massage. Thanks to masseur's mechanical movements, the muscle tissue warms up, blood circulation increases and the inflammation is resolved. We can apply the same principle employing ultrasound, using the radiation force principle of the ultrasound beam. During this treatment, we apply a force directly on the area of tissue that is penetrated by the ultrasound beam. The force acts on the tissue by increasing blood circulation which, thanks to iperossigenation, starts a healing process in the treated area.
Is it possible to use this effect on lung tissue as well?
Usually lung tissue is not ideal for ultrasound therapy, because it is normally full of air and so can’t conduct ultrasound waves. But in some cases, such as the ones we find in COVID-19 patients’ lungs, where large pulmonary areas are filled with fluids and thus become fibrotic, these could be treated like a muscle tissue.
As opposed to muscle tissues, not isolated by hard tissues like bones, the lung is wrapped in the rib cage. Hard tissues prevent the ultrasound beam from propagating underneath, because the beam is mostly reflected. That’s why, in order to treat lung tissue, we need to apply the ultrasound beam to the ligament interstitial tissue in between the ribs, so that it is allowed to pass through the rib cage and reach the lung deep regions.
Will your research be feasibly active in the near future?
Istituto Neurologico Carlo Besta is not directly involved in treating infectious diseases, but we are in contact with a scientific partner actively involved in COVID-19 treatment. They are interested in testing our method, for both the severe and the post traumatic stages of this disease. Of course, it is still too early to talk about large clinical applications; more research and trials are needed to further develop the proposal.