Clinical correlation of lung ultrasound profiles in patients with COVID-19 infection (original) (raw)
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Lung Ultrasound Can Predict the Clinical Course and Severity of COVID-19 Disease
Ultrasound in Medicine & Biology, 2021
Coronavirus disease 2019 (COVID-19) compromises the lung in large numbers of people. The development of minimally invasive methods to determine the severity of pulmonary extension is desired. This study aimed to describe the characteristics of sequential lung ultrasound and to test the prognostic usefulness of this exam in a group of patients admitted to the hospital with COVID-19. We prospectively evaluated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to our hospital between April and August 2020. Bedside lung ultrasound exams were performed at three time points: at inclusion in the study, after 48 h and on the seventh day of follow-up. Lung ultrasound scores were quantified according to the aeration loss in each of eight zones scanned. Sixty-six participants were included: 42 (63.6%) in the intensive care unit and 24 (36.3%) in the ward. Lung ultrasound scores were higher in participants admitted to the intensive care unit than in those admitted to the ward at the time of inclusion (16 [13À17] vs. 10 [4À14], p < 0.001), after 48 h (15.5 [13À17] vs. 12.5 [8.2À14.7], p = 0.001) and on the seventh day (16 [14À17] vs. 7 [4.5À13.7], p < 0.001) respectively. Lung ultrasound score measured at the time of inclusion in the study was independently associated with the need for admission to the intensive care unit (odds ratio = 1.480; 95% confidence interval, 1.093À2.004; p = 0.011) adjusted by the Sequential Organ Failure Assessment score.
Role of Lung Ultrasound in Predicting Clinical Severity and Fatality in COVID-19 Pneumonia
Journal of Personalized Medicine
Background: Lung ultrasound (LUS) is a useful imaging method for identifying COVID-19 pneumonia. The aim of this study was to explore the role of LUS in predicting the severity of the disease and fatality in patients with COVID-19. Methods: This was a single-center, follow-up study, conducted from 1 November 2020, to 22 March 2021. The LUS protocol was based on the assessment of 14 lung zones with a total score up to 42, which was compared to the disease severity and fatality. Results: A total of 133 patients with COVID-19 pneumonia confirmed by RT-PCR were enrolled, with a median time from hospital admission to lung ultrasound of one day. The LUS score was correlated with clinical severity at hospital admission (Spearman’s rho 0.40, 95% CI 0.24 to 0.53, p < 0.001). Patients with higher LUS scores were experiencing greater disease severity; a high flow nasal cannula had an odds ratio of 1.43 (5% CI 1.17–1.74) in patients with LUS score > 29; the same score also predicted the n...
Lung ultrasound as a prognostic tool in emergency patients clinically suspected of COVID-19
2021
INTRODUCTION Tools to quickly triage and evaluate patients with suspected COVID-19 in an emergency department (ED) can improve patient care and reduce risk of overcrowding. The aim of this study was to evaluate if lung ultrasound (LUS) may provide valuable prognostic information in adult patients suspected of COVID-19. METHODS A prospective cohort study of adult patients in an ED was conducted. LUS was performed within one hour of the patients' arrival; COVID-19 was defined by a respiratory syndrome coronavirus 2 RNA positive test. The primary outcome was the proportion of patients suspected of COVID-19 and normal LUS with critical outcomes during follow-up, defined as one or more of the following: need of non-invasive ventilation (NIV), invasive mechanical ventilation, intensive care unit (ICU) stay or death. Follow-up was 14 days. RESULTS A total of 83 patients were included between 9 March and 12 April 2020. In all, 47 (57%; 95% confidence interval (CI): 45.3-67.5%) had a nor...
New Score to Diagnose Covid 19 Infection Using Lung Ultrasound
2020
Background: PCR used for SARS-CoV-2 diagnosis is variable and unstable. Lung ultrasound has good safety and accuracy in pneumonia. We aim to evaluate the ability of bedside lung ultrasound in suspecting the diagnosis and/or predicting the prognosis of Covid 19 infection. Patients & Methods: We recruited any case with pulmonary symptoms necessitating admission in intermediate care and/or ICU during the period between 27th March and 11th April 2020 in 3 international centres. Patients were stratified according to Covid 19 PCR results. All patients underwent chest X ray, CT, lung ultrasound, echocardiography and laboratory analysis. Results: Eighty-two cases were recruited. Fifty cases (61%) were negative for SARS-CoV-2 while 32 cases (39%) were positive. Sixty-four cases (78%) were recovered while 18 cases (22%) died. Covid 19 patients had more A profile and more abnormal A lines than non-Covid 19 group (p<0.001). Smoking, congestion in X ray, A profile and abnormal A lines in lung ULS are independent predictors for Covid 19 infection. A scoring system for prediction of Covid 19 using clinical and radiological data was calculated with a sensitivity of 93.8% and a specificity of 58%. Mortality in Covid 19 patients is significantly correlated with age, duration of fever, presence of cardiac disease, B profile and abnormal A lines by lung ULS. However, it is negatively correlated with initial O2 saturation and EF by echocardiography Conclusion: Lung ULS could predict SARS-CoV-2 infection among patients with pulmonary symptoms necessitating admission. Lung ULS can also predict the outcome of Covid 19 infected patients. Introduction: Covid 19 (SARS-CoV-2) pandemic is the most serious medical problem worldwide nowadays. One of the primary findings for COVID-19 is pneumonia (1)(2). Many cases with chest infection may have similar symptoms and signs with SARS-CoV-2 infection. Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay is the test widely used to diagnose SARS-CoV-2 (3). However, RT-PCR test results of pharyngeal swab specimens have some variability and potential instability, therefore it should not be considered as the only indicator for diagnosis (4) Although Covid 19 infected patients have some typical radiological CT findings even in asymptomatic patients (5), atypical findings are increasingly common. Uptill now the role of CT poorly defined for diagnosis of
The Risk of Hospitalization in COVID-19 Patients Can Be Predicted by Lung Ultrasound in Primary Care
International Journal of Environmental Research and Public Health, 2021
Background: The usefulness of Lung Ultrasound (LUS) for the diagnosis of interstitial syndrome caused by COVID-19 has been broadly described. The aim of this study was to evaluate if LUS may predict the complications (hospital admission) of COVID-19 pneumonia in primary care patients. Methods: This observational study collects data from a cohort of 279 patients with clinical symptoms of COVID-19 pneumonia who attended the Balaguer Primary Health Care Area between 16 March 2020 and 30 September 2020. We collected the results of LUS scans reported by one general practitioner. We created a database and analysed the absolute and relative frequencies of LUS findings and their association with hospital admission. We found that different LUS patterns (diffuse, attenuated diffuse, and predominantly unilateral) were risk factors for hospital admission (p < 0.05). Additionally, an evolutionary pattern during the acute phase represented a risk factor (p = 0.0019). On the contrary, a normal ...
Lung Ultrasound Predicts Clinical Severity of COVID-19 Pneumonia
Journal of Perioperative Echocardiography, 2019
Background: Lung ultrasound is an easily available bedside imaging modality that has good specificity for the diagnosis of coronavirus disease-2019 (COVID-19). Limited evidence is available on its utility to predict clinical severity. Materials and methods: In this prospective observational study, adult patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) of a tertiary care hospital between June 2020 and August 2020 were included. Lung ultrasound was performed in at least four areas in each examination and video loops were scored by two independent observers. The statistical relationship was assessed between median lung ultrasound score, chest X-ray score, P/F ratio (ratio of the partial pressure of oxygen in arterial blood to the fraction of inspired oxygen), ROX index, SOFA score, ICU stay, and mortality. Results: Fifty lung ultrasound examinations were performed in 29 patients of age 54.7 ± 15.3 years. P/F ratio was <300 mm Hg during 80% of the examinations. There was moderate correlation between median lung ultrasound score and both ROX index (Spearman's rho = −0.543, p < 0.001) and P/F ratio (rho = −0.522, p < 0.001), while there was weak correlation between chest X-ray score and ROX index (rho = −0.0.345, p = 0.019) and no correlation between chest X-ray score and P/F ratio. There was correlation between chest X-ray score and ICU stay (rho = 0.434, p = 0.049). There was no difference in any of the parameters between survivors and non-survivors. Moderate inter-observer agreement was present between the two observers. Conclusion: Bedside lung ultrasound examination, even with a limited number of views, can reflect the clinical severity of COVID-19 pneumonia.
The use of lung ultrasound in COVID-19
ERJ Open Research
This review article addresses the role of lung ultrasound in patients with coronavirus disease 2019 (COVID-19) for diagnosis and disease management. As a simple imaging procedure, lung ultrasound contributes to the early identification of patients with clinical conditions suggestive of COVID-19, supports decisions about hospital admission and informs therapeutic strategy. It can be performed in various clinical settings (primary care facilities, emergency departments, hospital wards, intensive care units), but also in outpatient settings using portable devices.The article describes typical lung ultrasound findings for COVID-19 pneumonia (interstitial pattern, pleural abnormalities and consolidations), as one component of COVID-19 diagnostic workup that otherwise includes clinical and laboratory evaluation. Advantages and limitations of lung ultrasound use in COVID-19 are described, along with equipment requirements and training needs. To infer on the use of lung ultrasound in differ...
Frontiers in Medicine
IntroductionLung ultrasound (LUS) has proven to be a more sensitive tool than radiography (X-ray) to detect alveolar-interstitial involvement in COVID-19 pneumonia. However, its usefulness in the detection of possible pulmonary alterations after overcoming the acute phase of COVID-19 is unknown. In this study we proposed studying the utility of LUS in the medium- and long-term follow-up of a cohort of patients hospitalized with COVID-19 pneumonia.Materials and methodsThis was a prospective, multicentre study that included patients, aged over 18 years, at 3 ± 1 and 12 ± 1 months after discharge after treatment for COVID-19 pneumonia. Demographic variables, the disease severity, and analytical, radiographic, and functional clinical details were collected. LUS was performed at each visit and 14 areas were evaluated and classified with a scoring system whose global sum was referred to as the “lung score.” Two-dimensional shear wave elastography (2D-SWE) was performed in 2 anterior areas...
Lung ultrasound predicts clinical course and outcomes in COVID-19 patients
Intensive Care Medicine
Information regarding the use of lung ultrasound (LUS) in patients with Coronavirus disease 2019 (COVID-19) is quickly accumulating, but its use for risk stratification and outcome prediction has yet to be described. We performed the first systematic and comprehensive LUS evaluation of consecutive patients hospitalized with COVID-19 infection, in order to describe LUS findings and their association with clinical course and outcome. Methods: Between 21/03/2020 and 04/05/2020, 120 consecutive patients admitted to the Tel Aviv Medical Center due to COVID-19, underwent complete LUS within 24 h of admission. A second exam was performed in case of clinical deterioration. LUS score of 0 (best)-36 (worst) was assigned to each patient. LUS findings were compared with clinical data. Results: The median baseline total LUS score was 15, IQR [7-20]. Baseline LUS score was 0-18 in 80 (67%) patients, and 19-36 in 40 (33%) patients. The majority had patchy pleural thickening (n = 100; 83%), or patchy subpleural consolidations (n = 93; 78%) in at least one zone. The prevalence of pleural thickening, subpleural consolidations and the total LUS score were all correlated with severity of illness on admission. Clinical deterioration was associated with increased follow-up LUS scores (p = 0.0009), mostly due to loss of aeration in anterior lung segments. The optimal cutoff point for LUS score was 18 (sensitivity = 62%, specificity = 74%). Both mortality and need for invasive mechanical ventilation were increased with baseline LUS score > 18 compared to baseline LUS score 0-18. Unadjusted hazard ratio of death for LUS score was 1.08 per point [1.02-1.16], p = 0.008; Unadjusted hazard ratio of the composite endpoint (death or need for invasive mechanical ventilation) for LUS score was 1.12 per point [1.05-1.2], p = 0.0008. Conclusion: Hospitalized patients with COVID-19, at all clinical grades, present with pathological LUS findings. Baseline LUS score strongly correlates with the eventual need for invasive mechanical ventilation and is a strong predictor of mortality. Routine use of LUS may guide patients' management strategies, as well as resource allocation in case of surge capacity.