Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study

Abstract

Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival.

Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction

“…Similar COVID-19 pneumonia LUS findings have been already reported [ 13 , 33 ], but none described LUS specifically concerning CD, nor their evolution with treatment during the hospital stay. In our cohort, LUS findings prevalence improved along with successive time points, predominantly in CD− patients, consistent with other patients’ series [ 13 , 46 ]. In contrast, non-survivors showed an increase in the number of consolidations at D10.…”

“…Our data showed that LUS scores obtained at D1 predicted the P/F ratio when using comprehensive cohort data. As reported in the literature, such findings were more pronounced in CD− patients during their hospital stay [ 42 , 46 ]. In CD+ patients, we found no correlation between LUS scores and the P/F ratio until D10.…”

“…LUS is a useful first tool in an emergency setting to help diagnose COVID-19 pneumonia, distinguishing mild from severe forms of acute respiratory distress syndrome [ 10 , 39 – 41 ], and monitoring disease progression [ 7 , 9 , 12 , 42 – 46 ]. The presence of bilateral B-lines, white lung areas with patchy peripheral distribution and sparing areas is the most suggestive LUS picture of COVID-19 [ 41 ].…”

“…LUS score in COVID-19 pneumonia patients correlated with prognosis [ 7 , 9 , 10 , 12 , 46 ]. LUS score is calculated to demonstrate lung involvement and alveolar destruction [ 9 , 10 , 46 , 48 ]. Some B-line signs may be related only to COVID-19 pneumonia [ 39 ].…”

Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances

“…Fifth , Vetrugno et al [ 21 ] found that semi-continuous assessment with LUS score associated with the clinical context could help to understand the patient trajectory, and described four phenotypes: Phenotype 1: patients with clinical improvement independent from the LUS evolution; Phenotype 2: patients who presented a moderate improvement in their ultrasound imaging; Phenotype 3: patients who responded very clearly, with a significant reduction in pulmonary involvement and LUS score; Phenotype 4: patients who, while improving their clinical conditions, did not show an evident improvement from an ultrasound point of view, or presented an apparent worsening in LUS. …”