Lung ultrasound in predicting COVID‐19 clinical outcomes: A prospective observational study

Chardoli, Mojtaba; Kermani, S. Sabbaghan; Manqoutaei, Sanaz Abdollahzade; Loesche, Michael A.; Duggan, Nicole; Schulwolf, Sara; Tofighi, R.; Yadegari, Sina; Shokoohi, Hamid

doi:10.1002/emp2.12575

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…The investigators however did not describe individual features of the LUS such as A lines, B lines, and pleural disease and used a high cutoff to optimize sensitivity ( 9 ). In contrast to our findings of pleural irregularities among more severely ill participants, hospital-based cohort in Iran identified pleural thickening to be present in 95% of participants, but the undescribed criteria may have been lower than our greater than or equal to 0.5 cm cutoff ( 18 ). Although other studies have generally used a sum of all 12 lung zones ( 5 , 8 , 9 , 19 , 20 ), our study found the risk estimates were unchanged when some lung fields were not obtainable due to clinical instability.…”

Section: Discussioncontrasting

confidence: 99%

Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Blair

Siddharthan

Liu

et al. 2022

Critical Care Explorations

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The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear.DESIGN: Prospective cohort study. SETTING:A large tertiary care center in Maryland, between April 2020 and September 2021. PATIENTS:Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28 days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive mechanical ventilation, within 28 days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5-1.3). Following enrollment, 27 participants (10.0%) went on to require ICU-level care, and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27-10.2) and 28-day mortality (aHR, 3.10; 95% CI,. Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI,. CONCLUSIONS:Participants with a mLUSS greater than or equal to 1 or pleural line changes on LUS had an increased likelihood of subsequent requirement of high-flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

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Section: Discussioncontrasting

confidence: 99%

Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Blair

Siddharthan

Liu

et al. 2022

Critical Care Explorations

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“…Baseline diagnosis can cause several of the LUS findings, but the correlation of LUSS with FiO 2 needed, the differences between disease severity and ventilatory support groups, and the decrease with patient improvement show its usefulness as a monitoring tool. As shown by different publications, LUS is a useful tool in clinical examination and can quantify the loss of aeration at the bedside (29,30). Sequential assessments can help the clinician identify improvement or worsening; thus, they can be used to classify the severity of the disease and follow its progress (31).…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound Characteristics in Neonates With Positive Real Time Polymerase Chain Reaction for SARS-CoV-2 on a Tertiary Level Referral Hospital in Mexico City

et al. 2022

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IntroductionAcute respiratory syndrome secondary to SARS-CoV-2 virus infection has been declared a pandemic since December 2019. On neonates, severe presentations are infrequent but possible. Lung ultrasound (LUS) has been shown to be useful in diagnosing lung involvement and following up patients, giving more information, and reducing exposure compared to traditional examination.MethodsLUS was performed after the diagnosis of SARS-CoV-2 infection with respiratory Real Time Polymerase Chain Reaction RT-PCR with portable equipment protected with a silicone sleeve. If hemodynamic or cardiology consultation was necessary, a prepared complete ultrasound machine was used. Ten regions were explored (anterior superior and inferior, lateral, and posterior superior and inferior, right and left), and a semiquantitative score (LUSS) was calculated. Disease severity was determined with a pediatric modified score.ResultsThirty-eight patients with positive RT-PCR were admitted, 32 (81%) of which underwent LUS. Included patients had heterogenous diagnosis and gestational ages as expected on a referral neonatal intensive care unit (NICU) (median, ICR: 36, 30–38). LUS abnormalities found were B-line interstitial pattern 90%, irregular/interrupted/thick pleural line 88%, compact B-lines 65%, small consolidations (≤5 mm) 34%, and extensive consolidations (≥5 mm) 37%. Consolidations showed posterior predominance (70%). LUSS showed a median difference between levels of disease severity and ventilatory support (Kruskal–Wallis, p = 0.001) and decreased with patient improvement (Wilcoxon signed-rank test p = 0.005). There was a positive correlation between LUSS and FiO2 needed (Spearman r = 0.72, p = 0.01). The most common recommendation to the attending team was pronation (41%) and increase in positive end expiratory pressure (34%). Five patients with comorbidities died. A significant rank difference of LUSS and FiO2 needed between survivors and non-survivors was found (Mann–Whitney U-test, p = 0.005).ConclusionLUS patterns found were like the ones described in other series (neonatal and pediatrics). Eighty-eight percent of the studies were performed with handheld affordable equipment. While there is no specific pattern, it varies according to gestational age and baseline diagnosis LUS, which were shown to be useful in assessing lung involvement that correlated with the degree of disease severity and respiratory support.

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“…While these results suggest clinicians felt the potential advantages of LUS did not consistently outweigh barriers to use in the management of all patients with COVID-19, it is important to note that the perceived barriers are likely dynamic. For instance, lack of evidence for support of LUS in COVID-19 could change with time as there have been multiple studies demonstrating utility in COVID-19 published since our pilot ended [34][35][36]. This may allow a more targeted approach to utilize LUS in the COVID-19 patients who would most benefit.…”

Section: Discussionmentioning

confidence: 99%

Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study

Maw

Morris

Glasgow

et al. 2022

Implement Sci Commun

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Background Lung ultrasound (LUS) is a clinician-performed evidence-based imaging modality that has multiple advantages in the evaluation of dyspnea caused by multiple disease processes, including COVID-19. Despite these advantages, few hospitalists have been trained to perform LUS. The aim of this study was to increase adoption and implementation of LUS during the 2020 COVID-19 pandemic by using recurrent assessments of RE-AIM outcomes to iteratively revise our implementation strategies. Methods In an academic hospital, we implemented guidelines for the use of LUS in patients with COVID-19 in July 2020. Using a novel “RE-AIM dashboard,” we used an iterative process of evaluating the high-priority outcomes of Reach, Adoption, and Implementation at twice monthly intervals to inform revisions of our implementation strategies for LUS delivery (i.e., Iterative RE-AIM process). Using a convergent mixed methods design, we integrated quantitative RE-AIM outcomes with qualitative hospitalist interview data to understand the dynamic determinants of LUS Reach, Adoption, and Implementation. Results Over the 1-year study period, 453 LUSs were performed in 298 of 12,567 eligible inpatients with COVID-19 (Reach = 2%). These 453 LUS were ordered by 43 out of 86 eligible hospitalists (LUS order adoption = 50%). However, the LUSs were performed/supervised by only 8 of these 86 hospitalists, 4 of whom were required to complete LUS credentialing as members of the hospitalist procedure service (proceduralist adoption 75% vs 1.2% non-procedural hospitalists adoption). Qualitative and quantitative data obtained to evaluate this Iterative RE-AIM process led to the deployment of six sequential implementation strategies and 3 key findings including (1) there were COVID-19-specific barriers to LUS adoption, (2) hospitalists were more willing to learn to make clinical decisions using LUS images than obtain the images themselves, and (3) mandating the credentialing of a strategically selected sub-group may be a successful strategy for improving Reach. Conclusions Mandating use of a strategically selected subset of clinicians may be an effective strategy for improving Reach of LUS. Additionally, use of Iterative RE-AIM allowed for timely adjustments to implementation strategies, facilitating higher levels of LUS Adoption and Reach. Future studies should explore the replicability of these preliminary findings.

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Lung ultrasound in predicting COVID‐19 clinical outcomes: A prospective observational study

Cited by 6 publications

References 39 publications

Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Lung Ultrasound Characteristics in Neonates With Positive Real Time Polymerase Chain Reaction for SARS-CoV-2 on a Tertiary Level Referral Hospital in Mexico City

Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study

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