Prolonged mechanical ventilation in patients with severe COVID-19 is associated with serial modified-lung ultrasound scores: A single-centre cohort study

Abstract

Lung ultrasound (LUS), a rapid, bedside, goal-oriented diagnostic test, can be quantitatively assessed, and the scores can be used to evaluate disease progression. However, little data exists on predicting prolonged mechanical ventilation (PMV) and successful extubation using serial LUS scores. We examined the relationship of PMV with successful extubation in patients with severe coronavirus disease (COVID-19) by using two types of serial LUS scores. One LUS score evaluated both the pleura and lung fields, while the other assessed each separately (modified-LUS score). Both LUS scores were determined for 20 consecutive patients with severe COVID-19 at three timepoints: admission (day-1), after 48 h (day-3), and on the seventh follow-up day (day-7). We compared LUS scores with the radiographic assessment of the lung oedema (RALE) scores and laboratory test results, at the three timepoints. The PMV and successful extubation groups showed no significant differences in mortality, but significant differences occurred on day-3 and day-7 both LUS scores, day-7 RALE score, and day-7 PaO2/FiO2 ratio, in the PMV group (p<0.05); and day-3 and day-7 modified-LUS scores, day-7 C-reactive protein levels, and day-7 PaO2/FiO2 ratio, in the successful extubation group (p<0.05). The area under the curves (AUC) of LUS scores on day-3 and day-7, modified-LUS scores on day-3 and day-7,RALE score on day-7, and PaO2/FiO2 ratio on day-7 in the PMV group were 0.98, 0.85, 0.88, 0.98, 0.77, and 0.80, respectively. The AUC of modified-LUS scores on day-3 and day-7, C-reactive protein levels on day-7, and PaO2/FiO2 ratio on day-7 in the successful extubation group were 0.79, 0.90, 0.82, and 0.79, respectively. The modified-LUS score on day 7 was significantly higher than that on day 1 in PMV group (p<0.05). While the LUS score did not exhibit significant differences. The serial modified-LUS score of patients with severe COVID-19 could predict PMV.

COVID-19 Lung Ultrasound Scores and Lessons from the Pandemic: A Narrative Review

“…The intercostal approach is recommended in the Soldati score [36] and the modified LUS score [47], where not only whether the pleura is involved but also its appearance (i.e., indented or broken in the Soldati score, irregular or blurred in the modified LUS score) is considered. In particular, the modified LUS score evaluates the parenchyma and the pleura separately, which may provide an advantage in prognostic value.…”

“…Dargent et al proposed a score in which a rating of 27 is related to extubation failure and prompt need for NIV support [46]. Conversely, a reduction of the modified LUS score is associated with successful extubation [47].…”

Quality of Life In Post ICU COVID Patients: A Literature Review

“…The chance of developing ventilator-induced pulmonary strain injuries with the length of time a patient is on respiratory support, and lung damage increases with time. [14].…”

Association of Late Radiographic Assessment of Lung Edema Score with Clinical Outcome in Patients with Influenza-Associated Acute Respiratory Distress Syndrome

“…Noncardiogenic pulmonary edema is a critical characteristic of both the pathogenesis and prognosis of ARDS [8], but the current methods for quantifying the severity of pulmonary edema are invasive (e.g., right cardiac catheterization) or time consuming (e.g., computed tomographic imaging). The Radiographic Assessment of Lung Edema (RALE) score is a proposed method for evaluating the density and extent of opacities on chest radiographs in patients diagnosed with ARDS; it can be utilized to assess both the degree of pulmonary edema and the severity of ARDS [9][10][11][12][13][14]. Jabaudon et al reported that changes in the RALE score during the first 3 days after admission to the intensive care unit (ICU) are linked to the survival rate of patients who have ARDS [10].…”