Usefulness of serial lung ultrasound for a severe COVID-19 patient on extracorporeal membrane oxygenation

Taniguchi, Hayato; Ohta, Souichi; Honzawa, Hiroshi; Takahashi, Kazumasa; Iwashita, Masayuki; Abe, Takeru; Takeuchi, Ichiro

doi:10.1016/j.rmcr.2021.101383

Cited by 6 publications

(10 citation statements)

References 24 publications

(19 reference statements)

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“…Recently, it has been shown that LUS ndings are similar to chest CT ndings, and they are superior to chest radiography ndings for evaluating patients with COVID-19 [36,37]. Indeed, we reported the usefulness of LUS as the sole imaging modality with bedside accessibility to patients for the timely identi cation of pulmonary condition, thus reducing the risk of moving unstable ECMO patients [14]. Furthermore, de Almeida Monteiro et al showed a histological background that supports the fact that LUS can be used to characterise the progression and severity of lung damage in severe COVID-19 [38].…”

Section: Discussionmentioning

confidence: 84%

“…Several studies on the use of LUS in COVID-19 patients, which use CT as the reference standard, have indicated that LUS on admission may predict mortality or the need for invasive mechanical ventilation [13,14,23].…”

Section: Discussionmentioning

confidence: 99%

“…Lung ultrasound (LUS) is a rapid, bedside, goal-oriented, diagnostic test that is used to answer speci c clinical questions, and its ndings have been reported to be consistent with CT ndings [11,12]. Moreover, LUS can be quantitatively assessed, and the serial LUS score can be used to assess disease progression [13,14]. However, there is a concern regarding whether the ultrasound ndings can be reliably interpreted by examiners [15].…”

Section: Introductionmentioning

confidence: 99%

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Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

Taniguchi

Ohya

Yamagata

et al. 2021

Preprint

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Background: Some patients with severe coronavirus disease (COVID-19) who present with fibrosis on computed tomography (CT) require prolonged mechanical ventilation (PMV). Lung ultrasound (LUS), a rapid, bedside test, has been reported to have findings consistent with those of CT. Thus, this study aimed to assess whether serial LUS scores could predict PMV or successful extubation in severe COVID-19 patients.Methods: LUS was performed for 20 consecutive severe COVID-19 patients at three time points: admission (day 1), after 48 h (day 3), and seventh-day follow-up (day 7). We compared the LUS score with the results of chest X-rays and laboratory tests at three time points. Moreover, we assessed LUS score to determine the inter-rater reliability (IRR) of the results among examiners.Results: While there were no significant differences in mortality in each PMV and successful extubation groups, there were significant differences in LUS scores on day 3 and day 7; XP score on day 7; and P/F ratio on day 7 in the PMV group (p<0.05). There were significant differences in LUS scores on days 3 and 7, C-reactive protein (CRP) levels on day 7, and P/F ratio on day 7 in the successful extubation group (p<0.05). The areas under the curves (AUCs) of LUS score on days 3 and 7, XP score on day 7, and P/F ratio were 0.88, 0.98, 0.77, and 0.80, respectively in the PMV group; and the AUCs of LUS score on days 3 and 7, CRP levels on day 7, and P/F ratio 0.79, 0.90, 0.82, and 0.79, respectively, in the successful extubation group. Variations in serial LUS scores exhibited significant differences between the groups. The serial LUS score on day 7 was higher than that on day 1 in the PMV group but lower in the successful extubation group (p<0.05). However, there was slight IRR agreement in the LUS score changes on days 1 to 7 (κ= 0.15 [95% CI: 0-0.31]). Conclusions: The serial LUS score of severe COVID-19 patients could predicted PMV and successful extubation. To overcome IRR disagreement, the automatic ultrasound judgement, such as deep learning, would be needed.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

Taniguchi

Ohya

Yamagata

et al. 2021

Preprint

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“…Ventilation management was performed with pressure-controlled ventilation driving pressure <14 and positive end-expiratory pressure (PEEP), based on a high PEEP table, from the acute respiratory distress syndrome (ARDS) net of respiratory frequency <15 [ 10 ]. FiO2 was adjusted to SpO2 >93%.…”

Section: Methodsmentioning

confidence: 99%

“…Lung ultrasound (LUS) is a rapid, bedside, goal-oriented, diagnostic test used to answer specific clinical questions, and its findings have been reported to be consistent with CT findings [ 7 , 8 ]. Moreover, LUS can be quantitatively assessed, and the serial LUS scores can be used to evaluate disease progression [ 9 , 10 ]. However, there is little knowledge of association of PMV and successful extubation using serial LUS scores.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS

et al. 2021

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Background Lung ultrasound can accurately detect pandemic coronavirus disease (COVID-19) pulmonary lesions. A lung ultrasound score (LUS) was developed to improve reproducibility of the technique. Objectives To evaluate the clinical value of LUS monitoring to guide COVID-19-associated acute respiratory distress syndrome (ARDS) management. Methods We conducted a single center, prospective observational study, including all patients admitted with COVID-19-associated ARDS between March and April 2020. A systematic daily LUS evaluation was performed. Results Thirty-three consecutive patients were included. LUS was significantly and negatively correlated to P aO2 /F IO2 . LUS increased significantly over time in non-survivors compared to survivors. LUS increased in 83% of ventilatory associated pneumonia (VAP) episodes, when compared to the previous LUS evaluation. LUS was not significantly higher in patients presenting post-extubation respiratory failure. Conclusions In conclusion, our study demonstrates that LUS variations are correlated to disease severity and progression, and LUS monitoring could contribute to the early diagnosis of VAPs.

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Usefulness of serial lung ultrasound for a severe COVID-19 patient on extracorporeal membrane oxygenation

Cited by 6 publications

References 24 publications

Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

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

Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS

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