Can follow up lung ultrasound in Coronavirus Disease-19 patients indicate clinical outcome?

Hoffmann, Tatjana; Bulla, Peter; Jödicke, Lisa; Klein, Constantin; Bott, Sarah M; Keller, Ronald; Malek, Nisar P.; Fröhlich, Eckhart; Göpel, Siri; Blumenstock, Gunnar; Fusco, Stefano

doi:10.1371/journal.pone.0256359

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…Despite the profound difference between CT (tomographic) and ultrasound (exploring only superficial densities), LUS and CT scores showed a weak (but statistically significant) positive linear relationship. This agrees with other observations [ 39 , 40 , 41 ]. A plausible explanation can be found in the prevalent peripheral, subpleural expression of COVID-19 pulmonary injuries [ 11 , 15 ], which can minimize the differences between the two methods (axial and superficial estimates).…”

Section: Discussionsupporting

confidence: 94%

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Lugarà¹,

Tamburrini²,

Coppola³

et al. 2022

Diagnostics

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Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48–72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20–36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F–TC score correlation coefficient of −0.762, p < 0.001, and a P/F–LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19.

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Section: Discussionsupporting

confidence: 94%

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Lugarà¹,

Tamburrini²,

Coppola³

et al. 2022

Diagnostics

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“…This underlines that not only LUS assessed at admission, as shown by several authors [ 7 , 8 , 16 ], can predict clinical course but follow-up assessed LUS can help predict the progression and regression of respiratory failure. This is in line with the experience of an Italian study group [ 10 ] and with the data published by Hoffmann et al [ 17 ]. They showed that follow-up lung ultrasound on days 1, 3, and 5 of hospital stay could predict ICU admission and reasoned that lung ultrasound can indicate impending development of severe disease in COVID-19 patients.…”

Section: Discussionsupporting

confidence: 92%

“…In line with these findings, patients with a positive Δd1/d7, indicating a deterioration of LUS, required invasive ventilation in 92% and had a 90-day mortality of 46%, while patients with a negative Δd1/d7, indicating an improvement of LUS, required invasive ventilation in only 57% and had a 90-day mortality of 0%. These results strengthen several other studies, that LU can be a valuable monitoring tool to assess the course of lunge failure and can detect clinical deterioration early [ 7 , 10 , 17 , 19 ]. In a previous work we could show that LUS significantly increased in case of respiratory deterioration with the need for invasive ventilation [ 8 ].…”

Section: Discussionsupporting

confidence: 88%

Follow-up lung ultrasound to monitor lung failure in COVID-19 ICU patients

et al. 2022

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Objectives Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). To assess the progression or regression of respiratory failure in critically ill patients with COVID-19 on Intensive Care Unit (ICU) by using LU. Materials and methods We analyzed all patients admitted to Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich, from March 2020 to December 2020 suffering lung failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). LU was performed according to a standardized protocol at baseline and at follow up every other day for the first 15 days using a lung ultrasound score (LUSS). Ventilation data were collected simultaneously. Results Our study included 42 patients. At admission to ICU, 19 of them (45%) were mechanically ventilated. Of the non-invasive ventilated ones (n = 23, 55%), eleven patients required invasive ventilation over the course. While LUS did not differ at admission to ICU between the invasive ventilated ones (at baseline or during ICU stay) compared to the non-invasive ventilated ones (12±4 vs 11±2 points, p = 0.2497), LUS was significantly lower at d7 for those, who had no need for invasive ventilation over the course (13±5 vs 7±4 points, p = 0.0046). Median time of invasive ventilation counted 18 days; the 90-day mortality was 24% (n = 10) in our cohort. In case of increasing LUS between day 1 (d1) and day 7 (d7), 92% (n = 12/13) required invasive ventilation, while it was 57% (n = 10/17) in case of decreasing LUS. At d7 we found significant correlation between LU and FiO2 (Pearson 0.591; p = 0.033), p/F ratio (Pearson -0.723; p = 0.005), PEEP (Pearson 0.495; p = 0.043), pplat (Pearson 0.617; p = 0.008) and compliance (Pearson -0.572; p = 0.016). Conclusion LUS can be a useful tool in monitoring of progression and regression of respiratory failure and in indicating intubation in patients with COVID-19 in the ICU.

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“…In a study by Sonnweber et al, it was concluded that serial testing should be considered in patients with persistent symptoms, including serial lung function testing, echocardiography, and CT imaging [30]. LUS has been a more widely used tool in recent years in pulmonary imaging to identify pathological changes in COVID-19 pneumonia in the acute setting [3,5,9,20,[36][37][38]. LUS can function as one of four specified parameters to provide information on hospital admission in acute COVID-19 disease alongside cardiovascular disease, day of illness, and leucocyte count [39].…”

Section: Discussionmentioning

confidence: 99%

One-Year Follow-Up Lung Ultrasound of Post-COVID Syndrome—A Pilot Study

et al. 2022

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(1) Background: Millions of people worldwide were infected with COVID-19. After the acute phase of the disease, many suffer from prolonged symptoms, the post-COVID syndrome, especially the phenotype with lung residuals. Many open questions regarding lung ultrasound (LUS) have to be answered. One essential question is the means for optimal following-up of patients with post-COVID-19 residuals with LUS; (2) Methods: A retrospective data analysis of patients after acute COVID-19 infection diagnosed with post-COVID syndrome in the state hospital of Steyr and the rehabilitation center of Hochegg was performed. LUS examinations following a 12-zone scanning protocol were performed, and the LUS score quantified comet tail artifacts. A total of 16 patients were evaluated twice with LUS from May 2020 until June 2021. (3) Results: All patients’ reverberation artifacts were reduced over time. The initial LUS score of 17.75 (SD 4.84) points was decreased over the duration of the second rehabilitation to 8,2 (SD 5.94). The difference in the Wilcoxon test was significant (p < 0.001); (4) Conclusions: Lung ultrasound was a valuable tool in the follow-up of post-COVID-syndrome with lung residuals in the first wave of COVID-19. A reduction in reverberation artifacts was demonstrated. Further studies about the clinical significance have to follow.

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Can follow up lung ultrasound in Coronavirus Disease-19 patients indicate clinical outcome?

Cited by 6 publications

References 26 publications

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management

Follow-up lung ultrasound to monitor lung failure in COVID-19 ICU patients

One-Year Follow-Up Lung Ultrasound of Post-COVID Syndrome—A Pilot Study

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