Focused lung ultrasound to predict respiratory failure in patients with symptoms of COVID-19: a multicentre prospective cohort study

Abstract

Background In this study we aimed to assess if a focused lung ultrasound examination predict the need for mechanical ventilation admission to an intensive care unit, high-flow oxygen treatment, death of COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection. Methods A multicenter prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed. Results A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (RR 2.44, 95% CI 1.32–5.52), admission to intensive care (RR 2.55, 95% CI 1.41–54.59) and high-flow oxygen treatment (RR 1.95, 95% CI 1.5–2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in AUC-ROC between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones. Conclusion Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and high-flow oxygen. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms.

Qualitative and semi-quantitative ultrasound assessment in delta and Omicron Covid-19 patients: data from high volume reference center

“…Today, several Computed Tomography (CT) severity scores have been proposed [ 120 - 125 ] and, although CT is thought to play a key role COVID-19 patient diagnostic work-up [ 4 - 13 , 108 , 126 - 143 ], however the transport of infected patients for a CT scan followed requires necessary decontamination procedures that makes this procedure risky and time consuming [ 118 ]. According to the WHO [ 35 ], COVID‐19 patient, that require hospitalization for moderate–severe disease, will need supplementary oxygen and consistent observing to facilitate early recognition and escalation of the deteriorating patient.…”

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care

“…Fortunately LUS may have comparable results to chest CT with markedly reduced logistical challenges [ 35 ]. Thus, lung ultrasound has been recommended for increased use in all these roles [ 36 , 37 , 38 , 39 , 40 , 41 ]. Most of the mortality in COVID is due to respiratory failure, typically beginning ten days after exposure with the progression of infection from the nasopharynx to the lungs [ 42 ].…”

Thelung ultrasound in children with SARS-COV 2 infection: a national multicenter prospective study

“…As Covid-19 pneumonia mainly affects the peripheral areas of the lungs, early preliminary studies in both adults and children have documented that Lung Ultrasound (LUS) can easily detect low respiratory tract infection (LRTI) during SARS-CoV-2 [8]. However, while several adult studies on large cohorts have documented also a prognostic role of LUS in predicting hospitalizations and severe outcomes in infected adults, pediatric studies have provided less conclusive information, as they mostly included a small number of patients from single centers and without enough patients with moderate/severe disease [9][10][11][12][13][14][15][16][17][18]. For these reasons, we performed this multicenter national study in order to better characterize the clinical and prognostic role of LUS in children with Covid-19 assessed in the PED.…”