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

Abstract

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.

Point-of-care ultrasound use in COVID-19: a narrative review

“…Zieleskiewicz et al showed that LUS score was doubled in mechanically ventilated patients ( 21 ), and all patients requiring mechanical ventilation had LUS score >19 ( 21 , 106 - 108 ). LUS score was significantly lower at day 7 of ICU admission for those who did not require invasive ventilation versus those who were intubated ( 106 ). Majority of patients (92%) with increasing LUS score at day 7 required invasive ventilation compared to only 57% in the group with decreasing LUS score ( 106 ).…”

“…LUS score was significantly lower at day 7 of ICU admission for those who did not require invasive ventilation versus those who were intubated ( 106 ). Majority of patients (92%) with increasing LUS score at day 7 required invasive ventilation compared to only 57% in the group with decreasing LUS score ( 106 ). Hence, serial LUS measurements in ICU patients may be useful to predict the need for mechanical ventilation, to support patients’ respiratory functions in a timely fashion.…”

“…Hence, serial LUS measurements in ICU patients may be useful to predict the need for mechanical ventilation, to support patients’ respiratory functions in a timely fashion. During mechanical ventilation, LUS continued to be a valuable tool in monitoring respiratory failure and response to titration of mechanical ventilation, as worsening LUS score has been shown to significantly correlate with deteriorating ventilation parameters such as positive end expiratory pressure, FiO 2 and PaO 2 /FiO 2 ratio ( 101 , 106 ). The global LUS score was associated with successful extubation ( 109 ), independent of when the ultrasound was performed and severity of disease.…”

Lung ultrasound monitoring: impact on economics and outcomes

“…After the outbreak of SARS-CoV-2 epidemic, a radiology panel of expert stressed on the importance of findings in CT scan in hospital admitted patients [30]; however, the limited resources to treat the high number of patients made CT scan for all patients unsustainable and LUS gained popularity in emergency departments, wards and ICU [31,32 ▪▪ ,33,34 ▪ ,35 ▪ ]. A recent Cochrane systematic review and meta-analysis reports that chest X-ray has a pooled sensitivity of 73.1% (95% confidence interval [CI] 64.1–80.5) and specificity of 73.3% (95% CI 61.9–82.2), whereas LUS is characterized by a sensitivity of 88.9% (95% CI 84.9–92.0) and specificity of 72.2% (95% CI 58.8–82.5) [36 ▪▪ ].…”

Evaluation of the prognostic value of lncRNA UCA1 combined with extravascular lung water index and lung ultrasound score in patients with acute lung injury

“…Pulmonary ultrasound has become a routine examination of various lung diseases 10 . Lung ultrasound can evaluate pleural effusion, pneumothorax, and changes in lung parenchyma, and it is an important way to diagnose and predict lung lesions 11 . Thus, these arouse our interest.…”