Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

Abstract

Background: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward. Method: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death. Results: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001). Conclusions: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

“…B-lines are vertical hyperechoic laser-like rays arising from the pleural line and extended to the edge of the screen, which move with respiration (a sign called lungsliding). The B-line pattern is the most characteristic sign in COVID-19 with different varieties (separated B-lines, focal, multifocal, coalescent, "rocket sign", "light beam"), reported by most of the studies, with a predominantly posterior and inferior distribution [19][20][21][22][23][24]. The B-lines can coexist with A-lines, in the context of good aeration, called spared areas.…”

Alterações radiológicas presentes no sistema respiratório de pacientes com COVID-19: Uma revisão sistemática de literatura

“…Os foguetes de vidro e a variante Birolleau indicam áreas de vidro fosco na TC. Soma-se a isso, outros achados: descontinuação, irregularidade e espessamento da linha pleural, Linhas B visíveis sob a pleura e consolidações subpleurais (figura 4) (Bar et al, 2020;Mafort et al, 2020;Yasukawa et al, 2020;Yasukawa et al, 2021) Figura 4. Principais achados da POCUS.…”

“…A Figura 4 (a, b, c, d) apresenta esses principais achados, adaptados do estudo de Yasukawa et al (2020) e evidenciados pelos demais estudos que utilizam a POCUS (Bar et al, 2020;Mafort et al, 2020;Yasukawa et al, 2021). Nota-se uma pequena consolidação subpleural (a), a variante Birolleau (pulmão branco) (b), linhas B confluentes (c) e linha pleural espessa e irregular (d).…”

“…Nesse contexto, todos os estudos incluídos apresentaram os principais sinais e sintomas dos pacientes, a dispneia, febre, tosse e fadiga foram os mais indicados, esses sintomas estão associados com a gravidade da doença. Desse modo, houve baixa prevalência dos achados radiológicos em pacientes assintomáticos, sendo os pacientes que apresentaram sintomas tiveram maior gravidade e, consequentemente, maior comprometimento pulmonar (Bar et al, 2020;Dai et al, 2020;Liu et al, 2020: Mafort et al, 2020Parry et al, 2020;Salaffi et al, 2020;Yasukawa et al, 2020;Yasukawa et al, 2021).…”

“…Alguns estudos relatam que essas lesões pulmonares foram totalmente absorvidas em mais da metade dos pacientes após algumas semanas de alta, indicando que os danos causados pelo Sars-CoV-2 podem ser reparados. Contudo, algumas sequelas residuais podem persistir e que futuramente necessitariam de grande atenção dos serviços de saúde (Dai et al, 2020;Liu et al, 2020: Mafort et al, 2020Parry et al, 2020;Salaffi et al, 2020;Yasukawa et al, 2020;Yasukawa et al, 2021).…”