Prospective Longitudinal Evaluation of Point‐of‐Care Lung Ultrasound in Critically Ill Patients With Severe COVID‐19 Pneumonia

Abstract

Objectives To perform a prospective longitudinal analysis of lung ultrasound findings in critically ill patients with coronavirus disease 2019 (COVID‐19). Methods Eighty‐nine intensive care unit (ICU) patients with confirmed COVID‐19 were prospectively enrolled and tracked. Point‐of‐care ultrasound (POCUS) examinations were performed with phased array, convex, and linear transducers using portable machines. The thorax was scanned in 12 lung areas: anterior, lateral, and posterior (superior/inferior) bilaterally. Lower limbs were scanned for deep venous thrombosis and chest computed tomographic angiography was performed to exclude suspected pulmonary embolism (PE). Follow‐up POCUS was performed weekly and before hospital discharge. Results Patients were predominantly male (84.2%), with a median age of 43 years. The median duration of mechanical ventilation was 17 (interquartile range, 10–22) days; the ICU length of stay was 22 (interquartile range, 20.2–25.2) days; and the 28‐day mortality rate was 28.1%. On ICU admission, POCUS detected bilateral irregular pleural lines (78.6%) with accompanying confluent and separate B‐lines (100%), variable consolidations (61.7%), and pleural and cardiac effusions (22.4% and 13.4%, respectively). These findings appeared to signify a late stage of COVID‐19 pneumonia. Deep venous thrombosis was identified in 16.8% of patients, whereas chest computed tomographic angiography confirmed PE in 24.7% of patients. Five to six weeks after ICU admission, follow‐up POCUS examinations detected significantly lower rates ( P < .05) of lung abnormalities in survivors. Conclusions Point‐of‐care ultrasound depicted B‐lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings were significantly decreased by ICU discharge, suggesting persistent but slow resolution of at least some COVID‐19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20% of patients at the bedside, nearly one‐fourth of all patients were found to have computed tomography–proven PE.

Systematic review and meta-analysis of the prevalence of venous thromboembolic events in novel coronavirus disease-2019 patients

“…Systematic searches obtained a total of 2005 citations. After excluding duplicates and applying the inclusion/exclusion criteria, forty-one articles remained and met the inclusion criteria for quality appraisal after the full-text examination ( Figure 1 ) [ 4 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. In the quality assessment, thirty-one articles received a score of 8 out of 9, and nine studies received a score of 9 out of 9.…”

Continuous renal replacement therapy with the addition of CytoSorb cartridge in critically ill patients with COVID‐19 plus acute kidney injury: A case‐series

“…[2][3][4][5] Acute kidney injury (AKI) occurs in 2% to 25% of severe COVID-19 cases, and is associated with worse prognosis. [2][3][4][5][6][7][8] Care for patients with sepsis, ARDS, AKI, and COVID-19 is largely supportive and can include continuous renal replacement therapy (CRRT). Provocatively, CRRT may also remove deleterious cytokines, such as tumor necrosis factor (TNF) α and interleukin (IL) 1β and might, therefore, ameliorate the underlying biochemical disorder.…”

A Retrospective Analysis of Thromboembolic Phenomena in Mechanically Ventilated Patients with COVID-19

“…In this study (April to May 2020), the increased observed prevalence of PE as compared to our previously reported data (lower PE rate) for the month of June 2020 could be explained by the fact that the retrospective data were derived from the early stages of the COVID-19 outbreak in our country [ 5 ]. Hence, the observed discrepancies could reflect the change in our practices such as the integration of a more robust anticoagulation protocol for critically ill COVID-19 patients and better surveillance for the development of TEP [ 5 , 8 ].…”

“…Also, the administration of enhanced anticoagulation in patients with severe COVID-19 and Padua prediction score ≥4 or D-dimers >3.0 μ g/mL was suggested [ 4 ]. Recently, we documented a PE rate of approximately 25% in a point-of-care ultrasound study in critically ill COVID-19 patients [ 5 ]. Herein, we present a brief retrospective analysis of thromboembolic phenomena (TEP) in mechanically ventilated critically ill COVID-19 patients.…”