The utility of lung ultrasound in COVID-19 pneumonia in the intensive care unit in real life settings

Abstract

INTRODUCTIONLung ultrasound is a promising tool for the assessment of patients with respiratory failure in the intensive care unit (ICU). A caveat for the wide implementation of lung ultrasound is its operator-dependence. The aim of our study was to assess the utility of lung ultrasound in critically ill patients with COVID-19 pneumonia in real-life conditions. METHODS The multi-center Greek RECUP-19 database was used, which prospectively follows patients with COVID-19 pneumonia hospitalized in an ICU. Lung ultrasound was performed as part of the clinical evaluation within 24 hours upon admission. Six regions (upper/lower at the mid-clavicular, midaxillary and posterior axillary lines) were scanned in each hemithorax, and a score (Lung Ultrasound Score, LUS) was applied (0=normal, 1=multiple discrete B-lines, 2=coalescent B-lines, 3=consolidation). The 28-day mortality, static compliance (Cst), the P:F ratio, and serum CRP were recorded. RESULTSThe study included 29 patients with mean age 67.07 ± 13.69 years. The LUS was not significantly different between survivors (65.5% of patients) and non-survivors (34.5%), (score: 18.58 ± 6.62 vs 22.4 ± 4.20, p=0.11, respectively). LUS was positively correlated with the APACHE-II score (r=0.49, p=0.006) and negatively correlated with Cst (r= -0.39, p=0.03). LUS was not correlated with the P:F ratio or CRP (r= -0.05, p=0.78 and r=0.19, p=0.35, respectively). Patients with Cst ≥40 mL/cmH2O had a lower score, mainly at the anterior segments of the lungs, compared to Cst <40 mL/cmH2O (score: 4.15 ± 2.44 vs 6.75 ± 2.21, p=0.005). CONCLUSIONS LUS is a useful tool for the evaluation of patients with COVID-19 pneumonia in the ICU, which can be implemented in daily clinical practice.