Serial Lung Ultrasound in Monitoring Viral Pneumonia: the Lesson Learned from COVID-19

Overview

Journal ERJ Open Res

Specialty Pulmonary Medicine

Date 2023 Aug 16

PMID 37583967

Authors

David Clofent

Mario Culebras

Almudena Felipe-Montiel

Marta Arjona-Peris

Galo Granados

Maria Saez

Florencia Pilia

Antia Ferreiro

Antonio Alvarez

Karina Loor

Pau Bosch-Nicolau

Eva Polverino

Affiliations

Soon will be listed here.

Abstract

Background: Lung ultrasound (LUS) has proven to be useful in the evaluation of lung involvement in COVID-19. However, its effectiveness for predicting the risk of severe disease is still up for debate. The aim of the study was to establish the prognostic accuracy of serial LUS examinations in the prediction of clinical deterioration in hospitalised patients with COVID-19.

Methods: Prospective single-centre cohort study of patients hospitalised for COVID-19. The study protocol consisted of a LUS examination within 24 h from admission and a follow-up examination on day 3 of hospitalisation. Lung involvement was evaluated by a 14-area LUS score. The primary end-point was the ability of LUS to predict clinical deterioration defined as need for intensive respiratory support with high-flow oxygen or invasive mechanical ventilation.

Results: 200 patients were included and 35 (17.5%) of them reached the primary end-point and were transferred to the intensive care unit (ICU). The LUS score at admission had been significantly higher in the ICU group than in the non-ICU group (22 (interquartile range (IQR) 20-26) 12 (IQR 8-15)). A LUS score at admission ≥17 was shown to be the best cut-off point to discriminate patients at risk of deterioration (area under the curve (AUC) 0.95). The absence of progression in LUS score on day 3 significantly increased the prediction accuracy by ruling out deterioration with a negative predictive value of 99.29%.

Conclusion: Serial LUS is a reliable tool in predicting the risk of respiratory deterioration in patients hospitalised due to COVID-19 pneumonia. LUS could be further implemented in the future for risk stratification of viral pneumonia.

References

Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti D . Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID-19: A Simple, Quantitative, Reproducible Method. J Ultrasound Med. 2020; 39(7):1413-1419. PMC: 7228287. DOI: 10.1002/jum.15285. View

Jain S, Self W, Wunderink R, Fakhran S, Balk R, Bramley A . Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015; 373(5):415-27. PMC: 4728150. DOI: 10.1056/NEJMoa1500245. View

Ji L, Cao C, Gao Y, Zhang W, Xie Y, Duan Y . Prognostic value of bedside lung ultrasound score in patients with COVID-19. Crit Care. 2020; 24(1):700. PMC: 7754180. DOI: 10.1186/s13054-020-03416-1. View

Goncalves Martynychen Canan M, Souza Sokoloski C, Dias V, de Andrade J, Basso A, Chomiski C . Chest CT as a Prognostic Tool in COVID-19. Arch Bronconeumol. 2022; 58:69-72. PMC: 8895706. DOI: 10.1016/j.arbres.2022.02.006. View

Bhimraj A, Morgan R, Shumaker A, Lavergne V, Baden L, Cheng V . Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2020; . PMC: 7197612. DOI: 10.1093/cid/ciaa478. View

Buonsenso D, Musolino A, Ferro V, De Rose C, Morello R, Ventola C . Role of lung ultrasound for the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children: a prospective study. J Ultrasound. 2021; 25(2):185-197. PMC: 8213536. DOI: 10.1007/s40477-021-00600-z. View

Torres-Macho J, Sanchez-Fernandez M, Arnanz-Gonzalez I, Tung-Chen Y, Franco-Moreno A, Duffort-Falco M . Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study). J Clin Med. 2021; 10(21). PMC: 8584928. DOI: 10.3390/jcm10214818. View

Casella F, Barchiesi M, Leidi F, Russo G, Casazza G, Valerio G . Lung ultrasonography: A prognostic tool in non-ICU hospitalized patients with COVID-19 pneumonia. Eur J Intern Med. 2021; 85:34-40. PMC: 7778371. DOI: 10.1016/j.ejim.2020.12.012. View

Perrone T, Soldati G, Padovini L, Fiengo A, Lettieri G, Sabatini U . A New Lung Ultrasound Protocol Able to Predict Worsening in Patients Affected by Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia. J Ultrasound Med. 2020; 40(8):1627-1635. DOI: 10.1002/jum.15548. View

10.

Hernandez-Piriz A, Tung-Chen Y, Jimenez-Virumbrales D, Ayala-Larranaga I, Barba-Martin R, Canora-Lebrato J . Usefulness of lung ultrasound in the early identification of severe COVID-19: results from a prospective study. Med Ultrason. 2021; 24(2):146-152. DOI: 10.11152/mu-3263. View

11.

Ranieri V, Rubenfeld G, Thompson B, Ferguson N, Caldwell E, Fan E . Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. DOI: 10.1001/jama.2012.5669. View

12.

Bonadia N, Carnicelli A, Piano A, Buonsenso D, Gilardi E, Kadhim C . Lung Ultrasound Findings Are Associated with Mortality and Need for Intensive Care Admission in COVID-19 Patients Evaluated in the Emergency Department. Ultrasound Med Biol. 2020; 46(11):2927-2937. PMC: 7362856. DOI: 10.1016/j.ultrasmedbio.2020.07.005. View

13.

Secco G, Delorenzo M, Salinaro F, Zattera C, Barcella B, Resta F . Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations. Intern Emerg Med. 2021; 16(5):1317-1327. PMC: 7917171. DOI: 10.1007/s11739-020-02620-9. View

14.

Bellou V, Tzoulaki I, van Smeden M, Moons K, Evangelou E, Belbasis L . Prognostic factors for adverse outcomes in patients with COVID-19: a field-wide systematic review and meta-analysis. Eur Respir J. 2021; 59(2). PMC: 8576809. DOI: 10.1183/13993003.02964-2020. View

15.

Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein D, Mathis G, Kirkpatrick A . International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38(4):577-91. DOI: 10.1007/s00134-012-2513-4. View

16.

. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019; 394(10200):757-779. PMC: 6727070. DOI: 10.1016/S0140-6736(19)30721-4. View

17.

Gil-Rodriguez J, Perez de Rojas J, Aranda-Laserna P, Benavente-Fernandez A, Martos-Ruiz M, Peregrina-Rivas J . Ultrasound findings of lung ultrasonography in COVID-19: A systematic review. Eur J Radiol. 2022; 148:110156. PMC: 8783639. DOI: 10.1016/j.ejrad.2022.110156. View

18.

Biasucci D, Buonsenso D, Piano A, Bonadia N, Vargas J, Settanni D . Lung ultrasound predicts non-invasive ventilation outcome in COVID-19 acute respiratory failure: a pilot study. Minerva Anestesiol. 2021; 87(9):1006-1016. DOI: 10.23736/S0375-9393.21.15188-0. View

19.

Rubio-Gracia J, Gimenez-Lopez I, Garces-Horna V, Lopez-Delgado D, Sierra-Monzon J, Martinez-Lostao L . Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: a prospective noninterventional study. Eur Respir J. 2021; 58(3). PMC: 7877323. DOI: 10.1183/13993003.04283-2020. View

20.

Lomoro P, Verde F, Zerboni F, Simonetti I, Borghi C, Fachinetti C . COVID-19 pneumonia manifestations at the admission on chest ultrasound, radiographs, and CT: single-center study and comprehensive radiologic literature review. Eur J Radiol Open. 2020; 7:100231. PMC: 7129441. DOI: 10.1016/j.ejro.2020.100231. View