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. 2021 Jan 25;9(1):1.
doi: 10.1186/s40635-020-00367-3.

Lung ultrasound and computed tomography to monitor COVID-19 pneumonia in critically ill patients: a two-center prospective cohort study

Micah L A Heldeweg  1   2   3   4 , Jorge E Lopez Matta  5   6 , Mark E Haaksma  7   8   6 , Jasper M Smit  7   8   6 , Carlos V Elzo Kraemer  5   6 , Harm-Jan de Grooth  7   8 , Evert de Jonge  5   6 , Lilian J Meijboom  9 , Leo M A Heunks  7   8 , David J van Westerloo  5   6 , Pieter R Tuinman  7   8   6
Affiliations

Lung ultrasound and computed tomography to monitor COVID-19 pneumonia in critically ill patients: a two-center prospective cohort study

Micah L A Heldeweg et al. Intensive Care Med Exp. .

Abstract

Background: Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients.

Methods: Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints.

Results: We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging - 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor.

Conclusions: Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days.

Trial registration: NTR, NL8584. Registered 01 May 2020-retrospectively registered, https://www.trialregister.nl/trial/8584.

Keywords: Adult; COVID-19; Critical illness; Lung; Pneumonia; Respiratory distress syndrome; Ultrasonography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of COVID-19 patient screening and inclusion. Legend: n0 refers to the amount of baseline examinations. n1, n2, etc., refers to second examination, third examination, etc., respectively
Fig. 2
Fig. 2
a The correlation between LUSI and CTSI. Legend: the shaded area is a Bland–Altman where the line represents the biased association between the measurements (lung ultrasound underestimates CT involvement) and the shaded area represents the limits of agreement. The measurement error decreases with increased involvement. LUSI lung ultrasound score severity index; CTSI computed tomography severity involvement index. b Concordance between changes in sequentially measured LUSI and changes in CTSI. Legend: green squares denote concordance (involvement changes in the same direction) and red squares represent discordance (involvement changes in different directions). LUSI lung ultrasound score severity index; CTSI computed tomography severity involvement index
Fig. 3
Fig. 3
Forest plot of OR for the composite outcome of death or ICU stay > 30 days. Legend: high lung ultrasound score involvement index (LUSI) was ≥ 50% whereas high computed tomography severity involvement index (CTSI) was ≥ 65%. Only statistically significant variables were included in the multivariate model. OR odds ratio; ICU intensive care unit
See this image and copyright information in PMC

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