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Observational Study
. 2022 Jun;36(3):785-793.
doi: 10.1007/s10877-021-00709-w. Epub 2021 May 4.

Is lung ultrasound score a useful tool to monitoring and handling moderate and severe COVID-19 patients in the general ward? An observational pilot study

Marco Baciarello  1   2 , Andrea Bonetti  2 , Luigi Vetrugno  3 , Francesco Saturno  2 , Antonio Nouvenne  4 , Valentina Bellini  2 , Tiziana Meschi  4   5 , Elena Bignami  6   7
Affiliations
Observational Study

Is lung ultrasound score a useful tool to monitoring and handling moderate and severe COVID-19 patients in the general ward? An observational pilot study

Marco Baciarello et al. J Clin Monit Comput. 2022 Jun.

Abstract

Lung ultrasound is a well-established diagnostic tool in acute respiratory failure, and it has been shown to be particularly suited for the management of COVID-19-associated respiratory failure. We present exploratory analyses on the diagnostic and prognostic performance of lung ultrasound score (LUS) in general ward patients with moderate-to-severe COVID-19 pneumonia receiving O2 supplementation and/or noninvasive ventilation. From March 10 through May 1, 2020, 103 lung ultrasound exams were performed by our Forward Intensive Care Team (FICT) on 26 patients (18 males and 8 females), aged 62 (54 - 76) and with a Body Mass Index (BMI) of 30.9 (28.7 - 31.5), a median 6 (5 - 9) days after admission to the COVID-19 medical unit of the University Hospital of Parma, Italy. All patients underwent chest computed tomography (CT) the day of admission. The initial LUS was 16 (11 - 21), which did not significantly correlate with initial CT scans, probably due to rapid progression of the disease and time between CT scan on admission and first FICT evaluation; conversely, LUS was significantly correlated with PaO2/FiO2 ratio throughout patient follow-up [R = - 4.82 (- 6.84 to - 2.80; p < 0.001)]. The area under the receiving operating characteristics curve of LUS for the diagnosis of moderate-severe disease (PaO2/FiO2 ratio ≤ 200 mmHg) was 0.73, with an optimal cutoff value of 11 (positive predictive value: 0.98; negative predictive value: 0.29). Patients who eventually needed invasive ventilation and/or died during admission had significantly higher LUS throughout their stay.

Keywords: COVID-19; Computed tomography; Lung Ultrasound; Non invasive ventilation.

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Conflict of interest statement

Luigi Vetrugno received travel support for Congress Lecture by Cook Medical. The other authors declare that they have no conflicts of interest or competing interests.

Figures

Fig. 1
Fig. 1
Linear correlation of lung ultrasound scores with the estimated proportion of lung volume involved with COVID-19 associated interstitial pneumonia; the first CT scan and chest ultrasonography results are considered. CT computed tomography
Fig. 2
Fig. 2
Scatterplot of lung ultrasound scores against PaO2/FiO2 ratio on arterial blood gas analyses, different colors indicate types of ventilatory support. NIV noninvasive ventilation, IMV invasive ventilation via orotracheal or tracheostomy tube, NA information not available for the data point
Fig. 3
Fig. 3
Receiver operating characteristics curve for the diagnosis of PaO2/FiO2 ≤ 200 mmHg with ultrasound score: points along the curve indicate arbitrary proposed cut-offs; shaded areas represent 95% confidence intervals for the curve in those segments
Fig. 4
Fig. 4
Lung ultrasound scores and oxygenation in patients undergoing NIV. Data are from the first (Start) and last (End) examination while receiving NIV. Patients are categorized according to outcome at the end of NIV treatment; the endpoint was defined as the combination of ICU admission for invasive ventilation and/or in-hospital death (whichever occurred first). Asterisks indicate statistically significant differences at p < 0.05. ABG arterial blood gas analysis, ICU intensive care unit, NIV noninvasive ventilation
See this image and copyright information in PMC

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