Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 18;15(1):26159.
doi: 10.1038/s41598-025-99397-8.

Contribution of lung ultrasound to assess COVID-19 pneumonia in critical care setting: a prospective cohort study

Amira Jamoussi  1   2 , Sarra Zarrouk  3   4 , Emna Rachdi  3   4 , Fatma Jarraya  3   4 , Nacef Ben Mrad  3   4 , Selim Sellaouti  3   4 , Samia Ayed  3   4 , Jalila Ben Khelil  3   4
Affiliations

Contribution of lung ultrasound to assess COVID-19 pneumonia in critical care setting: a prospective cohort study

Amira Jamoussi et al. Sci Rep. .

Abstract

We aimed to describe lung ultrasound (LUS) findings in COVID-19 pneumonia and to analyze the association with initial severity and outcome. Prospective cohort study among intensive care unit (ICU) patients in a teaching hospital in Tunisia. A 20-bed respiratory medical intensive care unit of Abderrahmen Mami Teaching Hospital from January to December 2021. We included all COVID-19 pneumonia patients managed in ICU. LUS examination and chest computed tomography (CT), when possible, were performed during the first 24 h of ICU stay. LUS findings were described and association with severity was analysed for trends. During the one-year study period, 311 patients were included with a median age of 58 IQR [47-67] years. ARDS was diagnosed in 307 patients (98.7%). Median initial PaO2/FiO2 was 112 IQR [81-157] mmHg. Median length of stay was 10 IQR [7-14] days and overall mortality was of 45.3%. Median LUS score was 29 IQR [25-32]. LUS score gradients were apico-basal and postero-antero-lateral. There was a significant correlation between ROX index and LUS score with r= -0.146 and p = 0.013. LUS score above 25 was significantly associated with chest CT damage exceeding 75% (NPV = 80.7%). LUS score under 25 was significantly associated with chest CT damage < 50% (NPV = 77.5%). No association was found between the LUS score and mortality or the need for invasive ventilation. In COVID-19 pneumonia, LUS is a good and safe tool for initial severity assessment. LUS score is correlated with ROX index and extent of chest damage on CT scan. However, LUS score does not predict outcome nor need for invasive mechanical ventilation.

Keywords: Acute respiratory distress syndrome; COVID-19; Chest CT scan; Lung ultrasound; Outcome; ROX index; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Inclusion flowchart; ICU: intensive care unit, ARDS: acute respiratory distress syndrome, IMV: Invasive mechanical ventilation, LUS: Lung ultrasound, CT: chest computed tomography.
Fig. 2
Fig. 2
Percentages of LUS findings patterns according to lung quadrants: C = consolidation, B2 = coalescent B lines, B1 = at least three well-spaced B lines and A = A line alone or less than 3 B lines; ASQ : antero-superior quadrant, AIQ : antero-inferior quadrant, LSQ : latero-superior quadrant, LIQ : latero-inferior quadrant, PSQ : postero-superior quadrant, PIQ : postero-inferior quadrant.
Fig. 3
Fig. 3
Frontal plane: LUS score apico-basal severity gradient. C = consolidation, B2 = coalescent B lines, B1 = at least three well-spaced B lines and A = A line alone or less than 3 B lines; ASQ : antero-superior quadrant, AIQ : antero-inferior quadrant, LSQ : latero-superior quadrant, LIQ : latero-inferior quadrant, PSQ : postero-superior quadrant, PIQ : postero-inferior quadrant.
Fig. 4
Fig. 4
Cross-sectional plane: LUS score posterior-anterior-lateral severity gradient. C = consolidation, B2 = coalescent B lines, B1 = at least three well-spaced B lines and A = A line alone or less than 3 B lines; ASQ : antero-superior quadrant, AIQ : antero-inferior quadrant, LSQ : latero-superior quadrant, LIQ : latero-inferior quadrant, PSQ : postero-superior quadrant, PIQ : postero-inferior quadrant.
Fig. 5
Fig. 5
Correlation between LUS score and ROX index.
See this image and copyright information in PMC

References

    1. Lichtenstein, D. A. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest147(6), 1659–1670 (2015). - PubMed
    1. Soldati, G., Demi, M., Inchingolo, R., Smargiassi, A. & Demi, L. On the physical basis of pulmonary sonographic interstitial syndrome. J. Ultrasound Medicine: Official J. Am. Inst. Ultrasound Med.35(10), 2075–2086 (2016). - PubMed
    1. Kovács, A. et al. The sensitivity and specificity of chest CT in the diagnosis of COVID-19. Eur. Radiol.31(5), 2819–2824 (2021). - PMC - PubMed
    1. Zhao, W., Zhong, Z., Xie, X., Yu, Q. & Liu, J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. Am. J. Roentgenol.214(5), 1072–1077 (2020). - PubMed
    1. Soldati, G. et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: a simple, quantitative, reproducible method. J. Ultrasound Med.39(7), 1413–1419 (2020). - PMC - PubMed