Lung ultrasound aeration score for prognostication in invasively ventilated COVID-19 patients: multicenter observational study

Abstract

<b>Introduction:</b> Extensive consolidation of lung on chest CT scan is associated with worse outcomes in patients with coronavirus disease 2019 (COVID–19) ARDS. We hypothesized that the global lung ultrasound (LUS) score is also associated with outcome. <b>Aim:</b> To determine the prognostic accuracy of 12 region LUS–derived aeration score in patients with severe COVID–19 ARDS undergoing invasive ventilation. <b>Methods:</b> This was an international multicenter study. Global LUS–aeration score was calculated as the primary prediction. Secondary predictors were pleural line abnormalities and subpleural consolidations. The primary outcome was successful liberation from the ventilator and secondary outcome mortality at 28 days. <b>Results:</b> 55 patients were included. Global LUS–aeration score was significantly associated with successful liberation (hazard ratio (HR), 0.87 [95%–confidence interval (CI) 0.81–0.93]; p&lt;0.01) and ICU mortality (HR, 1.12 [95%–CI 1.02–1.23]; p=0.01). For successful liberation the best cutoff was 13 and for mortality 17. Subpleural consolidations and pleural line abnormalities were neither associated with successful liberation, nor mortality. <b>Conculsions:</b> To conclude, the global LUS–aeration score holds prognostic validity in invasively ventilated COVID–19 ARDS patients. (Sub)pleural abnormalities are not associated with outcome.