Abstract
BackgroundDuring COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease.MethodsWe performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern.ResultsOut of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17).ConclusionsLUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.
Highlights
During COVID-19 pandemic, optimization of the diagnostic resources is essential
Lung ultrasonography (LUS) is a rapid, bedside tool that has demonstrated to be more accurate than chest radiograph in the identification of the main pulmonary lesions of critically ill patients affected by acute respiratory distress syndrome (ARDS) [4]
We prospectively investigated all consecutive COVID19 patients with hypoxemic acute respiratory failure (hARF) admitted to Padua University Hospital Intensive care unit (ICU) between March and April 2020 (Table 1)
Summary
Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. In the current COVID-19 outbreak, this percentage overwhelms the health care system capabilities and requires a smart resource optimization. CT scan is considered the gold standard imaging modality for the investigation of patients with COVID-19 interstitial pneumonia [2], but its routine applicability is limited especially in critically ill patients and by consideration of its cost-effectiveness balance [3], because of the need to transfer unstable patients to the radiology department, the high costs and, of no minor concern, because of the risk of personal and environmental viral spread. Lung ultrasonography (LUS) is a rapid, bedside tool that has demonstrated to be more accurate than chest radiograph in the identification of the main pulmonary lesions of critically ill patients affected by acute respiratory distress syndrome (ARDS) [4]. The LUS score (LUSS) has been validated for monitoring lung aeration in ARDS patients with a good correlation with chest CT scan [6] and for prediction of post extubation distress [7]
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