Lung ultrasound may be a valuable aid in decision making for patients admitted with COVID-19 disease

Casper Falster, Niels Jacobsen, Lone Wulff Madsen, Line Dahlerup Rasmussen, Jesper Rømhild Davidsen, Fredrikke Christie Knudtzen, Stig Lønberg Nielsen, Isik Somuncu Johansen, Christian B Laursen, Casper Falster, Niels Jacobsen, Lone Wulff Madsen, Line Dahlerup Rasmussen, Jesper Rømhild Davidsen, Fredrikke Christie Knudtzen, Stig Lønberg Nielsen, Isik Somuncu Johansen, Christian B Laursen

Abstract

INTRODUCTION: COVID-19 is associated with a risk of severe pneumonia and acute respiratory distress syndrome (ARDS), requiring treatment at an intensive care unit (ICU). Since clinical deterioration may occur rapidly, a simple, fast, bedside, non-invasive method for assessment of lung changes is warranted. The primary aim of this study was to investigate whether lung ultrasound (LUS) findings within 72 hours of admission were predictive of clinical deterioration in hospitalized patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). METHODS: Patients admitted to a dedicated COVID-19 unit were subject to daily LUS examinations. Number of present consolidations and pleural effusions were registered and a Mongodi score was calculated. These findings were correlated with initial chest x-ray and clinical deterioration, defined as ICU-admission, ARDS diagnosis, death. RESULTS: In total, 29 of 83 patients had LUS performed during admission, 18 within 72 h of admission. Of these, four patients died during admission, six were transferred to the ICU and 13 were diagnosed with ARDS. Initial Mongodi-score did not differ significantly between patients with and without clinical deterioration (p = 0.95). Agreement between initial LUS and chest x-ray findings were fair with Cohen's Kappa at 0.21. CONCLUSION: LUS performed within 72 h in patients admitted to a dedicated COVID-19 unit could not predict ARDS, ICU admission or death. However, consecutive investigations may be of value, as sudden substantial changes may herald disease progression, enabling earlier supplementary diagnostics and treatment initiation.

Keywords: ARDS; COVID-19; Lung ultrasound; SARS-CoV-2; point-of-care ultrasound.

Conflict of interest statement

The author(s) report no conflict of interest.

© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Figures

Figure 1.
Figure 1.
LUS findings in COVID-19 and corresponding score.A: the pleuraline (PL) appears normal. No B-lines or consolidation is present corresponding to a score of 1.B: multiple B-lines (B) origninating from the pleural line (PL). The B-lines involve less than 50% of the pleuraline, corresponding to a score of 2.C: multiple confluent B-lines (CB) are present. More than 50% of the pleural line are involved corresponding to a score of 3.D: A small subpleural consolidation (C) is present just below the pleural line, corresponding to a score of 4
Figure 2.
Figure 2.
Overview of study population
Figure 3.
Figure 3.
LUS findings on day one, two and three. C: total number of consolidations. E: total number of effusions. n: number of patients scanned
Figure 4.
Figure 4.
Examples of individual changes in Mongodi score
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8032333/bin/ZECR_A_1909521_UF0001_OC.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8032333/bin/ZECR_A_1909521_UF0002_OC.jpg

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