Abdulrahman Alharthy1, Mohamed Abuhamdah1, Abdullah Balhamar1, Fahad Faqihi1, Nasir Nasim1, Shahzad Ahmad1, Alfateh Noor1, Hani Tamim2, Saleh A Alqahtani3, Ahad Alhassan Al Saud Bin Abdulaziz Al Saud4, Demetrios J Kutsogiannis5, Peter G Brindley5, Ziad A Memish6, Dimitrios Karakitsos1,7, Michael Blaivas8. 1. Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia. 2. Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon. 3. Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA. 4. Emergency Department, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA. 5. Critical Care Department, Alberta Health Care Services, Edmonton, Alberta, Canada. 6. Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia. 7. Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA. 8. Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA.
Abstract
Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia. OBJECTIVE: We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization. METHODS: We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2-4 MHz), convex (2-6 MHz) and linear (10-15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors. RESULTS: Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68-0.96, p = 0.048), increased lactate (HR: 1.17, 95% CI: 0.94-1.46, p = 0.049), and D-dimers (HR: 1.21, 95% CI: 1.03-1.44, p = 0.03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < 0.05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76-0.89) and specificity of 0.91 (95% CI: 0.94-0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. CONCLUSION: POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.
Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia. OBJECTIVE: We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically illCOVID-19patients during and after hospitalization. METHODS: We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2-4 MHz), convex (2-6 MHz) and linear (10-15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors. RESULTS: Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68-0.96, p = 0.048), increased lactate (HR: 1.17, 95% CI: 0.94-1.46, p = 0.049), and D-dimers (HR: 1.21, 95% CI: 1.03-1.44, p = 0.03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < 0.05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76-0.89) and specificity of 0.91 (95% CI: 0.94-0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. CONCLUSION: POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.
Authors: Sergey N Avdeev; Galina V Nekludova; Natalia V Trushenko; Andrey I Yaroshetskiy; Galia S Nuralieva Journal: Intensive Care Med Date: 2021-02-25 Impact factor: 17.440
Authors: Lorena Sousa de Carvalho; Ronaldo Teixeira da Silva Júnior; Bruna Vieira Silva Oliveira; Yasmin Silva de Miranda; Nara Lúcia Fonseca Rebouças; Matheus Sande Loureiro; Samuel Luca Rocha Pinheiro; Regiane Santos da Silva; Paulo Victor Silva Lima Medrado Correia; Maria José Souza Silva; Sabrina Neves Ribeiro; Filipe Antônio França da Silva; Breno Bittencourt de Brito; Maria Luísa Cordeiro Santos; Rafael Augusto Oliveira Sodré Leal; Márcio Vasconcelos Oliveira; Fabrício Freire de Melo Journal: World J Radiol Date: 2021-05-28