tetano
Editor, Senior Moderator
J Ultrasound Med
. 2021 Jan 26.
doi: 10.1002/jum.15617. Online ahead of print.
Lung Ultrasound for Identification of Patients Requiring Invasive Mechanical Ventilation in COVID-19
Claudia Seiler[SUP] 1 2 [/SUP], Cecilia Klingberg[SUP] 1 [/SUP], Maria H?rdstedt[SUP] 2 3 [/SUP]
Affiliations
Abstract
Objectives: Indication for invasive mechanical ventilation in COVID-19 pneumonia has been a major challenge. This study aimed to evaluate if lung ultrasound (LUS) can assist identification of requirement of invasive mechanical ventilation in moderate to severe COVID-19 pneumonia.
Materials and methods: Between April 23 and November 12, 2020, hospitalized patients with moderate to severe COVID-19 (oxygen demand ≥4 L/min) were included consecutively. Lung ultrasound was performed daily until invasive mechanical ventilation (IMV-group) or spontaneous recovery (non-IMV-group). Clinical parameters and lung ultrasound findings were compared between groups, at intubation (IMV-group) and highest oxygen demand (non-IMV-group). A reference group with oxygen demand <4 L/min was examined at hospital admission.
Results: Altogether 72 patients were included: 50 study patients (IMV-group, n = 23; non-IMV-group, n = 27) and 22 reference patients. LUS-score correlated to oxygen demand (SpO[SUB]2[/SUB] /FiO[SUB]2[/SUB] -ratio) (r = 0.728; p < 0.0001) and was higher in the IMV-group compared to the non-IMV-group (20.0 versus 18.0; p = 0.026). Based on receiver operating characteristic analysis, a LUS-score of 19.5 was identified as cut-off for requirement of invasive mechanical ventilation (area under the curve 0.68; sensitivity 56%, specificity 74%). In 6 patients, LUS identified critical coexisting conditions. Respiratory rate and oxygenation index ((SpO[SUB]2[/SUB] /FiO[SUB]2[/SUB] )/respiratory rate) ≥4.88 identified no requirement of invasive mechanical ventilation with a positive predictive value of 87% and negative predictive value of 100%.
Conclusions: LUS-score had only a moderate diagnostic value for requirement of invasive mechanical ventilation in moderate to severe COVID-19. However, LUS proved valuable as complement to respiratory parameters in guidance of disease severity and identifying critical coexisting conditions.
Keywords: COVID-19; Coronavirus; mechanical; ultrasonography; ventilators.
. 2021 Jan 26.
doi: 10.1002/jum.15617. Online ahead of print.
Lung Ultrasound for Identification of Patients Requiring Invasive Mechanical Ventilation in COVID-19
Claudia Seiler[SUP] 1 2 [/SUP], Cecilia Klingberg[SUP] 1 [/SUP], Maria H?rdstedt[SUP] 2 3 [/SUP]
Affiliations
- PMID: 33496362
- DOI: 10.1002/jum.15617
Abstract
Objectives: Indication for invasive mechanical ventilation in COVID-19 pneumonia has been a major challenge. This study aimed to evaluate if lung ultrasound (LUS) can assist identification of requirement of invasive mechanical ventilation in moderate to severe COVID-19 pneumonia.
Materials and methods: Between April 23 and November 12, 2020, hospitalized patients with moderate to severe COVID-19 (oxygen demand ≥4 L/min) were included consecutively. Lung ultrasound was performed daily until invasive mechanical ventilation (IMV-group) or spontaneous recovery (non-IMV-group). Clinical parameters and lung ultrasound findings were compared between groups, at intubation (IMV-group) and highest oxygen demand (non-IMV-group). A reference group with oxygen demand <4 L/min was examined at hospital admission.
Results: Altogether 72 patients were included: 50 study patients (IMV-group, n = 23; non-IMV-group, n = 27) and 22 reference patients. LUS-score correlated to oxygen demand (SpO[SUB]2[/SUB] /FiO[SUB]2[/SUB] -ratio) (r = 0.728; p < 0.0001) and was higher in the IMV-group compared to the non-IMV-group (20.0 versus 18.0; p = 0.026). Based on receiver operating characteristic analysis, a LUS-score of 19.5 was identified as cut-off for requirement of invasive mechanical ventilation (area under the curve 0.68; sensitivity 56%, specificity 74%). In 6 patients, LUS identified critical coexisting conditions. Respiratory rate and oxygenation index ((SpO[SUB]2[/SUB] /FiO[SUB]2[/SUB] )/respiratory rate) ≥4.88 identified no requirement of invasive mechanical ventilation with a positive predictive value of 87% and negative predictive value of 100%.
Conclusions: LUS-score had only a moderate diagnostic value for requirement of invasive mechanical ventilation in moderate to severe COVID-19. However, LUS proved valuable as complement to respiratory parameters in guidance of disease severity and identifying critical coexisting conditions.
Keywords: COVID-19; Coronavirus; mechanical; ultrasonography; ventilators.