1
|
Scarlata S, Okoye C, Zotti S, Lauretani F, Nouvenne A, Cerundolo N, Bruni AA, Torrini M, Finazzi A, Mazzarone T, Lunian M, Zucchini I, Maccioni L, Guarino D, Fabbri Della Faggiola S, Capacci M, Bianco MG, Guarona G, Bellelli G, Monzani F, Virdis A, Antonelli Incalzi R, Ungar A, Ticinesi A. Advancing healthcare through thoracic ultrasound research in older patients. Aging Clin Exp Res 2023; 35:2887-2901. [PMID: 37950845 PMCID: PMC10721707 DOI: 10.1007/s40520-023-02590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.
Collapse
Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy.
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Sonia Zotti
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Adriana Antonella Bruni
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Monica Torrini
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Tessa Mazzarone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Marco Lunian
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Irene Zucchini
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Lorenzo Maccioni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Marco Capacci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Giovanna Bianco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guglielmo Guarona
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Fabio Monzani
- Casa di Cura Venerabile Confraternita di Misericordia Navacchio, 56023, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| |
Collapse
|
2
|
Dearing E, Rempfer E, Frasure SE, Akselrod H, Dobbs JE, Poon AN, Salazar JE, Prajapati D, Boniface KS. Point-of-Care Ultrasound of Post-acute COVID-19 Syndrome: A Prospective Cohort Study. Cureus 2023; 15:e42569. [PMID: 37637589 PMCID: PMC10460260 DOI: 10.7759/cureus.42569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Acute COVID-19 patients can suffer from chronic symptoms known as post-acute sequelae of SARS-CoV-2 infection (PASC). Point-of-care ultrasound (POCUS) is established in acute COVID, but its utility in PASC is unclear. We sought to determine the incidence of cardiac and pulmonary abnormalities with POCUS in patients with PASC in a COVID-19 recovery clinic. Methods This prospective cohort study included adults (>18 years old) presenting with cardiopulmonary symptoms to the COVID-19 recovery clinic. A lung ultrasound and standard bedside echocardiogram were performed by ultrasound-trained physicians. Images were interpreted in real time by the performing sonographer and independently by a blinded ultrasound faculty member. Discrepancies in interpretation were addressed by consensus review. A modified Soldati score was calculated by the sum of the scores in each of the 12 lung zones, with each zone score ranging from 0 to 3 (maximum score of 36). The score was then compared to clinical outcomes and outpatient testing. Results Between April and July 2021, 41 patients received POCUS examinations, with 24 of those included in the study. In all, 15 out of 24 (62.5%) had a normal lung ultrasound. Of the nine subjects with lung abnormalities, the median modified Soldati score was 2. Three patients had trivial pericardial effusions, and all had normal left and right ventricular size and function. Conclusion The majority (62.5%) of patients presenting to the PASC clinic had a normal pulmonary ultrasound, and the vast majority (87.5%) had normal cardiac ultrasounds. These findings suggest that cardiopulmonary symptoms in PASC may be from etiologies not well evaluated by POCUS.
Collapse
Affiliation(s)
- Elizabeth Dearing
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Elizabeth Rempfer
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Sarah E Frasure
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Hana Akselrod
- Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - John E Dobbs
- Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Adrienne N Poon
- Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Juan E Salazar
- Department of Environmental and Occupational Health, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Dhruvil Prajapati
- Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Keith S Boniface
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| |
Collapse
|
3
|
Torres-Macho J, Casado-Suela MA, Duffort-Falcó M. Lung ultrasound must be the first-line image technique in COVID-19 patients. Eur J Intern Med 2023; 110:21-22. [PMID: 36898935 PMCID: PMC9939398 DOI: 10.1016/j.ejim.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Juan Torres-Macho
- Clinical Ultrasound Unit. Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain.
| | - Miguel Angel Casado-Suela
- Clinical Ultrasound Unit. Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Mercedes Duffort-Falcó
- Clinical Ultrasound Unit. Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| |
Collapse
|
4
|
Loke TK, Earl N, Begbey ACH, Sharma N, Wakeham NR, Sohn HM, Greenslade SJ, Ince E, Davey M, Cox K. Lung ultrasound as a tool for monitoring the interstitial changes in recently hospitalised patients with COVID-19 pneumonia - The COVIDLUS study. Respir Med 2023; 210:107176. [PMID: 36871866 PMCID: PMC9981476 DOI: 10.1016/j.rmed.2023.107176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Background Long-term respiratory effects can occur after COVID-19 pneumonia (CP). The COVID Lung Ultrasound Study (COVIDLUS) aimed to investigate the utility of serial lung ultrasound (LUS) to track functional and physiological recovery after hospitalisation in patients with CP. Methods Between April 2021 and April 2022, 21 patients were recruited at discharge (D0). LUS was performed on D0, day 41 (D41) and day 83 (D83). CT Thorax was performed on D83. Lymphocyte count, Ferritin, Lactate Dehydrogenase, Troponin, CRP, and D-dimers were measured at D0, D41 and D83. 6 minute walking test (6MWT) was performed on D83 and quality of life questionnaires and spirometry completed on D41 and D83. Results 19 subjects completed the study (10 males [52%]; mean age: 52 years [range:37-74]). 1 patient died. LUS scores were significantly higher at D0, compared to D41 and D83 (Mean score:10.9 [D0]/2.8 [D41]/1.5 [D83]; p < 0.0001). LUS scores correlated poorly with CT at D83 (Pearson r2 = 0.28). Mean lymphocyte counts were lower at D0 but increased at D41 and D83. Mean serum Ferritin was significantly lower at D41 and D83, as compared to D0. The mean 6MWT distance was 385 m (130-540 m). Quality of life measures did not differ at D41 and D83. Lung function increased between D41 and D83 with mean increase in FEV1 and FVC of 160 ml and 190 ml respectively. Conclusion LUS can monitor the early recovery of lung interstitial changes from CP. The utility of LUS to predict development of subsequent lung fibrosis post-COVID deserves further study.
Collapse
Affiliation(s)
- Tuck-Kay Loke
- Department of Respiratory Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom.
| | - Naomi Earl
- Department of Respiratory Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Austin C H Begbey
- Department of Respiratory Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Naveen Sharma
- Department of Radiology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Niklas R Wakeham
- Department of Radiology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Hyon-Mok Sohn
- Department of Radiology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Sarah J Greenslade
- Department of Respiratory Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Emma Ince
- Department of Respiratory Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Miriam Davey
- Department of Respiratory Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| | - Karina Cox
- Breast Unit, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Kent, TN2 4QJ, United Kingdom
| |
Collapse
|
5
|
Barbieri G, Gargani L, Lepri V, Spinelli S, Romei C, De Liperi A, Chimera D, Pistelli F, Carrozzi L, Corradi F, Ghiadoni L. Long-term lung ultrasound follow-up in patients after COVID-19 pneumonia hospitalization: A prospective comparative study with chest computed tomography. Eur J Intern Med 2023; 110:29-34. [PMID: 36564240 PMCID: PMC9729593 DOI: 10.1016/j.ejim.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
During COVID-19 pandemic, lung ultrasound (LUS) proved to be of great value in the diagnosis and monitoring of patients with pneumonia. However, limited data exist regarding its use to assess aeration changes during follow-up (FU). Our study aims to prospectively evaluate 232 subjects who underwent a 3-month-FU program after hospitalization for COVID-19 at the University Hospital of Pisa. The goals were to assess the usefulness of standardized LUS compared with the gold standard chest computed tomography (CT) to evaluate aeration changes and to verify LUS and CT agreement at FU. Patients underwent in the same day a standardized 16-areas LUS and high-resolution chest CT reported by expert radiologists, assigning interpretative codes. Based on observations distribution, LUS score cut-offs of 3 and 7 were selected, corresponding to the 50th and 75th percentile, respectively. Patients with LUS scores above both these thresholds were older and with longer hospital stay. Patients with a LUS score ≥3 had more comorbidities. LUS and chest CT showed a high agreement in identifying residual pathological findings, using both cut-off scores of 3 (OR 14,7; CL 3,6-64,5, Sensitivity 91%, Specificity 49%) and 7 (OR 5,8; CL 2,3-14,3, Sensitivity 65%, Specificity 79%). Our data suggest that LUS is very sensitive in identifying pathological findings at FU after a hospitalization for COVID-19 pneumonia, compared to CT. Given its low cost and safety, LUS could replace CT in selected cases, such as in contexts with limited resources or it could be used as a gate-keeper examination before more advanced techniques.
Collapse
Affiliation(s)
- Greta Barbieri
- Emergency Medicine Department, Pisa University Hospital, Italy; Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
| | - Luna Gargani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Vittoria Lepri
- Emergency Medicine Department, Pisa University Hospital, Italy
| | | | - Chiara Romei
- 2nd Radiology Unit, Department of Radiology, Pisa University Hospital, Italy
| | - Annalisa De Liperi
- 2nd Radiology Unit, Department of Radiology, Pisa University Hospital, Italy
| | - Davide Chimera
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Italy
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Lorenzo Ghiadoni
- Emergency Medicine Department, Pisa University Hospital, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| |
Collapse
|
6
|
Altersberger M, Goliasch G, Khafaga M, Schneider M, Cho Y, Winkler R, Funk G, Binder T, Huber G, Zwick R, Genger M. Echocardiography and Lung Ultrasound in Long COVID and Post-COVID Syndrome, a Review Document of the Austrian Society of Pneumology and the Austrian Society of Ultrasound in Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:269-277. [PMID: 35906952 PMCID: PMC9353420 DOI: 10.1002/jum.16068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 05/08/2023]
Abstract
Lung ultrasound has the potential to enable standardized follow-up without radiation exposure and with lower associated costs in comparison to CT scans. It is a valuable tool to follow up on patients after a COVID-19 infection and evaluate if there is pulmonary fibrosis developing. Echocardiography, including strain imaging, is a proven tool to assess various causes of dyspnea and adds valuable information in the context of long COVID care. Including two-dimensional (2D) strain imaging, a better comprehension of myocardial damage in post-COVID syndrome can be made. Especially 2D strain imaging (left and the right ventricular strain) can provide information about prognosis.
Collapse
Affiliation(s)
- Martin Altersberger
- Department of CardiologyNephrology and Intensive Care Medicine, State Hospital SteyrSteyrAustria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Mounir Khafaga
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory DiseasesGrimmensteinAustria
| | - Matthias Schneider
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Yerin Cho
- Department of CardiologyNephrology and Intensive Care Medicine, State Hospital SteyrSteyrAustria
| | - Roland Winkler
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory DiseasesGrimmensteinAustria
| | - Georg‐Christian Funk
- Department of Internal Medicine II, Division of PulmonologyHospital OttakringViennaAustria
| | - Thomas Binder
- Medical University of Vienna, Teaching CenterViennaAustria
| | | | - Ralf‐Harun Zwick
- Therme Wien Med—Outpatient Pulmonary RehabilitationViennaAustria
| | - Martin Genger
- Department of CardiologyNephrology and Intensive Care Medicine, State Hospital SteyrSteyrAustria
| |
Collapse
|
7
|
Perrone T, Falaschi F, Meloni F, Ballesio A, Sabatini U, Lenti MV, Melazzini F, Lettieri S, Novati S, Cutti S, Marioli CM, Klersy C, Bruno R, Oltrona Visconti L, Di Sabatino A. A mid-term follow-up with a lung ultrasonographic score correlates with the severity of COVID-19 acute phase. Intern Emerg Med 2023; 18:163-168. [PMID: 36469248 PMCID: PMC9734680 DOI: 10.1007/s11739-022-03144-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/21/2022] [Indexed: 12/09/2022]
Abstract
Lung ultrasound (LUS) has rapidly emerged in COVID-19 diagnosis and for the follow-up during the acute phase. LUS is not yet used routinely in lung damage follow-up after COVID-19 infection. We investigated the correlation between LUS score, and clinical and laboratory parameters of severity of SARS-COV-2 damage during hospitalization and at follow-up visit. Observational retrospective study including all the patients discharged from the COVID-19 wards, who attended the post-COVID outpatient clinic of the IRCCS Policlinico San Matteo in April-June 2020. 115 patients were enrolled. Follow-up visits with LUS score measurements were at a median of 38 days (IQR 28-48) after discharge. LUS scores were associated with the length of hospitalization (p < 0.001), patients' age (p = 0.036), use of non-invasive ventilation (CPAP p < 0.001 or HFNC p = 0.018), administration of corticosteroids therapy (p = 0.030), and laboratory parameters during the acute phase (WBC p < 0.001, LDH p < 0.001, CRP p < 0.001, D-dimer p = 0.008, IL-6 p = 0.045), and inversely correlated with lymphocyte count (p = 0.007). We found correlation between LUS score and both LDH (p = 0.001) and the antibody anti-SARS-CoV-2 titers (p value = 0.008). Most of these finding were confirmed by dichothomizing the LUS score (≤ 9 or > 9 points). We found a significantly higher LUS score at the follow-up in the patients with persistent dyspnea (7.00, IQR 3.00-11.00) when compared to eupnoeic patients (3.00, IQR 0-7.00 p < 0.001). LUS score at follow-up visit correlates with more severe lung disease. These findings support the hypothesis that ultrasound could be a valid tool in the follow-up medium-term COVID-19 lung damage.
Collapse
Affiliation(s)
- Tiziano Perrone
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Francesco Falaschi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Meloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessia Ballesio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Umberto Sabatini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Sara Lettieri
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefano Novati
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Cutti
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carola Maria Marioli
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
8
|
One-Year Follow-Up Lung Ultrasound of Post-COVID Syndrome-A Pilot Study. Diagnostics (Basel) 2022; 13:diagnostics13010070. [PMID: 36611362 PMCID: PMC9818489 DOI: 10.3390/diagnostics13010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Millions of people worldwide were infected with COVID-19. After the acute phase of the disease, many suffer from prolonged symptoms, the post-COVID syndrome, especially the phenotype with lung residuals. Many open questions regarding lung ultrasound (LUS) have to be answered. One essential question is the means for optimal following-up of patients with post-COVID-19 residuals with LUS; (2) Methods: A retrospective data analysis of patients after acute COVID-19 infection diagnosed with post-COVID syndrome in the state hospital of Steyr and the rehabilitation center of Hochegg was performed. LUS examinations following a 12-zone scanning protocol were performed, and the LUS score quantified comet tail artifacts. A total of 16 patients were evaluated twice with LUS from May 2020 until June 2021. (3) Results: All patients’ reverberation artifacts were reduced over time. The initial LUS score of 17.75 (SD 4.84) points was decreased over the duration of the second rehabilitation to 8,2 (SD 5.94). The difference in the Wilcoxon test was significant (p < 0.001); (4) Conclusions: Lung ultrasound was a valuable tool in the follow-up of post-COVID-syndrome with lung residuals in the first wave of COVID-19. A reduction in reverberation artifacts was demonstrated. Further studies about the clinical significance have to follow.
Collapse
|
9
|
Russo G, Flor N, Casella F, Ippolito S, Leidi F, Casazza G, Radovanovic D, Vezzulli F, Santus P, Cogliati C. Lung ultrasound in the follow-up of severe COVID-19 pneumonia: six months evaluation and comparison with CT. Intern Emerg Med 2022; 17:2261-2268. [PMID: 36103083 PMCID: PMC9472735 DOI: 10.1007/s11739-022-03084-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
While lung ultrasonography (LUS) proved to be a useful diagnostic and prognostic tool in acute phase of COVID 19 pneumonia, its role in detecting long-term pulmonary sequelae has yet to be explored. In our prospective observational study we assessed the potential of LUS in detecting the presence of computed tomography (CT) fibrotic-like changes after 6 months from COVID-19 pneumonia. Patients who were discharged with a diagnosis of severe COVID-19 pneumonia were enrolled. After 6 months from hospital discharge they underwent LUS, chest CT scan and pulmonary function tests. A logistic regression analysis was performed to assess the association between presence of symptoms, LUS score and diffusing capacity for carbon monoxide (DLCO) at 6-month after hospital discharge and CT scan fibrotic-like changes. A second logistic model was performed to assess the value of some predefined baseline factors (age, sex, worst PaO2/FiO2, ventilator support, worst CRP value, worst D-dimer value and worst LUS score during hospitalization) to predict fibrotic-like changes on 6-month CT scan. Seventy-four patients were enrolled in the study. Twenty-four (32%) showed lung abnormalities suitable for fibrotic-like changes. At multivariate logistic regression analysis LUS score after 6 months from acute disease was significantly associated with fibrotic-like pattern on CT scan. The second logistic model showed that D-dimer value was the only baseline predictive variable of fibrotic-like changes at multivariate analysis. LUS performed after 6 months from severe COVID-19 pneumonia may be a promising tool for detection and follow-up of pulmonary fibrotic sequelae.
Collapse
Affiliation(s)
- Giulia Russo
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy.
- Emerging Bacterial Pathogen Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Nicola Flor
- Radiology Unit, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Francesco Casella
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Sonia Ippolito
- Radiology Unit, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federica Leidi
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Università Degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federico Vezzulli
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Università Degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| |
Collapse
|
10
|
Espersen C, Platz E, Alhakak AS, Sengeløv M, Simonsen JØ, Johansen ND, Davidovski FS, Christensen J, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Lindholm MG, Kristiansen OP, Nielsen OW, Jeschke KN, Ulrik CS, Sivapalan P, Iversen K, Stæhr Jensen JU, Schou M, Skaarup SH, Højbjerg Lassen MC, Skaarup KG, Biering-Sørensen T. Lung ultrasound findings following COVID-19 hospitalization: A prospective longitudinal cohort study. Respir Med 2022; 197:106826. [PMID: 35453059 PMCID: PMC8976570 DOI: 10.1016/j.rmed.2022.106826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
Background Lung ultrasound (LUS) is a useful tool for diagnosis and monitoring in patients with active COVID-19-infection. However, less is known about the changes in LUS findings after a hospitalization for COVID-19. Methods In a prospective, longitudinal study in patients with COVID-19 enrolled from non-ICU hospital units, adult patients underwent 8-zone LUS and blood sampling both during the hospitalization and 2–3 months after discharge. LUS images were analyzed blinded to clinical variables and outcomes. Results A total of 71 patients with interpretable LUS at baseline and follow up (mean age 64 years, 61% male, 24% with acute respiratory distress syndrome (ARDS)) were included. The follow-up LUS was performed a median of 72 days after the initial LUS performed during hospitalization. At baseline, 87% had pathologic LUS findings in ≥1 zone (e.g. ≥3 B-lines, confluent B-lines or subpleural or lobar consolidation), whereas 30% had pathologic findings at follow-up (p < 0.001). The total number of B-lines and LUS score decreased significantly from hospitalization to follow-up (median 17 vs. 4, p < 0.001 and 4 vs. 0, p < 0.001, respectively). On the follow-up LUS, 28% of all patients had ≥3 B-lines in ≥1 zone, whereas in those with ARDS during the baseline hospitalization (n = 17), 47% had ≥3 B-lines in ≥1 zone. Conclusion LUS findings improved significantly from hospitalization to follow-up 2–3 months after discharge in COVID-19 survivors. However, persistent B-lines were frequent at follow-up, especially among those who initially had ARDS. LUS seems to be a promising method to monitor COVID-19 lung changes over time. Clinicaltrials.gov ID NCT04377035.
Collapse
|
11
|
What Is COVID 19 Teaching Us about Pulmonary Ultrasound? Diagnostics (Basel) 2022; 12:diagnostics12040838. [PMID: 35453889 PMCID: PMC9027485 DOI: 10.3390/diagnostics12040838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022] Open
Abstract
In lung ultrasound (LUS), the interactions between the acoustic pulse and the lung surface (including the pleura and a small subpleural layer of tissue) are crucial. Variations of the peripheral lung density and the subpleural alveolar shape and its configuration are typically connected to the presence of ultrasound artifacts and consolidations. COVID-19 pneumonia can give rise to a variety of pathological pulmonary changes ranging from mild diffuse alveolar damage (DAD) to severe acute respiratory distress syndrome (ARDS), characterized by peripheral bilateral patchy lung involvement. These findings are well described in CT imaging and in anatomopathological cases. Ultrasound artifacts and consolidations are therefore expected signs in COVID-19 pneumonia because edema, DAD, lung hemorrhage, interstitial thickening, hyaline membranes, and infiltrative lung diseases when they arise in a subpleural position, generate ultrasound findings. This review analyzes the structure of the ultrasound images in the normal and pathological lung given our current knowledge, and the role of LUS in the diagnosis and monitoring of patients with COVID-19 lung involvement.
Collapse
|
12
|
Tung-Chen Y, Giraldo Hernández A, Mora Vargas A, Dorado Doblado L, González Merino PE, Valencia Alijo Á, Herraiz Jiménez J, Gutiérrez Rojas Á, García Prieto S, Gutiérrez Abreu EV, Montero Hernández E. Impact of lung ultrasound during the SARS-CoV-2 pandemic: Distinction between viral and bacterial pneumonia. REUMATOLOGÍA CLÍNICA (ENGLISH EDITION) 2022; 18:546-550. [PMID: 35504823 PMCID: PMC8930392 DOI: 10.1016/j.reumae.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/30/2021] [Indexed: 12/01/2022]
Abstract
Introduction Lung Ultrasound is an accessible, low-cost technique that has demonstrated its usefulness in the prognostic stratification of COVID-19 patients. In addition, according to previous studies, it can guide us towards the potential aetiology, especially in epidemic situations such as the current one. Patients and methods 40 patients were prospectively recruited, 30 with confirmed SARS-CoV-2 pneumonia and 10 with community-acquired pneumonia (CAP). The patients included underwent both a chest X-ray and ultrasound. Results There were no differences in the 2 groups in terms of clinical and laboratory characteristics. The main ultrasound findings in the SARS-CoV-2 group were the presence of confluent B lines and subpleural consolidations and hepatinization in the CAP group. Pleural effusion was more frequent in the CAP group. There were no normal lung ultrasound exams. Analysis of the area under the curve (AUC) curves showed an area under the curve for Lung Ultrasound of 89.2% (95% CI: 75%.0–100%, p < .001) in the identification of SARS-CoV-2 pneumonia. The cut-off value for the lung score of 10 had a sensitivity of 93.3% and a specificity of 80.0% (p < .001). Discussion The combination of the findings of the Lung Ultrasound, with a Lung Score greater than 10, added to the rest of the additional tests, can be an excellent tool to predict the aetiology of the pneumonia.
Collapse
Affiliation(s)
- Yale Tung-Chen
- Facultad de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain; Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | - Alberto Mora Vargas
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Laura Dorado Doblado
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Ángela Valencia Alijo
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jesús Herraiz Jiménez
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ángela Gutiérrez Rojas
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Sonia García Prieto
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Esther Montero Hernández
- Servicio de Medicina de Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| |
Collapse
|
13
|
Stoicescu ER, Ciuca IM, Iacob R, Iacob ER, Marc MS, Birsasteanu F, Manolescu DL, Iacob D. Is Lung Ultrasound Helpful in COVID-19 Neonates?-A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11122296. [PMID: 34943533 PMCID: PMC8699875 DOI: 10.3390/diagnostics11122296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19. Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-19′. Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper. Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.
Collapse
Affiliation(s)
- Emil Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Ioana Mihaiela Ciuca
- Pediatric Department, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Correspondence:
| | - Roxana Iacob
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
| | - Emil Radu Iacob
- Department of Pediatric Surgery, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Monica Steluta Marc
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Florica Birsasteanu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Daniela Iacob
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
- Department of Neonatology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| |
Collapse
|
14
|
González Rockmore D, Tung-Chen Y, Gómez Nicolás C, Díaz de Santiago A. Importance of point-of-care ultrasound in early diagnosis of COVID-19 complications. BMJ Case Rep 2021; 14:e246311. [PMID: 34764124 PMCID: PMC8587469 DOI: 10.1136/bcr-2021-246311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- David González Rockmore
- Unidad docente Noroeste Madrid, Centro de Salud Villanueva del Pardillo, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Yale Tung-Chen
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Claudia Gómez Nicolás
- Servicio de Hematología, Hospital universitario Puerta de Hierro, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Alberto Díaz de Santiago
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| |
Collapse
|
15
|
[IMPACT OF LUNG ULTRASOUND DURING THE SARS-COV-2 PANDEMIC: DISTINCTION BETWEEN VIRAL AND BACTERIAL PNEUMONIA]. ACTA ACUST UNITED AC 2021; 18:546-550. [PMID: 34721593 PMCID: PMC8542447 DOI: 10.1016/j.reuma.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Lung Ultrasound is an accessible, low-cost technique that has demonstrated its usefulness in the prognostic stratification of COVID-19 patients. In addition, according to previous studies, it can guide us towards the potential aetiology, especially in epidemic situations such as the current one. PATIENTS AND METHODS 40 patients were prospectively recruited, 30 with confirmed SARS-CoV-2 pneumonia and 10 with community-acquired pneumonia (CAP). The patients included underwent both a chest X-ray and ultrasound. RESULTS There were no differences in the 2 groups in terms of clinical and laboratory characteristics. The main ultrasound findings in the SARS-CoV-2 group were the presence of confluent B lines and subpleural consolidations and hepatinization in the CAP group. Pleural effusion was more frequent in the CAP group. There were no normal lung ultrasound exams. Analysis of the area under the curve (AUC) curves showed an area under the curve for Lung Ultrasound of 89.2% (95% CI: 75.0-100%, p <.001) in the identification of SARS-CoV-2 pneumonia. The cut-off value for the lung score of 10 had a sensitivity of 93.3% and a specificity of 80.0% (p <.001). DISCUSSION The combination of the findings of the Lung Ultrasound, with a Lung Score greater than 10, added to the rest of the additional tests, can be an excellent tool to predict the aetiology of the pneumonia.
Collapse
|