Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS
Open Access
- 21 July 2020
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 15 (7), e0236312
- https://doi.org/10.1371/journal.pone.0236312
Abstract
COVID-19 pneumonia typically begins with subpleural ground glass opacities with progressive extension on computerized tomography studies. Lung ultrasound is well suited to this interstitial, subpleural involvement, and it is now broadly used in intensive care units (ICUs). The extension and severity of lung infiltrates can be described numerically with a reproducible and validated lung ultrasound score (LUSS). We hypothesized that LUSS might be useful as a tool to non-invasively monitor the evolution of COVID-19 pneumonia at the bedside. LUSS monitoring was rapidly implemented in the management of our COVID-19 patients with RT-PCR-documented COVID-19. The LUSS was evaluated repeatedly at the bedside. We present a graphic description of the course of LUSS during COVID-19 in 10 consecutive patients admitted in our intensive care unit with moderate to severe ARDS between March 15 and 30(th). LUSS appeared to be closely related to the disease progression. In successfully extubated patients, LUSS decreased and was lower than at the time of intubation. LUSS increased inexorably in a patient who died from refractory hypoxemia. LUSS helped with the diagnosis of ventilator-associated pneumonia (VAP), showing an increased score and the presence of new lung consolidations in all 5 patients with VAPs. There was also a good agreement between CT-scans and LUSS as for the presence of lung consolidations. In conclusion, our early experience suggests that LUSS monitoring accurately reflect disease progression and indicates potential usefulness for the management of COVID-19 patients with ARDS. It might help with early VAP diagnosis, mechanical ventilation weaning management, and potentially reduce the need for X-ray and CT exams. LUSS evaluation is easy to use and readily available in ICUs throughout the world, and might be a safe, cheap and simple tool to optimize critically ill COVID-19 patients care during the pandemic.Keywords
This publication has 6 references indexed in Scilit:
- Coronavirus Disease (COVID-19): Spectrum of CT Findings and Temporal Progression of the DiseaseAcademic Radiology, 2020
- Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemicIntensive Care Medicine, 2020
- The diagnostic accuracy for ARDS of global versus regional lung ultrasound scores - a post hoc analysis of an observational study in invasively ventilated ICU patientsIntensive Care Medicine Experimental, 2019
- Lung Ultrasound for Early Diagnosis of Ventilator-Associated PneumoniaSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2016
- Imaging in acute respiratory distress syndromeIntensive Care Medicine, 2016
- Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*Critical Care Medicine, 2012