Point-of-care lung ultrasound predicts severe disease and death due to COVID-19: a prospective cohort study.

Objective: The clinical utility of point-of-care lung ultrasound (LUS) for disease severity triage of hospitalized patients with COVID-19 is unclear. Design: Prospective cohort study Setting: A large tertiary care center in Maryland, USA between April 2020 to September 2021. Patients: Hospitalized adults (18 years of age or greater) with positive SARS-CoV-2 RT-PCR results. Interventions: None. Measurements and Main Results: All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean Lung Ultrasound Score (ranging from 0 to 3) across lung zones (mLUSS) was determined. The primary outcome was time to ICU-level care, defined as high flow oxygen, noninvasive, or mechanical ventilation, within 28-days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 59 years and 114 (43.2) % of participants were female. The median mLUSS was 1 (interquartile range: 0.5 to 1.3). Following enrollment, 29 (11.0%) participants went on to require ICU-level care and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (aHR = 3.63; 95% CI: 1.23 to 10.65) and 28-day mortality (aHR = 4.50; 95% CI: 1.52 to 13.31). Pleural line abnormalities were independently associated with disease progression to ICU-level care (aHR = 18.86; CI: 1.57 to 226.09). Conclusions: Participants with a mLUSS of 1 or more or pleural line changes on LUS had an increased likelihood of subsequent requirement of high flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

Lung Ultrasound in Pediatric Asthma - Characterizing Baseline Findings Outside of Acute Exacerbations

Background: Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress in the emergency department. However, very little is known about LUS findings in pediatric asthma outside of acute exacerbations. Objectives: The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. Methods: Eligible patients, aged 6 to 17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. A positive LUS was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation and/or pleural anomaly. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. Results: 52 patients were included. 10/52 patients had a positive LUS (19.2%, 95CI 8.3-30.1%). Of those with positive LUS findings, 8 had B lines, 7 had consolidations <1cm, 1 had a pleural line abnormality and 1 had a consolidation >1cm. Positive findings were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal spaces within one lung zone in 100% of participants. Conclusion: To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. Positive LUS findings in asthmatic children can be seen outside of acute exacerbations. Such findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

Lung ultrasound (LUS) can be used to assess loss of aeration, which is associated with outcome in patients with coronavirus disease 2019 (COVID-19) presenting to the emergency department. We hypothesized that LUS scores are associated with outcome in critically ill COVID-19 patients receiving invasive ventilation. This retrospective international multicenter study evaluated patients with COVID-19–related acute respiratory distress syndrome (ARDS) with at least one LUS study within 5 days after invasive mechanical ventilation initiation. The global LUS score was calculated by summing the 12 regional scores (range 0–36). Pleural line abnormalities and subpleural consolidations were also scored. The outcomes were successful liberation from the ventilator and intensive care mortality within 28 days, analyzed with multistate, competing risk proportional hazard models. One hundred thirty-seven patients with COVID-19–related ARDS were included in our study. The global LUS score was associated with successful liberation from mechanical ventilation (hazard ratio [HR]: 0.91 95% confidence interval [CI] 0.87–0.96; P = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97–1.08; P = 0.36). Subpleural consolidation and pleural line abnormalities did not add to the prognostic value of the global LUS score. Examinations within 24 hours of intubation showed no prognostic value. To conclude, a lower global LUS score 24 hours after invasive ventilation initiation is associated with increased probability of liberation from the mechanical ventilator COVID–19 ARDS patients, independently of the ARDS severity.

Can follow up lung ultrasound in Coronavirus Disease-19 patients indicate clinical outcome?

Purpose To evaluate whether there is a change in findings of coronavirus disease 2019 patients in follow up lung ultrasound and to determine whether these findings can predict the development of severe disease. Materials and methods In this prospective monocentric study COVID-19 patients had standardized lung ultrasound (12 area evaluation) at day 1, 3 and 5. The primary end point was detection of pathologies and their change over time. The secondary end point was relationship between change in sonographic results and clinical outcome. Clinical outcome was assessed on development of severe disease defined as need for intensive care unit. Results Data of 30 patients were analyzed, 26 patients with follow-up lung ultrasound. All of them showed lung pathologies with dynamic patterns. 26,7% developed severe disease tending to have an ubiquitous lung involvement in lung ultrasound. In patients with need for intensive care unit a previously developed increase in B-lines, subpleural consolidations and pleural line irregularities was more common. A statistically significant association between change in B-lines as well as change in pleural line irregularities and development of severe disease was observed (p<0,01). Conclusion The present study demonstrates that follow up lung ultrasound can be a powerful tool to track the evolution of disease and suggests that lung ultrasound is able to indicate an impending development of severe disease in COVID-19 patients.

Medical Image Enhancement Algorithm for B-Mode Ultrasound Image Analysis of Neonatal Respiratory Distress Syndrome

The aim of this paper was to explore the imaging characteristics of lung B-ultrasound images under image enhancement algorithm for neonatal respiratory distress syndrome (NRDS) and the therapeutic effect of vitamin A (VA) on NDRS. 30 newborn babies with NRDS in hospital were selected as the experimental group and 30 healthy newborn babies were selected as the control group. All of them received the lung B-ultrasound based on the image enhancement algorithm under the partial differential equation (PDE). The subjects of the control group were given formula milk every day. On the basis of formula milk, the subjects of the experimental group took VA soft capsule orally once a day at noon. Oxidative stress indexes, blood gas indexes, and mechanical ventilation parameters were recorded in the subjects of the two groups. The results of 30 newborn babies with NRDS in the experimental group indicated that the images of 12 cases presented the disappearance of line A and dense or discontinuous distribution of line B; the abnormal pleural line was found in the images of 8 cases; there was lung consolidation under the pleural line, patchy hypoecho, and point-strip hyperecho in the images of 5 cases; the images of 2 cases showed alveolar edema and alveolar interstitial syndrome. Compared with before treatment, the arterial partial pressure of oxygen (PaO2) of subjects in the experimental group (87.61 ± 5.79) increased dramatically, but their arterial partial pressure of carbon dioxide (PaCO2) decreased sharply after treatment (40.07 ± 6.12), with statistically huge differences ( P < 0.05 ). The respiratory rate (RR) and positive end expiratory pressure (PEEP) after treatment were greatly less than those before treatment of subjects in the experimental group ( P < 0.05 ), and the difference was statistically obvious ( P < 0.05 ). By comparing with before treatment, malondialdehyde (MDA) of subjects in the experimental group decreased after treatment while superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased considerably, with statistically marked differences ( P < 0.05 ). In conclusion, lung B-ultrasound based on partial image enhancement algorithm could clearly display the imaging characteristics of NRDS, such as pleural abnormalities and alveolar stroma. Besides, VA could effectively improve the neonatal shortness of breath, which had a good clinical effect.

Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

<b><i>Introduction:</i></b> Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. <b><i>Methods:</i></b> Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. <b><i>Results:</i></b> Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (<i>p</i> &#x3c; 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted <i>NICHD 2001-BPD</i> with <i>R</i>² = 0.522; AUC = 0.87 (0.79–0.94), <i>p</i> &#x3c; 0.001, and <i>Jensen 2019-BPD</i> with <i>R</i>² = 0.315 (AUC = 0.80 [0.70–0.90], <i>p</i> &#x3c; 0.001). A model including mechanical ventilation &#x3e;5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (<i>R</i>² = 0.655, <i>p</i> &#x3c; 0.001) with an AUC = 0.90 (0.84–0.97), <i>p</i> &#x3c; 0.001. <b><i>Conclusion:</i></b> LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.