Ultrasound-guided lung lesion index as a predictor of treatment outcomes: cohort study of 388 patients with coronavirus infection

INTRODUCTION. Currently there are a lot of articles of lung ultrasound (LUS) in COVID-19 both in the diagnosis and in the prognosis of the disease. OBJECTIVE. Evaluation of the relationship between the ultrasound-guided lung lesion index (UIL) with the volume of lung involvement determined by computed tomography (CT) and disease outcomes in patients with COVID-19. MATERIALS AND METHODS. A prospective observational cohort clinical study included 388 patients aged 18–75 years;diagnosed with pneumonia with COVID-19 or suspected COVID-19. Lung ultrasound was performed according to the 16-zone “Russian Protocol” within 24 hours after CT scan of the chest organs. RESULTS. The median lung lesion volume on CT was 55 (35– 74) % and UIL was 46 (28–60) points. UIL had a strong direct correlation of 0.873 (95 % CI 0.842–0.897, p < 0.01) with the change in the volume of lung involvement determined by CT and the inverse with the SpO2/FiO2 index — ​0.850 (95 % CI 0.827–0.871, p < 0.01). Mortality was 56 patients (14.4 %) (p = 0.018). The optimal cut-off point for ROC analysis in predicting mortality was 55 points and had a sensitivity of 97.6 % and a specificity of 73.9 % with an area under the curve of 0.896 (95 % CI 0.861–0.931). Kaplan— Meier analysis on the entire data set (n = 388) demonstrated a survival rate of 97.6 % in the group with a UIL score less than 55 points and 62 % in the group with a UIL score more than 55 points. Differences between groups were statistically significant (Log Rank test p < 0.001;Breslow test p < 0.001). As a result, multivariate Cox regression analysis, using the stepwise exclusion method, only UIL remained a significant predictor of adverse outcome (p < 0.01). CONCLUSIONS. UIL determined by 16-zone “Russian protocol” correlated with severity of respiratory failure and volume of lung injury and was a predictor of adverse prognosis of disease outcome. © 2022, Practical Medicine Publishing House LLC. All rights reserved.

Specificity and Sensitivity of Lung Ultrasound Examination in Patients with COVID-19 Induced Pneumonia

The coronavirus infection (COVID-19) is characterized by a high incidence of pneumonia. Extensive damage, high mortality associated with COVID-19 make the rapid bedside diagnosis and dynamic monitoring of the volume and nature of lung tissue damage a challenge. Lung ultrasound examination can be used as a tool to answer it. The objective: to compare the signs detected by lung computed tomography and ultrasound and to assess the sensitivity and specificity of ultrasound in the diagnosis of pneumonia induced by COVID-19. Subjects and Methods. The observational prospective clinical study included 388 patients aged 18–75 years old;they had a confirmed diagnosis of pneumonia caused by COVID-19 or suspected COVID-19. Lung ultrasound was performed within 24 hours after computed tomography (CT) of the chest organs. During CT, pathological signs, infiltration and consolidation of the lungs were visualized which were documented by lung segments. Lung ultrasound was performed according to the Russian Protocol, ultrasound signs of B-lines and consolidation were also documented based on the projection of lung segments on the chest wall. The distributions of variables was analyzed, described and summarized. The sensitivity and specificity of ultrasound methods were evaluated on the basis of ROC analysis according to CT gold standard. Results. Bilateral involvement was found in 100% of cases. Typical CT signs of pneumonia caused by coronavirus infection were ground-glass opacity of the pulmonary parenchyma, thickened pleura, consolidation, interstitium, reticular induration, and cobblestone appearance. With ultrasound examination of the lungs and pleura, the detected signs corresponded to CT signs. B lines (multifocal, discrete or merging) and consolidation of various volumes of lung tissue were most common during ultrasound. The sign of consolidation was detected less frequently versus infiltration (p < 0.001). The sensitivity of lung ultrasound in the diagnosis of lung lesions was 95.3%, and the specificity was 85.4%, the area under the curve was 0.976 with a confidence interval of 0.961–0.991 (p < 0.001). Conclusion. The use of lung ultrasound during the COVID-19 pandemic makes it possible to identify, assess the volume and nature of lung damage. Lung ultrasound demonstrated accuracy comparable to CT of the chest organs in detecting pneumonia in patients with COVID-19. © Chinese Journal of Microsurgery.All right reserved.

Lung ultrasound in COVID-19 pneumonia: Comparison with computed tomography. An observation prospective clinical trial

Introduction. Pneumonia is the most severe form of the new coronavirus infection (COVID-19). The large area of damage and the high mortality rate in COVID-19 pose the challenge of rapid bedside diagnosis and dynamic monitoring of the volume and nature of lung tissue damage. Objectives. The goal of the study was to compare the data obtained with computed tomography and ultrasound of the lungs, as well as the accuracy of ultrasound segmentby-segment verification of damage zones in patients with pneumonia caused by SARS-CoV-2. Material and methods. The observational prospective clinical study included 388 patients aged 18-75 years;with a confirmed diagnosis of pneumonia caused by COVID-19 or suspected COVID-19. Lung ultrasound was performed within 24 hours after computed tomography (CT) of the chest. During the CT scan, pathological signs, infiltration, and consolidation of the lungs were determined, which were recorded by lung segments. Ultrasound of the lungs was performed according to the “Russian Protocol”, ultrasound signs in the lines and consolidation were also recorded based on the projection of the lung segments on the chest wall. An analysis was performed to describe and generalize the distributions of variables. The sensitivity and specificity of ultrasound methods were evaluated with ROC analysis against CT as a “gold standard”. Results. Bilateral involvement was found in 100 % of cases. Typical signs of pneumonia caused by coronavirus infection on CT were a “ground glass” pattern, thickened pleura, consolidation, reticular pattern, and a “crazy paving” pattern. During ultrasound examination of the lungs and pleura, the detected signs corresponded to the signs of CT. B-lines (multifocal, discrete, or confluent) and consolidation of various volumes of lung tissue were most frequently encountered during ultrasound. The sensitivity of ultrasound of the lungs in the accuracy of the segment-by-segment diagnosis of damage by the sign of infiltration is 87.9 %, and the specificity is 91.5 % (the area under the ROC curve is 0.939;p < 0.001). The sensitivity of the ultrasonic sign of consolidation was 84.6 %, and the specificity was 79.2 % (the area under the ROC curve is 0.846;p < 0.001). Conclusions. The use of ultrasound of the lungs during the COVID-19 allows us to identify and assess the volume and nature of lung damage. Thus, lung ultrasonography has demonstrated accuracy comparable to chest CT in detecting lung damage in patients with COVID-19. © 2021, Practical Medicine Publishing House LLC. All rights reserved.

Oxygen-helium gas mixture «Heliox» for the treatment of respiratory failure in patients with new coronavirus infection Covid-19 (randomized single-center controlled trial)

IntRoDuCtIon Treatment of respiratory failure in pneumonia caused by coronavirus infection (COVID-19) is still an unsolved problem that requires a comprehensive approach and the development of new methods that expand the range of possibilities of modern therapy. There is evidence that the heated oxygen-helium mixture has a positive effect on gas exchange in the infiltration zone by improving both ventilation and diffusion. AIM oF StuDY To evaluate the effectiveness of the inclusion of a heated oxygen-helium mixture HELIOX (70% Helium/ 30% Oxygen) in the complex intensive care of respiratory failure of pneumonia caused by SARS-CoV-2 infection. MAteRIAL AnD MethoDS The study included 60 patients with confirmed viral pneumonia caused by COVID-19. The patients were randomized into two groups: group 1 (n=30) — patients who were treated with the standard COVID-19 treatment protocol with the heated oxygen-helium mixture HELIOX, and group 2 (control) (n=30) — patients who received standard therapy. Lethality was studied for 28 days, the time in days until a steady increase in SpO2>96% was achieved when breathing atmospheric air;the time until the patient is transferred from the intensive care unit (ICU) to the general department. ReSuLtS Inhalation of the HELIOX mixture (70% Helium / 30% Oxygen) resulted in a faster recovery of the hemoglobin oxygen saturation index (SpO2). Starting from day 3, these differences became statistically significant. The time in days from inclusion in the study to a persistent increase in the degree of oxygen saturation of hemoglobin (SpO2>96%) when breathing atmospheric air in the group with inhalation of the HELIOX mixture was less — 8 (7;10), compared to 10 (8;13) in the control group (p=0.006). In the group with inhaled HELIOX mixture, the median treatment time in the ICU was 8 (7;9.5) days vs 13 (8;17) days (p<0.001) in the comparison group. ConCLuSIonS Inhalation of the HELIOX mixture (70% Helium / 30% Oxygen) led to a faster recovery of the hemoglobin oxygen saturation index SpO2, which contributed to reduction in the duration of oxygen therapy and a decrease in mortality. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

The role and place of glucocorticosteroids in treatment of covid-19 pneumonia without hypoxemia

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19. Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease. Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: The main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators. Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group. Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease. © Salukhov V.V., Kryukov E.V., Chugunov A.A., Kharitonov M.A., Rudakov Y.V., Lakhin R.E., Dancev V.V., Stepanenko I.A., Gurba M.O., Stepanova T.V., Bolekhan A.V., Arzhavkina L.H. 2021.

One hundred questionnaires from repurposed hospitals: With what forces and means did we fight the «second wave» of covid-19?

In November-December 2020, the Federation of Anesthesiologists and Reanimatologists has conducted a survey of intensive care units (ICU) in 100 hospitals re-profiled for the treatment of COVID-19. There were regional (n=44), city (n=31), district (n=13), inter-district (n=8) and federal (n=4) hospitals from 27 constituent entities of the Russian Federation. Capacity of 59 hospitals was less than 300 beds, 23 hospitals — over 500 beds, 18 hospitals — 300—500 beds. The number of ICU beds exceeded 10% of repurposed beds in 35 hospitals, 5—10% of ICU beds — in 51 hospitals, less than 5% — in 14 hospitals. There were 6—12 patients per one physician in 68 ICUs, less than 6 patients — in 12 ICUs, over 12 patients — in 20 ICUs. Also, there were 3-6 patients per a nurse in 69 ICUs, less than 3 patients — in 2 ICUs, over 6 patients — in 29 ICUs. Over 70% of the repurposed beds were provided with a networked oxygen supply in 61 hospitals, 50—70% — in 25 hospitals, less than 50% — in 14 hospitals. Oxygen flow rate over 10 l/min was provided in 70 hospitals, 5—10 l/min — in 28 hospitals, less than 5 l/min — in 2 hospitals. Over 80% of ICU beds are equipped with ventilators in 78 hospitals, 50—80% — in 15 hospitals, less than 50% — in 7 hospitals. Less than 5% of ventilators have been out of order throughout the pandemic in 62 ICUs, 5—10% — in 20 departments, over 10% — in 18 ICUs. High-flow oxygen therapy was not available in 48 ICUs, ultrasound — in 10 ICUs. ECMO was available only in 17 ICUs. If we consider the pandemic as a model of health system response to non-standard global challenges, these data are essential for critical analysis despite small sample size. © 2021, Media Sphera Publishing Group. All rights reserved.