Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness: A Prospective Longitudinal Point-of-Care Lung Ultrasound Study.
J Ultrasound Med
; 40(9): 1823-1838, 2021 Sep.
Article
in English
| MEDLINE | ID: covidwho-921733
ABSTRACT
Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia. OBJECTIVE:
We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization.METHODS:
We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2-4 MHz), convex (2-6 MHz) and linear (10-15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors.RESULTS:
Cox regression analysis showed that lymphocytopenia (hazard ratio [HR] 0.88, 95% confidence intervals [CI] 0.68-0.96, p = .048), increased lactate (HR 1.17, 95% CI 0.94-1.46, p = 0.049), and D-dimers (HR 1.21, 95% CI 1.03-1.44, p = .03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < .05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI 0.76-0.89) and specificity of 0.91 (95% CI 0.94-0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively.CONCLUSION:
POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Lung Injury
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
J Ultrasound Med
Year:
2021
Document Type:
Article
Affiliation country:
Jum.15563
Similar
MEDLINE
...
LILACS
LIS