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Lung Ultrasound for Identification of Patients Requiring Invasive Mechanical Ventilation in COVID-19.
Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden.ORCID iD: 0000-0003-2026-2887
Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden.
Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden; Department of Cardiology, Falun Hospital, Falun, Sweden.ORCID iD: 0000-0002-3671-5046
2021 (English)In: Journal of ultrasound in medicine, ISSN 0278-4297, E-ISSN 1550-9613, Vol. 40, no 11, p. 2339-2351Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Indication for invasive mechanical ventilation in COVID-19 pneumonia has been a major challenge. This study aimed to evaluate if lung ultrasound (LUS) can assist identification of requirement of invasive mechanical ventilation in moderate to severe COVID-19 pneumonia.

MATERIALS AND METHODS: Between April 23 and November 12, 2020, hospitalized patients with moderate to severe COVID-19 (oxygen demand ≥4 L/min) were included consecutively. Lung ultrasound was performed daily until invasive mechanical ventilation (IMV-group) or spontaneous recovery (non-IMV-group). Clinical parameters and lung ultrasound findings were compared between groups, at intubation (IMV-group) and highest oxygen demand (non-IMV-group). A reference group with oxygen demand <4 L/min was examined at hospital admission.

RESULTS: Altogether 72 patients were included: 50 study patients (IMV-group, n = 23; non-IMV-group, n = 27) and 22 reference patients. LUS-score correlated to oxygen demand (SpO2 /FiO2 -ratio) (r = 0.728; p < .0001) and was higher in the IMV-group compared to the non-IMV-group (20.0 versus 18.0; p = .026). Based on receiver operating characteristic analysis, a LUS-score of 19.5 was identified as cut-off for requirement of invasive mechanical ventilation (area under the curve 0.68; sensitivity 56%, specificity 74%). In 6 patients, LUS identified critical coexisting conditions. Respiratory rate and oxygenation index ((SpO2 /FiO2 )/respiratory rate) ≥4.88 identified no requirement of invasive mechanical ventilation with a positive predictive value of 87% and negative predictive value of 100%.

CONCLUSIONS: LUS-score had only a moderate diagnostic value for requirement of invasive mechanical ventilation in moderate to severe COVID-19. However, LUS proved valuable as complement to respiratory parameters in guidance of disease severity and identifying critical coexisting conditions.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2021. Vol. 40, no 11, p. 2339-2351
Keywords [en]
COVID-19, Coronavirus, mechanical, ultrasonography, ventilators
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-102243DOI: 10.1002/jum.15617ISI: 000611675900001PubMedID: 33496362Scopus ID: 2-s2.0-85099952368OAI: oai:DiVA.org:oru-102243DiVA, id: diva2:1711172
Available from: 2022-11-16 Created: 2022-11-16 Last updated: 2024-03-06Bibliographically approved

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Seiler, ClaudiaHårdstedt, Maria

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