A lower global lung ultrasound score is associated with higher likelihood of successful extubation in invasively ventilated COVID-19 patients

Charalampos Pierrakos*, Arthur Lieveld, Luigi Pisani, Marry R. Smit, Micah Heldeweg, Laura A. Hagens, Jasper Smit, Mark Haaksma, Lars Veldhuis, Robin Walburgh Schmidt, Giacomo Errico, Valentina Marinelli, Rachid Attou, Cristina E. David, Claudio Zimatore, Francesco Murgolo, Salvatore Grasso, Lucia Mirabella, Gilda Cinnella, David de BelsMarcus J. Schultz, Pieter-Roel Tuinman, Lieuwe D. Bos

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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 5 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97-1.08; P 5 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.
Original languageEnglish
Pages (from-to)1490-1497
Number of pages8
JournalThe American journal of tropical medicine and hygiene
Volume105
Issue number6
Early online date18 Oct 2021
DOIs
Publication statusPublished - 1 Dec 2021

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