Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study.

Autor:	Blair PW; Austere environments Consortium for Enhanced Sepsis Outcomes, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD., Siddharthan T; Division of Pulmonary and Critical Care Medicine, University of Miami, Miami, FL.; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Liu G; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Bai J; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Cui E; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., East J; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Herrera P; Division of Pulmonary and Critical Care Medicine, University of Miami, Miami, FL., Anova L; Austere environments Consortium for Enhanced Sepsis Outcomes, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD., Mahadevan V; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Hwang J; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Hossen S; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Seo S; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Sonuga O; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Lawrence J; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Peters J; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD., Cox AL; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD., Manabe YC; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD., Fenstermacher K; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Shea S; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Rothman RE; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Hansoti B; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Sauer L; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD., Crainiceanu C; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Clark DV; Austere environments Consortium for Enhanced Sepsis Outcomes, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2022 Aug 12; Vol. 4 (8), pp. e0732. Date of Electronic Publication: 2022 Aug 12 (Print Publication: 2022).
DOI:	10.1097/CCE.0000000000000732
Abstrakt:	The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear. Design: Prospective cohort study. Setting: A large tertiary care center in Maryland, between April 2020 and September 2021. Patients: Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction 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 LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive 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 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5-1.3). Following enrollment, 27 participants (10.0%) 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 (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27-10.2) and 28-day mortality (aHR, 3.10; 95% CI, 1.29-7.50). Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI, 3.33-131.30). Conclusions: Participants with a mLUSS greater than or equal to 1 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. (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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