A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

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  • 1 Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers—AMC, Amsterdam, The Netherlands;
  • | 2 Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Belgium;
  • | 3 Department of Intensive Care and Acute Internal Medicine, Amsterdam University Medical Centers—VUMC, Amsterdam, The Netherlands;
  • | 4 Department of Anesthesia and Intensive Care, Miulli Regional Hospital, Acquaviva delle Fonti, Italy;
  • | 5 Mahidol–Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand;
  • | 6 Department of Anesthesia and Intensive Care, Foggia University Hospital, University of Foggia, Italy;
  • | 7 Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy;
  • | 8 Nuffield Department of Medicine, University of Oxford, United Kingdom;
  • | 9 ALIFE, Amsterdam Leiden IC Focussed Echograpy, Amsterdam, The Netherlands

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 = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97–1.08; P = 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.

Author Notes

Address correspondence to Charalampos Pierrakos, Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels. Belgium. E-mail: charalampos_p@hotmail.com

These authors contributed equally to this work.

Authors’ addresses: Charalampos Pierrakos, Amsterdam University Medical Centers—AMC, Amsterdam, The Netherlands, and Brugmann University Hospital, Université Libre de Bruxelles, Belgium, E-mail: charalampos_p@hotmail.com. Arthur Lieveld, Micah Heldeweg, Mark Haaksma, Jasper Smit, Lars Veldhuis, and Robin Walburgh Schmidt, Amsterdam University Medical Centers—VUMC, Amsterdam, The Netherlands, E-mails: a.lieveld@amsterdamumc.nl, m.heldeweg@amsterdamumc.nl, m.haaksma@amsterdamumc.nl, j.smit6@amsterdamumc.nll.i.veldhuis@amsterdamumc.nl, and r.walburgh@amsterdamumc.nl. Luigi Pisani, Amsterdam University Medical Centers—AMC, Amsterdam, The Netherlands, Miulli Regional Hospital, Acquaviva delle Fonti, Italy, and Mahidol University, Bangkok, Thailand, E-mail: luigipisani@gmail.com. Marry R. Smit, Laura A. Hagens, and Lieuwe D. Bos, Amsterdam University Medical Centers—AMC, Amsterdam, The Netherlands, E-mails: m.r.smit@amsterdamumc.nl, l.a.hagens@amsterdamumc.nl, and l.d.bos@amsterdamumc.nl. Giacomo Errico, Miulli Regional Hospital, Acquaviva delle Fonti, Italy, and Foggia University Hospital, University of Foggia, Italy, E-mail: giacomo.errico1@gmail.com. Valentina Marinelli and Francesco Murgolo, University of Bari, Bari, Italy, E-mails: v.marinelli22@gmail.com and francesco.murgolo@uniba.it. Rachid Attou, Cristina E. David, and David De Bels, Brugmann University Hospital, Université Libre de Bruxelles, Belgium, E-mails: rachid.attou@chu-brugmann.be, cristina.david@bordet.be, and david.debels@chu-brugmann.be. Claudio Zimatore and Salvatore Grasso, Amsterdam University Medical Centers—AMC, Amsterdam, The Netherlands, and University of Bari, Bari, Italy, E-mails: claudiozimatore@gmail.com and salvatore.grasso@uniba.it. Lucia Mirabella and Gilda Cinnella, Foggia University Hospital University of Foggia, Italy, E-mails: lucia.mirabella@unifg.it and gilda.cinnella@unifg.it. Marcus J. Schultz, Amsterdam University Medical Centers—AMC, Amsterdam, The Netherlands, Mahidol University, Bangkok, Thailand, and University of Oxford, United Kingdom, E-mail: marcus.j.schultz@gmail.com. Pieter-Roel Tuinman, Amsterdam University Medical Centers—VUMC, Amsterdam, The Netherlands, and Amsterdam Leiden IC Focussed Echograpy, E-mail: p.tuinman@amsterdamumc.nl.

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