Feasibility of a New Lung Ultrasound Protocol to Determine the Extent of Lung Injury in COVID-19 Pneumonia

Giovanni Volpicelli; Thomas Fraccalini; Luciano Cardinale; Giuseppe Stranieri; Rouslan Senkeev; Guido Maggiani; Alberto Pacielli; Domenico Basile

doi:10.1016/j.chest.2022.07.014

Feasibility of a New Lung Ultrasound Protocol to Determine the Extent of Lung Injury in COVID-19 Pneumonia

Chest. 2023 Jan;163(1):176-184. doi: 10.1016/j.chest.2022.07.014. Epub 2022 Jul 31.

Authors

Giovanni Volpicelli¹, Thomas Fraccalini², Luciano Cardinale³, Giuseppe Stranieri³, Rouslan Senkeev³, Guido Maggiani⁴, Alberto Pacielli³, Domenico Basile³

Affiliations

¹ Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy. Electronic address: giovi.volpicelli@gmail.com.
² Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy.
³ Department of Oncology, Radiology Unit, San Luigi Gonzaga University Hospital, Torino, Italy.
⁴ Department of Medical Sciences, Section of Geriatrics, Città della Salute e della Scienza University Hospital, Torino, Italy.

Abstract

Background: Lung ultrasound (LUS) scanning is useful to diagnose and assess the severity of pulmonary lesions during COVID-19-related ARDS (CoARDS). A conventional LUS score is proposed to measure the loss of aeration during CoARDS. However, this score was validated during the pre-COVID-19 era in patients with ARDS in the ICU and does not consider the differences with CoARDS. An alternative LUS method is based on grading the percentage of extension of the typical signs of COVID-19 pneumonia on the lung surface (LUSext).

Research question: Is LUSext feasible in patients with COVID-19 at the onset of disease, and does it correlate with the volumetric measure of severity of COVID-19 pneumonia lesions at CT scan (CTvol)?

Study design and methods: This observational study enrolled a convenience sampling of patients in the ED with confirmed COVID-19 whose condition demonstrated pneumonia at bedside LUS and CT scan. LUSext was visually quantified. All CT scan studies were analyzed retrospectively by a specifically designed software to calculate the CTvol. The correlation between LUSext and CTvol, and the correlations of each score with Pao₂/Fio₂ ratio were calculated.

Results: We analyzed data from 179 patients. Feasibility of LUSext was 100%. Time to perform LUS scan was 5 ± 1.5 mins. LUSext and CTvol were correlated positively (R = 0.67; P < .0001). Both LUSext and CTvol showed negative correlation with Pao₂/Fio₂ ratio (R = -0.66 and R = -0.54; P < .0001, respectively).

Interpretation: LUSext is a valid measure of the severity of the lesions when compared with the CT scan. Not only are LUSext and CTvol correlated, but they also have similar inverse correlation with the severity of respiratory failure. LUSext is a practical and simple bedside measure of the severity of pneumonia in CoARDS, whose clinical and prognostic impact need to be investigated further.

Keywords: ARDS; COVID-19 pneumonia; CT volumetry; interstitial pneumonia; lung ultrasound; lung ultrasound scoring.

MeSH terms

COVID-19* / complications
COVID-19* / diagnostic imaging
Feasibility Studies
Humans
Lung / diagnostic imaging
Lung Injury*
Observational Studies as Topic
Respiratory Distress Syndrome*
Retrospective Studies
Ultrasonography / methods