Heldeweg Micah L A, Lopez Matta Jorge E, Haaksma Mark E, Smit Jasper M, Elzo Kraemer Carlos V, de Grooth Harm-Jan, de Jonge Evert, Meijboom Lilian J, Heunks Leo M A, van Westerloo David J, Tuinman Pieter R
Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.
Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
Intensive Care Med Exp. 2021 Jan 25;9(1):1. doi: 10.1186/s40635-020-00367-3.
Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients.
Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints.
We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging - 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor.
Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days.
NTR, NL8584. Registered 01 May 2020-retrospectively registered, https://www.trialregister.nl/trial/8584.
肺部超声能够充分监测肺炎及急性呼吸窘迫综合征的疾病严重程度。我们推测肺部超声能够充分监测危重症患者的新型冠状病毒肺炎（COVID-19肺炎）。
纳入两所学术医院重症监护病房收治的成年COVID-19肺炎患者，这些患者均接受了12区肺部超声检查及胸部CT检查。记录基线特征以及包括复合终点死亡或入住重症监护病房超过30天在内的结局。将肺部超声和CT图像量化为肺部超声评分累及指数（LUSI）和CT严重程度累及指数（CTSI）。主要结局是LUSI与CTSI之间的相关性、一致性和协调性。次要结局是LUSI和CTSI与复合终点之间的关联。
我们纳入了34例患者的55次超声检查，其中88%为男性，平均年龄63岁，平均P/F比值为151。LUSI与CTSI之间的相关性很强（r = 0.795），总体偏差为15%，一致性界限为-40至9.7。连续测量的LUSI和CTSI变化之间的协调性为81%。在单变量模型中，LUSI和CTSI的高累及程度与复合终点相关。在多变量模型中，LUSI是唯一剩余的独立预测因素。
肺部超声可作为胸部CT的替代方法用于监测危重症患者的COVID-19肺炎，因为它能够量化肺部累及情况，记录疾病过程中的变化，并预测死亡或入住重症监护病房超过30天。
NTR，NL8584。2020年5月1日注册——追溯注册，https://www.trialregister.nl/trial/8584 。
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