Department of Medicine V, University Hospital, LMU, Munich, Germany.
Department of Medicine III, University Hospital, LMU, Munich, Germany.
PLoS One. 2022 Jul 14;17(7):e0271411. doi: 10.1371/journal.pone.0271411. eCollection 2022.
Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). To assess the progression or regression of respiratory failure in critically ill patients with COVID-19 on Intensive Care Unit (ICU) by using LU.
We analyzed all patients admitted to Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich, from March 2020 to December 2020 suffering lung failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). LU was performed according to a standardized protocol at baseline and at follow up every other day for the first 15 days using a lung ultrasound score (LUSS). Ventilation data were collected simultaneously.
Our study included 42 patients. At admission to ICU, 19 of them (45%) were mechanically ventilated. Of the non-invasive ventilated ones (n = 23, 55%), eleven patients required invasive ventilation over the course. While LUS did not differ at admission to ICU between the invasive ventilated ones (at baseline or during ICU stay) compared to the non-invasive ventilated ones (12±4 vs 11±2 points, p = 0.2497), LUS was significantly lower at d7 for those, who had no need for invasive ventilation over the course (13±5 vs 7±4 points, p = 0.0046). Median time of invasive ventilation counted 18 days; the 90-day mortality was 24% (n = 10) in our cohort. In case of increasing LUS between day 1 (d1) and day 7 (d7), 92% (n = 12/13) required invasive ventilation, while it was 57% (n = 10/17) in case of decreasing LUS. At d7 we found significant correlation between LU and FiO2 (Pearson 0.591; p = 0.033), p/F ratio (Pearson -0.723; p = 0.005), PEEP (Pearson 0.495; p = 0.043), pplat (Pearson 0.617; p = 0.008) and compliance (Pearson -0.572; p = 0.016).
LUS can be a useful tool in monitoring of progression and regression of respiratory failure and in indicating intubation in patients with COVID-19 in the ICU.
床边肺部超声（LU）是评估新型冠状病毒病（COVID-19）患者的重要工具。本研究旨在使用 LU 评估重症监护病房（ICU）中 COVID-19 患者的呼吸衰竭进展或缓解。
我们分析了 2020 年 3 月至 2020 年 12 月期间慕尼黑路德维希-马克西米利安大学（LMU）内科 ICU 收治的所有因严重急性呼吸综合征冠状病毒 2（SARS-CoV2）导致肺衰竭的患者。LU 是根据标准化方案进行的，在最初的 15 天内每隔一天进行一次，使用肺部超声评分（LUSS）。同时收集通气数据。
我们的研究纳入了 42 名患者。入 ICU 时，其中 19 名（45%）患者接受机械通气。在接受无创通气的患者中（n = 23，55%），11 名患者在此期间需要进行有创通气。在 ICU 入住时，与接受有创通气的患者相比，接受无创通气的患者的 LUS 无明显差异（基础值或 ICU 期间，12±4 分 vs 11±2 分，p = 0.2497），但在无有创通气需求的患者中，LUS 明显更低（d7 时，13±5 分 vs 7±4 分，p = 0.0046）。有创通气中位时间为 18 天；我们队列的 90 天死亡率为 24%（n = 10）。如果在第 1 天（d1）和第 7 天（d7）之间 LUS 增加，92%（n = 12/13）需要有创通气，而如果 LUS 降低，则有 57%（n = 10/17）需要有创通气。在 d7，我们发现 LU 与 FiO2（Pearson 0.591；p = 0.033）、p/F 比值（Pearson -0.723；p = 0.005）、PEEP（Pearson 0.495；p = 0.043）、平台压（Pearson 0.617；p = 0.008）和顺应性（Pearson -0.572；p = 0.016）之间存在显著相关性。
在 ICU 中，LU 可以成为监测 COVID-19 患者呼吸衰竭进展或缓解以及提示插管的有用工具。
