Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy.
Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy.
Chest. 2023 Jan;163(1):176-184. doi: 10.1016/j.chest.2022.07.014. Epub 2022 Jul 31.
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).
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)?
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 Pao/Fio ratio were calculated.
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 Pao/Fio ratio (R = -0.66 and R = -0.54; P < .0001, respectively).
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.
肺部超声（LUS）扫描可用于诊断和评估 COVID-19 相关急性呼吸窘迫综合征（CoARDS）期间的肺部病变严重程度。目前提出了一种常规的 LUS 评分来衡量 CoARDS 期间的通气丧失。然而，该评分是在 COVID-19 之前在 ICU 中的 ARDS 患者中进行验证的，并未考虑与 CoARDS 的差异。另一种 LUS 方法基于对肺部表面上 COVID-19 肺炎典型征象的扩展百分比进行分级（LUSext）。
在疾病发作时，LUSext 对 COVID-19 患者是否可行，它是否与 CT 扫描（CTvol）上 COVID-19 肺炎病变严重程度的容积测量相关？
这项观察性研究纳入了在急诊科就诊的经证实的 COVID-19 患者，这些患者的床边 LUS 和 CT 扫描显示有肺炎。对 LUSext 进行了视觉量化。所有 CT 扫描研究均由专门设计的软件进行回顾性分析，以计算 CTvol。计算了 LUSext 与 CTvol 的相关性，以及每个评分与 PaO2/FIO2 比值的相关性。
我们分析了 179 名患者的数据。LUSext 的可行性为 100%。进行 LUS 扫描的时间为 5±1.5 分钟。LUSext 和 CTvol 呈正相关（R=0.67；P<0.0001）。LUSext 和 CTvol 均与 PaO2/FIO2 比值呈负相关（R=-0.66 和 R=-0.54；P<0.0001，分别）。
与 CT 扫描相比，LUSext 是一种评估病变严重程度的有效方法。不仅 LUSext 和 CTvol 相关，而且它们与呼吸衰竭严重程度也具有相似的负相关。LUSext 是一种实用且简单的床边 CoARDS 肺炎严重程度测量方法，其临床和预后影响需要进一步研究。
