van Blydenstein S A, Nell T, Menezes C, Jacobson B F, Omar S
Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Division of Diagnostic Radiology, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Afr J Thorac Crit Care Med. 2025 Mar 28;31(1):e1887. doi: 10.7196/AJTCCM.2025.v31i1.1887. eCollection 2025.
Pulmonary ultrasound techniques have historically been applied to acute lung diseases to describe lung lesions, particularly in critical care.
To explore the role of lung ultrasound (LUS) in hospitalised patients with hypoxaemic pneumonia during the COVID-19 pandemic.
This was a single-centre prospective, observational study of two groups of adult patients with hypoxaemic pneumonia: those with COVID-19 pneumonia, and those with non-COVID-19 community-acquired pneumonia (CAP). A pulmonologist performed bedside LUS using the Bedside Lung Ultrasound in Emergency (BLUE) protocol, and the findings were verified by an independent study-blinded radiologist.
We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID CAP. The COVID-19 patients were significantly older than those with non-COVID CAP (median (interquartile range (IQR)) age 52 (42 - 62.5) years v. 42.5 (36 - 52.5) years, respectively; p=0.007), and had a lower prevalence of HIV infection (25% v. 54%, respectively; p=0.01) and higher prevalences of hypertension (54% v. 7%; p=0.002) and diabetes mellitus (19% v. 8%; p=0.04). In both groups, close to 30% of the patients had severe acute respiratory distress syndrome. A confluent B-line pattern in the right upper lobe was significantly associated with COVID-19 pneumonia compared with the C pattern (relative risk (RR) 3.8; 95% confidence interval (CI) 1.7 - 8.6). Bilateral changes on LUS rather than unilateral or no changes were associated with COVID-19 pneumonia (RR 1.55; 95% CI 1.004 - 2.387). There were no statistically significant differences in median (IQR) lung scores between patients with COVID-19 pneumonia and those with non-COVID CAP (8 (4 - 11.5) v. 7.5 (4.5 - 12.5), respectively). Patients with COVID-19 pneumonia had a higher than predicted mortality. Logistic regression analysis showed a higher Simplified Acute Physiology Score (SAPS II) (RR 1.11; 95% CI 1.02 - 1.21) and a lower total LUS score indicating B lines v. consolidation (RR 0.80; 95% CI 0.65 - 0.99) to be associated with mortality.
Patients with right upper zone consolidation were more likely to have non-COVID CAP than COVID-19 pneumonia. Finding a B pattern as opposed to consolidation was associated with mortality. The admission LUS score was unable to discriminate between COVID-19 and non-COVID CAP, and did not correlate with the ratio of partial pressure of oxygen to fractional inspired oxygen, clinical severity or mortality.
During the COVID-19 pandemic, in a resource-limited, high-prevalence setting, lung ultrasound (LUS) patterns on admission to hospital were used to distinguish between COVID-19 and other causes in patients with hypoxaemic pneumonia. Patients with right upper zone consolidation were more likely to have non-COVID-19 community-acquired pneumonia (CAP) than COVID-19 pneumonia. The admission LUS score was unable to discriminate between COVID-19 pneumonia and non-COVID CAP, and did not correlate with the ratio of partial pressure of oxygen to fractional inspired oxygen, clinical severity or mortality. The pattern was more valuable than the total LUS score in understanding the disease process.
肺超声技术历来应用于急性肺部疾病以描述肺部病变，尤其是在重症监护中。
探讨肺超声（LUS）在2019年冠状病毒病（COVID-19）大流行期间住院低氧血症性肺炎患者中的作用。
这是一项单中心前瞻性观察性研究，纳入两组低氧血症性肺炎成年患者：COVID-19肺炎患者和非COVID-19社区获得性肺炎（CAP）患者。一名肺科医生采用急诊床旁肺超声（BLUE）方案进行床旁LUS检查，检查结果由一名独立的、对研究不知情的放射科医生核实。
我们纳入了48例COVID-19肺炎患者和24例非COVID CAP患者。COVID-19患者的年龄显著大于非COVID CAP患者（年龄中位数（四分位间距（IQR））分别为52（42 - 62.5）岁和42.5（36 - 52.5）岁；p = 0.007），HIV感染患病率较低（分别为25%和54%；p = 0.01），高血压（分别为54%和7%；p = 0.002）和糖尿病（分别为19%和8%；p = 0.04）患病率较高。两组中近30%的患者患有严重急性呼吸窘迫综合征。与C型相比，右上叶融合的B线模式与COVID-19肺炎显著相关（相对风险（RR）3.8；95%置信区间（CI）1.7 - 8.6）。LUS显示双侧改变而非单侧或无改变与COVID-19肺炎相关（RR 1.55；95% CI 1.004 - 2.387）。COVID-19肺炎患者和非COVID CAP患者的肺评分中位数（IQR）无统计学显著差异（分别为8（4 - 11.5）和7.5（4.5 - 12.5））。COVID-19肺炎患者具有高于预期的死亡率。逻辑回归分析显示，较高的简化急性生理学评分（SAPS II）（RR 1.11；95% CI 1.
