Prospective Longitudinal Evaluation ofPoint-of-CareLung Ultrasound in Critically Ill Patients With SevereCOVID-19 Pneumonia
Prospective Longitudinal Evaluation ofPoint-of-CareLung Ultrasound in Critically Ill Patients With SevereCOVID-19 Pneumonia
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DOI：
10.1002/jum.15417
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发表时间：
2020-08-14
影响因子：
2.3
通讯作者：
Blaivas, Michael
中科院分区：
文献类型：
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作者：
Alharthy, Abdulrahman;Faqihi, Fahad;Blaivas, Michael
目的对2019冠状病毒病（COVID-19）危重患者肺部超声表现进行前瞻性纵向分析。方法对89例确诊COVID-19重症监护病房（ICU）患者进行前瞻性随访。点护理超声（POCUS）检查进行相控阵，凸和线性换能器使用便携式机器。扫描胸部12个肺区：双侧前、侧、后（上/下）。下肢深静脉血栓及胸部ct血管造影排除疑似肺栓塞（PE）。每周及出院前随访POCUS。结果患者以男性为主（84.2%），中位年龄43岁。机械通气持续时间中位数为17天(四分位数间距10-22天);ICU住院时间22天（四分位数间距20.2 ~ 25.2天）；28天死亡率为28.1%。在ICU入院时，POCUS发现双侧不规则胸膜线（78.6%）伴合并和分离b线（100%），变异性实变（61.7%），胸膜和心脏积液（分别为22.4%和13.4%）。这些发现似乎表明COVID-19肺炎处于晚期阶段。16.8%的患者发现深静脉血栓形成，而24.7%的患者发现胸部ct血管造影证实PE。入院后5 ~ 6周，随访POCUS检查发现幸存者肺部异常发生率明显降低（P < 0.05）。结论：定点超声显示b线、胸膜线不规则和可变实变。出院后肺部超声表现明显下降，提示至少部分COVID-19肺部病变持续但缓慢消退。尽管POCUS在不到20%的床边患者中发现了深静脉血栓，但近四分之一的患者被发现有计算机断层扫描证实的PE。
Objectives To perform a prospective longitudinal analysis of lung ultrasound findings in critically ill patients with coronavirus disease 2019 (COVID-19). Methods Eighty-nine intensive care unit (ICU) patients with confirmed COVID-19 were prospectively enrolled and tracked. Point-of-care ultrasound (POCUS) examinations were performed with phased array, convex, and linear transducers using portable machines. The thorax was scanned in 12 lung areas: anterior, lateral, and posterior (superior/inferior) bilaterally. Lower limbs were scanned for deep venous thrombosis and chest computed tomographic angiography was performed to exclude suspected pulmonary embolism (PE). Follow-up POCUS was performed weekly and before hospital discharge. Results Patients were predominantly male (84.2%), with a median age of 43 years. The median duration of mechanical ventilation was 17 (interquartile range, 10-22) days; the ICU length of stay was 22 (interquartile range, 20.2-25.2) days; and the 28-day mortality rate was 28.1%. On ICU admission, POCUS detected bilateral irregular pleural lines (78.6%) with accompanying confluent and separate B-lines (100%), variable consolidations (61.7%), and pleural and cardiac effusions (22.4% and 13.4%, respectively). These findings appeared to signify a late stage of COVID-19 pneumonia. Deep venous thrombosis was identified in 16.8% of patients, whereas chest computed tomographic angiography confirmed PE in 24.7% of patients. Five to six weeks after ICU admission, follow-up POCUS examinations detected significantly lower rates (P < .05) of lung abnormalities in survivors. Conclusions Point-of-care ultrasound depicted B-lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings were significantly decreased by ICU discharge, suggesting persistent but slow resolution of at least some COVID-19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20% of patients at the bedside, nearly one-fourth of all patients were found to have computed tomography-proven PE.