key: cord-0714951-cg10o4u3
authors: Nguyen, Maxime; Gaujard, Guillaume; Guinot, Pierre-Grégoire; Bouhemad, Belaid
title: Using the lung ultrasound score to monitor disease progression for COVID-19-associated ARDS
date: 2021-09-30
journal: Intensive Care Med
DOI: 10.1007/s00134-021-06515-x
sha: 36ae619ee37dcd8a7a7b8ae80e4425b0c10f7c0d
doc_id: 714951
cord_uid: cg10o4u3

nan

Dear Editor, The lung ultrasound (LUS) score identifies patients with coronavirus disease 2019 (COVID-19) and may guide triage [1] . Its monitoring and prognostic value in patients in intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) needing ventilation support remains unknown.

During the first wave of the COVID-19 pandemic, we consecutively and prospectively followed 60 patients admitted for ARDS COVID-19 in our ICU. LUS score [2] was performed at admission, daily for the first-7 days and then on a 3-days' basis, since LUS examination is part of a routine monitoring of our patients. Computed tomography (CT) scan measurement of fibrosis and ground-glass opacities (GGOs) scores [3, 4] and their changes during the ICU stay were recorded. LUS score and CT scores were compared for patients who survived and with ICU stays ≤ 14 days (group 1, n = 26) and patients who died or with ICU stays > 14 days (group 2, n = 34). (Table 1) .

The LUS score at admission is higher in group 2 (18 ± 6 vs 22 ± 5, p < 0.05). Bedside applicability of a difference of four in patients with high LUS score remain limited. This was showed by a receiver operating characteristic (ROC) curve area of 0.72 ± 0.08 (confidence interval 0.56-0.87, p = 0.012) for the LUS score at admission to predict an ICU stay > 14 days. However, LUS score at day 1 is correlated to the GGO score (r = 0.56, p = 0.003) and the GGOs score was significantly higher in group 2 (38 ± 21 vs 60 ± 25; p = 0.001) ( Table 1) . No fibrosis was found in group 1, in contrast to group 2 (fibrosis score: median = 0 with IQR = [0-10]; p = 0.006).

At day 7, LUS score remained high and was not significantly different between the both groups (19 ± 6 vs 22 ± 3, p = 0.055). Twelve (35%) patients died in group 2 after a median of 9 days (IQR: 13.5). Patients in group 1 left the ICU after a median stay of 7.5 days [2.3-11.8] despite the persistence of a high LUS. This underlines the discrepancy between absence of image resolution and clinical improvement. Increase of fibrosis scores can be detected using LUS only if GGOs decrease. It seems that LUS detection of fibrosis could be improved by adding quantification of pleura changes. This was recently showed in a histopathological study correlating fibroproliferative changes with a modified LUS, including a study of pleural change [5] .

To summarize, our study, further clarifies the prognostic value and place of the LUS in ARDS COVID-19 patients admitted for ventilation in ICU. LUS scores is correlated with the GGO score at Day 1. However, a discrepancy between persistent high LUS score and clinical improvement was observed. Moreover, in some patients, we observed a decrease in the LUS score associated with fibroproliferative change. The severity of the included patients, may explain this discrepancy from previous triage studies [1] .

Funding Support was provided solely from institutional and/or departmental sources (Service d' Anesthésie Réanimation CHU Dijon, BP 77908, 21709 Dijon Cedex, France).

On behalf of all authors, the corresponding author states that there is no conflict of interest.

In accordance with the law on personal data protection of 6 January 1978 (number 78-17), our study was submitted to the National Commission of Data Protection (CNIL) via the hospital's personal data protection correspondent (declaration number 2013053v0).

Observational study for whom written consent was waived according to French law (Law 88-1138 of 20 December 1988, modified on 9 August 2004, on biomedical research). Patients received an information concerning study, their right to refuse to participate in the study and their right to withdraw at any time.

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Numbers are given as mean (± SD), median [IQR], number (%). Group 1: surviving patients with an ICU stay ≤ 14 days; group 2: deceased patients or patients with an ICU stay > 14 days. Comparisons between groups were made using the Mann-Whitney U and Chi-squared tests for continuous and categorical variables. P/F PaO 2 / FiO 2 ratio, PEEP positive end expiratory pressure, Pplat plateau pressure. CT scan at admission were available in 21 (81%) patients of group 1 and 29 (82%) patients for group 2 

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Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings