Lung ultrasound, considered a simple method for detecting lung disease, can help predict the clinical progression of COVID-19 patients, according to a study conducted at the University of São Paulo School of Medicine (FM-USP) in São Paulo City, Brazil.
The lead investigator for the study was Heraldo Possolo de Souza, a professor at FM-USP and a attending physician at his teaching and general hospital, Hospital das Clínicas (HC).
The researchers applied an ultrasound examination protocol covering 12 lung regions in 180 COVID-19 patients receiving treatment at HC. The results showed that the higher the lung ultrasound score, the greater the risk of admission to an intensive care unit (ICU), intubation, and death.
The study was supported by the São Paulo Research Foundation – FAPESP and was reported in an article published in History of intensive care.
We found that lung ultrasound was a good predictor of the need for intensive care with endotracheal intubation and risk of death for COVID-19 patients admitted to the emergency room. It can be a simple, inexpensive way to estimate the prognosis for patients with the virus. “
Heraldo Possolo de Souza, Professor, FM-USP
At the onset of the pandemic, Souza and other emergency rooms (ERs) at HC and other hospitals around the world had to treat staggering numbers of patients who lacked adequate facilities. In learning to deal with this challenge, which has now receded as a result of declining patient numbers, healthcare teams have discovered that they need to use tools to assess the severity. in all cases so that facilities such as ICU beds and air conditioners are properly allocated and possible care priorities established.
Given the importance of diagnostic imaging of the lungs in the treatment of very severe COVID-19 patients, the FM-USP group accepted that screening of patients admitted with the lung may also be useful. disease based on the expected outcome. They chose lung ultrasound to test the hypothesis because the method is widely used in ERs, as well as being fast, easy to achieve with portable equipment, and inexpensive.
“Lung ultrasound is a very important point of care in the pandemic. It can be done at the bedside with ER workers who do not need to be well trained to interpret the images and they are regarding a breast CT scan, for example, “said Julio Cesar Garcia de Alencar, an ER who attended HC and the first author of the article on the study.
Approach
The study subjects were RT-PCR-confirmed patients and were admitted to HC between March and May 2020, in the early stages of the pandemic. The researchers performed lung ultrasound tests on the volunteers and reported their scores on the day they entered the ER. The median age of the subjects was 60, and over half (58%) were male.
The scoring method, called the LUS protocol, involved examination of 12 lung areas in the anterior, lateral and posterior sides of the chest wall on each side. Each area was assessed according to an aeration pattern, with scores ranging from zero to 3 points according to the worst observed pattern. The final score was the sum of the points in all 12 categories, ranging from zero to 36.
The results showed that patients scoring 14-16 were most likely to require ICU care, and those with scores above 20 were more likely to have a fatal outcome.
The average LUS was 18.7, with an overall bias of 6.8. Of the 180 patients enrolled, 109 (60%) were discharged alive, 74 (56%) were treated in the ICU, 52 (39%) were admitted and 61 (33%) died. ).
“We confirmed the hypothesis that LUS helps predict ICU induction, intubation, and mortality in severe COVID-19 patients,” Alencar said.
Higher risk of death
In another study conducted as part of the project and published in the journal PLOS AON, the same group of researchers found that out of 506 patients with confirmed COVID-19 pneumonia who were admitted to the ER, 333 (65.9%) were discharged home, 153 died (30.2%), and 20 (3.9%) remained in hospital. A total of 300 patients (59.3%) required intensive care, and 227 (44.9%) required admission. Mortality was 30.2% overall, and 55.9% for patients with intubated.
“We created a group of ER physicians at HC not only to deliver patient care but to work as researchers who collect data that can be used as indicators to predict the outcomes of severe cases. of COVID-19, “Souza said.
Source:
São Paulo Research Foundation (FAPESP)
Magazine Reference:
de Alencar, JCG, et al. (2021) Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department. History of intensive care. doi.org/10.1186/s13613-020-00799-w.