Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT?
Abstract Background It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-02-01
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| Series: | The Ultrasound Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13089-022-00299-x |
| _version_ | 1797865220407820288 |
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| author | Arthur W. E. Lieveld Micah L. A. Heldeweg Jasper Schouwenburg Lars Veldhuis Mark E. Haaksma Rutger M. van Haaften Berend P. Teunissen Jasper M. Smit Jos Twisk Leo Heunks Prabath W. B. Nanayakkara Pieter Roel Tuinman |
| author_facet | Arthur W. E. Lieveld Micah L. A. Heldeweg Jasper Schouwenburg Lars Veldhuis Mark E. Haaksma Rutger M. van Haaften Berend P. Teunissen Jasper M. Smit Jos Twisk Leo Heunks Prabath W. B. Nanayakkara Pieter Roel Tuinman |
| author_sort | Arthur W. E. Lieveld |
| collection | DOAJ |
| description | Abstract Background It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints. Methods This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models. Results 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31–0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73–0.95), 0.94 (95% CI 0.90–0.96), and 0.84 (95% CI 0.65–0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC. Conclusions LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool. |
| first_indexed | 2024-04-09T23:05:43Z |
| format | Article |
| id | doaj.art-d87cbb3cd6f743c699c8b4e61738d4c0 |
| institution | Directory Open Access Journal |
| issn | 2524-8987 |
| language | English |
| last_indexed | 2024-04-09T23:05:43Z |
| publishDate | 2023-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Ultrasound Journal |
| spelling | doaj.art-d87cbb3cd6f743c699c8b4e61738d4c02023-03-22T10:45:30ZengSpringerOpenThe Ultrasound Journal2524-89872023-02-0115111110.1186/s13089-022-00299-xMonitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT?Arthur W. E. Lieveld0Micah L. A. Heldeweg1Jasper Schouwenburg2Lars Veldhuis3Mark E. Haaksma4Rutger M. van Haaften5Berend P. Teunissen6Jasper M. Smit7Jos Twisk8Leo Heunks9Prabath W. B. Nanayakkara10Pieter Roel Tuinman11Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterSection Emergency Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VU Medical CenterSection Emergency Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterDepartment of Epidemiology and Data Science, Amsterdam UMC, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterSection Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location VU Medical CenterDepartment of Intensive Care Medicine, Amsterdam University Medical Centers, Location VU Medical CenterAbstract Background It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints. Methods This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models. Results 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31–0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73–0.95), 0.94 (95% CI 0.90–0.96), and 0.84 (95% CI 0.65–0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC. Conclusions LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool.https://doi.org/10.1186/s13089-022-00299-xCOVID-19Point-of-cafe ultrasoundLung ultrasoundComputed tomographyMonitoringMortality |
| spellingShingle | Arthur W. E. Lieveld Micah L. A. Heldeweg Jasper Schouwenburg Lars Veldhuis Mark E. Haaksma Rutger M. van Haaften Berend P. Teunissen Jasper M. Smit Jos Twisk Leo Heunks Prabath W. B. Nanayakkara Pieter Roel Tuinman Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? The Ultrasound Journal COVID-19 Point-of-cafe ultrasound Lung ultrasound Computed tomography Monitoring Mortality |
| title | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
| title_full | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
| title_fullStr | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
| title_full_unstemmed | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
| title_short | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
| title_sort | monitoring of pulmonary involvement in critically ill covid 19 patients should lung ultrasound be preferred over ct |
| topic | COVID-19 Point-of-cafe ultrasound Lung ultrasound Computed tomography Monitoring Mortality |
| url | https://doi.org/10.1186/s13089-022-00299-x |
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