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Disease, and treatment / thematic poster session lung ultrasound b-lines are frequently found in two easily accessible imaging sites in COVID-19 and relate to disease severity: Implications for screening, triage and prognosis
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1277162
ABSTRACT
Rationale Lung ultrasound B-lines artifacts represent abnormal interstitial thickening or edema, have been related to patient mortality, and are often visualized when imaging the anteroapex of the lung. Unlike other probe locations, these 2 sites on the upper chest can be readily accessed by healthcare givers and patients alike. In COVID-19 infection, the potential value of these sites for detecting early lung involvement depends not only on accessibility, but also on the relationship of its findings with significant disease. Therefore, as few ultrasound data exist from the lung apex in hospitalized COVID-19 pneumonia, we sought to report the prevalence of apical lung B-line artifacts in inpatients and their association with illness severity.

Methods:

In a 300-bed community hospital, medical and imaging data from inpatients with known COVID-19 infection who had been referred for echocardiography with lung imaging or who had received a lung point-of-care ultrasound study was reviewed for the presence of ≥3 B-lines (COMETS) in either anteroapex of the lungs. COVID-19 disease was categorized by the CDC Clinical Severity Scale on presentation as mild (no dyspnea, normal CXR/CT), moderate (abnormal CXR/CT, O2 sat>94%), severe (tachypnea, O2 sat <94%, infiltrates >50%), or critical (respiratory failure, shock, multiorgan system failure). Age, gender, diabetes, hypertension, obesity, and time from onset of symptoms to the imaging study were analyzed for univariable associations with COMET presence and then considered with severity category in a reduced multivariable model using backwards elimination.

Results:

Of n=56 patients, age (mean±SD) was 63±16 years. COMETS were present in 35/56 (63%) of patients overall, and in 30/37 (81%) of severe-critical disease vs. 5/19 (26)% of mild-moderate disease (p=0.0002). Of the patients with vs. without COMETS, 31 (76%) vs. 10 (24%) had an abnormal CXR and 30 (79%) vs. 8 (21%) had O2 sat<94% on admission, respectively (p<0.05). In the multivariable model, obesity (OR=9.64[95%CI2.19-68.48], p<0.007) and severe/critical disease (OR=19.47[95%CI4.33-142.28], p<0.0006) best predicted the presence of COMETs.

Conclusions:

Ultrasound B-lines in the anteroapex of the lung are a prevalent finding in hospitalized COVID-19 infection and increase with disease severity and obesity, reaching >80% in severe/critical disease. This imaging site, in particular, may be ideal for outpatient screening, ER triage, or patient home imaging, where it may herald the need for early respiratory diagnosis, therapies or hospitalization. Future studies involving the prevalence, timing and outcome of outpatient ultrasound lung imaging may consider the use of this easily-accessed site on the chest wall. .

Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Tipo de estudo: Estudo prognóstico Idioma: Inglês Revista: American Journal of Respiratory and Critical Care Medicine Ano de publicação: 2021 Tipo de documento: Artigo

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Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Tipo de estudo: Estudo prognóstico Idioma: Inglês Revista: American Journal of Respiratory and Critical Care Medicine Ano de publicação: 2021 Tipo de documento: Artigo