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Lung ultrasound findings in patients with novel SARS-CoV-2

Mark E. Haaksma, Micah L.A. Heldeweg, Jorge E. Lopez Matta, Jasper M. Smit, Jessica D. van Trigt, Jip S. Nooitgedacht, Carlos V. Elzo Kraemer, Mark van de Wiel, Armand R.J. Girbes, Leo Heunks, David J. van Westerloo, Pieter R. Tuinman
ERJ Open Research 2020; DOI: 10.1183/23120541.00238-2020
Mark E. Haaksma
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
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Micah L.A. Heldeweg
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
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Jorge E. Lopez Matta
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
4Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Jasper M. Smit
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
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Jessica D. van Trigt
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Jip S. Nooitgedacht
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Carlos V. Elzo Kraemer
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
4Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Mark van de Wiel
5Department of Epidemiology & Data Science, Amsterdam University Medical Centers, location VUmc, Amsterdam, NL
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Armand R.J. Girbes
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Leo Heunks
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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David J. van Westerloo
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
4Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Pieter R. Tuinman
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
2Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
3Amsterdam Leiden Intensive care Focused Echography (ALIFE), , The Netherlands
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Abstract

Background Over 2 million people worldwide have been infected with Severe Acute Respiratory Distress Syndrome Corona Virus 2 (SARS CoV-2). Lung ultrasound has been proposed to diagnose and monitor it, despite the fact that little is known about the ultrasound appearance due to the novelty of the illness. The aim of this manuscript is to characterise the lung ultrasonographic appearance of critically ill patients with SARS CoV-2 pneumonia with particular emphasis on its relationship with the time course of the illness and clinical parameters.

Methods On the Intensive Care Unit of two academic hospitals, adult patients who tested positive for SARS-CoV-2 were included. Images were analysed using internationally recognised techniques which included assessment of the pleural line, number of B-lines, pathology in the PLAPS (Postero Lateral Alveolar and Pleural Syndrome) point, BLUE-profiles (Bedside Lung Ultrasound in Emergency), and the lung ultrasound score (LUS). The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) duration of symptoms and their correlation with clinical parameters.

Results In this pilot observational study, 61 patients were included with 76 examinations for analysis. 26% of patients had no anterior lung abnormalities, while the most prevalent pathological ultrasound findings present but subtle lung sliding (35%), thickening of the pleura (42%), ≥B-lines per view (38%) and present PLAPS (74%). Patients with “long” duration of symptoms presented more frequently with a thickened and irregular pleura (21% (32) versus 9% (11)), C-profile (47% (18) versus 25% (8)) and pleural effusion (19% (14) versus 5% (3)), compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with P/F ratio, fluid balance or dynamic compliance.

Conclusion SARS CoV-2 results in significant, but not specific, ultrasound changes, with decreased lung sliding, thickening of the pleura and a B-profile being the most observed. With time, a thickened and irregular pleura, C-profile and pleural effusion become more common findings. When screening patients, a comprehensive ultrasound protocol might be necessary.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Mark E. Haaksma

Conflict of interest: Micah L.A. Heldeweg

Conflict of interest: I have no conflict of interest

Conflict of interest: Jasper M. Smit

Conflict of interest: Jessica D. van Trigt

Conflict of interest: Jip S. Nooitgedacht

Conflict of interest: Carlos V. Elzo Kraemer

Conflict of interest: Mark van de Wiel

Conflict of interest: Armand R.J. Girbes

Conflict of interest: Leo Heunks

Conflict of interest: No conflicts of interest

Conflict of interest: Dr. Tuinman has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received May 2, 2020.
  • Accepted September 25, 2020.
  • Copyright ©ERS 2020
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Lung ultrasound findings in patients with novel SARS-CoV-2
Mark E. Haaksma, Micah L.A. Heldeweg, Jorge E. Lopez Matta, Jasper M. Smit, Jessica D. van Trigt, Jip S. Nooitgedacht, Carlos V. Elzo Kraemer, Mark van de Wiel, Armand R.J. Girbes, Leo Heunks, David J. van Westerloo, Pieter R. Tuinman
ERJ Open Research Jan 2020, 00238-2020; DOI: 10.1183/23120541.00238-2020

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Lung ultrasound findings in patients with novel SARS-CoV-2
Mark E. Haaksma, Micah L.A. Heldeweg, Jorge E. Lopez Matta, Jasper M. Smit, Jessica D. van Trigt, Jip S. Nooitgedacht, Carlos V. Elzo Kraemer, Mark van de Wiel, Armand R.J. Girbes, Leo Heunks, David J. van Westerloo, Pieter R. Tuinman
ERJ Open Research Jan 2020, 00238-2020; DOI: 10.1183/23120541.00238-2020
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