Lung ultrasound findings in patients with novel SARS-CoV-2
- Mark E. Haaksma1,2,3,
- Micah L.A. Heldeweg1,2,3,
- Jorge E. Lopez Matta3,4,
- Jasper M. Smit1,2,3,
- Jessica D. van Trigt1,2,
- Jip S. Nooitgedacht1,2,
- Carlos V. Elzo Kraemer3,4,
- Mark van de Wiel5,
- Armand R.J. Girbes1,2,
- Leo Heunks1,2,
- David J. van Westerloo3,4 and
- Pieter R. Tuinman1,2,3
- 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), www.alifeofpocus.com, The Netherlands
- 4Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
- 5Department of Epidemiology & Data Science, Amsterdam University Medical Centers, location VUmc, Amsterdam, NL
- Mr M.E. Haaksma, VU University Medical Center Amsterdam, Postbox 7507, 1007MB, Amsterdam, The Netherlands. E-mail: m.haaksma{at}amsterdamumc.nl
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.
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- Received May 2, 2020.
- Accepted September 25, 2020.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.