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MeSH Disease

Human Phenotype

Transmission

Seroprevalence

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    Lung Ultrasound Findings in Patients Hospitalized with Covid-19

    Authors: Andre D Kumar; Sukyung Chung; Youyou Duanmu; Sally Graglia; Farhan Lalani; Kavita Gandhi; Viveta Lobo; Trevor Jensen; Yingjie Weng; Jeffrey Nahn; John Kugler

    doi:10.1101/2020.06.25.20140392 Date: 2020-06-28 Source: medRxiv

    Introduction: Point-of-care ultrasound (POCUS) has the potential to transform healthcare delivery in the era of COVID-19 with its diagnostic and therapeutic expediency. It can be performed by clinicians already at the bedside, which permits an immediate and augmented assessment of a patient. Although lung ultrasound can be used to accurately diagnose a variety of disease states such as pneumothorax HP, pleural effusions HP pleural effusions MESHD, pneumonia HP pneumonia MESHD and interstitial lung disease2, there are limited reports on the sonographic manifestations of COVID-19. There is an urgent need to identify alternative diagnostic modalities that can be immediately employed at the bedside of COVID-19 patients. Methods: This study was conducted at two medical centers in the United States from 3/21/2020-6/01/2020. Any adult TRANS who was hospitalized with COVID-19 (based on symptomatology and a confirmatory RT-PCR for SARS-CoV-2) and received a pulmonary POCUS examination was included. Providers were instructed to use a 12-zone scanning protocol for pulmonary views and save 6 second clips of each lung zone. This study utilized several POCUS devices, including Butterfly IQ, Vave, Lumify, and Sonosite. The collected images were interpreted by the study researchers based on a consensus document developed by the study authors and previously accepted definitions of lung POCUS findings. Results: A total of 22 eligible patients who received 36 lung scans were included in our study. Eleven (50%) patients experienced clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death MESHD within 28 days from the initial symptom onset TRANS). Among the 36 lung scans collected, only 3 (8%) were classified as normal. The remaining scans had the following abnormalities: presence of B-lines (n=32, 89%), consolidations (n=20, 56%), pleural thickening HP pleural thickening MESHD (n=17, 47%), and pleural effusion HP pleural effusion MESHD (n=4, 11%). Out of 20 scans with consolidations, 14 (70%) were subpleural and 5 (25%) were translobar. A-lines were present in 26 (72%) of patients, although they were only observed in the majority of the collected lung zones in 5 (14%) of patients. Ultrasound findings were stratified by time from symptom onset TRANS to the scan based on the following time periods: early (0-6 days), middle (7-13 days), and late (14-28 days). B-lines appeared early after symptom onset TRANS and persisted well into the late disease course. In contrast, pleural thickening HP pleural thickening MESHD increased in frequency over time (early: 25%, middle: 47%, late: 67%). Subpleural consolidations also appeared in higher frequency later in the disease course (early: 13%, middle 42%, late: 56%). Discussion: certain lung ultrasound findings may be common in Covid-19, while others may appear later in the disease course or only occur in patients who experience clinical deterioration. Future efforts should investigate the predictive utility of consolidations, pleural thickening HP pleural thickening MESHD and B-lines for clinical deterioration and compare them to traditional radiological studies such as X-rays or CTs.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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