Prospective Longitudinal Evaluation of Point‐of‐Care Lung Ultrasound in Critically Ill Patients With Severe COVID‐19 Pneumonia

Alharthy, Abdulrahman; Faqihi, Fahad; Abuhamdah, Mohamed; Noor, Alfateh; Naseem, Nasir; Balhamar, Abdullah; Al Saud, Ahad Alhassan Al Saud Bin Abdulaziz; Brindley, Peter G.; Memish, Ziad A.; Karakitsos, Dimitrios; Blaivas, Michael

OBJECTIVES: To perform a prospective longitudinal analysis of lung ultrasound findings in critically ill patients with coronavirus disease 2019 (COVID‐19). METHODS: Eighty‐nine intensive care unit (ICU) patients with confirmed COVID‐19 were prospectively enrolled and tracked. Point‐of‐care ultrasound (POCUS) examinations were performed with phased array, convex, and linear transducers using portable machines. The thorax was scanned in 12 lung areas: anterior, lateral, and posterior (superior/inferior) bilaterally. Lower limbs were scanned for deep venous thrombosis and chest computed tomographic angiography was performed to exclude suspected pulmonary embolism (PE). Follow‐up POCUS was performed weekly and before hospital discharge. RESULTS: Patients were predominantly male (84.2%), with a median age of 43 years. The median duration of mechanical ventilation was 17 (interquartile range, 10–22) days; the ICU length of stay was 22 (interquartile range, 20.2–25.2) days; and the 28‐day mortality rate was 28.1%. On ICU admission, POCUS detected bilateral irregular pleural lines (78.6%) with accompanying confluent and separate B‐lines (100%), variable consolidations (61.7%), and pleural and cardiac effusions (22.4% and 13.4%, respectively). These findings appeared to signify a late stage of COVID‐19 pneumonia. Deep venous thrombosis was identified in 16.8% of patients, whereas chest computed tomographic angiography confirmed PE in 24.7% of patients. Five to six weeks after ICU admission, follow‐up POCUS examinations detected significantly lower rates (P < .05) of lung abnormalities in survivors. CONCLUSIONS: Point‐of‐care ultrasound depicted B‐lines, pleural line irregularities, and variable consolidations. Lung ultrasound findings were significantly decreased by ICU discharge, suggesting persistent but slow resolution of at least some COVID‐19 lung lesions. Although POCUS identified deep venous thrombosis in less than 20% of patients at the bedside, nearly one‐fourth of all patients were found to have computed tomography–proven PE.