COVID-19 phenotypes, lung ultrasound, chest computed tomography, and clinical features in critically ill mechanically ventilated patients

Orlandi, D; Battaglini, D; Robba, C; Viganò, M; Bergamaschi, G; Mignatti, T; ML, Radice; Lapolla, A; Turtulici, G; Pelosi, P

Chest computed tomography (CT) may provide insights in the pathophysiology of COVID-19, although it is not suitable for a timely bedside dynamic assessment of patients admitted to intensive care unit (ICU); therefore, lung ultrasound (LUS) has been proposed as complementary diagnostic tool. The aims of this study were to investigate different lungs’ phenotypes in patients with COVID-19, assessing differences between ICU survivors and non-survivors in CT and LUS scores. We also explored the association between CT and LUS, and oxygenation (PaO(2)/FiO(2)) and clinical parameters. Thirty-nine COVID-19 patients were included. CT scan revealed type 1, 2, 3 phenotypes in 62%, 28%, and 10% respectively. Among survivors, pattern-1 was prevalent (p<0.005). Chest CT and LUS scores differed between survivors and non-survivors both at ICU admission and 10-days thereafter and were associated with ICU-mortality. Chest CT score positively correlated with LUS findings at ICU admission (r=0.953, p<0.0001), while inversely correlated with PaO(2)/FiO(2) (r=-0.375, p=0.019), and C-Reactive Protein (r=0.329, p=0.041). LUS score inversely correlated with PaO(2)/FiO(2) (r=-0.345, p=0.031). COVID-19 presents distinct phenotypes, with differences between survivors and non-survivors. LUS should be considered as valuable monitoring tool in ICU setting, since it may correlate with CT findings and mortality, although it cannot predict oxygenation changes.