TY - JOUR
T1 - Lung ultrasound is associated with distinct clinical phenotypes in COVID-19 ARDS
T2 - A retrospective observational study
AU - Dayan, Roy Rafael
AU - Blau, Maayan
AU - Taylor, Jonathan
AU - Hasidim, Ariel
AU - Galante, Ori
AU - Almog, Yaniv
AU - Gat, Tomer
AU - Shavialiova, Darya
AU - Miller, Jacob David
AU - Khazanov, Georgi
AU - Ghalion, Fahmi Abu
AU - Sagy, Iftach
AU - Shitrit, Itamar Ben
AU - Fuchs, Lior
N1 - Publisher Copyright:
Copyright: © 2024 Dayan et al.
PY - 2024/6/1
Y1 - 2024/6/1
N2 - Background ARDS is a heterogeneous syndrome with distinct clinical phenotypes. Here we investigate whether the presence or absence of large pulmonary ultrasonographic consolidations can categorize COVID-19 ARDS patients requiring mechanical ventilation into distinct clinical phenotypes. Methods This is a retrospective study performed in a tertiary-level intensive care unit in Israel between April and September 2020. Data collected included lung ultrasound (LUS) findings, respiratory parameters, and treatment interventions. The primary outcome was a composite of three ARDS interventions: prone positioning, high PEEP, or a high dose of inhaled nitric oxide. Results A total of 128 LUS scans were conducted among 23 patients. The mean age was 65 and about two-thirds were males. 81 scans identified large consolidation and were classified as “C-type”, and 47 scans showed multiple B-lines with no or small consolidation and were classified as “B-type”. The presence of a “C-type” study had 2.5 times increased chance of receiving the composite primary outcome of advanced ARDS interventions despite similar SOFA scores, Pao2/FiO2 ratio, and markers of disease severity (OR = 2.49, %95CI 1.40–4.44). Conclusion The presence of a “C-type” profile with LUS consolidation potentially represents a distinct COVID-19 ARDS subphenotype that is more likely to require aggressive ARDS interventions. Further studies are required to validate this phenotype in a larger cohort and determine causality, diagnostic, and treatment responses.
AB - Background ARDS is a heterogeneous syndrome with distinct clinical phenotypes. Here we investigate whether the presence or absence of large pulmonary ultrasonographic consolidations can categorize COVID-19 ARDS patients requiring mechanical ventilation into distinct clinical phenotypes. Methods This is a retrospective study performed in a tertiary-level intensive care unit in Israel between April and September 2020. Data collected included lung ultrasound (LUS) findings, respiratory parameters, and treatment interventions. The primary outcome was a composite of three ARDS interventions: prone positioning, high PEEP, or a high dose of inhaled nitric oxide. Results A total of 128 LUS scans were conducted among 23 patients. The mean age was 65 and about two-thirds were males. 81 scans identified large consolidation and were classified as “C-type”, and 47 scans showed multiple B-lines with no or small consolidation and were classified as “B-type”. The presence of a “C-type” study had 2.5 times increased chance of receiving the composite primary outcome of advanced ARDS interventions despite similar SOFA scores, Pao2/FiO2 ratio, and markers of disease severity (OR = 2.49, %95CI 1.40–4.44). Conclusion The presence of a “C-type” profile with LUS consolidation potentially represents a distinct COVID-19 ARDS subphenotype that is more likely to require aggressive ARDS interventions. Further studies are required to validate this phenotype in a larger cohort and determine causality, diagnostic, and treatment responses.
UR - http://www.scopus.com/inward/record.url?scp=85194997265&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0304508
DO - 10.1371/journal.pone.0304508
M3 - Article
C2 - 38829891
AN - SCOPUS:85194997265
SN - 1932-6203
VL - 19
JO - PLoS ONE
JF - PLoS ONE
IS - 6 June
M1 - e0304508
ER -