Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS.
Auguste Dargent, Emeric Chatelain, Salim Si-Mohamed and 6 others
PMID 34107394WHAT IT FOUND
In 33 ventilated COVID-19 ARDS patients, lung ultrasound score rose around confirmed ventilator-associated pneumonia episodes and changed with oxygenation, but the study did not test whether this improved outcomes.
Key findings
01During confirmed ventilator-associated pneumonia episodes, the lung ultrasound score rose in 83% of episodes and was higher within 24 hours of diagnosis than in the previous 72 hours (26 ± 3 versus 21 ± 4).
02Higher lung ultrasound scores went with lower oxygenation during follow-up (r = -0.37, p < 0.0001).
03Before extubation, the lung ultrasound score did not distinguish patients who later needed reintubation or rescue ventilation within 72 hours (22 ± 6.2 versus 19 ± 2.8).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study included only 33 patients in one ICU, so it is small and not generalisable. It was observational with no control group, so it cannot show that lung ultrasound monitoring improved outcomes. Daily scans were planned, but the median interval was 2.1 days, so changes between scans may have been missed. Ventilator-associated pneumonia was confirmed only with positive respiratory cultures, so a rising score alone was not treated as proof of infection. Pre-extubation scans were available for only 15 of the 25 extubated patients. This limits what the study can say about post-extubation failure. Different investigators scanned the same patients, and ultrasound scores can depend on the operator. Static compliance was not standardised, with variable PEEP settings, so the lack of correlation with compliance is uncertain.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not treat a rising lung ultrasound score as proof that ventilator-associated pneumonia is present or that monitoring improves outcomes. Ventilator-associated pneumonia required positive respiratory cultures, and this small observational study had no control group.