tetano
Editor, Senior Moderator
PLoS One
. 2024 Jun 3;19(6):e0304508.
doi: 10.1371/journal.pone.0304508. eCollection 2024. Lung ultrasound is associated with distinct clinical phenotypes in COVID-19 ARDS: A retrospective observational study
Roy Rafael Dayan[SUP] 1 [/SUP], Maayan Blau[SUP] 1 [/SUP], Jonathan Taylor[SUP] 2 [/SUP], Ariel Hasidim[SUP] 1 [/SUP], Ori Galante[SUP] 1 3 [/SUP], Yaniv Almog[SUP] 1 3 [/SUP], Tomer Gat[SUP] 1 [/SUP], Darya Shavialiova[SUP] 1 [/SUP], Jacob David Miller[SUP] 1 [/SUP], Georgi Khazanov[SUP] 1 [/SUP], Fahmi Abu Ghalion[SUP] 1 [/SUP], Iftach Sagy[SUP] 1 4 [/SUP], Itamar Ben Shitrit[SUP] 1 4 [/SUP], Lior Fuchs[SUP] 1 3 [/SUP]
Affiliations
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.
. 2024 Jun 3;19(6):e0304508.
doi: 10.1371/journal.pone.0304508. eCollection 2024. Lung ultrasound is associated with distinct clinical phenotypes in COVID-19 ARDS: A retrospective observational study
Roy Rafael Dayan[SUP] 1 [/SUP], Maayan Blau[SUP] 1 [/SUP], Jonathan Taylor[SUP] 2 [/SUP], Ariel Hasidim[SUP] 1 [/SUP], Ori Galante[SUP] 1 3 [/SUP], Yaniv Almog[SUP] 1 3 [/SUP], Tomer Gat[SUP] 1 [/SUP], Darya Shavialiova[SUP] 1 [/SUP], Jacob David Miller[SUP] 1 [/SUP], Georgi Khazanov[SUP] 1 [/SUP], Fahmi Abu Ghalion[SUP] 1 [/SUP], Iftach Sagy[SUP] 1 4 [/SUP], Itamar Ben Shitrit[SUP] 1 4 [/SUP], Lior Fuchs[SUP] 1 3 [/SUP]
Affiliations
- PMID: 38829891
- DOI: 10.1371/journal.pone.0304508
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.