الفهرس | Only 14 pages are availabe for public view |
Abstract COVID-19 is a highly contagious illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main diagnostic method, (RT-PCR) of the nucleic acid of SARS-CoV-2, has many limitations, such as low sensitivity and technical difficulties in performing the test. (CT) scan reveals with higher sensitivity ground glass opacities (GGOs), however the use of chest CT remains very limited in the critically ill as the transport of unstable patients and exposure of infected patients may also outweigh the clinical benefit. On the other hand ultrasound machines are widely available; therefore, LUS can be performed in few minutes, in mild or even unstable patients and in different hospital settings, and we aimed to evaluate the role of LUS in follow up of patients with COVID 19 in relation to clinical and laboratory data . Summary of our results: This study included 116 Covid-19 patients (62 males and 54 females) in need of oxygen therapy or non-invasive ventilation with a median age of 59 years (range from 23 to 85). All the studied patients presented with cough and dyspnea, while 56%, 47.4%, 38.8%, 20.7% and 2.6% of whom had cough and dyspnea after 3, 6, 9, 12 and 15 days, respectively. Also, all patients had fever on admission while 56%, 34.5%, 21.6%, 14.7% and 0.9% of whom elicited fever after 3, 6, 9, 12 and 15 days, respectively. Moreover, 47.4% of patients showed GIT symptoms on admission, and that percentage was dropped to 21.6%, 4.3% and 0% after 3, 6 and 9 days All 116 patients elicited interstitial syndrome, of whom, 89.5% showed confluent B-lines (unilateral in 6.3% of patients and bilateral in 93.8%) and 12.5% showed focal B-lines. The confluent B-lines were most frequently distributed in posterolateral zone (31.6% of the affected zones) followed by lateral zone (19.1%). Subpleural consolidations were elicited by 70.8% of patients, unilaterally in 22.9% and bilaterally in 47.9%, moreover, they were distributed predominantly in posterolateral zone (43.6% of affected zones) and posteroinferior zone (22.3%). One third of patients elicited alveolar consolidations with bronchogram, detected unilaterally in 25% of patients and bilaterally in 8.3%, moreover, they were distributed predominantly in posterolateral zone (56.3% of affected zones) and posteroinferior zone (25%.). Only 2.1% of patients had Pleural effusion detected unilaterally On admission, non-invasive MV was the most predominant method of oxygenation (in 42.2% of patients) followed by high flow nasal cannula (31.9%) then non rebreathing mask (17.2%). After 3 days, more than half of patients (58.6%) were on non-invasive MV and around one third (33.6%) were on high flow nasal cannula. After 6 days, the most frequently used method was high flow nasal cannula (in 43.1% of patients) then noninvasive MV (29.3%). After 9 and 12 days, high flow nasal cannula was used in 49.1% and 29.3% of patients respectively while invasive MV was applied to 36.2% and 28.4% respectively. Moreover, 7.8% of patients were on high flow nasal cannula after 15 days There was a statistically significant difference among timepoints regarding FiO2, SpO2 and P/F measurements as FiO2 was significantly decreased after 9, 12 and 15 days than baseline while both SpO2 and P/F were significantly increased after 9, 12 and 15 days than baseline 37.9% of patients had moderate Covid-19 and 62.1% had severe diagnosis on admission with a median LUS score of 19 (IQR between 17 and 20). After 3 days, 42.2% manifested moderate disease and 57.8% had severe disease with a median LUS score of 19 (IQR between 16 and 21). After 6 days, more than half of patients (58.6%) showed moderate disease and 41.4% had severe diagnosis, with a median LUS score of 17 (IQR between 12 and 23). After 9 days, 27.6%, 31% and 41.4% of patients had mild, moderate and severe diagnosis, respectively, with a median LUS score of 14 (IQR between 7 and 26). After 12 days, 21.6%, 9.5% and 28.4% showed mild, moderate and severe disease, respectively, with a median LUS score of 14 (IQR between 7 and 30). After 15 days, 4.3% of patients showed mild disease and 3.4% showed moderate disease with a median score of 7 (IQR between 6 and 13). LUS score was significantly different among timepoints (P<0.001) as it was significantly decreased (indicating less severe diagnosis) after 9, 12 and 15 days when compared to its value on admission. |