Lung Ultrasound Identifies Patients Who Could Benefit from Longer-Term COVID-19 Rehab

August 11, 2020
Whitney J. Palmer

Lung ultrasound scans pinpoint lingering lung damage in patients who meet clinical parameters for hospital discharge, alerting doctors to patients who will need longer-term care.

Lung ultrasound has proven helpful in managing the active course of disease in patients who are COVID-19-positive. But, new research has also revealed it could play a vital role in assessing patients who are in the post-acute and recovery phase, as well.

In a study published in the Aug. 8 Journal of Ultrasound in Medicine, a group of Italian investigators led by Domenico Cianflone, M.D., director of cardiac rehabilitation at the Instituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute in Milan, determined that lung ultrasound can identify lingering remnants of COVID-19 infection even in patients who have met all clinical hospital discharge criteria.

“CT remains the central tool for initial diagnostic assessment and in-hospital management, [but] lung ultrasound may be adopted in primary care and outpatient settings for the effective monitoring of patients after discharge, particularly after a sever acute phase,” the team wrote. “The use of lung ultrasound might simplify the follow-up with a reduction of direct and indirect costs linked to COVID-19 and optimization of available resources.”

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Based on this pilot study, which the team said it believes is the first to evaluate the performance of lung ultrasound in the post-acute phase of COVID-19, the team determined that these scans can pinpoint residual lung alterations at discharge in patients who had more severe viral infection. With this information, they said, doctors will be able to better identify which patients need prolonged at-home or outpatient rehabilitation programs.

To make this determination, the team prospectively enrolled 70 COVID-19-positive patients – 22 women and 48 men – who had prolonged hospitalization with inpatient rehabilitation between April 6, 2020, and May 22, 2020. Of the group 27 had mild disease with no ventilatory support (group 1), and 43 had severe disease with ventilation (group 2). Every patient underwent a lung ultrasound when they were ready to leave the hospital.

At the time of discharge, the team found lung ultrasound scores were significantly higher in patients who had experienced severe disease versus milder disease – 8.0 compared to 2.0, respectively. Looking at the scans, the team saw most lung ultrasound-detectable lesions from group 2 were located in the anterior areas, likely due to the prone positioning needed for ventilation, and in the posterior in group 1. It could be possible, though, that these lesion locations could indicate more about the virus, they said.

“Anterior segment damage of the lung may be the hallmark of more severe COVID-19 that is less common than the mild disease type,” they said. “In this latter perspective, lung ultrasound could be way to identify the two clinical phenotypes of COVID-19, in which patients with broad anterior involvement would lean to more considerable lung damage and clinical compromise.”

The team also saw other differences. With 30-second chair stand test scores, the average score for group 1 was 15, and it was 10 for group 2. Group 2 also had higher pulmonary artery systolic pressure values, potentially indicating incomplete resolution of damage. In addition, they said, the findings point to lung ultrasound as being a more accurate index than transthoracic echocardiography for assessing residual lung impairment associated with the virus.

The team does acknowledge that the size of the pilot study was small and additional investigations are needed to confirm the observations with large populations, but they assert their findings point to the longer-term utility of the modality.

“The absence of main changes in laboratory tests and transthoracic echocardiography findings suggests that the lung ultrasound score could be a more sensitive indicator of subclinical, residual lung damage in clinically healed patients, deserving a central role in follow-up monitoring,” they said.

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