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Medicina crítica (Colegio Mexicano de Medicina Crítica)
versão impressa ISSN 2448-8909
Resumo
ORTIZ LARIOS, Fabricio; GARCIA SALAS, Yessica; TORRES ADALID, José David e IBARRA ESTRADA, Miguel. Role of lung ultrasound in the classification by phenotypes of ARDS by COVID-19. Med. crít. (Col. Mex. Med. Crít.) [online]. 2022, vol.36, n.4, pp.228-234. Epub 02-Dez-2022. ISSN 2448-8909. https://doi.org/10.35366/105794.
Introduction:
Most mechanically ventilated COVID-19 patients meet the Berlin criteria for acute respiratory distress syndrome (ARDS), however, a discrepancy between the degree of hypoxemia and pulmonary distensibility has been observed. Based on respiratory mechanics and tomographic findings two distinct phenotypes have been proposed: L and H, each phenotype could benefit from distinct ventilation strategies, however, performing tomographic scans during pandemic is complicated.
Objective:
To determine the usefulness of lung ultrasound to differentiate ARDS phenotypes by COVID-19, by correlating LUS and respiratory system distensibility.
Material and methods:
We prospectively analyzed patients with COVID-19 under invasive mechanical ventilation on admission to the ICU.
Results:
Of a total of 90 patients, 62% men, median 60 years, SOFA 7 points. The incidence of phenotype H was 83.3%. LUS had a significant difference between both phenotypes (p = 0.001), with an area under the curve of 0.797 (p < 0.001). With cutoff point for phenotype H prediction: LUS >18 points (sensitivity 82.6%, specificity 73.3%).
Conclusion:
Lung ultrasound reliably assesses the degree of pulmonary aeration and, together with distensibility, allows the classification of patients with ARDS by COVID-19 phenotypes.
Palavras-chave : Lung; ultrasound; phenotypes; acute respiratory distress syndrome; COVID-19.