Thoracic ultrasound in covid-19: use of lung and diaphragm ultrasound in evaluating dyspnea in survivors of critical illness from covid-19 pneumonia in a post-icu clinic

SESSION TITLE: Long COVID: It Can Take Your Breath AwaySESSION TYPE: Original InvestigationsPRESENTED ON: 10/16/2022 10:30 am - 11:30 amPURPOSE: Dyspnea is a common complaint in survivors of severe COVID-19 pneumonia, which may originate from intrinsic lung injury, diaphragmatic weakness, or other etiologies. Point-of-care ultrasound has revolutionized evaluation of acute respiratory failure in inpatient settings. Ultrasound however has seldomly been employed in ambulatory practice. We report on the use of thoracic ultrasound in evaluating dyspnea in survivors of critically ill COVID-19 pneumonia in a Post-ICU clinic. We aimed to determine how thoracic ultrasound (comprised of the lung ultrasound score (LUS) and diaphragm excursion during inspiration) correlate with patient-reported dyspnea (per the Borg Dyspnea Scale) during 6-minute walk test (6MWT). We hypothesize higher LUS and lower diaphragm excursion will correlate with severity of dyspnea.METHODS: Single-center cross-sectional study of survivors of critically ill COVID-19 pneumonia (requiring high-flow nasal cannula, or invasive- or non-invasive mechanical ventilation) seen in our Post-ICU clinic. All patients underwent standardized scanning protocols to compute LUS and diaphgram excursion (at quiet and deep inspiration). Pearson correlations were performed to detect association between LUS and diaphragm excursion with dyspnea at rest and exertion during 6MWT.RESULTS: Between 1/15/21-1/15/22, we enrolled n=45 patients. Average age was 61.5±13.9 years, 57.7% were male, with average BMI of 32.3±7.2. Higher LUS correlated significantly with dyspnea, at rest (r = +0.41, p = <0.01) and at exertion (r = +0.40, p = <0.01). Higher LUS correlated significantly with lower oxygen saturation during 6MWT (r = -0.55, p = <0.01) and lower 6MWT distance (r = -0.44, p = <0.01). Diaphragm excursion (on quiet and deep inspiration), correlated significantly with 6MWT distance (r = +0.33, p = 0.05; r = +0.37, p = 0.03), but did not correlate with dyspnea at rest or exertion.CONCLUSIONS: Higher LUS correlated positively and significantly with patient-reported dyspnea, both at rest and during exertion. Higher LUS significantly correlated with more exertional oxygen desaturation during 6MWT and lower 6MWT distance. While diaphragm excursion did not correlate with dyspnea, higher excursion (on quiet and deep inspiration) did correlate positively and significantly with 6MWT distance.CLINICAL IMPLICATIONS: Higher LUS reflect severity of lung injury following viral pneumonia in post-COVID-19 patients. LUS may thus predict which patients will desaturate during exertion, and which patients may require prolonged oxygen support during recovery. Hypoxemia from post-viral lung injury may limit exercise capacity, thus LUS may also guide clinicians in determining the role of physical or pulmonary rehabilitation. Diaphragm excursion correlated with 6MWT distance, and thus may provide insight for clinicians into the capacity of a patient's extra-pulmonary respiratory system in relation to patient exercise tolerance.DISCLOSURES: No relevant relationships by Seth CongdonNo relevant relationships by Gerardo EmanNo relevant relationships by Benjamin Galenno disclosure on file for Aluko Hope;No relevant relationships by Marjan IslamNo relevant relationships by Shwe Synn SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Dyspnea is a common complaint in survivors of severe COVID-19 pneumonia, which may originate from intrinsic lung injury, diaphragmatic weakness, or other etiologies. Point-of-care ultrasound has revolutionized evaluation of acute respiratory failure in inpatient settings. Ultrasound however has seldomly been employed in ambulatory practice. We report on the use of thoracic ultrasound in evaluating dyspnea in survivors of critically ill COVID-19 pneumonia in a Post-ICU clinic. We aimed to determine how thoracic ultrasound (comprised of the lung ultrasound score (LUS) and diaphragm excursion during inspiration) correlate with patient-reported dyspnea (per the Borg Dyspnea Scale) during 6-minute walk test (6MWT). We hypothesize higher LUS and lower diaphragm excursion will correlate with severity of dyspnea. METHODS: Single-center cross-sectional study of survivors of critically ill COVID-19 pneumonia (requiring high-flow nasal cannula, or invasive- or non-invasive mechanical ventilation) seen in our Post-ICU clinic. All patients underwent standardized scanning protocols to compute LUS and diaphgram excursion (at quiet and deep inspiration). Pearson correlations were performed to detect association between LUS and diaphragm excursion with dyspnea at rest and exertion during 6MWT. RESULTS: Between 1/15/21-1/15/22, we enrolled n=45 patients. Average age was 61.5±13.9 years, 57.7% were male, with average BMI of 32.3±7.2. Higher LUS correlated significantly with dyspnea, at rest (r = +0.41, p = <0.01) and at exertion (r = +0.40, p = <0.01). Higher LUS correlated significantly with lower oxygen saturation during 6MWT (r = -0.55, p = <0.01) and lower 6MWT distance (r = -0.44, p = <0.01). Diaphragm excursion (on quiet and deep inspiration), correlated significantly with 6MWT distance (r = +0.33, p = 0.05; r = +0.37, p = 0.03), but did not correlate with dyspnea at rest or exertion. CONCLUSIONS: Higher LUS correlated positively and significantly with patient-reported dyspnea, both at rest and during exertion. Higher LUS significantly correlated with more exertional oxygen desaturation during 6MWT and lower 6MWT distance. While diaphragm excursion did not correlate with dyspnea, higher excursion (on quiet and deep inspiration) did correlate positively and significantly with 6MWT distance. CLINICAL IMPLICATIONS: Higher LUS reflect severity of lung injury following viral pneumonia in post-COVID-19 patients. LUS may thus predict which patients will desaturate during exertion, and which patients may require prolonged oxygen support during recovery. Hypoxemia from post-viral lung injury may limit exercise capacity, thus LUS may also guide clinicians in determining the role of physical or pulmonary rehabilitation. Diaphragm excursion correlated with 6MWT distance, and thus may provide insight for clinicians into the capacity of a patient's extra-pulmonary respiratory system in relation to patient exercise tolerance. DISCLOSURES: No relevant relationships by Seth Congdon No relevant relationships by Gerardo Eman No relevant relationships by Benjamin Galen no disclosure on file for Aluko Hope; No relevant relationships by Marjan Islam No relevant relationships by Shwe Synn