Lung Ultrasound Score as a Predictor of Failure to Wean COVID-19 Elderly Patients off Mechanical Ventilation: A Prospective Observational Study

Abstract

Background

The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear.

Methods

This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC).

Results

The mean age of the 35 patients in the study was (75 ± 9) years and 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770–0.999, p < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups.

Conclusion

The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard.

Trial Registration

https://clinicaltrials.gov/ct2/show/NCT05706441.

Keywords:

• lung ultrasound score
• diaphragmatic excursion
• spontaneous breathing trial
• weaning
• COVID-19
• critical care

Abbreviations

AUC, Area under the curves; COVID-19, Coronavirus disease 2019; IL-6, Interleukin-6; RSBI, Rapid shallow breathing index.

Data Sharing Statement

The datasets in this study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The trial was approved by the Institutional Review Board of the Second Affiliated Hospital of the Medical College of Zhejiang University (IR2023-0020) and conducted in accordance with Good Clinical Practice and the Declaration of Helsinki. Informed consent was obtained from the legal guardians of all study participants.

Acknowledgments

Ying Wang and Yu Yi are co-first authors for this study. We sincerely thank the intensive care staff for their hard work.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This work was supported by the National Clinical Key Specialty Construction Project of China (2021-LCZDZK-01); Leading Health Talents of Zhejiang Province, Zhejiang Health Office No. 18(2020); and Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province.