Journal of Perioperative Echocardiography

Register      Login

VOLUME 7 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Lung Ultrasound Predicts Clinical Severity of COVID-19 Pneumonia

Alisha Goel, Neeti Dogra, Arun Sharma, Mandeep Garg, Narender Kaloria, Karan Singla, Navdeep Kaur, Varun Mahajan

Keywords : Coronavirus disease-2019, Lung ultrasound, P/F ratio, Pneumonia, ROX index

Citation Information : Goel A, Dogra N, Sharma A, Garg M, Kaloria N, Singla K, Kaur N, Mahajan V. Lung Ultrasound Predicts Clinical Severity of COVID-19 Pneumonia. J Perioper Echocardiogr 2019; 7 (2):28-32.

DOI: 10.5005/jp-journals-10034-1103

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Lung ultrasound is an easily available bedside imaging modality that has good specificity for the diagnosis of coronavirus disease-2019 (COVID-19). Limited evidence is available on its utility to predict clinical severity. Materials and methods: In this prospective observational study, adult patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) of a tertiary care hospital between June 2020 and August 2020 were included. Lung ultrasound was performed in at least four areas in each examination and video loops were scored by two independent observers. The statistical relationship was assessed between median lung ultrasound score, chest X-ray score, P/F ratio (ratio of the partial pressure of oxygen in arterial blood to the fraction of inspired oxygen), ROX index, SOFA score, ICU stay, and mortality. Results: Fifty lung ultrasound examinations were performed in 29 patients of age 54.7 ± 15.3 years. P/F ratio was <300 mm Hg during 80% of the examinations. There was moderate correlation between median lung ultrasound score and both ROX index (Spearman's rho = −0.543, p < 0.001) and P/F ratio (rho = −0.522, p < 0.001), while there was weak correlation between chest X-ray score and ROX index (rho = −0.0.345, p = 0.019) and no correlation between chest X-ray score and P/F ratio. There was correlation between chest X-ray score and ICU stay (rho = 0.434, p = 0.049). There was no difference in any of the parameters between survivors and non-survivors. Moderate inter-observer agreement was present between the two observers. Conclusion: Bedside lung ultrasound examination, even with a limited number of views, can reflect the clinical severity of COVID-19 pneumonia.

  1. Parasher A. COVID-19: current understanding of its pathophysiology, clinical presentation and treatment. Postgrad Med J 2020. DOI: 10.1136/postgradmedj-2020-138577.
  2. Lomoro P, Verde F, Zerboni F, et al. COVID-19 pneumonia manifestations at the admission on chest ultrasound, radiographs, and CT: single-center study and comprehensive radiologic literature review. Eur J Radiol Open 2020;7:100231. DOI: 10.1016/j.ejro.2020.100231.
  3. Lopes AJ, Mafort TT, Costa CH, et al. Comparison between lung ultrasound and computed tomographic findings in patients with COVID-19 pneumonia. J Ultrasound Med 2020. DOI: 10.1002/jum.15521.
  4. Convissar DL, Gibson LE, Berra L, et al. Application of lung ultrasound during the COVID-19 pandemic: a narrative review. Anesth Analg 2020;131(2):345–350. DOI: 10.1213/ANE.0000000000004929.
  5. Soldati G, Smargiassi A, Inchingolo R, et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: a simple, quantitative, reproducible method. J Ultrasound Med 2020;39(7):1413–1419. DOI: 10.1002/jum.15285.
  6. Borghesi A, Zigliani A, Masciullo R, et al. Radiographic severity index in COVID-19 pneumonia: relationship to age and sex in 783 Italian patients. Radiol Med 2020;125(5):461–464. DOI: 10.1007/s11547-020-01202-1.
  7. Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care 2016;35:200–205. DOI: 10.1016/j.jcrc.2016.05.022.
  8. Bangdiwala SI, Shankar V. The agreement chart. BMC Med Res Methodol 2013;13(1):97. Available from:
  9. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg 2018;126(5):1763–1768. DOI: 10.1213/ANE.0000000000002864.
  10. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med 2012;22(3):276–282. DOI: 10.11613/bm.2012.031.
  11. Sahu AK, Mathew R, Bhoi S, et al. Lung sonographic findings in COVID-19 patients. Am J Emerg Med 2020. DOI: 10.1016/j.ajem.2020.08.080.
  12. Lichter Y, Topilsky Y, Taieb P, et al. Correction to: lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med 2020;46(11):2128–2129. DOI: 10.1007/s00134-020-06254-5.
  13. Castelao J, Graziani D, Soriano JB, et al. Findings and prognostic value of lung ultrasound in COVID-19 pneumonia. J Ultrasound Med 2020. Online ahead of print. Available from:
  14. Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100(1):9–15. DOI: 10.1097/00000542-200401000-00006.
  15. Bhandari S, Singh A, Bagarhatta M, et al. Evaluation of clinico–radiological profile and correlation with ultrasonography of the chest in coronavirus disease 2019 pneumonia. Indian J Med Specialit 2020;11(2):70. DOI: 10.4103/injms.injms_55_20.
  16. Maiese A, Manetti AC, La Russa R, et al. Autopsy findings in COVID-19-related deaths: a literature review. Forensic Sci Med Pathol 2020. 1–18. DOI: 10.1007/s12024-020-00310-8.
  17. Yusuf GT, Wong A, Rao D, et al. The use of contrast-enhanced ultrasound in COVID-19 lung imaging. J Ultrasound 2020. 1–5. DOI: 10.1007/s40477-020-00517-z.
  18. Kumar A, Weng Y, Graglia S, et al. Interobserver agreement of lung ultrasound findings of COVID-19 10.1101/2020.08.16.20176156.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.