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.

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