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BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. We aimed to study the potential role of lung ultrasound score (LUS) in subjects with COVID-19. METHODS: We conducted an observational, prospective pilot study, including consecutive subjects admitted to an intermediate care unit due to COVID-19 pneumonia. LUS is a 12-zone examination method for lung parenchyma assessment. LUS was performed with a portable convex transducer, scores from 0 to 36 points. Clinical and demographic data were collected at LUS evaluation. Survival analysis was performed using a composite outcome including ICU admission or death. Subjects were followed for 30 d from LUS assessment. RESULTS: Of 36 subjects included, 69.4% were male, and mean age was 60.19 ± 12.75 y. A cutoff LUS ≥ 24 points showed 100% sensitivity, 69.2% specificity, and an area under the receiver operating characteristic curve of 0.85 for predicting worse prognosis. The composite outcome was present in 10 subjects (55.6%) with LUS ≥ 24 points, but not in the group with lower LUS scores (P < .001). Subjects with LUS ≥ 24 points had a higher risk of ICU admission or death (hazard ratio 9.97 [95% CI 2.75–36.14], P < .001). Significant correlations were observed between LUS and [Formula: see text] , serum D-dimer, C-reactive protein, lactate dehydrogenase, and lymphocyte count. CONCLUSIONS: LUS ≥ 24 points can help identify patients with COVID-19 who are likely to require ICU admission or to die during follow-up. LUS also correlates significantly with clinical and laboratory markers of COVID-19 severity.

Introduction: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; p < 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31–7.42; p < 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38–3.99; p = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61–5.43; p < 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06–0.40; p < 0.001).Conclusions: IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

Background: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the impact of an IMCU in the management of severe COVID-19.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6% Vs 24.2%; pConclusions: IMCU allow to safely and effectively manage severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

Background: Transbronchial lung cryobiopsy (TBLC) has been established as a common and safe procedure in the diagnosis of diffuse interstitial lung diseases (ILD). The patient can be discharged after a few hours under observation, except if a complication is presented, mainly bleeding or pneumothorax (PTX). Chest X-ray (CXR) is the conventional examination performed to detect PTX, but sometimes the delay in carrying it out may lengthen the patient’s hospital stay. Chest ultrasound (US) is more sensitive in the detection of PTX. Objective: to assess if chest US could replace CXR to detect PTX. Methods: prospective study in patients with indication of TBLC for the study of ILD from April 2018 to February 2019. Chest US was performed 1 hour after the procedure in the recovery area and a CXR was performed 4 hours after the procedure in the Radiology department, except if the patient had symptoms or if the US showed PTX, performing CXR earlier. Results: 32 patients were included,57.3% males.94% of the biopsies were performed in lower lobes.24 patients did not present PTX on US and this was confirmed with CXR, except in one patient who presented late PTX on the CXR.4 patients presented PTX on US and it was also confirmed with CXR. US detected 1 PTX that was not visible in CXR. In 3 cases there were doubts in the US image due to a bad window, of which 1 had PTX and another 2 did not. About the patients who presented PTX (22%), only two (6.2%) required a chest tube. The rest were discharged after 24-72 hours of observation. Conclusions: Chest US can replace conventional CXR in a large number of patients, allowing early discharge, although the possibility of late PTX (3.1%) must be taken into account.

Introduction: Surgical biopsy is the gold standard technique for the pathological diagnosis of diffuse interstitial lung diseases (ILD). Pulmonary cryobiopsy (PC) emerges as an alternative due to its reduction of surgical complications, maintaining an accurate diagnostic yield. However, complications are reported. It is still unclear if these complications could be related to technical, radiological or clinical features. Material and Methods: Retrospective descriptive study of consecutive patients who have undergone a PC for ILD diagnosis between 2012 and 2017. Mild bleeding was considered if only suction was necessary; moderate bleeding if balloon occlusion and cold serum instillation were required; and severe bleeding if a blocker was maintained and patients remainded intubated, or embolization was required. Severe pneumothorax was considered when thoracic drain was inserted. Technical aspects as well as clinical variables were confronted to type and degree of complications. Results: 117 patients were included, 55% male, average age was 61 y-o and 15% were smokers. Average lung function was FVC 86%, FEV1 85%, FEV1/FVC 80%, DLCO 61%. The main radiological findings were ground glass (41%) followed by reticular pattern (28%). In 32% of the cases fibrosis was present. Complications were described in 11.95%: bleeding (moderate 9.4%, severe 0.85%), pneumothorax (mild 0.85%, severe 0.85%), death 0%. PC could not be performed in 7% due to high traction-resistance. Conclusions: Pulmonary cryobiopsy is a safe technique, with a total complication rate of 11.95%, being severe complications rare (1.7%). In the described series, no association between complications and technical, clinical nor radiological features were found.