Table 1.
Clinical characteristics of studies evaluating lung ultrasound in COVID-19.
| Study | Country | Type of study | Patients and participants included in the studies | Diagnosis of COVID-19 | Clinical picture | Comorbidities | Treatment |
|---|---|---|---|---|---|---|---|
| Thomas et al.19 | Canada | Case report | 64 years old, female and health professional. | RT-PCR | Productive cough and dyspnea on exertion. After 6 days in O2 catheter → invasive mechanical ventilaton. 88% SpO2. | NS | Support: Invasive mechanical ventilation + intubation. |
| Soldati et al.12 | Italy | Protocol | 30 patients. | NS | NS | NS | NS |
| Buonsenso et al.15 | Italy | Case report | 1 adult, 52 years old, male. | NS | Fever, asthenia, cough, headache, myalgia, photophobia for 1 week; 90% SpO2. Dyspnea and bilateral rales. | NS | NS |
| Kim et al.18 | Canada | Case report | 1 man, 67 years old. | NS | Fever and chills for 5 days, non-productive cough, myalgia and malaise. 80/40 arterial pressure, 38.7oC temperature, 120 cardiac rate, 24 RF, 93% SpO2 in ambient air. | Hypertension and dyslipidemia. | NS |
| Denina et al.25 | Italy | Descriptive observational | 8 children and adolescents (0–17 years old), divided into 3 female and 5 male participants. | NS | Fever (6 patients); dry cough (5 patients); dyspnea/tachypnea (3 patients); odynophagia (3 patients); vomit or diarrhea (3 patients) and hypoxemia (2 patients). | NS | Oxygen therapy. |
| Yasukawa et al.26 | USA | Analytical observational | 10 adults (31–71 years old), divided into 7 male and 3 female participants. | Detection of SARS-CoV-2 in nasopharyngeal swab RT-PCR. | Fever, cough, dyspnea, SpO2 from 89 to 96%. | Rheumatoid arthritis, SAH, asthma, sleep obstructive apnea, obesity, hyperlipidemia and atrial fibrillation. | Oxygen therapy with mask (4 patients). |
| Musolino et al.27 | Italy | Analytical observational | 10 children (mean age 11 years). | Nasopharyngeal swab RT-PCR. | Fever (80%), cough (50%), anosmia (10%), arthralgia (30%), chest pain (20%), headache (20%). | NS | Patient did not require hospital treatment or ICU. |
| Ji et al.29 | China | Case report | 1 female adult (60 years old). | Oropharyngeal swab RT-PCR. | Fever, chills, dry cough, fatigue and dyspnea. RF 30 breaths per minute; 92% SpO2 in ambient air. | SAH and systemic lupus erythematosus. | Respiratory support and interferon inhalation. |
| Buosenso et al.30 | Italy | Case report | 4 pregnant women (31–42 years old — mean age 37 years). Gestacional periods=17, 24, 35 and 38 weeks. | Nasopharyngeal swab RT-PCR. | NS | No comorbidities. | All patients received hydroxychloroquine, lopinavir/ritonavir, no need for ICU. Tocilizumab was added for the patient based on the pulmonary impairment revealed by the LU. |
| Inchingolo et al.31 | Italy | Descriptive observational | 1 pregnant woman (age not informed). Gestational period = 23 weeks. | Oropharyngeal swab RT-PCR. | Cough and fever, eupneic, no respiratory discomfort, 98% SpO2 in ambient air. Bilateral reduced vesicular murmur in bases. | NS | NS |
| Duclos et al.32 | France | Case report | 1 male adult. | Nasopharyngeal swab RT-PCR. | Dry cough (4 patients); anosmia (1 patient); fever ≥38 °C (3 patients) temperature. | NS | NS |
| Zieleskiewicz et al.33 | France | Case report | 2 older people (65-year-old male; and 72-year-old female participants). | NS | NS | NS | Mechanical ventilation for the 65-year-old patient. |
| Youssef et al.34 | Italy | Case report/Letter to the editor | 1 pregnant woman, 33 years old, gestational period = 26 weeks. | Positive nasopharyngeal swab. | Fever, mild chest pain and dyspnea for three days, with normal oxygen saturation. | NS | NS |
| Tung-Chen et al.35 | Spain | Case report | 35-year-old male adult. | RT-PCR | Abrupt chills and sickness, dry cough after 20 h of isolation, bilateral cephalgia and normal lung auscultation. | NS | Supportive therapy was started with ibuprofen and paracetamol. After confirming worsening of symptoms and LU findings, hydroxychloroquine 200mg twice a day and azithromycin were added to the treatment. |
| Lu et al. 38 | China | Observational | 30 (16 male and 14 female) with mean age of 52 ± 15 years. | RT-PCR — including two patients with positive results. | Fever: 20 patients (66.7%); cough: 14 patients (46.7%); fatigue: 5 patients (16.7%); muscle soreness: 5 patients (16.7%); nausea: 2 patients (6.7%); no obvious symptoms: 3 patients (10%). | NS | NS |
| Tan et al.62 | China | Case series | 12 (4 male and 8 female), ranging from 52 to 79 years old, mean age 60.5 years. | RT-PCR | Moderate (4 patients): fever, diarrhea or other respiratory tract symptoms. Severe (4 patients) — showing any of the following: RF ≥30 times/min OR at rest, peripheral venous oxygen saturation ≤93% or PaO2/FiO2 ≤300 mmHg. Critical (4 patients) — showing any of the following: respiratory failure with mechanical ventilation OR shock OR with other organic failure and need for admission in the ICU. |
Hypertension (1 patient), diabetes mellitus (1 patient) and cardiovascular diseases (2 patients). | NS |
| Mafort et al.63 | Brazil | Transversal observational | 409 (134 male and 275 female), ranging from 35 to 51 years old (mean age 41 years) — all of them health care professionals. | RT-PCR | Cough (84%); fever (69.7%); dyspnea (36.2%). | NS | NS |
| Veronese et al.64 | Italy | Retrospective study | 48 patients living in nursing homes (women = 81.3%), mean age 84.1 years. | RT-PCR | NS | Dementia and mostly bedridden patients. | NS |
| Zieleskiewicz et al.65 | France | Observational study with retrospective analysis | 100 (65 male and 35 female), ranging from 54 to 77 years old (mean age 61 years). | RT-PCR | Acute dyspnea (SpO2 <94% or breathing difficulty). | Body mass index >30 (17%); SAH (24%); coronariopathy (11%); cardiac failure (16%); diabetes mellitus (16%); chronic obstructive pulmonary disease (10%); cancer (7%); chronic kidney disease (2%), hepatopathy (1%) and immunosuppression (1%). | NS |
| Yassa et al.66 | Turkey | Prospective cohort | 296 pregnant women (23 with positive result for COVID-19), age range from 17 to 43 years old (mean age 26.8 years); gestacional period from 5 to 42 weeks (mean gestacional period 35.18 weeks). | RT-PCR | Pregnant women admitted in Gynecology and Obstetrics unit for any reason were tested for SARS-CoV-2 RT-PCR and examined with LU; 23 pregnant women with positive SARS-CoV-2 RT-PCR result, from whom 11 (3.72%) were symptomatic and 12 (4.05%) were asymptomatic. | NS | NS |
| Zhao et al.67 | China | Retrospective study | 35 (24 men and 11 women) patients divided into 2 groups: refractory (7 patients), mean age 62.14 years and non-refractory (28 patients), mean age 64.14 years. | RT-PCR | 1. Severe: respiratory distress with RF ≥30, SpO2 ≤93% and PaO2/FiO2 ≤300 mmHg, at rest. Non-refractory. 2. Critical: respiratory failure requiring mechanical ventilation, shock and another organic failure requiring admission in the ICU. Non-refractory. 3. Refractory: refractory respiratory disease with PaO2/FiO2 ≤100 mmHg or patients treated with ECMO. |
NS | High flow nasal cannula; mechanical ventilation; ECMO. |
| Dargent et al.68 | France | Prospective study | 10 (8 men and 2 women) ages ranging from 46 to 63 (mean age 56 years). | RT-PCR | Moderate to severe ARDS. | Obesity | Mechanical ventilation. |
| Bonadia et al.69 | Italy | Prospective cohort | 41 (28 men and 13 women) mean age 60 ± 22.7 years. | RT-PCR | 24 patients (58.5%) with dyspnea; 32 patients (78%) with fever; 27 patients (65.8%) with cough. | NS | Ventilatory support: none in 11 (26.8%); low flow oxygen in 13 (31.7%); high flow oxygen in 2 (4.9%); non-invasive positive pressure ventilation in 9 (21.9%); intubation in 6 (14.6%). |
| Deng et al.70 | China | Retrospective study | 128* (75 men and 53 women) ages ranging from 55 to 71 years old (mean age 65 years). | RT-PCR | Divided into 4 groups: 1. Light: light symptoms without HRCT alteration. 2. Common: fever and signals of respiratory infection with pneumonia alterations in the HRCT. 3. Severe: any of these symptoms, (a) respiratory distress with RF ≥30, (b) SpO2 ≤93% at rest or (c) PaO2/FiO2 ≤300 mmHg. 4. Critical: (a) respiratory failure requiring mechanical ventilation, (b) shock, (c) admission in the ICU due to multiple organ failure. |
44 (34%) patients with hypertension; 22 (17.2%) patients with coronary disease; 19 (14,8%) patients with diabetes melittus; fatigue (96.1%); fever (95.3%) and breathlessness (94.5%); decreased SpO2 in 99 (77.3%) patients. | Oxygen therapy in all patients. Non-invasive ventilation in 38 patients; mechanical ventilation in 31 patients; ECMO in 4 patients; and 42 patients in the ICU. * Out of the 128 participants, 7 remained in hospital, 84 were discharged and 37 died. |
| Pagano et al.71 | Italy | Observational study | 18 (13 men and 5 women), mean age 69 years. | RT-PCR | Light to moderate ARDS. | NS | Non-invasive CPAP. |
| Martinez et al.72 | Spain | Case series | 3 (pediatrics age range without specifying the individuals’ ages). | RT-PCR | NS | Severe, but not specific. | NS |
| Yu et al.73 | China | Case report | Case 1 = 54-year-old man. | RT-PCR | Case 1 = cough. | NS | NS |
| Case 2 = 37-year-old woman. | RT-PCR | Case 2 = tightness in chest for a week, solved at admission. Without respiratory symptoms. | NS | NS | |||
| Cho et al.74 | South Korea | Case series | 6 (2 men and 4 women) ages ranging from 16 months to 85 years old. | RT-PCR | Case 1 = sore throat, backache, dry cough and fever on the 5th day. | NS | Case 1 = lopinavir/ritonavir. |
| RT-PCR | Case 2 = cough and chills for a day, fever >37.5 °C temperature and myalgia. | NS | Case 2 = lopinavir/ritonavir. | ||||
| RT-PCR | Case 3 = dyspnea and fever >37.5 °C temperature. | NS | Case 3 = OTI and mechanical ventilation. | ||||
| RT-PCR | Case 4 = fever for 8 days, dyspnea. | NS | Case 4 = empirical antibiotic therapy and oseltamivir followed by lopinavir/ritonavir; OTI, methylprednisolone + inhaled nitric oxide and veno-venous ECMO. | ||||
| RT-PCR | Case 5 = rhinorrhea, nasal obstruction and sputum. | NS | Case 5 = NS | ||||
| RT-PCR | Case 6 = asymptomatic and stable. | NS | Case 6 = no need for treatment. | ||||
| Lichter et al.75 | Israel | Prospective study | 120 (74 men and 46 women) mean age 64.7 ± 18.2 years. | RT-PCR | Respiratory symptoms; fever; chest pain; fatigue; SpO2 with 95% median and 89–98% interval. | Found in 81% of the patients: hypertension in 67 (55.8%); diabetes mellitus in 34 (28.3); obesity (not informed %); atrial fibrilation/flutter in 21 (17.5%); ischemic cardiac disease in 21 (17.5%); transient ischemic attack/stroke in 14 (11.7%). | NS |
| Lu et al.76 | China | Observational study | 16 (9 men and 7 women), ages ranging from 47 to 68 years old (mean age 58 years). | NS | Severe COVID-19 consistent with any of the following criteria: respiratory difficulty, RF >30 or SpO2 <93% in ambient air or PaO2/FiO2 ≤300 mmHg or pulmonary lesion with over 50% progression in 24-48 h in imaging examination. | NS | High flow cannula, non-invasive ventilation and OTI with mechanical ventilation. |
| Dini et al.77 | Italy | Observational study | 150 (23 men and 127 women), ages ranging from 72 to 106 years old (mean age 88 years). | RT-PCR | Respiratory symptoms, cough, dyspnea, fever, asthenia. | 92 (61.3%) patients with hypertension; 35 (23%) patients with chronic kidney disease; 28 (18.7%) patients with diabetes mellitus; 25 (16.7%) patients with coronary disease; 41 (27.3%) patients with other cardiac diseases; 44 (29.3%) patients with stroke; 28 (18.7%) patients with atrial fibrillation; 12 (8%) patients with cardiac failure; chronic obstructive pulmonary disease in 13 (8.7%) patients. | NS |
| Iodice et al.78 | Italy | Observational study | 29 (26 men and 3 women), ages ranging from 34 to 79 years old (mean age 60 years). | RT-PCR | Fever: 26 (90%) patients; cough: 15 (52%) patients; dyspnea: 8 (28%) patients; arthralgia: 4 (14%) patients; conjunctivitis: 2 (7%) patients. | 15 (62%) patients with hypertension; 5 (21%) patients with diabetes mellitus; 4 (17%) patients with asthma; 6 (21%) smoker patients. | Oxygen therapy in 23 (79%) patients. |
| Tung-Chen et al.79 | Spain | Prospective study | 51 (28 men and 23 women), mean age 61.4 years. | RT-PCR | Dyspnea: 29 (56.9%) patients; fever: 23 (45.1%) patients; myasthenia: 22 (43.1%) patients; gastrointestinal tract symptoms: 10 (19.6%) patients; cough: 22 (43.1%) patients; ageusia/anosmia: 4 (7.8%) patients. | 14 (27.5%) patients with cardiovascular disease; 12 (23.5%) patients with pulmonary disease; 10 (19.6%) patients with diabetes mellitus; 6 (11.8%) patients with chronic kidney disease; 8 (15.8%) patients with immunosuppression; 20 (39.2%) patients with hypertension; 13 (25.5%) patients with malignity. | NS |
| Gregorio-Hernández et al.80 | Spain | Case report | Case 1 (male newborn)= 2 days old and gestacional period = 38 + 3 | RT-PCR | Case 1 = mother with postpartum fever without respiratory symptoms. | Case 1: meconium aspiration syndrome. | Case 1: mechanical ventilation, nitric oxide, vasoactive drugs, cooling therapy and anticonvulsants (due to severe hypoxic ischemic encephalopathy). |
| Case 2 (male newborn)=78 days old and gestacional period=39+3. | RT-PCR | Case 2 = asymptomatic, but investigated after case 1 diagnosis. | Case 2: prematurity and bronchopulmonary dysplasia. | Case 2: oxygen therapy. | |||
| Case 3 (male newborn) = 6 days old and gestacional period=39+6 (gestacional period at the moment of the diagnosis). | RT-PCR | Case 3=asymptomatic, but investigated after case 1 diagnosis. | Case 3: Hirschsprung. | Case 3: no need for respiratory support. | |||
| LeVine et al.81 | Bhutan | Case report | A 76-year-old man. | RT-PCR | Swell, loss of appetite, diarrhea and fatigue in the first 48 h. Cough and dyspnea with 78% SpO2 in ambient air on the 4th day of symptoms. | Hypertension, hyperlipidemia, neuropathy and splenectomy due to mantle cell lymphoma. | Oxygen therapy, OTI and prone position, intravenous immunoglobulin, oseltamivir, ceftriaxone, doxycycline, lopinavir/ritonavir and antibiotic substitution with meropenem and vancomycin. |
| Nouvenne et al.82 | Italy | Observational study | 83 participants (23 men and 60 women), mean age 85 ± 8 years. | RT-PCR | 33 (40%) patients with cough; 52 (63%) patients with fever; 33 (40%) patients with dyspnea or light desaturation. | NS | Empirical pharmacological treatment with antibiotics, hydroxychloroquine and corticosteroids. |
| Yang et al.83 | China | Observational study | 29 participants (18 men and 11 women), mean age 55.2 ± 16 years. | NS | NS | NS | NS |
| Schmid et al.84 | Germany | Case report | A 76-year-old man. | NS | Fever for four days; dry cough and diarrhea; tachypnea, respiratory failure, 93% SpO2 (with O2 15 L/min in mask). | Absence of comorbidities. | Intensive treatment, not specified. |
| López Zúñiga et al.85 | Spain | Case report | Case 1 = 87-year-old man. | Cases 1 = positive RT-PCR. | Case 1 = dyspnea, dry cough, no fever. | NS | NS |
| Case 2 = 53-year-old man. | Case 2 = negative RT-PCR with positive serology. | Case 2 = fever, cough, dyspnea. | |||||
| Case 3= 55-year-old man. | Case 3 = positive RT-PCR. | Case 3 = dyspnea. | |||||
| Case 4 = 35-year-old-man. | Case 4=diagnositc exam not specified. | Case 4 = fever for 3 days. | |||||
| Giacomelli et al.86 | Italy | Case report | A 67-year-old man. | RT-PCR | Fever for 7 days, absence of cough or dyspnea; 89% SpO2 in ambient air. | Hypertension; surgical background of abdominal aorta aneurysm open repair with graft in 2014. | Antiviral therapy (lopinavir/ritonavir); hydroxychloroquine; thrombotic prophylaxis with prophylactic subcutaneous enoxaparin; CPAP and introduction of methylprednisolone and tocilizumab; OTI and prone position. After worsening and evidence of the abdominal aorta graft thrombosis, introduction of sodium heparin and the use of vasoactive drugs. |
| Nouvenne et al.87 | Italy | Transversal observational | 26 participants (14 men and 12 women), mean age 64 ± 16 years. | RT-PCR | 25 (96%) patients with fever; 21 (81%) patients with cough; 10 (38%) patients with dyspnea. | Comorbidities in 19 (73%) patients, but not specified. | Oxygen therapy in 17 (26%) patients. |
| Peyrony et al.88 | France | Prospective observational cohort | 391 participants (241 men and 150 women) ages ranging from 48 to 71 years old (mean age 62 years). | Positive RT-PCR in 225 (57.6%) patients. | Fever in 176 (78.2%) patients; cough in 158 (70.2%) patients; dyspnea in 131 (58.2%) patients; myalgia in 71 (31.6%) patients; rhinitis/pharyngitis in 19 (8.4%) patients; anosmia in 31 (13.8%) patients. | Immunosuppression in 195 (50.5%) patients. Chronic pulmonary disease in 85 (22.1%) patients. Cardiovascular disease in 156 (40.4%) patients. Obesity in 58 (15.2%) participants. | NS |
| Rodriguez-Gonzalez et al.89 | Spain | Case report | A 6-month-old male participant. | Negative RT-PCR. Detection of anti-SARS-CoV-2 Immunoglobulin M and anti-SARS-CoV-2 Immunoglobulin G on day 21 of illness. | 2-week history of nasal congestion and cough, irritability, tachypnoea (80 breaths per minute), cyanosis (81% SpO2), tachycardia (170 beats per minute), hypotension (59/32 mmHg), poor perfusion, weak peripheral pulses and hepatomegaly (3 cm). | Short bowel syndrome with fever and cyanosis; cardiogenic shock secondary to severe pulmonary hypertension and right ventricular failure without pulmonary thromboembolism condition labelled as pediatric multisystem inflammatory syndrome. | Prophylaxis with low molecular weight heparin; mechanical ventilation and prone position; inotropic support with milrinone and norepinephrine and broad-spectrum antibiotics (meropenem, vancomycin and fluconazole); Tocilizumab, azithromycin, hydroxychloroquine and methylprednisolone. |
COVID-19 = coronavirus disease 2019; RT-PCR = real time polymerase chain reaction; O2 = oxygen; SpO2 = oxygen peripheral saturation; ICU = intensive care unit; NS = not stated; RF = respiratory frequency; LU = lung ultrasound; SAH = systemic arterial hypertension; FiO2 = fraction of inspired oxygen; OTI = orotracheal intubation; CPAP = Continuous Positive Airway Pressure; HRCT= high resolution computerized tomography; ECMO = Extracorporeal Membrane Oxygenation; PaO2 = oxygen arterial pressure; ARDS= acute respiratory distress syndrome; % = percentage; USA=United States of America; SARS-CoV-2=Severe Acute Respiratory Syndrome Coronavirus 2.