Lung ultrasound scoring system vs ROX index as a predictor for progression to the invasive mechanical ventilation in COVID-19 patients

Main Article Content

Ibrahim EL-Zoghby
Sara Aly
Shereen Elgengeehy
M. Hamed
Karim Mashhour


COVID-19, Lung ultrasound scoring system , ROX index, HFNC,NIPPV, Invasive mechanical ventilation


Background: During the outbreak of the highly contagious Coronavirus disease 19 (COVID19), rapid and simple prognostic tools were needed to support clinical decisions and predict the need of invasive mechanical ventilation. the ROX index, and the lung ultrasound score (LUSS) were proposed to objectively predict patient prognosis in addition to the subjective clinical assessment
Aim: This study aimed to compare lung ultrasound score with ROX index in predicting the need of invasive ventilation in COVID-19 patients requiring advanced oxygen therapy.
Patients and Methods: We studied 50 patients with severe COVID-19 pneumonia in the intensive care unit in the isolated area at Kasr Al-Ainy hospital. Complete Medical history, physical examination and laboratory investigations were obtained on admission. All patients underwent bedside lung ultrasonography scan and LUSS was calculated at the 2nd and the 12th hours, also ROX index was calculated at the 2nd, 6th and 12th hours from initiating the advanced oxygen therapy.
Results: From a total of fifty patients with COVID-19, 56.0% were males, with mean age of 65.98 + 11.68 years, and mortality rate was 68%. The optimal cut off value of the ROX index at (2, 6, 12 hour) is (2.495, 2.675, 3.06) respectively, (p <0.001) with sensitivity 90.9% and specificity 76.5% at the 12 hour. Also the optimal cut off point of LUSS is 25.50 (p <0.001) with sensitivity 93.9% and specificity 88.2% for prediction of the invasive mechanical ventilation.
Conclusion and recommendations: The study concluded that LUSS is more sensitive in predicting the need of invasive mechanical ventilation than ROX index.

Abstract 86 | PDF Downloads 82


1. Y. W, Y. W, Y. C, Q. Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020;
2. Roca O, Messika J, Caralt B, García-de-Acilu M, Sztrymf B, Ricard JD, 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.
3. Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of rox index in prediction of risk of intubation in patients with covid-19 pneumonia. Adv Respir Med. 2021;89(1).
4. Bouhemad B, Mongodi S, Via G, Rouquette I. Ultrasound for “lung monitoring” of ventilated patients. Vol. 122, Anesthesiology. 2015.
5. Deng Q, Zhang Y, Wang H, Chen L, Yang Z, Peng Z, et al. Semiquantitative lung ultrasound scores in the evaluation and follow-up of critically ill patients with COVID-19: a single-center study. Acad Radiol. 2020;27(10).
6. de Alencar JCG, Marchini JFM, Marino LO, da Costa Ribeiro SC, Bueno CG, da Cunha VP, et al. Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department. Ann Intensive Care. 2021;11(1).
7. Niyogi SG, Kumar B, Puri GD, Negi S, Mishra AK, Singh Thingnam SK. Utility of Lung Ultrasound in the Estimation of Extravascular Lung Water in a Pediatric Population—A Prospective Observational Study. J Cardiothorac Vasc Anesth. 2022;36(8).
8. Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012;40(7).
9. Zhao L, Yu K, Zhao Q, Tian R, Xie H, Xie L, et al. Lung Ultrasound Score in Evaluating the Severity of Coronavirus Disease 2019 (COVID-19) Pneumonia. Ultrasound Med Biol. 2020;46(11).
10. Chan YH. Biostatistics 102: Quantitative Data - Parametric & Non-parametric Tests. Singapore Med J. 2003;44(8):391–6.
11. Chan YH. Biostatistics 103: Qualitative Data - Tests of Independence. Vol. 44, Singapore Medical Journal. 2003. p. 498–503.
12. Chan. Biostatistics 104: correlational analysis. Singapore Med J. 2003;
13. Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Vol. 395, The Lancet. 2020.
14. Celejewska-Wójcik N, Polok K, Górka K, Stachura T, Kania A, Nastałek P, et al. High-flow nasal oxygen therapy in the treatment of acute respiratory failure in severe COVID-19 pneumonia: A prospective observational study. Polish Arch Intern Med. 2021;131(7–8).
15. Myers LC, Mark D, Ley B, Guarnieri M, Hofmeister M, Paulson S, et al. Validation of Respiratory Rate-Oxygenation Index in Patients With COVID-19-Related Respiratory Failure. Crit Care Med. 2022;50(7).
16. Rubio-Gracia J, Giménez-López I, Garcés-Horna V, López-Delgado D, Sierra-Monzón JL, Martínez-Lostao L, et al. Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: A prospective noninterventional study. Eur Respir J. 2021;58(3).
17. Sosa FA, Matarrese A, Saavedra S, Osatnik J, Roberti J, Oribe BT, et al. Lung ultrasound as a predictor of mortality of patients with covid-19. J Bras Pneumol. 2021;47(4).
18. Lichter Y, Topilsky Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med. 2020;46(10).