Between June 2, 2020 and August 11, 2020, this prospective study enrolled consecutive critically ill adult patients who were admitted to the intensive care unit (ICU) of the Hospital de Clínicas de Porto Alegre, which is a 1000-bed tertiary teaching hospital in Brazil. Patients were considered eligible if they were  > 18 years old, admitted to the ICU with suspected or confirmed severe COVID-19 pneumonia, defined by the requirement of invasive mechanical ventilation within the first 24 h after ICU admission. The exclusion criteria were a diagnosis of thrombosis at ICU admission, previous use of anticoagulation therapy, pregnancy, anatomical impossibility to scan the lower extremities and death or discharge from the ICU within 48 h after admission. Potentially eligible patients were also excluded when the number of ultrasonography examinations exceeded the research team’s capacity to perform scans (up to five scans per follow-up day). A daily screening of patients with either confirmed or suspected severe COVID-19 pneumonia admitted to a COVID-19-dedicated ICU was performed. If any eligibility criteria were not met, the reason was recorded, and the patient was then excluded.

All procedures performed were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments. This study was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre approved the study protocol (2020–0194). All participants or their legal representatives provided informed consent by phone. This study is reported according to the STROBE guidelines [11].

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