Abstract
BackgroundTo assess diagnostic performance of lung ultrasound (LUS) in identifying ARDS morphology (focal vs non-focal), compared with the gold standard computed tomography.MethodsMechanically ventilated ARDS patients undergoing lung computed tomography and ultrasound were enrolled. Twelve fields, were evaluated. LUS score was graded from 0 (normal) to 3 (consolidation) according to B-lines extent. Total and regional LUS score as the sum of the four ventral (LUSV), intermediate (LUSI) or dorsal (LUSD) fields, were calculated. Based on lung CT, ARDS morphology was defined as (1) focal (loss of aeration with lobar distribution); (2) non-focal (widespread loss of aeration or segmental loss of aeration distribution associated with uneven lung attenuation areas), and diagnostic accuracy of LUS in discriminating ARDS morphology was determined by AU-ROC in training and validation set of patients.ResultsForty-seven patients with ARDS (25 training set and 22 validation set) were enrolled. LUSTOT, LUSV and LUSI but not LUSD score were significantly lower in focal than in non-focal ARDS morphologies (p < .01). The AU-ROC curve of LUSTOT, LUSV, LUSI and LUSD for identification of non-focal ARDS morphology were 0.890, 0.958, 0.884 and 0.421, respectively. LUSV value ≥ 3 had the best predictive value (sensitivity = 0.95, specificity = 1.00) in identifying non-focal ARDS morphology. In the validation set, an LUSV score ≥ 3 confirmed to be highly predictive of non-focal ARDS morphology, with a sensitivity and a specificity of 94% and 100%.ConclusionsLUS had a valuable performance in distinguishing ARDS morphology.
Highlights
To assess diagnostic performance of lung ultrasound (LUS) in identifying Acute respiratory distress syndrome (ARDS) morphology, compared with the gold standard computed tomography
Total and regional LUS score in different ARDS morphologies Overall, Total Lung Ultrasound Score (LUSTOT) was significantly lower in the focal compared to the non-focal ARDS morphology [focal 14 (IQR 10–20); non-focal 24 (IQR 18–27), p < 0.01] (Fig. 3)
In both ventral and intermediate regions, LUS scores were significantly lower in focal [LUS score in the ventral lung regions (LUSV) 1 (IQR 0–2); LUS score in the intermediate lung regions (LUSI) 4 (IQR 2–7) compared to non-focal [LUSV 6 (IQR 6–8), p < 0.01; LUSI 8 (IQR 5–9), p < 0.05] ARDS morphology (Fig. 3)
Summary
To assess diagnostic performance of lung ultrasound (LUS) in identifying ARDS morphology (focal vs non-focal), compared with the gold standard computed tomography. Acute respiratory distress syndrome (ARDS) is characterized by significant loss of lung aeration and increased lung weight as a consequence of increased lung permeability leading to accumulation of protein-rich edema [1]. Computed tomography (CT) is the gold standard imaging technique for the identification, characterization of Costamagna et al Ann. Intensive Care (2021) 11:51 interventions [5,6,7]. Our study explored the feasibility and accuracy of lung ultrasound as imaging technique for identification of ARDS morphology (focal vs non-focal) as compared to CT scan. We hypothesized that LUS performed at the bedside accurately quantifies aeration loss in ARDS patients, providing useful information about ARDS morphology (focal vs non-focal)
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