CORRELATION OF RADIOGRAPHIC ASSESSMENT OF THE QUANTITY OF LUNG EDEMA (RALE) SCORES AND ARDS SEVERITY

Abstract

SESSION TITLE: ARDS: Fine-tuning Details in Management SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Our primary outcome was to determine if a correlation exists between RALE scores and ARDS severity as measured by the time to decreased FiO2 requirement less than 0.4. We also evaluated if RALE scores were correlated with brain natriuretic peptide (BNP), Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, and in-hospital mortality. METHODS: We performed a retrospective chart review of all admissions to a 16-bed medical intensive care unit (MICU) in an urban community-academic hospital from May 2016 to January 2018. We identified 47 patients intubated for acute hypoxic respiratory failure, and who met ARDS criteria based on chest x-ray findings and pulse oximetric saturation Spo2/Fio2 (SF) ratio. Data collected for these patients included: Ventilator settings, BNP, APACHE score, time to decreased FiO2 RESULTS: 36/47 (76.5%) of the patients had a high RALE score (>23). In pts with RALE score >23, the average time to decrease FiO2 23 patients had a high apache score (>23) and 13/32 (40%) had a high BNP (>583). The death rate in patients with higher RALE Score was 17/36 (47%); of these 7/17 (41%) were associated to an elevated BNP and 6/17 (35%) had a higher APACHE. Only 3/17 (17.6%) deaths had both elevated BNP and APACHE score. Contrarily, 11/47 (23.5%) of our ARDS patients had a low RALE score (23) and 1/6 (16.7%) had a high BNP (>583). The death rate in patients with lower RALE Score was 6/11 (54.5%); of these 1/6 (16.7%) were associated to an elevated BNP and 6/6 (100%) had a higher APACHE. Only 1/6 (16.7) deaths had both elevated BNP and APACHE score. CONCLUSIONS: Higher RALE scores did not correlate with worse clinical outcomes in our patient population compared to those with a lower RALE score. Lower RALE scores seem to correlate with worse characteristics and clinical outcomes including higher BNP, APACHE and death rates. These finding suggest that RALE score alone does not determine ARDS severity. Given our ARDS population also had elevated BNPs it would be worthwhile extending the study to include the role of diuresis in these patients. CLINICAL IMPLICATIONS: Though effective in creating an objective measure for ARDS severity, the RALE score alone doesn’t correlate with acuity of patients with ARDS and their clinical outcomes. A larger patient population would be needed to further analyze the relation between RALE scores and other patient characteristics that increase ARDS severity. DISCLOSURES: No relevant relationships by John Kileci, source=Web Response No relevant relationships by Young Im Lee, source=Web Response No relevant relationships by Natalie Marte, source=Web Response No relevant relationships by Martha Catalina Morales Alvarez, source=Web Response No relevant relationships by Risako Shirane, source=Web Response No relevant relationships by M. Faisal Siddiqi, source=Web Response