Abstract
BackgroundThe prognostic value of extravascular lung water indices (EVLWI) has been widely investigated, which is determined by lung ultrasound B-lines. However, the clinical value of lung ultrasound B-lines for determining prognosis/intensive care unit (ICU) outcomes in patients with acute respiratory distress syndrome (ARDS) has been rarely reported.MethodsTwenty-one ARDS patients admitted to the ICU of Fu Xing Hospital underwent both lung ultrasonography and pulse index continuous cardiac output (PiCCO) monitoring on the first, second, and third days after diagnosis. The correlation between lung ultrasound score (LUS) and EVLWI measured by the PiCCO system was investigated. The prognostic clinical value of lung ultrasonography in ARDS patients was explored. Chest ultrasound was performed using the 12 regions method. The comprehensive score of lung ultrasound was determined according to the level of lung aeration.ResultsWith ICU mortality as the end point, 21 patients were divided into a survivor group (8 patients, 39.1 %) and a non-survivor group (13 patients, 61.9 %). Significant positive linear correlations were found between LUS and EVLWI, including predicted body weight (r2 = 0.906), sequential organ failure assessment score (r2 = 0.815), lung injury score (r2 = 0.361), and PaO2/FiO2 (r2 = 0.472). Significantly different LUSs were found between the non-survivor and survivor groups (F = 77.64, P <0.01) by repeated-measures analysis of variance. There were no significant differences between the two groups on different days. The areas under the receiver operating characteristic curves of LUS and EVLW measured by PiCCO were 0.846 (P < 0.01) and 0.918 (P < 0.01), respectively. The cut-off of LUS for prognosis prediction was 16.5.ConclusionsLung ultrasonography is a non-invasive, economic, simple, user-friendly, and radiation-free bedside method for predicting the prognosis of ARDS patients. Early measurement of LUS is a better prognostic indicator in patients with ARDS.
Highlights
The prognostic value of extravascular lung water indices (EVLWI) has been widely investigated, which is determined by lung ultrasound B-lines
In the intensive care unit (ICU), 19 % of patients with mechanical ventilation are diagnosed with acute respiratory distress syndrome (ARDS), which is characterized by increased extravascular lung water (EVLW) and
Patients Criteria for inclusion: (1) ARDS patients admitted to the ICU of Fu Xing Hospital affiliated with the Capital University of Medical Sciences from June 2012 to May 2013; (2) Patients meeting the diagnostic criteria of ARDS [6]
Summary
The prognostic value of extravascular lung water indices (EVLWI) has been widely investigated, which is determined by lung ultrasound B-lines. The clinical value of lung ultrasound B-lines for determining prognosis/intensive care unit (ICU) outcomes in patients with acute respiratory distress syndrome (ARDS) has been rarely reported. The correlation between lung ultrasound and PiCCO monitoring was investigated to determine EVLW and evaluate the value of these two examinations in predicting ICU prognosis of ARDS patients. This economic and noninvasive bedside examination is expected to be used in the prognostic evaluation of ARDS patients
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