Prophetic values of lung ultrasound score on post-extubation distress in patients with acute respiratory distress syndrome

Ran Wang,Xiaohua Zhang,Liang Meng,Xiaofei Wu,Benquan Qi

doi:10.1186/s40001-022-00652-9

Ran Wang, Xiaohua Zhang + Show 3 more

Open Access

https://doi.org/10.1186/s40001-022-00652-9

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Abstract

BackgroundAcute respiratory distress syndrome (ARDS) has been a prevalent disease in ICU with mortality of up to 27–45%. A considerable proportion of extubated ARDS patients passing spontaneous breathing trial (SBT) still requires reintubation.MethodsLung ultrasonography (LUS) was used to predict the success rate of extubation. Ninety-two patients passing the 60-min SBT were included in this prospective research. Their clinical characters including LUS, APACHE II, SOFA, CPIS, EVLWI and PaO2/FiO2 were collected before the SBT. Another two LUS assessments were performed at the end of and 4 h after SBT. LUS results were evaluated and scored by two independent experts, and the correlations of LUS scores, APACHE-II scores, SOFA scores, CPIS and EVLWI with the success rate of extubation and rate of reintubation were analyzed.ResultsFailed weaning and reintubation of ARDS patients were correlated with higher LUS scores both before and after SBT. Post-extubation distress was correlated with higher APACHE-II scores, SOFA scores, CPIS and EVLWI before SBT. There were positive correlations between the LUS score and APACHE-II score, SOFA score, CPIS and EVLWI before SBT, respectively.ConclusionLUS score measured at the end of 60-min SBT could be used to predict post-extubation distress in ARDS patients.

Highlights

Acute respiratory distress syndrome (ARDS) has been a prevalent disease in intensive care unit (ICU) with mortality of up to 27–45%
Study design and participants To investigate the correlation between the Lung ultrasonography (LUS) scores and the incidence of post-extubation distress following the 60-min spontaneous breathing trial (SBT) in ARDS patients, a retrospective trial was performed in this research
In conclusion, we tried to illustrate the predictive effect of LUS scores measured at different time points on the outcome of ARDS patients 48 h after extubation in this study

Summary

Introduction

Acute respiratory distress syndrome (ARDS) has been a prevalent disease in ICU with mortality of up to 27–45%. Ultrasonography began to be used in lung examinations in critically ill and emergency patients such as acute respiratory failure in the late 1990s [6, 7]. LUS can quickly differentiate and diagnose a variety of lung diseases, with increased diagnostic sensitivity and specificity [9]. Indirect signs shown by ultrasound such as abnormal pleural line, disappearance of A-line, abnormal increase of B-line, lung consolidation and other manifestations can be used for the diagnosis of multiple diseases [11]. Previous studies have demonstrated that lung consolidation accompanied by bronchial inflation, abnormal pleural lines, diffuse pulmonary edema and disappearance of A-line are the main signs of LUS in ARDS patients [12]. Pulmonary consolidation, diffuse pulmonary edema and abnormal pleural line are closely related to the onset of ARDS [13]

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