The Use of Lung Ultrasound in the Diagnosis of Weaning-Induced Pulmonary Oedema in Mechanically Ventilated Patients

Abstract

Abstract Background Studies dealing with the use of lung ultrasound in the context of weaning have rather calculated lung ultrasound scores with aeration loss (without specifically addressing the issue of weaning induced pulmonary oedema “WIPO”) or assessed post-extubation distress. Our study specifically focuses on WIPO. Advantages of lung ultrasound for diagnosing WIPO are numerous. It provides a non-invasive and direct assessment of lung water accumulation by detecting lung interstitial syndrome (the first stage of haemodynamic pulmonary oedema), lung ultrasound is easier to learn and perform compared to Doppler echocardiography and the acquisition and analysis can be performed within 2 min. Objective To test the ideal profile (increase in the number of B-lines) for diagnosing WIPO using lung ultrasound to avoid the poor outcome of weaning failure. Patients and Methods This study was performed in intensive care units of Ain Shams University hospitals between October 2020 and March 2021. This study was carried out on 51 patients, the final outcome divided this group into three subgroups, successful group include 28 patients (54.9%), failed group without WIPO include 10 patients (19.6%) and failed group with WIPO include 13 patients (25.5%). Results The sensitivity of B-line in predict the successful weaning was 95.0, while the specificity was 90.0% and the accuracy was 92.0% at cut off value 5.0. The sensitivity of B-line in predict the WIPO was 90.0, while the specificity was 84.0% and the accuracy was 87.0% at cut off value 5.5. Conclusion From the results of this study it was concluded that an increase in the number of Blines ≥ 5 on four anterior points during SBT provided the best accuracy for diagnosing WIPO with lung ultrasound. We suggest calling this sign the WIPO profile. These encouraging results must be confirmed by larger series, so that LUCI may empower the non-invasive monitoring tools, including biochemical indices, for the diagnosis of this common problem.