Pulmonary ultrasound scoring system for intubated critically ill patients and its association with clinical metrics and mortality: A prospective cohort study

• Published in: Journal of clinical ultrasound Vol. 46; no. 1; pp. 14 - 22
• Main Authors: Tierney, David M., Boland, Lori L., Overgaard, Josh D., Huelster, Joshua S., Jorgenson, Ann, Normington, James P., Melamed, Roman R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2018
• Subjects: Abnormalities; Adult; Adults; Aged; Aged, 80 and over; Asthma - diagnostic imaging; Asthma - mortality; Asthma - physiopathology; Cohort analysis; Cohort Studies; Critical Illness - mortality; Diagnostic systems; Etiology; Extubation; Female; Humans; Intubation; Lungs; Male; Middle Aged; Mortality; Patients; Point-of-Care Systems; point‐of‐care ultrasound; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnostic imaging; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; pulmonary ultrasonography; Respiratory Distress Syndrome, Adult - diagnostic imaging; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory failure; respiratory insufficiency; Respiratory Insufficiency - diagnostic imaging; Respiratory Insufficiency - mortality; Respiratory Insufficiency - physiopathology; Ultrasonic imaging; Ultrasonography - methods; Ultrasound; Young Adult; intubation; pulmonary ultrasonography; point-of-care ultrasound; respiratory insufficiency
• ISSN: 0091-2751; 1097-0096
• DOI: 10.1002/jcu.22526

Purpose Pulmonary ultrasound (PU) examination at the point‐of‐care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often‐subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics. Methods In this prospective study of 250 adults intubated for ARF, a PU examination was performed at intubation, 48‐hours later, and at extubation. A total lung score (TLS) was calculated. Clinical metrics and final diagnosis were extracted from the medical record. Results TLS correlated positively with mortality (P = .03), ventilator hours (P = .003), intensive care unit, and hospital length of stay (P = .003, P = .008), and decreasing PaO2/FiO2 (P < .001). Agreement of PU findings was very good (kappa = 0.83). Baseline TLS and subscores differed significantly between ARF categories (nonpulmonary, obstructive, and parenchymal disease). Conclusions A quick, scored, PU examination was associated with clinical metrics, including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers.