Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study

• Published in: PloS one Vol. 13; no. 12; p. e0204832
• Main Authors: Leopold, Stije J, Ghose, Aniruddha, Plewes, Katherine A, Mazumder, Subash, Pisani, Luigi, Kingston, Hugh W F, Paul, Sujat, Barua, Anupam, Sattar, M Abdus, Huson, Michaëla A M, Walden, Andrew P, Henwood, Patricia C, Riviello, Elisabeth D, Schultz, Marcus J, Day, Nicholas P J, Kumar Dutta, Asok, White, Nicholas J, Dondorp, Arjen M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12.12.2018; Public Library of Science (PLoS)
• Subjects: Abnormalities; Adult; Aeration; Bangladesh; Biology and Life Sciences; Confidence intervals; Critical care; Edema; Ethics; Female; Health risks; Hospitals; Humans; Intensive care; Internal medicine; Lung - diagnostic imaging; Lungs; Malaria; Malaria - diagnostic imaging; Male; Medicine; Medicine and Health Sciences; Observational studies; Patients; Physical Sciences; Point-of-Care Systems; Prospective Studies; Research and Analysis Methods; Respiratory distress syndrome; Respiratory Distress Syndrome - diagnostic imaging; Sepsis; Sepsis - diagnostic imaging; Severity of Illness Index; Ultrasonic imaging; Ultrasonography; Ultrasound; Vector-borne diseases; Bangladesh; Netherlands; United Kingdom > UK; United States > US; Massachusetts; Thailand; Bangkok Thailand
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0204832

Patients with severe malaria or sepsis are at risk of developing life-threatening acute respiratory distress syndrome (ARDS). The objective of this study was to evaluate point-of-care lung ultrasound as a novel tool to determine the prevalence and early signs of ARDS in a resource-limited setting among patients with severe malaria or sepsis. Serial point-of-care lung ultrasound studies were performed on four consecutive days in a planned sub study of an observational cohort of patients with malaria or sepsis in Bangladesh. We quantified aeration patterns across 12 lung regions. ARDS was defined according to the Kigali Modification of the Berlin Definition. Of 102 patients enrolled, 71 had sepsis and 31 had malaria. Normal lung ultrasound findings were observed in 44 patients on enrolment and associated with 7% case fatality. ARDS was detected in 10 patients on enrolment and associated with 90% case fatality. All patients with ARDS had sepsis, 4 had underlying pneumonia. Two patients developing ARDS during hospitalisation already had reduced aeration patterns on enrolment. The SpO2/FiO2 ratio combined with the number of regions with reduced aeration was a strong prognosticator for mortality in patients with sepsis (AUROC 91.5% (95% Confidence Interval: 84.6%-98.4%)). This study demonstrates the potential usefulness of point-of-care lung ultrasound to detect lung abnormalities in patients with malaria or sepsis in a resource-constrained hospital setting. LUS was highly feasible and allowed to accurately identify patients at risk of death in a resource limited setting.