Clinical performance of lung ultrasound in predicting ARDS morphology

• Published in: Annals of intensive care Vol. 11; no. 1; p. 51
• Main Authors: Costamagna, Andrea, Pivetta, Emanuele, Goffi, Alberto, Steinberg, Irene, Arina, Pietro, Mazzeo, Anna Teresa, Del Sorbo, Lorenzo, Veglia, Simona, Davini, Ottavio, Brazzi, Luca, Ranieri, V. Marco, Fanelli, Vito
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 29.03.2021; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; ARDS; ARDS morphology; Bedside tests; Critical Care Medicine; Emergency Medicine; Intensive; Intensive care; Lung ultrasound; Lungs; Medical diagnosis; Medicine; Medicine & Public Health; Morphology; Point of care diagnostic tests; Respiratory distress syndrome; Respiratory monitoring; Ultrasonic imaging; Ventilation; ARDS morphology; Bedside tests; Respiratory monitoring; Lung ultrasound; Point of care diagnostic tests; ARDS
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-021-00837-1

Background To assess diagnostic performance of lung ultrasound (LUS) in identifying ARDS morphology (focal vs non-focal), compared with the gold standard computed tomography. Methods Mechanically ventilated ARDS patients undergoing lung computed tomography and ultrasound were enrolled. Twelve fields, were evaluated. LUS score was graded from 0 (normal) to 3 (consolidation) according to B-lines extent. Total and regional LUS score as the sum of the four ventral (LUS V ), intermediate (LUS I ) or dorsal (LUS D ) fields, were calculated. Based on lung CT, ARDS morphology was defined as (1) focal (loss of aeration with lobar distribution); (2) non-focal (widespread loss of aeration or segmental loss of aeration distribution associated with uneven lung attenuation areas), and diagnostic accuracy of LUS in discriminating ARDS morphology was determined by AU-ROC in training and validation set of patients. Results Forty-seven patients with ARDS (25 training set and 22 validation set) were enrolled. LUS TOT , LUS V and LUS I but not LUS D score were significantly lower in focal than in non-focal ARDS morphologies ( p  < .01). The AU-ROC curve of LUS TOT , LUS V , LUS I and LUS D for identification of non-focal ARDS morphology were 0.890, 0.958, 0.884 and 0.421, respectively. LUS V value ≥ 3 had the best predictive value (sensitivity = 0.95, specificity = 1.00) in identifying non-focal ARDS morphology. In the validation set, an LUS V score ≥ 3 confirmed to be highly predictive of non-focal ARDS morphology, with a sensitivity and a specificity of 94% and 100%. Conclusions LUS had a valuable performance in distinguishing ARDS morphology.