Clinical performance of
lung ultrasound in predicting ARDS morphology
by Andrea Costamagna, Emanuele Pivetta, Alberto Goffi, Irene
Steinberg, Pietro Arina, Anna Teresa Mazzeo, Lorenzo Del Sorbo, Simona Veglia,
Ottavio Davini, Luca Brazzi, V. Marco Ranieri and Vito Fanelli
Annals of Intensive Care volume 11,
Article number: 51 (2021)
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
(LUSV), intermediate (LUSI) or dorsal (LUSD) 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. LUSTOT, LUSV and LUSI but not LUSD score
were significantly lower in focal than in non-focal ARDS morphologies (p < .01).
The AU-ROC curve of LUSTOT, LUSV, LUSI and LUSD for identification of
non-focal ARDS morphology were 0.890, 0.958, 0.884 and 0.421, respectively. LUSV value ≥ 3
had the best predictive value (sensitivity = 0.95, specificity = 1.00) in
identifying non-focal ARDS morphology. In the validation set, an LUSV 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.
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