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

J Clin Ultrasound. 2018 Jan;46(1):14-22. doi: 10.1002/jcu.22526. Epub 2017 Oct 6.

Abstract

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.

Keywords: intubation; point-of-care ultrasound; pulmonary ultrasonography; respiratory insufficiency.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Asthma / diagnostic imaging
  • Asthma / mortality
  • Asthma / physiopathology
  • Cohort Studies
  • Critical Illness / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Systems
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnostic imaging
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Respiratory Distress Syndrome, Adult / diagnostic imaging
  • Respiratory Distress Syndrome, Adult / mortality
  • Respiratory Distress Syndrome, Adult / physiopathology
  • Respiratory Insufficiency / diagnostic imaging*
  • Respiratory Insufficiency / mortality*
  • Respiratory Insufficiency / physiopathology
  • Ultrasonography / methods
  • Young Adult