Application of lung ultrasonography score on clinical evaluating in patients with acute respiratory distress syndrome / 中华急诊医学杂志

ABSTRACT

Objective:To evaluate the value of lung ultrasound (LUS) in the early assessment of patients with acute respiratory distress syndrome (ARDS).Methods:A prospective double-blind cohort study was conducted. Patients with ARDS conformed to the Berlin diagnosis criteria admitted to the Intensive Care Unit (ICU) of Ningbo Yinzhou People’s Hospital from July 2016 to January 2020. According to the oxygenation index (OI), the patients were divided into the mild to moderate group (100 mmHg<OI≤300 mmHg) and the severe group (OI≤100 mmHg); Patients underwent LUS and transpulmonary thermodilution technique (TPTD) monitoring and chest CT on the first day after diagnosis. Acute physiology and chronic health status (APACHEⅡ) score, lung injury score (LIS), and PaO 2/FiO 2 (OI) were recorded at admission. LUS score, EVLWI, OI, APACHEⅡ score and LIS were compared. The correlation between LUS and EVLWI, OI, APACHEⅡ score and LIS score was measured by Pearson linear correlation anaysis. Receiver operating characteristic (ROC) curve were used to evaluate LUS score in predicting ARDS. Results:A total of 52 patients with ARDS were enrolled, 34 patients in the mild to moderate group and 18 patients in the severe group. Compared with chest CT scans, the accuracy of LUS diagnosis was 93.12%, the sensitivity was 91.33%, the specificity was 95.31%, the positive predictive value was 95.95%, and the negative predictive value was 90.03%. Pearson linear correlation analysis showed that LUS was positively correlatied with EVLWI ( r=0.756, P<0.01), LIS score ( r=0.817, P<0.01), and APACHEⅡ score ( r=0.655, P<0.01), while was negatively correlated with OI ( r=-0.823, P<0.01). The areas under the receiver operating characteristic curves of LUS and EVLWI measured by TPTD were 0.922 ( P<0.01) and 0.972 ( P<0.01), LUS score threshold value of 19.5 had the sensitivity of 0.833 and specificity of 0.791 for prediction of severe ARDS. Conclusions:LUS is convenient and easy to perform, and LUS score has a high value, which is a better prognostic indicator for early assessment of ARDS patients.