Journal article
The diagnostic accuracy for ARDS of global versus regional lung ultrasound scores - a post hoc analysis of an observational study in invasively ventilated ICU patients
- Abstract:
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Background
Semi-quantification of lung aeration by ultrasound helps to assess presence and extent of pulmonary pathologies, including the acute respiratory distress syndrome (ARDS). It is uncertain which lung regions add most to the diagnostic accuracy for ARDS of the frequently used global lung ultrasound (LUS) score. We aimed to compare the diagnostic accuracy of the global versus those of regional LUS scores in invasively ventilated intensive care unit patients.Methods
This was a post-hoc analysis of a single-center observational study in the mixed medical–surgical intensive care unit of a university-affiliated hospital in the Netherlands. Consecutive patients, aged ≥ 18 years, and are expected to receive invasive ventilation for > 24 h underwent a LUS examination within the first 2 days of ventilation. The Berlin Definition was used to diagnose ARDS, and to classify ARDS severity. From the 12-region LUS examinations, the global score (minimum 0 to maximum 36) and 3 regional scores (the ‘anterior,’ ‘lateral,’ and ‘posterior’ score, minimum 0 to maximum 12) were computed. The area under the receiver operating characteristic (AUROC) curve was calculated and the best cutoff for ARDS discrimination was determined for all scores.Results
The study enrolled 152 patients; 35 patients had ARDS. The global score was higher in patients with ARDS compared to patients without ARDS (median 19 [15–23] vs. 5 [3–9]; P < 0.001). The posterior score was the main contributor to the global score, and was the only score that increased significantly with ARDS severity. However, the posterior score performed worse than the global score in diagnosing ARDS, and it had a positive predictive value of only 50 (41–59)% when using the optimal cutoff. The combined anterolateral score performed as good as the global score (AUROC of 0.91 [0.85–0.97] vs. 0.91 [0.86–0.95]).Conclusions
While the posterior score increases with ARDS severity, its diagnostic accuracy for ARDS is hampered due to an unfavorable signal-to-noise ratio. An 8-region ‘anterolateral’ score performs as well as the global score and may prove useful to exclude ARDS in invasively ventilated ICU patients.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, 610.0KB, Terms of use)
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- Publisher copy:
- 10.1186/s40635-019-0241-6
Authors
- Publisher:
- Springer
- Journal:
- Intensive Care Medicine Experimental More from this journal
- Volume:
- 7
- Issue:
- Suppl 1
- Article number:
- 44
- Publication date:
- 2019-07-25
- Acceptance date:
- 2019-03-07
- DOI:
- EISSN:
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2197-425X
- Pmid:
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31346914
- Language:
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English
- Keywords:
- Pubs id:
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1039689
- Local pid:
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pubs:1039689
- Deposit date:
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2020-11-06
Terms of use
- Copyright holder:
- Pisani, l et al.
- Copyright date:
- 2019
- Rights statement:
- © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Licence:
- CC Attribution (CC BY)
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