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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

Open Access 01-12-2021 | Computed Tomography | Research

Clinical performance of lung ultrasound in predicting ARDS morphology

Authors: 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, Vito Fanelli

Published in: Annals of Intensive Care | Issue 1/2021

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Abstract

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.
Appendix
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Metadata
Title
Clinical performance of lung ultrasound in predicting ARDS morphology
Authors
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
Vito Fanelli
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00837-1

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