Lung ultrasound score for the assessment of lung aeration in ARDS patients: comparison of two approaches

Abstract

Purpose A 4-step lung ultrasound (LUS) score has been previously used to quantify lung density. We compared 2 versions of this scoring system for distinguishing severe from moderate loss of aeration in ARDS: coalescence-based score (cLUS) vs. quantitative-based score (qLUS – >50% pleura occupied by artefacts).

Materials and Methods  We compared qLUS and cLUS to lung density measured by quantitative CT scan in 12 standard thoracic regions. A simplified approach (1 scan per region) was compared to an extensive one (regional score computed as the mean of all relevant intercostal space scores).

Results  We examined 13 conditions in 7 ARDS patients (7 at PEEP 5, 6 at PEEP 15 cmH2O-156 regions, 398 clips). Switching from cLUS to qLUS resulted in a change in interpretation in 117 clips (29.4%, 1-point reduction) and in 41.7% of the regions (64 decreases (range 0.2–1), 1 increase (0.2 points)). Regional qLUS showed very strong correlation with lung density (rs=0.85), higher than cLUS (rs=0.79; p=0.010). The agreement with CT classification in well aerated, poorly aerated, and not aerated tissue was moderate for cLUS (agreement 65.4%; Cohen’s K coefficient 0.475 (95%CI 0.391–0.547); p<0.0001) and substantial for qLUS (agreement 81.4%; Cohen’s K coefficient 0.701 (95%CI 0.653–0.765), p<0.0001). The agreement between single spot and extensive approaches was almost perfect (cLUS: agreement 89.1%, Cohen’s kappa coefficient 0.840 (95%CI 0.811–0.911), p<0.0001; qLUS: agreement 86.5%, Cohen’s kappa coefficient 0.819 (95%CI 0.761–0.848), p<0.0001).

Conclusion  A LUS score based on the percentage of occupied pleura performs better than a coalescence-based approach for quantifying lung density. A simplified approach performs as well as an extensive one.

Keywords

lung ultrasound score - lung monitoring - quantitative lung ultrasound - lung density - lung aeration

Publication History

Received: 15 February 2024

Accepted after revision: 21 July 2024

Article published online:
21 October 2024

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