The Value of Pulmonary Bedside Ultrasound System in the Evaluation of Severity and Prognosis of Acute Lung Injury

Lei Li, Yanfen Yao, Shanshan Liu, Lei Li, Yanfen Yao, Shanshan Liu

Abstract

Objective: To evaluate the value of pulmonary bedside ultrasound system in the assessment of severity and prognosis of acute lung injury (ALI).

Method: Seventy-two ALI patients in the intensive care unit (ICU) of our hospital from April 2019 to April 2021 were selected as subjects. The changes of lung ultrasound score (LUS) and parameters at D1, D2, and D3 after admission were analyzed (LUS, oxygenation index (PaO2/FiO2), Acute Physiology and Chronic Health Evaluation II (APACHE-II), and Sequential Organ Failure Assessment (SOFA) score). Pearson correlation analysis was used to assess the relationship between LUS and PaO2/FiO2, APACHE-II score, and SOFA score at D1, D2, and D3. Logistic regression analysis was used for influencing factors for the prognosis of ALI patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of baseline LUS, PaO2/FiO2, APACHE-II score, and SOFA score for the prognosis of ALI patients.

Result: LUSs at D1, D2 and D3 showed an increasing trend with the increase of disease severity (P < 0.05). From D1 to D3, LUS, PaO2/FiO2, APACHE-II score, and SOFA score showed a downward trend (P < 0.05). LUS was negatively correlated with PaO2/FiO2 at D1, D2, and D3 but positively correlated with APACHE-II score and SOFA score (P < 0.05). Logistic regression analysis showed that after controlling for age, PaO2 and PaCO2, an increase in baseline LUS, APACHE-II score, SOFA score, and a decrease in PaO2/FiO2 were independent risk factors for death at 28 d in ALI patients (P < 0.05). ROC curve showed that LUS, PaO2/FiO2, APACHE-II score, and SOFA score were combined to predict the prognosis of ALI patients with the highest AUC value of 0.920, corresponding sensitivity of 88.89%, and specificity of 95.56%.

Conclusion: LUS can evaluate the change of pulmonary ventilation area in ALI patients, further evaluate the severity of the disease, and effectively predict the prognosis of patients.

Conflict of interest statement

The authors declare no competing interests.

Copyright © 2022 Lei Li et al.

Figures

Figure 1
Figure 1
(a–d) Pulmonary ultrasound signs.
Figure 2
Figure 2
ROC curve of baseline LUS, PaO2/FiO2, APACHE-II score, and SOFA score predicting the prognosis of ALI patients.

References

    1. Cardinal-Fernández P., Correger E., Villanueva J., Rios F. Acute respiratory distress: from syndrome to disease. Medicina Intensiva . 2016;40(3):169–175. doi: 10.1016/j.medin.2015.11.006.
    1. Wang B. Q., Shi M., Zhang J. P., et al. Knockdown of TFPI-anchored endothelial cells exacerbates lipopolysaccharide-induced acute lung injury via NF-κB signaling pathway. Shock . 2019;51(2):235–246. doi: 10.1097/SHK.0000000000001120.
    1. Yao Z. C., Rong F. Clinical application of color Doppler ultrasound in adult pneumonia. Chinese Journal of Medical Research . 2020;18(29):183–186.
    1. Khatri M., Richardson L. A., Meulia T. Mesenchymal stem cell-derived extracellular vesicles attenuate influenza virus-induced acute lung injury in a pig model. Stem Cell Research & Therapy . 2018;9(1):p. 17. doi: 10.1186/s13287-018-0774-8.
    1. Shen Y., Zhu Z., Cai X., Chen L. Pulmonary ultrasonography in patients with acute respiratory distress syndrome treated with prone ventilation. Applied Gerontology . 2020;34(9):951–952, 966.
    1. Elsayed Y. N., Hinton M., Graham R., Dakshinamurti S. Lung ultrasound predicts histological lung injury in a neonatal model of acute respiratory distress syndrome. Pediatric Pulmonology . 2020;55(11):2913–2923. doi: 10.1002/ppul.24993.
    1. Fang Y. W., Ji Y. J., Xu W., et al. Clinical value of emergency surgeon-led emergency bedside ultrasound enhanced trauma focus ultrasound evaluation in perioperative period for multiple thoracic and abdominal trauma. Chinese Journal of Emergency Medicine . 2019;39(6):542–545.
    1. Gao Y. Z., Liu S. Y., Wu C. S., Lu X., Zhang M. Lung ultrasound guided individual diagnosis and treatment of acute respiratory distress syndrome. Chinese Journal of Ultrasound Imaging . 2018;27(11):1008–1012.
    1. Chinese Society of Critical Care Medicine. Diagnosis and treatment of acute lung injury and acute respiratory distress syndrome. Chinese Medical Information Review . 2007;22(13):p. 20.
    1. Ranieri V. M., Rubenfeld G. D., Thompson B. T. Acute respiratory distress syndrome. JAMA . 2012;307(23):2526–2533. doi: 10.1001/jama.2012.5669.
    1. Hou L., Yang Z., Wang Z., et al. NLRP3/ASC-mediated alveolar macrophage pyroptosis enhances HMGB1 secretion in acute lung injury induced by cardiopulmonary bypass. Laboratory Investigation . 2018;98(8):1052–1064. doi: 10.1038/s41374-018-0073-0.
    1. Cong Z., Li D., Tao Y., Lv X., Zhu X. α2A‐AR antagonism by BRL‐44408 maleate attenuates acute lung injury in rats with downregulation of ERK1/2, p38MAPK, and p65 pathway. Journal of Cellular Physiology . 2020;235(10):6905–6914. doi: 10.1002/jcp.29586.
    1. Qiang J. T., He J. W. Analysis of the effect of rapid management of severe ultrasound on the diagnosis of acute dyspnea or hemodynamic instability in RICU patients. International Journal of Respiration . 2020;40(15):1154–1159.
    1. Dong X., Ks Y., Gao J. The application value of lung ultrasound in lung disease diagnosis and lung protection ventilation strategies. International Journal of Anesthesiology and Resuscitation . 2019;40(12):1146–1150.
    1. Palazzuoli A., Ruocco G., Beltrami M., Nuti R., Cleland J. G. Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clinical Research in Cardiology . 2018;107(7):586–596. doi: 10.1007/s00392-018-1221-7.
    1. Huang Y. S., Peng J. H. The effect of lung ultrasound combined with oxygenation index detection in the diagnosis of severity and prognosis of patients with severe pneumonia. Chinese Journal of Emergency Resuscitation and Disaster Medicine . 2019;14(10):974–977.
    1. Li G., Rong L., Zhao M. J., Sun J. The effect of bedside ultrasound-guided optimal positive end expiratory pressure on oxygenation index and hemodynamics in patients with acute respiratory distress syndrome. China Quan Medical Science . 2019;22(5):616–620.
    1. Bataille B., Rao G., Cocquet P., et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome. Journal of Clinical Monitoring and Computing . 2015;29(1):169–176. doi: 10.1007/s10877-014-9582-6.
    1. Santos T. M., Franci D., Coutinho C. M., et al. A simplified ultrasound-based edema score to assess lung injury and clinical severity in septic patients. The American Journal of Emergency Medicine . 2013;31(12):1656–1660. doi: 10.1016/j.ajem.2013.08.053.
    1. Volpicelli G., Elbarbary M., Blaivas M., et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Medicine . 2012;38(4):577–591. doi: 10.1007/s00134-012-2513-4.
    1. Monastesse A., Girard F., Massicotte C.-L. C., Chartrand-Lefebvre C., Girard M. Lung ultrasonography for the assessment of perioperative atelectasis. Anesthesia and Analgesia . 2017;124(2):494–504. doi: 10.1213/ANE.0000000000001603.
    1. Zhang L., Zhou C. J., Yao T., Yu W. J., Chen G. Z. The clinical application value of lung ultrasound in the assessment of acute respiratory distress syndrome. Chinese Journal of Emergency Medicine . 2020;29(3):392–397.
    1. Wang C., Cheng R. H., Zhao Y. H., Wang H. J. Evaluation value of lung ultrasound score in the prognosis and severity of patients with acute respiratory distress syndrome. Journal of Clinical Research . 2020;37(4):506–508.
    1. Liu Q., Ci X., Wen Z., Peng L. Diosmetin alleviates lipopolysaccharide-induced acute lung injury through activating the Nrf 2 pathway and inhibiting the NLRP3 inflammasome. Biomolecules & Therapeutics . 2018;26(2):157–166. doi: 10.4062/biomolther.2016.234.
    1. Zeng H., Yang L., Zhang X., Chen Y., Cai J. Dioscin prevents LPS-induced acute lung injury through inhibiting the TLR4/MyD88 signaling pathway via upregulation of HSP70. Molecular Medicine Reports . 2018;17(5):6752–6758. doi: 10.3892/mmr.2018.8667.
    1. Caltabeloti F., Monsel A., Arbelot C., et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Critical Care . 2014;18(3):p. R91. doi: 10.1186/cc13859.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe