Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Abstract

Acute respiratory distress syndrome (ARDS) constitutes a high burden for intensive care units. Although several methods are proposed to monitor aeration in ARDS, availability, costs, simplicity, and hazards (eg, ionizing radiation) limit the use of many of them at patients' bedsides. Given the widespread use of lung ultrasonography (US) in intensive care units, research is growing regarding its use to monitor aeration in patients with ARDS. We reviewed the actual role of lung US in ARDS and its potential impact in practice. Lung US can be readily used for assessing aeration, although, as a main limitation, a normal lung cannot be distinguished from hyperinflation. Additionally, an improvement in aeration by lung US does not always correlate with an increase in oxygenation. Lung US can be considered the main imaging method for monitoring aeration in ARDS, but in view of its limitations, it should not be used in isolation. Further studies are needed to validate lung US in large ARDS populations.

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

“…Like other diffuse inflammatory lung diseases, such as bronchiolitis and "adult" acute RDS (ARDS), dependent lung zones are the most affected in BPD. Importantly, LUS scores have also shown promising results in predicting outcomes of these conditions [33][34][35][36]. The lack of assessment of posterior lung zones may explain the lower predictive value of early LUS in the aforementioned studies compared with our results.…”

Value of Ultrasound in the Management of Acute Respiratory Distress Syndrome by Optimal PEEP

“…Furthermore, Soummer et al [47] reported that, the LUS can monitor the weaning from MV. Finally, Bello and Blanco [48] conclude that, LUS is an attractive, non-invasive tool to monitor lung recruitment in patients with ARDS. In addition, it is readily available, portable and radiation-free tool.…”

Are pocket sized ultrasound devices sufficient in the evaluation of lung ultrasound patterns and aeration scoring in pulmonary ICU patients?

“…At least three different video images were recorded from each region and two intensive care physician (GG, TG) independently examined these recorded video images for all findings offline. Finally, the LAS was calculated for each ultrasonography devices using all these parameters as previously described [2,6]. The orginal LAS score we used distinguishes four steps of progressive loss of aeration [7,8], each corresponding to a score: A-lines or two or fewer B-lines (normal aeration, score 0), three or more well-spaced B-lines (moderate loss of aeration, score 1), coalescent B-lines (severe loss of aeration, score 2), tissue-like pattern (complete loss of aeration, score 3;).…”