Lung ultrasound score as an indicator of dynamic lung compliance during veno-venous extra-corporeal membrane oxygenation

Abstract

Decisions on weaning from veno-venous extra-corporeal membrane oxygenation (VV-ECMO) requires the ability to maintain adequate gas exchange and work of breathing with reductions in ECMO pump flow and fresh gas flow. Testing of the readiness to wean the patient from ECMO however may vary dependent upon local protocols and clinical judgment. This study sought to validate the use of the LUS-score during VV-ECMO against the changes in chest x-ray infiltrates, dynamic lung compliance (CLdyn) and VV-ECMO settings (as standard measures of native lung function and the level of ECMO support) during the ECMO cycle. This prospective cohort study of 10 patients on VV-ECMO compared the LUS score (range 0–36) within 48-h, day 5 and day 10 of commencement of ECMO (or on the day of ECMO decannulation) to dynamic lung compliance, Murray Lung Injury Score and ECMO settings. Seven Male and three Female patients were included (average age 37 years (SD 14.8) and weight 71 Kg (SD 16.9). Median (IQR) duration of ECMO, ICU and hospital length of stay was 7.5 days (5.2–19.0), 12.5 days (8.5–22.7), 19.0 days (12.1– 36.1), respectively. There was a strong negative association between LUS-score and dynamic lung compliance (rs(33) = –0.66, p < .001) providing some validation on the use of the LUS score as a potential surrogate measure of lung aeration and lung mechanics during VV-ECMO weaning.

Ultrasound-assessed lung aeration correlates with respiratory system compliance in adults and neonates with acute hypoxemic restrictive respiratory failure: an observational prospective study

“…However, these data are lacking and we only know that, in adult ARDS patients, lung compliance correlates with the amount of aerated lung tissue being proportional to the residual ventilable lung volume: the smaller the open lung, the lower the compliance [ 13 ]. Furthermore, a recent case series reported a negative correlation between LUS and dynamic compliance in 10 adults undergoing veno-venous extra-corporeal membrane oxygenation (ECMO) [ 14 ].…”

Reynoutria japonica Houtt for Acute Respiratory Tract Infections in Adults and Children: A Systematic Review

“…Three RCTs ( Yang et al, 2019 ; Yang, 2019 ; Liu et al, 2020 ) evaluated the lung injury severity based simply on oxygenation criteria (PaO2/FiO2) (by calculating with PaO2/FiO2 when the fresh gas flow was off at the time of the arterial blood gas sampling, a higher score means lower percentage oxygenation and more severe lung injury) ( Ntoumenopoulos et al, 2021 ). Those three trials focused on adults and compared herbal remedies that included F. japonica plus usual care with usual care: Shufeng Jiedu capsule could significantly reduce the score in acute RTIs (MD -3.49, 95% CI [-3.96 to -3.03]) ( Liu et al, 2020 ) and in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (MD -3.49, 95% CI [-3.96 to -3.03]) ( Yang et al, 2019 ); and Xuanfei Quyu Tongluo liquid was less likely to reduce the score in AECOPD than usual care (MD -0.60, 95% CI [-0.98 to -0.22]) (Yang Q 2019).…”

Lung Ultrasound in Pediatric Acute Respiratory Distress Syndrome Received Extracorporeal Membrane Oxygenation: A Prospective Cohort Study

“…Systematic prospective multi-institutional studies indicated that EVLW is directly correlated to PaO 2 /FiO 2 and OI ( 22 – 24 ). Moreover, a strong negative association between LUS score and Cdyn at 48 h, Day 5 and Day 10 of commencement of VV-ECMO was observed in adult patients with ARDS ( 25 ). Consistently, our study revealed that LUS score mildly increased within 24 h, then gradually decreased after 72 h ECMO support in survivors.…”