Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome

Abstract

BackgroundThe lung ultrasound score has been regarded as a decent semiquantitative score to measure the lung aeration loss. The score has been proven to be valuable in diagnosing and monitoring lung pathology, but no studies have demonstrated its relationship to the outcome. We aimed to investigate the relationship between the lung ultrasound score and outcome in shock patients in the Intensive Care Unit.MethodsThe data were extracted from the SHOCK-ICU study, a 14-month prospective study of shock patients in the Medical Intensive Care Unit in West China Hospital. A bivariate logistic regression model was established to identify the correlation between the lung ultrasound score on admission and the 28-day mortality. For subsequent analyses, we divided patients into lung ultrasound score quartiles, and survival analysis was performed using Cox stratified survival analysis and regression analysis with the Breslow method of ties.ResultsA total of 175 cases with a completed lung ultrasound exam were included. The mean APACHE II score was 23.7 ± 8.8, and the 28-day mortality was 46.3% (81/175). The multivariate analysis demonstrated that the lung ultrasound score was an independent risk factor for 28-day mortality, as well as the APACHE II score and lactate level. When divided into lung ultrasound score quartiles, after correcting for the APACHE II score, vasoactive use, PaO2/FiO2, and lactate level, the COX analysis reveals that a higher lung ultrasound score was related to a lower survival rate. Quartile 1 and quartile 2 had a significantly lower hazard ratio versus quartile 4 (OR 0.442[0.215–0.911]; 0.484[0.251–0.934], respectively).ConclusionsThe lung ultrasound score is independently related to the 28-day mortality, as well as the APACHE II score and lactate level, in Intensive Care Unit shock patients. A higher elevated lung ultrasound score on admission is associated with a worse outcome.Trial registrationThe study is registered on Clinical Trials. Trial registration: NCT03082326; retrospectively registered on 3 March 2017.

Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 2

“…More recently, Zou et al [17] broadened the prognostic value of LUS score to include shock intensive care unit (ICU) patients, and showed that a modified LUS score may act as an independent risk factor for ICU mortality. These data on shock patients were confirmed by Yin et al [18] in a study involving 175 patients in which the LUS score correlated with 28-day mortality as well as the APACHE II score and lactate serum levels.…”

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

“…LUS scores (0-36, calculated by summing all 12 individual quadrant scores) are used to assess aeration changes, and a higher grade represents more serious aeration loss but is inapplicable for pneumothorax ( Figure 2) [24][25][26]. The scoring system is as follows: score 0, healthy lung, equidistant A-lines parallel to the sliding pleura; score 1, moderate aeration loss, no fewer than 3 dispersive B lines originated from the pleural cavity; score 2, serious aeration loss, presence of coalescent B lines with pleural irregularities; and score 3, absolute aeration loss, subpleural consolidation.…”

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

“…A daily LAS assessment can be used to monitor of the respiratory disease. The LAS may guide fluid management in septic ARDS patients: in this setting, the LAS score variations are more sensitive than oxygenation in early detection of lung aeration deterioration due to fluid loading [ 32 – 34 ]. In patients with ARDS, the regional lung ultrasound score is strongly correlated with tissue density assessed with quantitative computed tomography (CT), and the increase in lung volume induced by positive end-expiratory pressure (PEEP) in patients with ARDS [ 33 , 34 ].…”