Objectives: The study goal was to concurrently evaluate agreement of a 9-point pulmonary ultrasound protocol and portable chest radiograph with chest CT for localization of pathology to the correct lung and also to specific anatomic lobes among a diverse group of intubated patients with acute respiratory failure. Design: Prospective cohort study. Setting: Medical, surgical, and neurologic ICUs at a 670-bed urban teaching hospital. Patients: Intubated adults with acute respiratory failure having chest CT and portable chest radiograph performed within 24 hours of intubation. Interventions: A 9-point pulmonary ultrasound examination performed at the time of intubation. Measurements and Main Results: Sixty-seven patients had pulmonary ultrasound, portable chest radiograph, and chest CT performed within 24 hours of intubation. Overall agreement of pulmonary ultrasound and portable chest radiograph findings with correlating lobe (“lobe-specific” agreement) on CT was 87% versus 62% (p < 0.001), respectively. Relaxing the agreement definition to a matching CT finding being present anywhere within the correct lung (“lung-specific” agreement), not necessarily the specific mapped lobe, showed improved agreement for both pulmonary ultrasound and portable chest radiograph respectively (right lung: 92.5% vs 65.7%; p < 0.001 and left lung: 83.6% vs 71.6%; p = 0.097). The highest lobe-specific agreement was for the finding of atelectasis/consolidation for both pulmonary ultrasound and portable chest radiograph (96% and 73%, respectively). The lowest lobe-specific agreement for pulmonary ultrasound was normal lung (79%) and interstitial process for portable chest radiograph (29%). Lobe-specific agreement differed most between pulmonary ultrasound and portable chest radiograph for interstitial findings (86% vs 29%, respectively). Pulmonary ultrasound had the lowest agreement with CT for findings in the left lower lobe (82.1%). Pleural effusion agreement also differed between pulmonary ultrasound and portable chest radiograph (right: 99% vs 87%; p = 0.009 and left: 99% vs 85%; p = 0.004). Conclusions: A clinical, 9-point pulmonary ultrasound protocol strongly agreed with specific CT findings when analyzed by both lung- and lobe-specific location among a diverse population of mechanically ventilated patients with acute respiratory failure; in this regard, pulmonary ultrasound significantly outperformed portable chest radiograph.

Purpose: Pulmonary ultrasound (PU) examination at the point-of-care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics. Methods:In this prospective study of 250 adults intubated for ARF, a PU examination was performed at intubation, 48-hours later, and at extubation. A total lung score (TLS) was calculated.Clinical metrics and final diagnosis were extracted from the medical record.Results: TLS correlated positively with mortality (P 5 .03), ventilator hours (P 5 .003), intensive care unit, and hospital length of stay (P 5 .003, P 5 .008), and decreasing PaO 2 /FiO 2 (P < .001).Agreement of PU findings was very good (kappa 5 0.83). Baseline TLS and subscores differed significantly between ARF categories (nonpulmonary, obstructive, and parenchymal disease).Conclusions: A quick, scored, PU examination was associated with clinical metrics, including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers. K E Y W O R D Sintubation, point-of-care ultrasound, pulmonary ultrasonography, respiratory insufficiency | I N TR ODU C TI ONPulmonary ultrasound (PU) has become an essential tool for rapidly identifying the etiology of acute respiratory failure (ARF), following treatment progress, and clarifying nonspecific chest radiograph (CXR) abnormalities among critically ill patients, 1-5 and with test characteristics better than the clinical examination and CXR. 6,7 When used in combination with cardiac and vascular ultrasound, it can enhance the understanding of etiology 3 and may reduce the need for CXR or chest CT. [8][9][10] Acquisition, interpretation, and integration of PU findings at an isolated point in time are essential to prompt and accurate diagnosis.Tracking PU changes over time is equally important in confirming a diagnosis and adjusting treatment. To do so requires a standardized approach to PU such that providers can document and agree not only with themselves but also with each other over time. [11][12][13][14] PU scoring models have been developed to meet the need for standardization and have been shown to correlate with various metrics in specific patient populations. 5,11,[15][16][17] Scoring systems correlate with mortality in patients with acute respiratory distress syndrome

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