Lung ultrasound and the role of lung aeration score in patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation

Abstract

Objective: This was a pilot study to determine the utility of daily lung ultrasound (LUS) in patients requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). Design: This was a prospective, observational study. Setting: The study took place in the intensive care unit at Royal Papworth Hospital in Cambridge, UK. Participants: We recruited adult patients receiving VV-ECMO for ARDS. Interventions: All patients received a lung computed tomography (CT) scan and LUS on admission. Bedside chest radiography (CXR) and LUS were done on a daily basis until patients were decannulated. Measurements and main results: Daily LUS aeration scores were calculated according to the appearance of four defined patterns. An independent radiologist calculated corresponding scores for CT and CXR, retrospectively. These were checked for correlation with LUS aeration scores. There were statistically significant correlations between LUS versus CT ( r = 0.868, p = 0.002) and LUS versus CXR ( r = 0.498, p = 0.018) with good agreement and no evidence of proportional bias. LUS was able to detect 13.5% of pleural effusions and 54.2% of pneumothorax that were not picked up on CXR. In most of the patients who were weaned off VV-ECMO, a progressive reduction of LUS aeration scores corresponding to lung re-aeration was observed. Conclusions: LUS correlated with findings on CT and CXR for quantifying lung aeration and the clinical presentation of patients. LUS also picked up more pleural effusions and pneumothorax than CXR. Together with traditional imaging techniques, the routine use of LUS should be considered for this patient group.

Lung ultrasound to evaluate pulmonary changes in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation:A retrospective study

“…Bedside pulmonary ultrasound has been established as an important tool for the evaluation of critically ill patients and has been proven to be helpful in the diagnosis of speci c pathological features, such as interstitial oedema, consolidation and pleural effusion [17]. In this retrospective study, dynamic pulmonary ultrasound monitoring was performed on 22 patients who received VA-ECMO treatment for shock.…”

Physiotherapy-led lung ultrasound in neonatal extra-corporeal membrane oxygenation: A case-study

“…A pilot study determining the utility of daily LUS in patients requiring veno-venous ECMO, for acute respiratory distress syndrome, reported that LUS correlated with CT and CXR findings. 1…”

“…Shred sign is visible where alveolar air has been replaced by fluid, giving the lung a tissue like appearance. 1,6 Air bronchograms appear as hyperechoic lines within a hypoechoic area, representing air trapped in small airways within consolidation. 1 As the assessment findings displayed persistent right lung collapse and consolidation physiotherapy treatment was completed.…”

“…Reported uses include the detection of pleural effusion and pneumothorax, monitoring of aeration and measurement of lung mechanics. [1][2][3] However, literature supporting the use of LUS in neonatal and paediatric ECMO patients is limited. LUS is also gaining popularity amongst critical care physiotherapists.…”

Setting and Monitoring of Mechanical Ventilation During Venovenous ECMO

“…Lung ultrasound can be used to guide the setting of mechanical ventilation in ARDS patients and assess bedside lung recruitment [ 34 ]. Changes in the lung ultrasound score correlated with PEEP-induced increases in end-expiratory lung volume in a series of ARDS patients receiving conventional mechanical ventilation [ 35 ] and also correlated significantly with computed tomography (CT) scan data in a series of 18 patients receiving ECMO [ 36 ].…”