A Modified Lung Ultrasound Score for Assessing Oxygenation Status and Predicting the Need for Invasive Ventilation in Preterm Neonates with RDS

Abstract PurposeWe propose a modified lung ultrasound score (LUS) in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The LUS was evaluated for validity, interrater agreement and prognostic power in relation to the need for respiratory support on day of life (DOL) 3. The hypothesis of the dominant weight of posterior scans in the LUS was also verified.Materials and methodsA total of 647 serial lung scans were performed in 70 preterm infants <32 weeks gestation and birth weight <1500 g. Assessments were performed within 24 hours of birth (LUS0) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS was correlated to oxygen saturation over fraction of inspired oxygen (SpO2/FiO2) and mode of respiratory support. Probabilities of the need for respiratory support on DOL 3 were assessed with ordinal logistic regression.ResultsThe LUS correlated significantly with SpO2/FiO2 (Spearman rho = -0.635; p<0.0001) and had excellent interrater agreement (Cronbach’s alpha = 0.99). Posterior fields had dominant weight over the anterior fields (ls mean [confidence level]) 4.0 [3.8–4.1] vs 2.2 [2.0–2.4]; p<0.0001. Significant predictors of ventilation requirements on DOL 3 were LUS0 (p<0.016) and birth weight (BW) (p<0.0001); invasive ventilation was the most likely option with LUS0 ≥7 (BW 900 g), ≥10 (BW 1050 g) and ≥15 (BW 1280 g).ConclusionPostbirth LUS predicts the need for mechanical ventilation on DOL 3. Posterior fields play a dominant role in sonographic assessment of lungs in neonatal RDS.

Download Full-text

Modified lung ultrasound score predicts ventilation requirements in neonatal respiratory distress syndrome

BMC Pediatrics ◽

10.1186/s12887-020-02485-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Piotr Szymański ◽

Piotr Kruczek ◽

Roman Hożejowski ◽

Piotr Wais

Keyword(s):

Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Rating Scale ◽

Lung Ultrasound ◽

Interrater Agreement ◽

Respiratory Support ◽

Invasive Ventilation ◽

Cronbach's Alpha

Abstract Background We propose a modified lung ultrasound (LUS) score in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The purpose of this study was to evaluate the reproducibility of the rating scale and its correlation with blood oxygenation and to assess the ability of early post-birth scans to predict the mode of respiratory support on day of life 3 (DOL 3). As a secondary objective, the weight of posterior scans in the overall LUS score was assessed. Methods We analyzed 619 serial lung scans performed in 70 preterm infants < 32 weeks gestation and birth weight < 1500 g. Assessments were performed within 24 h of birth (LUS0) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS scores were correlated with oxygen saturation over fraction of inspired oxygen (S/F) and mode of respiratory support. Interrater agreement was determined with the intraclass correlation coefficient (ICC) and Cronbach’s alpha. Probabilities of the need for various respiratory support modes on DOL 3 were assessed with ordinal logistic regression. Least square (ls) means of the posterior and anterior pulmonary field scores were compared. Results The LUS score correlated significantly with S/F (Spearman rho = −0.635; p < 0.0001) and had excellent interrater agreement (ICC = 0.94, 95% CI 0.93–0.95; Cronbach’s alpha = 0.99). Significant predictors of ventilation requirements on DOL 3 were LUS0 (p < 0.016) and birth weight (BW) (p < 0.001). In the ROC analysis, LUS0 had high reliability in prognosing invasive ventilation on DOL 3 (AUC = 0.845 (95% DeLong CI: 0.738–0.951; p < 0.001)). Invasive ventilation was the most likely mode of respiratory support for LUS0 scores: ≥7 (in infants with BW 900 g), ≥ 10 (in infants with BW 1050 g) and ≥ 15 (in infants with BW 1280 g). Posterior fields exhibited significantly higher average scores than anterior fields. Respective ls means (confidence levels) were 4.0 (3.8–4.1) vs. 2.2 (2.0–2.4); p < 0.001. Conclusions Post-birth LUS predicts ventilation requirements on DOL 3. Scores of posterior pulmonary fields have a predominant weight in the overall LUS score.

Download Full-text

Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066620988831 ◽

2021 ◽

Vol 36 (3) ◽

pp. 334-342 ◽

Cited By ~ 1

Author(s):

Kosuke Yasukawa ◽

Taro Minami ◽

David R. Boulware ◽

Ayako Shimada ◽

Ernest A. Fischer

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Prognostic Value ◽

Lung Ultrasound ◽

Point Of Care ◽

Respiratory Support ◽

Point Of Care Ultrasound ◽

Bilateral Involvement ◽

Ultrasound Score ◽

B Lines

Background: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward. Method: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death. Results: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001). Conclusions: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

Download Full-text

Lung Ultrasound Score Predicts the Extravascular Lung Water Content in Low-Birth-Weight Neonates with Patent Ductus Arteriosus

Medical Science Monitor ◽

10.12659/msm.921671 ◽

2020 ◽

Vol 26 ◽

Author(s):

Min Zhao ◽

Xian-mei Huang ◽

Lin Niu ◽

Wei-xing Ni ◽

Zhi-qun Zhang

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Patent Ductus Arteriosus ◽

Extravascular Lung Water ◽

Lung Ultrasound ◽

Ductus Arteriosus ◽

Lung Water ◽

Ultrasound Score ◽

Lung Water Content ◽

Patent Ductus

Download Full-text

A Lower Global Lung Ultrasound Score Is Associated with Higher Likelihood of Successful Extubation in Invasively Ventilated COVID-19 Patients

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0545 ◽

2021 ◽

Author(s):

Charalampos Pierrakos ◽

Arthur Lieveld ◽

Luigi Pisani ◽

Marry R. Smit ◽

Micah Heldeweg ◽

...

Keyword(s):

Mechanical Ventilation ◽

Prognostic Value ◽

Lung Ultrasound ◽

Invasive Mechanical Ventilation ◽

Proportional Hazard ◽

Invasive Ventilation ◽

Pleural Line ◽

Ultrasound Score ◽

International Multicenter Study ◽

International Multicenter

Lung ultrasound (LUS) can be used to assess loss of aeration, which is associated with outcome in patients with coronavirus disease 2019 (COVID-19) presenting to the emergency department. We hypothesized that LUS scores are associated with outcome in critically ill COVID-19 patients receiving invasive ventilation. This retrospective international multicenter study evaluated patients with COVID-19–related acute respiratory distress syndrome (ARDS) with at least one LUS study within 5 days after invasive mechanical ventilation initiation. The global LUS score was calculated by summing the 12 regional scores (range 0–36). Pleural line abnormalities and subpleural consolidations were also scored. The outcomes were successful liberation from the ventilator and intensive care mortality within 28 days, analyzed with multistate, competing risk proportional hazard models. One hundred thirty-seven patients with COVID-19–related ARDS were included in our study. The global LUS score was associated with successful liberation from mechanical ventilation (hazard ratio [HR]: 0.91 95% confidence interval [CI] 0.87–0.96; P = 0.0007) independently of the ARDS severity, but not with 28 days mortality (HR: 1.03; 95% CI 0.97–1.08; P = 0.36). Subpleural consolidation and pleural line abnormalities did not add to the prognostic value of the global LUS score. Examinations within 24 hours of intubation showed no prognostic value. To conclude, a lower global LUS score 24 hours after invasive ventilation initiation is associated with increased probability of liberation from the mechanical ventilator COVID–19 ARDS patients, independently of the ARDS severity.

Download Full-text

The Value of Lung Ultrasound Score Predicts the Ventilator use in Preterm with Dyspnea within 24h after Hospitalization

10.21203/rs.3.rs-1203352/v1 ◽

2022 ◽

Author(s):

lihua zhang ◽

jinnan Feng ◽

di jin ◽

zekun yu ◽

mingyang qu ◽

...

Keyword(s):

Preterm Infants ◽

Sensitivity And Specificity ◽

Area Under Curve ◽

Lung Ultrasound ◽

Respiratory Support ◽

Good Reliability ◽

Non Invasive ◽

Mcnemar Test ◽

Kappa Value ◽

Ultrasound Score

Abstract This study aims to explore the predictive value of LUSsc(Lung Ultrasound Score) in the selection of respiratory support mode for premature infants with dyspnea.We prospectively included 857 preterm infants and performed LU in the first 2 hours of admission and scored LUSsc by two specialist sonographers. They were divided into two stratification according to gestational age (<32 +0 weeks and 32 +0 -36+6 weeks), and had two main outcomes: invasive and non-invasive respiratory support. In the training set, analysis the clinical factors finding the best cut-off value of lung ultrasound score then verified the consistency in the verification set. The choice of invasive respiratory support is based on neonatal mechanical ventilation rules. Preterm infants with invasive respiratory support had higher LUS scores and lower OI 、birth weight、than those with non-invasive support. For preterm <32 +0 weeks the cut-off point of LUSsc was 6.5 that the area under curve was 0.749 (95% CI: 0.689-0.809), which was statistically significant (P<0.05), and the sensitivity and specificity were 74.0% and 68.3%, for preterm 32 +0 -36 +6 weeks, cut-off point was 6.5 and the area under curve was 0.863 (95% CI: 0.811-0.911), sensitivity and specificity were 75.3% and 0.836%.In the validation set, use actual clinical respiratory support selection results to verify, for preterm <32 +0 weeks (Kappa value 0.660, P<0.05, McNemar test P ＞0.05),for preterm 32 +0 -36 +6 weeks (Kappa value 0.779, P<0.05, McNemar test P ＞0.05). Conclusion: The LUS score shows good reliability to predict respiratory support mode for preterm infants with dyspnea

Download Full-text

Lung ultrasound score to monitor non-invasive respiratory support in hypoxemic patients

10.1183/13993003.congress-2019.pa2322 ◽

2019 ◽

Author(s):

Silvia Mongodi ◽

Erminio Santangelo ◽

Giulia Salve ◽

Sandro Pregnolato ◽

Silvia Bonaiti ◽

...

Keyword(s):

Lung Ultrasound ◽

Respiratory Support ◽

Non Invasive ◽

Ultrasound Score

Download Full-text

Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants

Pediatric Pulmonology ◽

10.1002/ppul.24410 ◽

2019 ◽

Vol 54 (9) ◽

pp. 1404-1409 ◽

Cited By ~ 14

Author(s):

Almudena Alonso‐Ojembarrena ◽

Simón Pedro Lubián‐López

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Bronchopulmonary Dysplasia ◽

Very Low Birth Weight ◽

Lung Ultrasound ◽

Low Birth Weight Infants ◽

Ultrasound Score ◽

Early Predictor

Download Full-text

Role of lung ultrasound in the assessment of recruitment maneuvers in ventilated preterm neonates with respiratory distress syndrome and its correlation with tracheal IL-6 levels: A randomized controlled trial

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200605 ◽

2020 ◽

pp. 1-6

Author(s):

N.M.A. Shady ◽

H.A.S. Awad ◽

D.R. Kamel ◽

E.M. Fouda ◽

N.T. Ahmed ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Lung Ultrasound ◽

Controlled Trial ◽

Controlled Study ◽

Preterm Neonates ◽

Invasive Ventilation ◽

Randomized Controlled ◽

Group I

BACKGROUND: This study’s aim is to evaluate lung ultrasound (LUS) efficacy in detecting opening and closing lung pressures and its correlation with the tracheal interleukin 6 (IL-6) level. METHOD: This single-blinded randomized controlled study was done at Ain Shams University Children’s Hospital neonatal intensive care units, Egypt. It consists of 44 mechanically ventilated preterm neonates with Respiratory Distress Syndrome (RDS). Initial LUS assessment was done followed by randomization to one of 2 groups; group I: 22 patients underwent LUS guided RM and group II: 22 patients underwent non-ultrasound guided RM. Tracheal IL-6 level was measured before and after RM in both groups. RESULTS: The LUS scores showed a sensitivity of 86.7% , specificity of 62.10% and accuracy of 70.45% at the cut-off point >B1 grade. After RM, there was a higher percentage of changes in mean airway pressure (p = 0.03), FiO2 (p = 0.01), PaO2/FiO2 ratio (p = 0.01), and IL-6 (p < 0.01) in group I. The duration of oxygen requirement (6 vs.13.5 days, p = 0.01), invasive ventilation (3 vs.5.5 days, p = 0.03), non-invasive ventilation (2.5 vs. 5 days, p = 0.02) and NICU stay (21.5 vs. 42.5 days, p = 0.03) was less in group I. A positive correlation between reaeration score and the duration of O2 requirement (p = 0.002), duration of invasive ventilation (p = 0.001), NICU length of stay (p = 0.002) and negative correlation with PaO2/FiO2 ratio before RM (p = 0.012). The best cut-off point for the reaeration score is >21 with a sensitivity of 75% , specificity of 71.43% and area under the curve of 78.1% . CONCLUSION: LUS-guided RM achieved earlier lowest FiO2, shorter O2 dependency, lesser NICU stay and marked decrease in lung inflammation by decreasing atelectotrauma and shortening the duration of invasive ventilation.

Download Full-text