Comparing prognostic value of lung ultrasound scores in predicting outcome of shock patients: an observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20251290Keywords:
Critical care ultrasound, Lungs ultrasound score, Shock, ICUAbstract
Background: Shock is a common causes of mortality in ICU. Several scoring systems have been developed to grade the severity of illness. These systems are moderately accurate in predicting survival. Several
scoring systems like APACHE, SOFA,SAPS, MODS etc have been used to risk stratify patients in ICU. The lung ultrasound score (LUSS) has been regarded as semi quantitative score to measure lung aeration loss. LUSS can be compared to scoring systems like acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA).
Methods: Our study was a prospective observational study. 100 patients who fulfilled the inclusion criteria for shock were included. Their APACHE II scores at admission and 24 hours were calculated. Similarly, SOFA scores at 24 and 48 hours post admission were calculated. Lung ultrasound examination was done at four regions of chest and scores noted. All the three scores were statistically analyzed for length of hospital stay, ICU stay, ventilator days and the outcome.
Results: Out of 100 cases satisfying the inclusion and exclusion, it was observed that high lung ultrasound scores were associated with increased mortality and number of days on mechanical ventilator. This association was statistically significant. Findings also correlated with high APACHE II and SOFA scores. All the above findings were statistically significant.
Conclusions: High lung ultrasound scores at admission were directly related with mortality and increased number of days on mechanical ventilator.
Metrics
References
Via G, Storti E, Gulati G, Neri L, Mojoli F, Braschi A. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol. 2012;78(11):1282-96.
Brusasco C, Santori G, Bruzzo E, Trò R, Robba C, Tavazzi G, et al. Quantitative lung ultrasonography: a putative new algorithm for automatic detection and quantification of B-lines. Crit Care. 2019;23(1):288. DOI: https://doi.org/10.1186/s13054-019-2569-4
Miglioranza MH, Picano E, Badano LP, Sant'Anna R, Rover M, Zaffaroni F, et al. Pulmonary congestion evaluated by lung ultrasound predicts decompensation in heart failure outpatients. Int J Cardiol. 2017;240:271-8. DOI: https://doi.org/10.1016/j.ijcard.2017.02.150
Bataille B, Riu B, Ferre F, Moussot PE, Mari A, Brunel E, et al. Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest. 2014;146(6):1586-93. DOI: https://doi.org/10.1378/chest.14-0681
Wang XT, Liu DW, Zhang HM, Chai WZ. Integrated cardiopulmonary sonography: a useful tool for assessment of acute pulmonary edema in the intensive care unit. J Ultrasound Med. 2014;33(7):1231-9. DOI: https://doi.org/10.7863/ultra.33.7.1231
Xia Y, Ying Y, Wang S, Li W, Shen H. Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis. J Thorac Dis. 2016;8(10):2822-31. DOI: https://doi.org/10.21037/jtd.2016.09.38
Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004;30(2):276-81. DOI: https://doi.org/10.1007/s00134-003-2075-6
Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009;27(4):379-84. DOI: https://doi.org/10.1016/j.ajem.2008.03.009
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29. DOI: https://doi.org/10.1097/00003246-198510000-00009
Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Lung Ultrasound Study Group. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012;40(7):2064-72. DOI: https://doi.org/10.1097/CCM.0b013e31824e68ae
Caltabeloti F, Monsel A, Arbelot C, Brisson H, Lu Q, Gu WJ, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care. 2014;18(3):91. DOI: https://doi.org/10.1186/cc13859
Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pak J Med Sci. 2016;32(5):1146-51.
Sperandeo M, Carnevale V, Muscarella S, Sperandeo G, Varriale A, Filabozzi P, et al. Clinical application of transthoracic ultrasonography in inpatients with pneumonia. Eur J Clin Invest. 2011;41(1):1-7. DOI: https://doi.org/10.1111/j.1365-2362.2010.02367.x
Forte, D., Ranzani, O., Stape, N. APACHE II and SOFA scores for intensive care and hospital outcome prediction in oncologic patients. Crit Care. 2007;11:93. DOI: https://doi.org/10.1186/cc5880
Narasimhan M, Koenig SJ, Mayo PH. A Whole-Body Approach to Point of Care Ultrasound. Chest. 2016;150(4):772-6. DOI: https://doi.org/10.1016/j.chest.2016.07.040
Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183(3):341-7. DOI: https://doi.org/10.1164/rccm.201003-0369OC
Zagli G, Cozzolino M, Terreni A, Biagioli T, Caldini AL, Peris A. Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography. Chest. 2014;146(6):1578-85. DOI: https://doi.org/10.1378/chest.13-2922
Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010;38(1):84-92. DOI: https://doi.org/10.1097/CCM.0b013e3181b08cdb
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-91. DOI: https://doi.org/10.1007/s00134-012-2513-4
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-77. DOI: https://doi.org/10.1007/s00134-017-4683-6
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;8;345(19):1368-77. DOI: https://doi.org/10.1056/NEJMoa010307
Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, et al. Clinical review: Update on hemodynamic monitoring--a consensus of 16. Crit Care. 2011;15(4):229. DOI: https://doi.org/10.1186/cc10291
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795-815. DOI: https://doi.org/10.1007/s00134-014-3525-z
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637-42. DOI: https://doi.org/10.1097/01.CCM.0000132904.35713.A7
Chung FT, Lin HC, Kuo CH, Yu CT, Chou CL, Lee KY, et al. Extravascular lung water correlates multiorgan dysfunction syndrome and mortality in sepsis. PLoS One. 2010;5(12):15265. DOI: https://doi.org/10.1371/journal.pone.0015265
Kuzkov VV, Kirov MY, Sovershaev MA, Kuklin VN, Suborov EV, Waerhaug K, et al. Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med. 2006;34(6):1647-53. DOI: https://doi.org/10.1097/01.CCM.0000218817.24208.2E
Martin GS, Bernard GR; International Sepsis Forum. Airway and lung in sepsis. Intensive Care Med. 2001;27(1):63-79. DOI: https://doi.org/10.1007/PL00003798
Fernández-Mondéjar E, Guerrero-López F, Colmenero M. How important is the measurement of extravascular lung water? Curr Opin Crit Care. 2007;13(1):79-83. DOI: https://doi.org/10.1097/MCC.0b013e328011459b
Via G, Lichtenstein D, Mojoli F, Rodi G, Neri L, Storti E, et al. Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes. Intensive Care Med. 2010;36(6):999-1007. DOI: https://doi.org/10.1007/s00134-010-1834-4
Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659-70. DOI: https://doi.org/10.1378/chest.14-1313
Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pak J Med Sci. 2016;32(5):1146-51. DOI: https://doi.org/10.12669/pjms.325.10080
Clerk AM. Lung Ultrasound Score for Prognosticating Ventilator-associated Pneumonia (VAP): Evidence and Wisdom. Indian J Crit Care Med. 2024;28(11):991-2. DOI: https://doi.org/10.5005/jp-journals-10071-24837
Govil D, Pachisia AV. Seeing is Believing: The Import of Lung Ultrasound! Indian J Crit Care Med. 2022;26(8):894-5. DOI: https://doi.org/10.5005/jp-journals-10071-24291