The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS
Abstract Background Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS. Obje...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-10-01
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| Series: | The Ultrasound Journal |
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| Online Access: | https://doi.org/10.1186/s13089-023-00340-7 |
| _version_ | 1797453503943147520 |
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| author | Leila N. Atmowihardjo Job R. Schippers Mark E. Haaksma Marry R. Smit Harm J. Bogaard Leo Heunks Nicole P. Juffermans Marcus J. Schultz Henrik Endeman Patricia van Velzen Pieter R. Tuinman Jurjan Aman Lieuwe D. J. Bos |
| author_facet | Leila N. Atmowihardjo Job R. Schippers Mark E. Haaksma Marry R. Smit Harm J. Bogaard Leo Heunks Nicole P. Juffermans Marcus J. Schultz Henrik Endeman Patricia van Velzen Pieter R. Tuinman Jurjan Aman Lieuwe D. J. Bos |
| author_sort | Leila N. Atmowihardjo |
| collection | DOAJ |
| description | Abstract Background Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS. Objectives This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS. Methods In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS–ARDS), an 8-region anterior–lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated. Results 26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS–ARDS (r = 0.58) and anterior–lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior–lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior–lateral and 0.85 for the LUS–ARDS score. Conclusions Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate–to–severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value. Trial registration: ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020–005447-23. |
| first_indexed | 2024-03-09T15:23:47Z |
| format | Article |
| id | doaj.art-d474e83ef80d45cc9a8302595f1e262f |
| institution | Directory Open Access Journal |
| issn | 2524-8987 |
| language | English |
| last_indexed | 2024-03-09T15:23:47Z |
| publishDate | 2023-10-01 |
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| series | The Ultrasound Journal |
| spelling | doaj.art-d474e83ef80d45cc9a8302595f1e262f2023-11-26T12:40:59ZengSpringerOpenThe Ultrasound Journal2524-89872023-10-0115111110.1186/s13089-023-00340-7The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDSLeila N. Atmowihardjo0Job R. Schippers1Mark E. Haaksma2Marry R. Smit3Harm J. Bogaard4Leo Heunks5Nicole P. Juffermans6Marcus J. Schultz7Henrik Endeman8Patricia van Velzen9Pieter R. Tuinman10Jurjan Aman11Lieuwe D. J. Bos12Intensive Care, Amsterdam UMC Location University of AmsterdamDepartment of Pulmonology, Amsterdam UMC Location Vrije Universiteit AmsterdamIntensive Care, Amsterdam UMC Location Vrije Universiteit AmsterdamIntensive Care, Amsterdam UMC Location University of AmsterdamDepartment of Pulmonology, Amsterdam UMC Location Vrije Universiteit AmsterdamDepartment of Intensive Care, Radboud University Medical CenterIntensive Care, Erasmus University Medical CenterIntensive Care, Amsterdam UMC Location University of AmsterdamIntensive Care, Erasmus University Medical CenterDijklander Hospital Location Purmerend, Intensive CareIntensive Care, Amsterdam UMC Location Vrije Universiteit AmsterdamDepartment of Pulmonology, Amsterdam UMC Location Vrije Universiteit AmsterdamIntensive Care, Amsterdam UMC Location University of AmsterdamAbstract Background Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS. Objectives This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS. Methods In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS–ARDS), an 8-region anterior–lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated. Results 26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS–ARDS (r = 0.58) and anterior–lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior–lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior–lateral and 0.85 for the LUS–ARDS score. Conclusions Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate–to–severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value. Trial registration: ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020–005447-23.https://doi.org/10.1186/s13089-023-00340-7UltrasonographyThermodilutionExtravascular lung waterPulmonary edemaCOVID-19Respiratory distress syndrome |
| spellingShingle | Leila N. Atmowihardjo Job R. Schippers Mark E. Haaksma Marry R. Smit Harm J. Bogaard Leo Heunks Nicole P. Juffermans Marcus J. Schultz Henrik Endeman Patricia van Velzen Pieter R. Tuinman Jurjan Aman Lieuwe D. J. Bos The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS The Ultrasound Journal Ultrasonography Thermodilution Extravascular lung water Pulmonary edema COVID-19 Respiratory distress syndrome |
| title | The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS |
| title_full | The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS |
| title_fullStr | The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS |
| title_full_unstemmed | The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS |
| title_short | The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS |
| title_sort | diagnostic accuracy of lung ultrasound to determine picco derived extravascular lung water in invasively ventilated patients with covid 19 ards |
| topic | Ultrasonography Thermodilution Extravascular lung water Pulmonary edema COVID-19 Respiratory distress syndrome |
| url | https://doi.org/10.1186/s13089-023-00340-7 |
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