TY - JOUR
T1 - Ultrasound versus Computed Tomography Assessment of Focal Lung Aeration in Invasively Ventilated ICU Patients
AU - For the Lung Ultrasound Consortium
AU - Smit, Marry R.
AU - Pisani, Luigi
AU - de Bock, Eva J.E.
AU - van der Heijden, Ferdinand
AU - Paulus, Frederique
AU - Beenen, Ludo F.M.
AU - Leopold, Stije J.
AU - Huson, Michaëla A.M.
AU - Henwood, Patricia C.
AU - Riviello, Elisabeth D.
AU - Walden, Andrew P.
AU - Dondorp, Arjen M.
AU - Schultz, Marcus J.
AU - Bos, Lieuwe D.J.
AU - Lung Ultrasound Consortium
N1 - Funding Information: No funding was received for this study. The authors declare no conflicts of interest. Publisher Copyright: © 2021 The Authors
PY - 2021/9
Y1 - 2021/9
N2 - It is unknown whether and to what extent the penetration depth of lung ultrasound (LUS) influences the accuracy of LUS findings. The current study evaluated and compared the LUS aeration score and two frequently used B-line scores with focal lung aeration assessed by chest computed tomography (CT) at different levels of depth in invasively ventilated intensive care unit (ICU) patients. In this prospective observational study, patients with a clinical indication for chest CT underwent a 12-region LUS examination shortly before CT scanning. LUS images were compared with corresponding regions on the chest CT scan at different subpleural depths. For each LUS image, the LUS aeration score was calculated. LUS images with B-lines were scored as the number of separately spaced B-lines (B-line count score) and the percentage of the screen covered by B-lines divided by 10 (B-line percentage score). The fixed-effect correlation coefficient (β) was presented per 100 Hounsfield units. A total of 40 patients were included, and 372 regions were analyzed. The best association between the LUS aeration score and CT was found at a subpleural depth of 5 cm for all LUS patterns (β = 0.30, p < 0.001), 1 cm for A- and B1-patterns (β = 0.10, p < 0.001), 6 cm for B1- and B2-patterns (β = 0.11, p < 0.001) and 4 cm for B2- and C-patterns (β = 0.07, p = 0.001). The B-line percentage score was associated with CT (β = 0.46, p = 0.001), while the B-line count score was not (β = 0.07, p = 0.305). In conclusion, the subpleural penetration depth of ultrasound increased with decreased aeration reflected by the LUS pattern. The LUS aeration score and the B-line percentage score accurately reflect lung aeration in ICU patients, but should be interpreted while accounting for the subpleural penetration depth of ultrasound.
AB - It is unknown whether and to what extent the penetration depth of lung ultrasound (LUS) influences the accuracy of LUS findings. The current study evaluated and compared the LUS aeration score and two frequently used B-line scores with focal lung aeration assessed by chest computed tomography (CT) at different levels of depth in invasively ventilated intensive care unit (ICU) patients. In this prospective observational study, patients with a clinical indication for chest CT underwent a 12-region LUS examination shortly before CT scanning. LUS images were compared with corresponding regions on the chest CT scan at different subpleural depths. For each LUS image, the LUS aeration score was calculated. LUS images with B-lines were scored as the number of separately spaced B-lines (B-line count score) and the percentage of the screen covered by B-lines divided by 10 (B-line percentage score). The fixed-effect correlation coefficient (β) was presented per 100 Hounsfield units. A total of 40 patients were included, and 372 regions were analyzed. The best association between the LUS aeration score and CT was found at a subpleural depth of 5 cm for all LUS patterns (β = 0.30, p < 0.001), 1 cm for A- and B1-patterns (β = 0.10, p < 0.001), 6 cm for B1- and B2-patterns (β = 0.11, p < 0.001) and 4 cm for B2- and C-patterns (β = 0.07, p = 0.001). The B-line percentage score was associated with CT (β = 0.46, p = 0.001), while the B-line count score was not (β = 0.07, p = 0.305). In conclusion, the subpleural penetration depth of ultrasound increased with decreased aeration reflected by the LUS pattern. The LUS aeration score and the B-line percentage score accurately reflect lung aeration in ICU patients, but should be interpreted while accounting for the subpleural penetration depth of ultrasound.
KW - Computed tomography
KW - Critical care
KW - Lung aeration
KW - Lung ultrasound
KW - Mechanical ventilation
UR - http://www.scopus.com/inward/record.url?scp=85109397549&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ultrasmedbio.2021.05.019
DO - https://doi.org/10.1016/j.ultrasmedbio.2021.05.019
M3 - Article
C2 - 34172339
SN - 0301-5629
VL - 47
SP - 2589
EP - 2597
JO - Ultrasound in Medicine and Biology
JF - Ultrasound in Medicine and Biology
IS - 9
ER -