Pulmonary Ultrasound Scoring System For Intubated Critically Ill Patients And Its Association With Clinical Metrics And Mortality: A Prospective Cohort Study

PurposePulmonary ultrasound (PU) examination at the point-of-care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics.MethodsIn this prospective study of 250 adults intubated for ARF, a PU examination was performed at intubation, 48-hours later, and at extubation. A total lung score (TLS) was calculated. Clinical metrics and final diagnosis were extracted from the medical record.ResultsTLS correlated positively with mortality (P=.03), ventilator hours (P=.003), intensive care unit, and hospital length of stay (P=.003, P=.008), and decreasing PaO2/FiO(2) (P<.001). Agreement of PU findings was very good (kappa=0.83). Baseline TLS and subscores differed significantly between ARF categories (nonpulmonary, obstructive, and parenchymal disease).ConclusionsA quick, scored, PU examination was associated with clinical metrics, including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers.