Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review
Gabriela Bello MD
Intensive Care Unit, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
Hospital Policial, Montevideo, Uruguay
Search for more papers by this authorCorresponding Author
Pablo Blanco MD
Ecodiagnóstico-Centro de Diagnóstico por Imágenes, Necochea, Argentina
Address correspondence to Pablo Blanco, MD, Ecodiagnóstico-Centro de Diagnóstico por Imágenes, 3272 50th St, 7630 Necochea, Argentina (P.B.). E-mail: [email protected]Search for more papers by this authorGabriela Bello MD
Intensive Care Unit, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
Hospital Policial, Montevideo, Uruguay
Search for more papers by this authorCorresponding Author
Pablo Blanco MD
Ecodiagnóstico-Centro de Diagnóstico por Imágenes, Necochea, Argentina
Address correspondence to Pablo Blanco, MD, Ecodiagnóstico-Centro de Diagnóstico por Imágenes, 3272 50th St, 7630 Necochea, Argentina (P.B.). E-mail: [email protected]Search for more papers by this authorAbstract
Acute respiratory distress syndrome (ARDS) constitutes a high burden for intensive care units. Although several methods are proposed to monitor aeration in ARDS, availability, costs, simplicity, and hazards (eg, ionizing radiation) limit the use of many of them at patients' bedsides. Given the widespread use of lung ultrasonography (US) in intensive care units, research is growing regarding its use to monitor aeration in patients with ARDS. We reviewed the actual role of lung US in ARDS and its potential impact in practice. Lung US can be readily used for assessing aeration, although, as a main limitation, a normal lung cannot be distinguished from hyperinflation. Additionally, an improvement in aeration by lung US does not always correlate with an increase in oxygenation. Lung US can be considered the main imaging method for monitoring aeration in ARDS, but in view of its limitations, it should not be used in isolation. Further studies are needed to validate lung US in large ARDS populations.
Supporting Information
Supplemental material online at jultrasoundmed.org
Videos online at wileyonlinelibrary.com/journal/jum
| Filename | Description |
|---|---|
| jum14671-sup-0001-suppinfo1.TIF545.6 KB | Template 1 |
| jum14671-sup-0002-suppinfo2.TIF563.9 KB | Template 2 |
| jum14671-sup-0003-suppinfov1.wmv8.4 MB |
Video 1. Patterns of aeration on lung US images. As noted in the text, a normal pattern cannot be clearly distinguished from hyperinflation. |
| jum14671-sup-0004-suppinfov2.wmv4.1 MB |
Video 2. Signs of right ventricular overload on transthoracic echocardiography compared with normal. Right ventricular dysfunction is shown as right ventricular dilatation, reduced systolic function, and flattening of the interventricular septum. |
| jum14671-sup-0005-suppinfov3.wmv856.6 KB |
Video 3. Pneumothorax, clearly shown by absent lung sliding and by the presence of a lung point. |
| jum14671-sup-0006-suppinfov4.wmv864.5 KB |
Video 4. Substantial pleural effusion. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1 Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315: 788–800.
- 2 Matthay MA, Ware LB, Zimmerman GA. The acute respiratory distress syndrome. Clin Invest 2012; 122: 2731–2740.
- 3 Estenssoro E, Dubin A. Acute respiratory distress syndrome [in Spanish]. Medicina (B Aires) 2016; 76: 235–241.
- 4 Arbelot C, Ferrari F, Bouhemad B, Rouby JJ. Lung ultrasound in acute respiratory distress syndrome and acute lung injury. Curr Opin Crit Care 2008; 14: 70–74.
- 5 Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149: 818–824.
- 6 ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012; 307: 2526–2533.
- 7 Walkey AJ, Goligher EC, Del Sorbo L, et al. Low tidal volume versus non-volume-limited strategies for patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Ann Am Thorac Soc 2017; 14(suppl 4): S271–S279.
- 8 Bein T, Grasso S, Moerer O, et al. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia. Intensive Care Med 2016; 42: 699–711.
- 9 Pesenti A, Musch G, Lichtenstein D, et al. Imaging in acute respiratory distress syndrome. Intensive Care Med 2016; 42: 686–698.
- 10 Ball L, Vercesi V, Costantino F, Chandrapatham K, Pelosi P. Lung imaging: how to get better look inside the lung. Ann Transl Med 2017; 5: 294.
- 11 Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004; 100: 9–15.
- 12 Tsubo T, Sakai I, Suzuki A, Okawa H, Ishihara H, Matsuki A. Density detection in dependent left lung region using transesophageal echocardiography. Anesthesiology 2001; 94: 793–798.
- 13 Tsubo T, Yatsu Y, Tanabe T, Okawa H, Ishihara H, Matsuki A. Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography. Crit Care Med 2004; 32: 83–87.
- 14 Tsubo T, Yatsu Y, Suzuki A, et al. Daily changes of the area of density in the dependent lung region: evaluation using transesophageal echocardiography. Intensive Care Med 2001; 27: 1881–1886.
- 15 Gardelli G, Feletti F, Gamberini E, Bonarelli S, Nanni A, Mughetti M. Using sonography to assess lung recruitment in patients with acute respiratory distress syndrome. Emerg Radiol 2009; 16: 219–221.
- 16 Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 2010; 38: 84–92.
- 17 Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 2011; 183: 341–347.
- 18 Stefanidis K, Dimopoulos S, Tripodaki ES, et al. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Critical Care 2011; 15: R185.
- 19 Rode B, Vučić M, Siranović M, et al. Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment. Wien Klin Wochenschr 2012; 124: 842–847.
- 20
Algieri I,
Mongodi S,
Chiumello D, et al. CT scan and ultrasound comparative assessment of PEEP-induced lung aeration changes in ARDS. Crit Care 2014; 18(suppl 1): P285.
10.1186/cc13475 Google Scholar
- 21 Soummer A, Perbet S, Brisson H, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med 2012; 40: 2064–2072.
- 22 Prat G, Guinard S, Bizien N, et al. Can lung ultrasonography predict prone positioning response in acute respiratory distress syndrome patients? J Crit Care 2016; 32: 36–41.
- 23 Haddam M, Zieleskiewicz L, Perbet S, et al. Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS. Intensive Care Med 2016; 42: 1546–1556.
- 24 Papazian L, Paladini MH, Bregeon F, et al. Can the tomographic aspect characteristics of patients presenting with acute respiratory distress syndrome predict improvement in oxygenation-related response to the prone position? Anesthesiology 2002; 97: 599–607.
- 25 Wang XT, Ding X, Zhang HM, Chen H, Su LX, Liu DW; Chinese Critical Ultrasound Study Group (CCUSG). Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome. Crit Care 2016; 20: 385.
- 26 Mongodi S, Pozzi M, Orlando A, et al. Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience. Intensive Care Med 2018; 44: 123–124.
- 27 Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577–591.
- 28 Brogi E, Gargani L, Bignami E, et al. Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment. Crit Care 2017; 21: 325.
- 29 Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med 2017; 43: 29–38.
- 30 Cardenas-Garcia JL, Singh AK, Koenig SJ. A 75-year-old woman with fever and a right upper lobe pulmonary mass. Chest 2015; 147: e1–e4.
- 31 Tusman G, Acosta CM, Böhm SH, et al. Postural lung recruitment assessed by lung ultrasound in mechanically ventilated children. Crit Ultrasound J 2017; 9: 22.
- 32 Tusman G, Acosta CM, Nicola M, Esperatti M, Bohm SH, Suarez-Sipmann F. Real-time images of tidal recruitment using lung ultrasound. Crit Ultrasound J 2015; 7: 19.
- 33 Tusman G, Acosta CM, Costantini M. Ultrasonography for the assessment of lung recruitment maneuvers. Crit Ultrasound J 2016; 8: 8.
- 34 Beaubien-Souligny W, Rhéaume M, Blondin MC, et al. A simplified approach to extravascular lung water assessment using point-of-care ultrasound in patients with end-stage chronic renal failure undergoing hemodialysis. Blood Purif 2017; 45: 79–87.
- 35 Cortellaro F, Ceriani E, Spinelli M, et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern Emerg Med 2017; 12: 1011–1017.
- 36 Blanco PA, Cianciulli TF. Pulmonary edema assessed by ultrasound: impact in cardiology and intensive care practice. Echocardiography 2016; 33: 778–787.
- 37 Caltabeloti F, Monsel A, Arbelot C, 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: R91.
- 38 Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2017; 318: 1335–1345.
- 39 Vieillard-Baron A, Matthay M, Teboul JL, et al. Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation. Intensive Care Med 2016; 42: 739–749.
- 40 Mongodi S, Bouhemad B, Orlando A, et al. Modified lung ultrasound score for assessing and monitoring pulmonary aeration. Ultraschall Med 2017; 38: 530–537.
Citing Literature
