Prognostic Value of Extravascular Lung Water Assessed with Lung Ultrasound in Patients with Acute Respiratory Distress Syndrome

Abstract

The acute respiratory distress syndrome (ARDS) is an important cause of acute respiratory failure that is often associated with multiple organ failure. Several clinical disorders can precipitate ARDS, including pneumonia, sepsis, aspiration of gastric contents, and major trauma. Physiologically, ARDS is characterized by increased permeability pulmonary edema, severe arterial hypoxemia, and impaired carbon dioxide excretion. Objectives: The present study is a prospective observational cohort study conducted on 35 children with ARDs. The aim of study was to evaluate the prognostic value of extravascular lung water assessed with lung ultrasound score in patients admitted to PICU. Patients and Methods: The demographic data of the study showed that the patients were 23 female, 12 male with age ranged from 1.2 to 120 months, range of weight was 6 to 40 kgs, mean HR was 146.79 ± 20.77 b/m, mean RR was 53.21 ± 15.69 cycle/min, mean temperature was 38.17 ± 0.87 C and mean Systolic blood pressure was 73.58 ± 14.08 mmHg and mean Diastolic 44.18 ± 10.52mmHg, the mean of initial ABGs were (PH 7.13 ± 0.14, Co2 79.82 ± 14.31, Pao252.33 ± 17.45, HCO319.93 ± 4.02) and the mean of P/F ratio was 149.69 ± 88.96, 34.3% of patients had complications, 14.3% had pneumothorax, 40% had sepsis, and 8.6% had DIC and mortality was 40%, 31.4%of patients had mild lung injury, 34.3% had moderate lung injury, same percent with severe lung injury (34.3%) Results: Fifteen of patients were on conventional mode of ventilation (mean PIP, PEEP, rate, FIO2 =24.88 ± 12.14, 9.64 ± 3.35, 42.4 ± 40.1, 52.5±49.3 respectively), 3 patients were on HFO mode (mean Delta B, FIO2, rate = 40±12.3, 52.5±49.3, 10.36±9.73 respectively) while 10 were on HFO and changed to conventional and 7 were on conventional and changed to HFO mode with no significant difference between both groups, also no difference regarding days on PICU nor days on MV affected by modes of vent but significant difference was noted as regards SOFA score and PF ratio. The mean lung ultrasound score was 19.83 ± 9.21 which was statistically significant between survivors and non survivors groups and the results of AUC of lung ultrasound score at cut off point (>27) showed statistical significant with outcomes with 100% sensitivity and 100% specificity. Significant correlations were found between items of ABG and lung ultrasound score, but no correlations found regarding stay in PICU, days on MV. Conclusion: Lung ultrasound is noninvasive, easily repeatable and allows assessment of changes in lung aeration induced by the various therapies. It is among the most promising bedside techniques for monitoring patients with acute respiratory distress syndrome with a significant predictive value as regards patients through study.