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Critical Care Ultrasonography Differentiates ARDS, Pulmonary Edema, and Other Causes in the Early Course of Acute Hypoxemic Respiratory Failure.
Chest. 2015 May 21;
Authors: Sekiguchi H, Schenck LA, Horie R, Suzuki J, Lee EH, McMenomy BP, Chen TE, Lekah A, Mankad SV, Gajic O
Abstract
Background: Pathogenic causes of acute hypoxic respiratory failure (AHRF) can be difficult to identify at early clinical presentation. We evaluated the diagnostic utility of combined cardiac and thoracic critical care ultrasonography (CCUS).
Methods: Adult patients in the intensive care unit (ICU) were prospectively enrolled from January through September 2010 when the ratio of Pao2 to fraction of inspired oxygen (Fio2) was less than 300 on arterial blood gas (ABG) within 6 hours of a new hypoxic event or ICU admission. Focused cardiac and thoracic CCUS was conducted within 6 hours of ABG testing. Causes of AHRF were categorized into cardiogenic pulmonary edema (CPE), acute respiratory distress syndrome (ARDS), and other, miscellaneous causes after reviewing the hospitalization course in electronic medical records.
Results: Enrollment involved 134 patients (median [interquartile range] Pao2/Fio2 ratio, 191 [122-253]). Fifty-nine patients (44%) received a CPE diagnosis; 42 (31%), ARDS; and 33 (25%), miscellaneous cause. Analysis on CCUS findings showed that a low B-line ratio (proportion of chest zones with positive B-lines of all zones examined) was predictive for miscellaneous cause vs CPE or ARDS. Area under the receiver operator characteristic curve (AUC) was 0.82 (95% CI, 0.75-0.88). For further differentiation of CPE from ARDS, left pleural effusion (>20 mm), moderately or severely decreased left ventricular function, and a large minimal inferior vena cava diameter (>23 mm) were predictive for CPE. AUC was 0.79 (95% CI, 0.70-0.87).
Conclusions: Combined cardiac and thoracic CCUS assists in early bedside differential diagnosis of ARDS, CPE, and other causes of AHRF.
PMID: 25996139 [PubMed - as supplied by publisher]