SESSION TITLE: Pulmonary & Critical Care Imaging
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM
PURPOSE: To describe a novel, clinically feasible, pulmonary point-of-care ultrasound (PPOCUS) scoring system for use in critical care patients who are intubated for primary cardiopulmonary reasons, and its correlation to clinical metrics and mortality.
METHODS: A prospective cohort study was conducted in 227 consecutive, intubated intensive care unit (ICU) patients at a single tertiary care facility between 2014 and 2015. Physicians blinded to the clinical scenario performed 3 PPOCUS exams: 1) as close to intubation as possible (i.e. baseline), 2) 48 hours after intubation, and 3) just prior to extubation. PPOCUS findings at 9 points across the anterior and lateral chest were used to compute a score (range = 0-36) that quantified b-lines, consolidation, atelectasis, pleural effusion, and pneumothorax. Individual exam scores were compared to clinical metrics.
RESULTS: Primary diagnoses for ICU admission included: pneumonia (32%), congestive heart failure (14%), acute lung injury/acute respiratory distress syndrome (11%), COPD exacerbation (10%), and sepsis (10%). Tertile of the baseline pulmonary ultrasound score (0-9, 9.5-18, 18.5-36) had a strong positive linear relationship with ICU length of stay (6, 7, 10 days respectively; p = 0.028) and ventilator hours (92, 83, 147 hr; p < 0.001), a strong negative linear relationship with P/F ratio (267, 222, 181; p = 0.005), and a moderate positive linear relationship with mortality (21%, 27%, 30%; p = 0.089). The PPOCUS exam was clinically feasible in 100% of eligible patients and on average required 135 seconds to perform.
CONCLUSIONS: A quick 9-point PPOCUS exam and scoring algorithm correlated well with mortality and other important clinical metrics in intubated ICU patients.
CLINICAL IMPLICATIONS: The value of PPOCUS in critical care patients is magnified in the intubated patient where single-view portable chest x-ray is the most readily available alternative without moving the patient out of the ICU. In addition to the diagnostic and therapeutic guidance PPOCUS provides the clinician, this simple scoring system can enhance patient monitoring and augment difficult clinician predictions of ventilator timeline, expected ICU stay, and patient mortality.
DISCLOSURE: The following authors have nothing to disclose: David Tierney, Roman Melamed, Lori Boland, Josh Overgaard, Ann Jorgenson, James Normington
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