title: Modified Lung Ultrasound Score for Assessing and Monitoring Pulmonary Aeration.
abstract: PurposeLung Ultrasound Score (LUSS) is a useful tool for lung aeration assessment but presents two theoretical limitations. First, standard LUSS is based on longitudinal scan and detection of number/coalescence of B lines. In the longitudinal scan pleura visualization is limited by intercostal space width. Moreover, coalescence of B lines to define severe loss of aeration is not suitable for non-homogeneous lung pathologies where focal coalescence is possible. We therefore compared longitudinal vs. transversal scan and also cLUSS (standard coalescence-based LUSS) vs. qLUSS (quantitative LUSS based on % of involved pleura).Materials and methods38 ICU patients were examined in 12 thoracic areas in longitudinal and transversal scan. B lines (number, coalescence), subpleural consolidations (SP), pleural length and pleural involvement (> or ≤ 50 %) were assessed. cLUSS and qLUSS were computed in longitudinal and transversal scan.ResultsTransversal scan visualized wider (3.9 [IQR 3.8 - 3.9] vs 2.0 [1.6 - 2.5] cm, p < 0.0001) and more constant (variance 0.02 vs 0.34 cm, p < 0.0001) pleural length, more B lines (70 vs 59 % of scans, p < 0.0001), coalescence (39 vs 28 %, p < 0.0001) and SP (22 vs 14 %, p < 0.0001) compared to longitudinal scan. Pleural involvement > 50 % was observed in 17 % and coalescence in 33 % of cases. Focal coalescence accounted for 52 % of cases of coalescence. qLUSS-transv generated a different distribution of aeration scores compared to cLUSS-long (p < 0.0001).ConclusionIn unselected ICU patients, variability of pleural length in longitudinal scans is high and focal coalescence is frequent. Transversal scan and quantification of pleural involvement are simple measures to overcome these limitations of LUSS.
authors.affiliation: Anesthesiology, Intensive Care and Pain Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mongodi
authors.affiliation: Anesthesia and Intensive care, Centre Hospitalier Universitaire de Dijon, France.
authors.forename: Bélaïd
authors.initials: B
authors.lastname: Bouhemad
authors.affiliation: Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universita degli Studi di Pavia Facolta di Medicina e Chirurgia, Pavia, Italy.
authors.forename: Anita
authors.initials: A
authors.lastname: Orlando
authors.affiliation: Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universita degli Studi di Pavia Facolta di Medicina e Chirurgia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
authors.affiliation: Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universita degli Studi di Pavia Facolta di Medicina e Chirurgia, Pavia, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Tavazzi
authors.affiliation: Anesthesiology, Intensive Care and Pain Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Via
authors.affiliation: Anesthesiology, Intensive Care and Pain Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Giorgio Antonio
authors.initials: GA
authors.lastname: Iotti
authors.affiliation: Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universita degli Studi di Pavia Facolta di Medicina e Chirurgia, Pavia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braschi
authors.affiliation: Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universita degli Studi di Pavia Facolta di Medicina e Chirurgia, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mojoli
mesh_terms: D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000502:physiology; D010994:Pleura / Q000000981:diagnostic imaging / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography