Modified Lung Ultrasound Score for Assessing and Monitoring Pulmonary Aeration

Area of Science:

• Critical Care Medicine
• Radiology
• Pulmonology

Background:

• Lung Ultrasound Score (LUSS) is utilized for lung aeration assessment.
• Standard LUSS has limitations in visualizing pleura and assessing non-homogeneous lung pathologies due to reliance on longitudinal scans and B-line coalescence.
• Focal coalescence of B-lines can mimic severe aeration loss in non-uniform conditions.

Purpose of the Study:

• To compare the efficacy of longitudinal versus transversal scanning in lung ultrasound.
• To evaluate the performance of standard coalescence-based LUSS (cLUSS) against a quantitative LUSS (qLUSS) based on pleural involvement percentage.
• To identify methods to overcome the limitations of standard LUSS in lung aeration assessment.

Main Methods:

• 38 ICU patients were assessed using both longitudinal and transversal scans across 12 thoracic areas.
• Evaluated parameters included B-lines (number, coalescence), subpleural consolidations (SP), pleural length, and pleural involvement (> or ≤ 50%).
• Calculated both cLUSS and qLUSS for both scanning approaches.

Main Results:

• Transversal scans provided wider and more consistent visualization of pleural length compared to longitudinal scans.
• Transversal scans detected B-lines, coalescence, and subpleural consolidations more frequently than longitudinal scans.
• Quantitative LUSS using transversal scans (qLUSS-transv) produced a significantly different distribution of aeration scores compared to standard longitudinal cLUSS.

Conclusions:

• Longitudinal scans exhibit high variability in pleural length and frequent focal B-line coalescence in unselected ICU patients.
• Transversal scanning and quantification of pleural involvement are effective strategies to enhance LUSS accuracy.
• These quantitative and transversal approaches address the limitations of standard LUSS, particularly in complex lung pathologies.