Lung ultrasound score as an indicator of dynamic lung compliance during veno-venous extra-corporeal membrane oxygenation

Abstract

Decisions on weaning from veno-venous extra-corporeal membrane oxygenation (VV-ECMO) requires the ability to maintain adequate gas exchange and work of breathing with reductions in ECMO pump flow and fresh gas flow. Testing of the readiness to wean the patient from ECMO however may vary dependent upon local protocols and clinical judgment. This study sought to validate the use of the LUS-score during VV-ECMO against the changes in chest x-ray infiltrates, dynamic lung compliance (CLdyn) and VV-ECMO settings (as standard measures of native lung function and the level of ECMO support) during the ECMO cycle. This prospective cohort study of 10 patients on VV-ECMO compared the LUS score (range 0–36) within 48-h, day 5 and day 10 of commencement of ECMO (or on the day of ECMO decannulation) to dynamic lung compliance, Murray Lung Injury Score and ECMO settings. Seven Male and three Female patients were included (average age 37 years (SD 14.8) and weight 71 Kg (SD 16.9). Median (IQR) duration of ECMO, ICU and hospital length of stay was 7.5 days (5.2–19.0), 12.5 days (8.5–22.7), 19.0 days (12.1– 36.1), respectively. There was a strong negative association between LUS-score and dynamic lung compliance (r_s(33) = –0.66, p < .001) providing some validation on the use of the LUS score as a potential surrogate measure of lung aeration and lung mechanics during VV-ECMO weaning.

Keywords

Ultrasound oxygenation lung compliance ECMO

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References

Ferguson

Fan

Camporota

, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012; 38(10): 1573–1582.

Banfi

Pozzi

Siegenthaler

, et al. Veno-venous extracorporeal membrane oxygenation: cannulation techniques. J Thorac Dis 2016; 8(12): 3762–3773.

Figueroa-Casas

Brunner

Dwivedi

, et al. Accuracy of the chest radiograph to identify bilateral pulmonary infiltrates consistent with the diagnosis of acute respiratory distress syndrome using computed tomography as reference standard. J Crit Care 2013; 28(4): 352–357.

Hartley

Sanderson

Vasques

, et al. Prediction of readiness to decannulation from venovenous extracorporeal membrane oxygenation. Perfusion 2020; 35(1 Suppl.): 57–64.

Hew

Tay

TR.

The efficacy of bedside chest ultrasound: from accuracy to outcomes. Eur Respir Rev 2016; 25(141): 230–246.

Chiumello

Umbrello

Sferrazza Papa

, et al. Global and regional diagnostic accuracy of lung ultrasound compared to CT in patients with acute respiratory distress syndrome. Crit Care Med 2019; 47(11): 1599–1606.

Via

Storti

Gulati

, et al. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 2012; 78(11): 1282–1296.

Mongodi

Pozzi

Orlando

, et al. Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience. Intensive Care Med 2018; 44(1): 123–124.

Spinelli

Mauri

Carlesso

, et al. Time-course of physiologic variables during extracorporeal membrane oxygenation and outcome of severe acute respiratory distress syndrome. ASAIO J 2020; 66: 663–670.

10.

Peek

Clemens

Elbourne

, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res 2006; 6: 163.

11.

Bouhemad

Zhang

, et al. Clinical review: bedside lung ultrasound in critical care practice. Crit Care 2007; 11(1): 205.

12.

Arbelot

Schreiber

, et al. Ultrasound assessment of lung aeration in subjects supported by venovenous extracorporeal membrane oxygenation. Respir Care 2019; 64(12): 1478–1487.

13.

Chiu

Hung

, et al. Dynamic driving pressure associated mortality in acute respiratory distress syndrome with extracorporeal membrane oxygenation. Ann Intensive Care 2017; 7(1): 12.

14.

Gattinoni

Vassalli

Romitti

, et al. Extracorporeal gas exchange: when to start and how to end? Crit Care 2019; 23(Suppl. 1): 203.

15.

Camporota

Nicoletti

Malafronte

, et al. International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure. Minerva Anestesiol 2015; 81(11): 1170–1183.

16.

Stahl

Moller

Schumann

, et al. Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome. Crit Care Med 2006; 34(8): 2090–2098.