The Application Of Lung Ultrasound In Adult Patients With Acute Respiratory Distress Syndrome:Systematic Review And Meta-analysis

Background and Purpose:The wildly accepted imaging diagnostic criteria for acute respiratory distress syndrome(ARDS)is bilateral opacities detected by CT or chest radiography.However,ultrasonography has a good sensitivity to the detection of lung lesions and that examination is flexible and convenient,which can be used at the bedside.In the exploration of the application of lung ultrasound in ARDS,some studies proposed to use lung ultrasound as imaging examination for the diagnosis of ARDS in adult patients,and others proposed to use the lung ultrasound score(LUS)to assess the severity and prognosis in adults with ARDS.The purpose of our study was conducting a systematic review and meta-analysis to evaluate the diagnostic value of lung ultrasound and the value of the LUS in assessing the severity and prognosis in adult patients with ARDS.Methods:In this systematic review,six databases including CNKI,WanFang,VIP,PubMed,Embase and Cochrane Library were systematically searched by computer depending on the purpose of our study from inception to December 20,2021.Two reviewers independently screened the literature,extracted the data,evaluated the quality of the included literatures and assessed the risk of bias of the included studies.Meta-analysis was performed to analysis the data using Stata14.0 software,aimed to explore whether there was difference in the LUS between severe and mild-moderate or dead and alive adults with ARDS,the difference was represented by standardized mean difference(SMD),and to explore that based on the imaging diagnostic criteria of the Berlin definition as the gold standard,the diagnostic sensitivity and specificity of lung ultrasound for adults with ARDS,overall diagnostic performance were estimated by using the pooled area under the summary receiver operating characteristic curve(AUROC).Results:A total of 45 studies in 24 literatures,were included in the meta-analysis to explore the value of the LUS in assessing the severity and prognosis of adult patients with ARDS.A total of 5 studies in 3 literatures,were included in the meta-analysis to explore the diagnostic value of lung ultrasound in adults with ARDS.Meta-analysis showed that the LUS of severe patients were higher than the mild-moderate,SMD=1.18(95%CI:0.76,1.61),patients who died were higher than the survived,SMD=1.77(1.43,2.12),and both of the difference was statistically significant(P<0.05).For the diagnosis of ARDS in adults by lung ultrasound examination,sensitivity(SEN)was 0.85(0.73,0.93);specificity(SPE)was 0.70(0.52,0.84);positive likelihood ratio(PLR)was 2.89(1.58,5.26);negative likelihood ratio(NLR)was 0.21(0.10,0.45);diagnostic odds ratio(DOR)was 12.46(4.22,36.80);AUROC was 0.86(0.83,0.89).Conclusion:Lung ultrasound is helpful in screening adult patients with ARDS,and the application of the LUS can effectively identify the adult patients with ARDS who are severe or at a high risk of death.Lung ultrasound is a valuable imaging technique for adult patients with ARDS.