Lung water assessment by lung ultrasonography in intensive care: a pilot study

Objective: To investigate the accuracy of lung ultrasonography (LUS) in the quantification of lung water in critically ill patients by using quantitative computed tomography (CT) as the gold standard for the determination of lung weight. Methods: Twenty consecutive patients admitted to an intensive care unit who underwent chest CT as a step in their clinical management were evaluated within 4 h by LUS. Lung weight, lung volume, and physical lung density were calculated from the CT scans using ad hoc software. Semiquantitative ultrasound assessment of lung water was performed by determining the ultrasound B-line score, defined as the total number of B-lines detectable in an anterolateral LUS examination. Results: Good correlations were found between the B-line score and lung weight (r = 0.75, p < 0.05) and density (r = 0.82, p < 0.01), that only marginally increased when the lung density of the first 10 mm of subpleural lung tissue was evaluated (r = 0.83, p < 0.01). Moreover, values of subpleural lung density were not significantly different from values of the whole lung density (0.34 +/- A 0.11 vs. 0.37 +/- A 0.16 g/ml, p = ns). Very good correlations were found between the B-line score and both the weight (r = 0.85, p < 0.01) and the density (r = 0.88, p < 0.01) of the upper lobes. The weight of the lower lobes was not correlated with the B-line score (r = 0.14, p = ns). Conclusions: Lung ultrasound B-lines are correlated with lung weight and density determined by CT. LUS may provide a reliable, simple and radiation-free lung densitometry in the intensive care setting.