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Accuracy of Daily Lung Ultrasound for the Detection of Pulmonary Edema Following Subarachnoid Hemorrhage

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Abstract

Background

Early detection of pulmonary edema is vital to appropriate fluid management following subarachnoid hemorrhage (SAH). Lung ultrasound (LUS) has been shown to accurately identify pulmonary edema in patients with acute respiratory failure (ARF). Our objective was to determine the accuracy of daily screening LUS for the detection of pulmonary edema following SAH.

Methods

Screening LUS was performed in conjunction with daily transcranial doppler for SAH patients within the delayed cerebral ischemia (DCI) risk period in our neuroICU. We reviewed records of SAH patients admitted 7/2012–5/2014 who underwent bilateral LUS on at least 5 consecutive days. Ultrasound videos were reviewed by an investigator blinded to the final diagnosis. “B+ lines” were defined as ≥3 B-lines on LUS. Two other investigators blinded to ultrasound results determined whether pulmonary edema with ARF (PE-ARF) was present during the period of evaluation on the basis of independent chart review, with a fourth investigator performing adjudication in the event of disagreement. The diagnostic accuracy of B+ lines for the detection of PE-ARF and RPE was determined.

Results

Of 59 patients meeting criteria for inclusion, 21 (36 %) had PE-ARF and 26 (44 %) had B+ lines. Kappa for inter-rater agreement was 0.821 (p < 0.0001) for clinical diagnosis of PE-ARF between the two investigators. B+ lines demonstrated sensitivity 90 % (95 % CI 70–99 %) and specificity 82 % (66–92 %), for PE-ARF. Median days from B+ lines onset to PE-ARF was 1 (IQR 0–1).

Conclusion

Screening LUS was a sensitive test for the detection of symptomatic pulmonary edema following SAH and may assist with fluid titration during the risk period for DCI.

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Conflict of interest

Craig A. Williamson, Ivan Co, Aditya S. Pandey, B. Gregory Thompson, and Venkatakrishna Rajajee have no conflict of interest to declare.

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Authors and Affiliations

  1. Departments of Neurosurgery and Neurology, University of Michigan, 3552 Taubman Health Care Center; 1500 E. Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109, USA

    Craig A. Williamson & Venkatakrishna Rajajee

  2. Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, 3916 Taubman Center, SPC 5360, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA

    Ivan Co

  3. Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center; 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Aditya S. Pandey & B. Gregory Thompson

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  1. Craig A. Williamson
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Correspondence to Venkatakrishna Rajajee.

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Williamson, C.A., Co, I., Pandey, A.S. et al. Accuracy of Daily Lung Ultrasound for the Detection of Pulmonary Edema Following Subarachnoid Hemorrhage. Neurocrit Care 24, 189–196 (2016). https://doi.org/10.1007/s12028-015-0161-6

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