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Meta-Analysis
. 2024 Jul 8;28(1):224.
doi: 10.1186/s13054-024-04985-1.

Diagnostic accuracy of lung ultrasound in diagnosis of ARDS and identification of focal or non-focal ARDS subphenotypes: a systematic review and meta-analysis

Maud M A Boumans  1 , William Aerts  2 , Luigi Pisani  3   4 , Lieuwe D J Bos  5   6 , Marry R Smit  2   7 , Pieter R Tuinman  8   9   10   11
Affiliations
Meta-Analysis

Diagnostic accuracy of lung ultrasound in diagnosis of ARDS and identification of focal or non-focal ARDS subphenotypes: a systematic review and meta-analysis

Maud M A Boumans et al. Crit Care. .

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a life-threatening respiratory condition with high mortality rates, accounting for 10% of all intensive care unit admissions. Lung ultrasound (LUS) as diagnostic tool for acute respiratory failure has garnered widespread recognition and was recently incorporated into the updated definitions of ARDS. This raised the hypothesis that LUS is a reliable method for diagnosing ARDS.

Objectives: We aimed to establish the accuracy of LUS for ARDS diagnosis and classification of focal versus non-focal ARDS subphenotypes.

Methods: This systematic review and meta-analysis used a systematic search strategy, which was applied to PubMed, EMBASE and cochrane databases. Studies investigating the diagnostic accuracy of LUS compared to thoracic CT or chest radiography (CXR) in ARDS diagnosis or focal versus non-focal subphenotypes in adult patients were included. Quality of studies was evaluated using the QUADAS-2 tool. Statistical analyses were performed using "Mada" in Rstudio, version 4.0.3. Sensitivity and specificity with 95% confidence interval of each separate study were summarized in a Forest plot.

Results: The search resulted in 2648 unique records. After selection, 11 reports were included, involving 2075 patients and 598 ARDS cases (29%). Nine studies reported on ARDS diagnosis and two reported on focal versus non-focal ARDS subphenotypes classification. Meta-analysis showed a pooled sensitivity of 0.631 (95% CI 0.450-0.782) and pooled specificity of 0.942 (95% CI 0.856-0.978) of LUS for ARDS diagnosis. In two studies, LUS could accurately differentiate between focal versus non-focal ARDS subphenotypes. Insufficient data was available to perform a meta-analysis.

Conclusion: This review confirms the hypothesis that LUS is a reliable method for diagnosing ARDS in adult patients. For the classification of focal or non-focal subphenotypes, LUS showed promising results, but more research is needed.

Keywords: ARDS; Diagnostic test accuracy; Lung ultrasound; Respiratory medicine.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram presenting the study search strategy and study selection process
Fig. 2
Fig. 2
Forest plots comparing diagnostic accuracy parameters from all studies with parameters from the study of Smit et al., after using a low and high cutoff point as suggested by the authors of this study. The dashed line represents median values of sensitivity and specificity. Sensitivity and confidence intervals: Smit (high cutoff): 0.51 [0.44–0.59] Smit (low cutoff): 0.91 [0.85–0.94], Daabis: 0.41 [0.18–0.68], Bass: 0.79 [0.63–0.89], Huang: 0.96 [0.83–0.99], See: 0.42 [0.34–0.51], Pisani: 0.79 [0.63–0.89], Baid: 0.29 [0.17–0.45], Chaitra: 0.81 [0.58–0.93], Arthur: 0.67 [0.47–0.83]. Specificity and confidence intervals: Smit (high cutoff): 0.94 [0.91–0.97] Smit (low cutoff): 0.50 [0.44–0.55], Daabis: 0.99 [0.95–1.00], Bass: 0.62 [0.50–0.73], Huang: 0.82 [0.60–0.93], See: 0.91 [0.87–0.94], Pisani: 0.89 [0.82–0.93], Baid: 0.99 [0.97–1.00], Chaitra: 0.99 [0.94–1.00], Arthur: 0.98 [0.95–0.99]
Fig. 3
Fig. 3
sROC curve after meta-analysis of nine studies assessing diagnostic accuracy of LUS in ARDS diagnosis
Fig. 4
Fig. 4
Deek’s Funnel plot for assessment of publication bias
See this image and copyright information in PMC

Comment in

  • LUS me up: elevating ARDS diagnosis.
    da Hora Passos R, da Cunha Lyrio RM, Lourenço ID, de Almeida Figueiredo EJ, Flato UAP, Barbas CV, da Silva AA. da Hora Passos R, et al. Crit Care. 2024 Jul 29;28(1):257. doi: 10.1186/s13054-024-05044-5. Crit Care. 2024. PMID: 39075592 Free PMC article.
  • Lung ultrasound and ARDS: global collaboration is the way to go.
    Smit MR, Boumans M, Aerts W, Tuinman PR. Smit MR, et al. Crit Care. 2024 Sep 17;28(1):307. doi: 10.1186/s13054-024-05075-y. Crit Care. 2024. PMID: 39289755 Free PMC article.

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