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

中文翻译：

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肺部超声诊断 ARDS 和识别局灶性或非局灶性 ARDS 亚表型的准确性：系统评价和荟萃分析


急性呼吸窘迫综合征 (ARDS) 是一种危及生命的呼吸系统疾病，死亡率很高，占所有重症监护病房入院人数的 10%。肺部超声（LUS）作为急性呼吸衰竭的诊断工具已获得广泛认可，并且最近被纳入 ARDS 的更新定义中。这提出了 LUS 是诊断 ARDS 的可靠方法的假设。我们的目的是确定 LUS 对 ARDS 诊断以及局灶性与非局灶性 ARDS 亚表型分类的准确性。这项系统评价和荟萃分析使用了系统搜索策略，该策略应用于 PubMed、EMBASE 和 Cochrane 数据库。其中包括调查 LUS 与胸部 CT 或胸部 X 线摄影 (CXR) 相比在 ARDS 诊断中的诊断准确性或成年患者的局灶性与非局灶性亚表型的研究。使用 QUADAS-2 工具评估研究质量。使用 Rstudio 4.0.3 版中的“Mada”进行统计分析。每个单独研究的敏感性和特异性（置信区间为 95%）总结在森林图中。搜索结果为 2648 条唯一记录。经过筛选，共纳入 11 篇报告，涉及 2075 名患者、598 例 ARDS 病例（29%）。九项研究报告了 ARDS 诊断，两项研究报告了局灶性与非局灶性 ARDS 亚表型分类。 Meta 分析显示，LUS 诊断 ARDS 的汇总敏感性为 0.631（95% CI 0.450–0.782），汇总特异性为 0.942（95% CI 0.856–0.978）。在两项研究中，LUS 可以准确地区分局灶性与非局灶性 ARDS 亚表型。没有足够的数据来进行荟萃分析。 本综述证实了 LUS 是诊断成人 ARDS 的可靠方法的假设。对于局灶性或非局灶性亚表型的分类，LUS 显示了有希望的结果，但还需要更多的研究。