[Predictive value of early Lung Ultrasound Score for the development of hypoxemia in postoperative patients with acute intracerebral hemorrhage].

OBJECTIVE

To investigate the predictive value of the Lung Ultrasound Score (LUS) on postoperative day 1 for the development of hypoxemia in patients after surgery for acute intracerebral hemorrhage.

METHODS

A retrospective case-control study was conducted. Postoperative patients with acute intracerebral hemorrhage admitted to the department of critical care medicine, Lu'an Hospital of Anhui Medical University, from January 2022 to August 2024 were enrolled. Baseline characteristics and key therapeutic variables [including the cumulative doses of mannitol and furosemide within 3 days after surgery, duration of mannitol use, cumulative fluid balance on postoperative day 1, tidal volume during mechanical ventilation, and positive end-expiratory pressure (PEEP)] were collected. Lung ultrasound examination was performed on postoperative day 1 using the 12-zone method, and the LUS score was calculated. According to whether the oxygenation index (PaO2/FiO2) within 7 days after surgery was <300 mmHg (1 mmHg=0.133 kPa), patients were divided into the hypoxemia group and the non-hypoxemia group. Differences in the above variables between the two groups were compared. Multivariate Logistic regression analyses were performed to determine the independent predictive value of LUS for hypoxemia, and receiver operator characteristic curve (ROC curve) was constructed to evaluate its predictive performance.

RESULTS

A total of 108 postoperative patients with acute intracerebral hemorrhage were included, of whom 37 were in the hypoxemia group and 71 in the non-hypoxemia group. Body mass index, Sequential Organ Failure Assessment (SOFA), total lung LUS score, and anterolateral LUS score were significantly higher in the hypoxemia group than in the non-hypoxemia group (all P<0.05). There were no statistically significant differences in key early postoperative therapeutic parameters between the two groups (all P>0.05), indicating that the confounding effect of therapeutic differences on the study results was limited. Multivariate Logistic regression analysis showed that after adjustment for SOFA score, the total lung LUS score remained an independent predictor of postoperative hypoxemia [odds ratio (OR)=1.827, 95% confidence interval (95%CI) was 1.444-2.311, P<0.001]. ROC curve analysis demonstrated that the area under the curve (AUC) for total lung and anterolateral LUS scores in predicting postoperative hypoxemia was 0.902 (95%CI was 0.836-0.968). At the optimal cut-off value of 14.5 points, the sensitivity was 86.50%, specificity was 87.30%, and the negative predictive value reached 92.54%. The anterolateral LUS score also demonstrated good predictive performance (AUC=0.855). Correlation analysis revealed a moderate positive correlation between the anterolateral LUS score and the total lung LUS score (r=0.870, P<0.001). Bland-Altman analysis indicated a systematic bias between the two methods (6.213), with 95% limits of agreement ranging from 1.272 to 11.150 points.

CONCLUSIONS

The LUS score on postoperative day 1 has high predictive value for hypoxemia in patients after surgery for acute intracerebral hemorrhage. The simplified anterolateral scoring scheme may serve as a rapid bedside screening tool and is of great significance for early identification of high-risk patients and guidance of clinical interventions.