CHEST Guidelines-Lung-Ultrasound-in-a-Patient-With-ARDS-Secondary-t

Lung-Ultrasound-in-a-Patient-With-ARDS-Secondary-t

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The document describes a case report of a 41-year-old homeless male patient who presented at the emergency department with abdominal pain and confusion, later diagnosed with severe Acute Respiratory Distress Syndrome (ARDS) secondary to pancreatitis. He had a history of alcoholic liver disease and recurrent pancreatitis of unknown etiology. The patient exhibited respiratory distress, low oxygen saturation, hypotension, and required intubation and vasopressors. Initial lab results indicated severe pancytopenia and metabolic acidosis, confirmed by arterial blood gases showing a low pH and bicarbonate levels, and a very low PaO2/FIO2 ratio of 48.<br /><br />A chest X-ray revealed bilateral opacities consistent with ARDS. A bedside ultrasound showed lung consolidation with pleural effusion and ascites. Dynamic changes in lung aeration were observed by adjusting the ventilator settings, demonstrating the value of lung ultrasound in monitoring critically ill patients and adjusting clinical interventions. Despite aggressive treatment, including protective lung ventilation strategies and various antibiotics to cover possible infectious causes of ARDS, the patient's condition deteriorated; he developed worsening hypotension and died the following day. Necropsy confirmed pancreatitis as the underlying cause.<br /><br />The case emphasizes the utility of point-of-care ultrasound in providing real-time insights into lung aeration and function and highlights the potential benefits of using standardized scoring methods like the Lung Ultrasound Score (LUS) to evaluate changes and guide therapeutic decisions in ARDS. Although not widely standardized, lung ultrasound is shown to be a valuable, non-invasive tool for assessing lung condition and response to treatment in ICU and emergency settings.

Keywords

ARDS

pancreatitis

lung ultrasound

point-of-care ultrasound

protective lung ventilation

hypotension

alcoholic liver disease

pancytopenia

metabolic acidosis

Lung Ultrasound Score