Respiratory failure & ventilation
Early lung ultrasound score changes predict the failure of non-invasive respiratory supports in acute hypoxemic patients: a multicenter prospective observational study
Authors' conclusion
Changes in LUS aeration scores induced by 2 h of non-invasive respiratory support help early predict the risk of treatment failure. LUS score improved only in responders and was an independent predictor of failure.
Study context
- Population
- Hypoxemic patients (PaO2/FiO2 < 300 mmHg) undergoing non-invasive respiratory support (HFNC, CPAP, NIV)13 HFNC, 68 CPAP, 19 NIV
- Participants
- 100 patients
- Exposure
- Failing vs non-failing patients on non-invasive respiratory support
- Outcome
- Early prediction of failure of non-invasive respiratory support by LUS (escalation within 48 h)
- Follow-up
- 2 h after treatment start
Methodological detailsmulticentre, international
- Multicentre
- International
Main finding
As reported in the abstract
Prediction of treatment failure (AUC) · 2 h
- Overall treatment failure rate
- 22%
- Global lung ultrasound (LUS) score variations, failing vs non-failing (median [IQR]), p < 0.001
- 0.0 [−2.0-1.0] vs. −3.0 [−5.0 - −2.0]
- AUC, global LUS score variations
- 0.73 [0.62-0.89]
- AUC, 2-hour ROX index
- 0.71 [0.58-0.84]
- AUC, 2-hour PaO2/FiO2
- 0.73 [0.60-0.85]
- AUC, combined ROX-US score
- 0.82 [0.73-0.91]
- ROX-US≥1 identifying success: sensitivity / specificity
- 95% / 50%
- ROX-US≥2 identifying success: sensitivity / specificity
- 45% / 96%
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| PaO2/FiO2 after 2 h · lower in failing patients | P = 0.001 |
| ROX index after 2 h · lower in failing patients | P = 0.003 |
| Lateral LUS aeration score after 2 h · higher in failing patients | P = 0.047 |
| Antero-lateral LUS aeration score after 2 h · higher in failing patients | P = 0.027 |
| Global LUS aeration score after 2 h · higher in failing patients | P = 0.036 |
- PaO2/FiO2 after 2 h: baseline clinical and ultrasound parameters similar in failing and non-failing patients
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Early lung ultrasound score changes predict the failure of non-invasive respiratory supports in acute hypoxemic patients: a multicenter prospective observational study. Crit Care. Published 7 January 2026. doi:10.
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