Objectives This study aimed to investigate the relationship between lung ultrasound morphology patterns—localized tissue-like patterns (TLP) and diffuse B-lines (DBP)—and patients’ response to routine clinician-directed management in high-risk mechanically ventilated patients undergoing weaning. Methods In this retrospective study, 97 high-risk mechanically ventilated patients with a Lung Ultrasound Score (LUS) > 13 were stratified into TLP and DBP groups based on their lung ultrasound patterns. Lung reaeration was assessed using the Lung Recruitment Score (LRS) before and after the application of routine therapeutic measures. Primary outcomes included changes in LRS. Secondary outcomes included weaning failure rates, duration of mechanical ventilation, intensive care unit (ICU) mortality, and length of ICU stay. Results The study included 97 high-risk mechanically ventilated patients, of whom 49 had TLP and 48 had DBP on lung ultrasound. Upon ICU admission, the TLP group exhibited significantly higher global LUS compared to the DBP group (17.20 ± 2.01 vs. 14.21 ± 2.04, P < 0.001), with more pronounced differences observed in the posterior (9.65 ± 0.90 vs. 7.5 ± 0.58, P < 0.001) and lateral regions (4.94 ± 1.05 vs. 4.35 ± 1.24, P = 0.014). Following routine clinician-directed, the TLP group demonstrated more substantial improvement in global LRS compared to the DBP group (5.43 ± 3.42 vs. 4.04 ± 2.99, P = 0.036), indicating enhanced lung reaeration. Multivariate analysis identified Apache II score (OR = 1.105, P = 0.021) and global LRS (OR = 0.476, P = 0.003) as independent predictors of weaning failure. Among successfully weaned patients, those in the TLP group exhibited significantly higher LRS than those in the DBP group (6.71 ± 2.31 vs. 5.39 ± 2.26, P = 0.021), suggesting a more favorable response to interventions in the TLP group. Conclusions Patients with TLP demonstrated superior response to routine clinician-directed management and achieved comparable weaning outcomes to those with DBP, despite higher initial LUS. Lung morphology patterns and regional LRS assessments may assist in tailoring management strategies and predicting weaning outcomes in high-risk mechanically ventilated patients.

Lung ultrasound morphology patterns predict treatment response and weaning outcomes in high-risk mechanically ventilated patients

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2025年12月12日

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Hongyu He,
Sheng Xu,
Qinnan Yang,
Xin Zheng,
Yimei Liu,
Lizhen Xuan,
Zhunyong Gu,
Ming Zhong,
Minjie Ju

摘要

Objectives

This study aimed to investigate the relationship between lung ultrasound morphology patterns—localized tissue-like patterns (TLP) and diffuse B-lines (DBP)—and patients’ response to routine clinician-directed management in high-risk mechanically ventilated patients undergoing weaning.

Methods

In this retrospective study, 97 high-risk mechanically ventilated patients with a Lung Ultrasound Score (LUS) > 13 were stratified into TLP and DBP groups based on their lung ultrasound patterns. Lung reaeration was assessed using the Lung Recruitment Score (LRS) before and after the application of routine therapeutic measures. Primary outcomes included changes in LRS. Secondary outcomes included weaning failure rates, duration of mechanical ventilation, intensive care unit (ICU) mortality, and length of ICU stay.

Results

The study included 97 high-risk mechanically ventilated patients, of whom 49 had TLP and 48 had DBP on lung ultrasound. Upon ICU admission, the TLP group exhibited significantly higher global LUS compared to the DBP group (17.20 ± 2.01 vs. 14.21 ± 2.04, P < 0.001), with more pronounced differences observed in the posterior (9.65 ± 0.90 vs. 7.5 ± 0.58, P < 0.001) and lateral regions (4.94 ± 1.05 vs. 4.35 ± 1.24, P = 0.014). Following routine clinician-directed, the TLP group demonstrated more substantial improvement in global LRS compared to the DBP group (5.43 ± 3.42 vs. 4.04 ± 2.99, P = 0.036), indicating enhanced lung reaeration. Multivariate analysis identified Apache II score (OR = 1.105, P = 0.021) and global LRS (OR = 0.476, P = 0.003) as independent predictors of weaning failure. Among successfully weaned patients, those in the TLP group exhibited significantly higher LRS than those in the DBP group (6.71 ± 2.31 vs. 5.39 ± 2.26, P = 0.021), suggesting a more favorable response to interventions in the TLP group.

Conclusions

Patients with TLP demonstrated superior response to routine clinician-directed management and achieved comparable weaning outcomes to those with DBP, despite higher initial LUS. Lung morphology patterns and regional LRS assessments may assist in tailoring management strategies and predicting weaning outcomes in high-risk mechanically ventilated patients.