Method: hand-held ultrasound
The lungs are divided into 6 zones (3 on left and 3 on right) based on:
(1) parasternal line (first and second intercostals spaces)
(2) anterior axillary line (third and fourth intercostal spaces)
(3) posterior axillary line (diaphragm)
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Finding in each zone
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Points
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normal (lung sliding with A lines OR 1-2 isolated B lines)
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1
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>= 3 well-defined B lines (moderate loss of lung aeration)
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2
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multiple thick and/or coalescent B lines (severe loss of lung aeration)
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3
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consolidation
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4
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where:
• Lung slide is the movement of the pleural line during respiration.
• A lines are horizontal artifacts parallel to the pleural line and arising from it.
• B lines are vertical hyperechoic reverberation artifacts arising from the pleural line and extending to the bottom of the screen without fading and moving synchronously with lung sliding.
• Lung consolidation is indicated by subpleural echo-poor region or tissue-like echotexture.
total SLESS =
= SUM(points for all 6 zones)
Interpretation:
• minimum SLESS: 6
• maximum SLESS: 24
• SLESS increases with severity of sepsis (early sepsis 6 or 7, severe sepsis 9 or 10, septic shock >= 11).
• The presence of concurrent pneumonia would have a greater impact than acute lung injury alone.
