among lung compartments, it was expected that they correlate closely. EFFi is easier to study, as it is noninvasive and may be continuously monitored. The study is limited to small groups. However, at health, the results show a low degree of variation, as expected from absence of variability caused by disease. The total separation between health and ARDS indicates that, in mechanically ventilated patients, EFFi may be useful for monitoring of ARDS evolution. This aspect is strengthened by the fact that EFFi may automatically, continuously, and noninvasively be monitored in the individual patient, who then serves as his own standard of reference. EFFi merits further studies in broad materials covering ARDS and other diseases, performed with modern capnographic equipment. n Author disclosures are available with the text of this letter at www.atsjournals.org.
IntroductionThe study was designed to assess the impact of fluid loading on lung aeration, oxygenation and hemodynamics in patients with septic shock and acute respiratory distress syndrome (ARDS).MethodsDuring a 1-year period, a prospective observational study was performed in 32 patients with septic shock and ARDS. Cardiorespiratory parameters were measured using Swan Ganz (n = 29) or PiCCO catheters (n = 3). Lung aeration and regional pulmonary blood flows were measured using bedside transthoracic ultrasound. Measurements were performed before (T0), at the end of volume expansion (T1) and 40 minutes later (T2), consisting of 1-L of saline over 30 minutes during the first 48 h following onset of septic shock and ARDS.ResultsLung ultrasound score increased by 23% at T2, from 13 at baseline to 16 (P < 0.001). Cardiac index and cardiac filling pressures increased significantly at T1 (P < 0.001) and returned to control values at T2. The increase in lung ultrasound score was statistically correlated with fluid loading-induced increase in cardiac index and was not associated with increase in pulmonary shunt or regional pulmonary blood flow. At T1, PaO2/FiO2 significantly increased (P < 0.005) from 144 (123 to 198) to 165 (128 to 226) and returned to control values at T2, whereas lung ultrasound score continued to increase.ConclusionsEarly fluid loading transitorily improves hemodynamics and oxygenation and worsens lung aeration. Aeration changes can be detected at the bedside by transthoracic lung ultrasound, which may serve as a safeguard against excessive fluid loading.
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