Evaluating Extravascular Lung Water in Sepsis: Three Lung-Ultrasound Techniques Compared against Transpulmonary Thermodilution

Pirompanich, Pattarin; Karakitsos, Dimitrios; Alharthy, Abdulrahman; Gillman, Lawrence M.; Blaivas, Michael; Buchanan, Brian; Brindley, Peter G.; Wattanathum, Anan

doi:10.4103/ijccm.ijccm_256_18

Cited by 13 publications

(8 citation statements)

References 36 publications

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“…45 The original protocol is based on the 28-sector scan, but most studies correlating B-lines to EVLWI used a simplified 4-sector 25,26 or 8-sector scan. 17 The only study so far comparing all different protocols with EVLWI was performed in a total of 89 critically ill patients with sepsis 46 : Pirompanich et al described a high specificity of 28-sector, 4-sector and 8-sector scan in diagnosing EVLWI ≥ 10, whereas sensitivity was quite low for 4-sector and 8-sector scan. According to our results, both 28-BL as well as 4s-BL showed sufficiently high ability to identify pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients

Mayr

Lukas

Habenicht

et al. 2020

J Intensive Care Med

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Introduction: Visualization of B-lines via lung ultrasound provides a non-invasive estimation of pulmonary hydration. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) assessed by transpulmonary thermodilution (TPTD) represent the most validated parameters of lung water and alveolocapillary permeability, but measurement is invasive and expensive. This study aimed to compare the correlations of B-lines scores from extensive 28-sector and simplified 4-sector chest scan with EVLWI and PVPI derived from TPTD in the setting of intensive care unit (primary endpoint). Methods: We performed scoring of 28-sector and 4-sector B-Lines in 50 critically ill patients. TPTD was carried out with the PiCCO-2-device (Pulsion Medical Systems SE, Maquet Getinge Group). Median time exposure for ultrasound procedure was 12 minutes for 28-sector and 4 minutes for 4-sector scan. Results: Primarily, we found close correlations of 28-sector as well as 4-sector B-Lines scores with EVLWI (R2 = 0.895 vs. R2 = 0.880) and PVPI (R2 = 0.760 vs. R2 = 0.742). Both B-lines scores showed high accuracy to identify patients with specific levels of EVLWI and PVPI. The extensive 28-sector B-lines score revealed a moderate advantage compared to simplified 4-sector scan in detecting a normal EVLWI ≤ 7 (28-sector scan: sensitivity = 81.8%, specificity = 94.9%, AUC = 0.939 versus 4-sector scan: sensitivity = 81.8%, specificity = 82.1%, AUC = 0.902). Both protocols were approximately equivalent in prediction of lung edema with EVLWI ≥ 10 (28-sector scan: sensitivity = 88.9%, specificity = 95.7%, AUC = 0.977 versus 4-sector scan: sensitivity = 81.5%, specificity = 91.3%, AUC = 0.958) or severe pulmonary edema with EVLWI ≥ 15 (28-sector scan: sensitivity = 91.7%, specificity = 97.4%, AUC = 0.995 versus 4-sector scan: sensitivity = 91.7%, specificity = 92.1%, AUC = 0.978). As secondary endpoints, our evaluations resulted in significant associations of 28-sector as well as simplified 4-sector B-Lines score with parameters of respiratory function. Conclusion: Both B-line protocols provide accurate non-invasive evaluation of lung water in critically ill patients. The 28-sector scan offers a marginal advantage in prediction of pulmonary edema, but needs substantially more time than 4-sector scan.

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Section: Discussionmentioning

confidence: 99%

B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients

Mayr

Lukas

Habenicht

et al. 2020

J Intensive Care Med

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“…To quantify the degree of pulmonary congestion, we used a comprehensive approach, in which 28 predefined points were scanned for B-lines. This approach, first used by Jambrik et al [37], seems to have a better diagnostic accuracy for EVLW assessment than others [57]. However, we did not analyse the relationship between B-lines and lung surface abnormalities, which might have caused at least some of the B-lines seen on LU [48].…”

Section: Study Strengths and Limitationsmentioning

confidence: 86%

Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial

et al. 2021

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The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose of this trial was to evaluate if a BLS-guided fluid management strategy could improve fluid balance and short-term mortality in surgical intensive care unit (ICU) patients. We conducted a randomised, controlled trial within the ICUs of two university hospitals. Critically ill patients were randomised upon ICU admission in a 1:1 ratio to BLS-guided fluid management (active group) or standard care (control group). In the active group, BLS was monitored daily until ICU discharge or day 28 (whichever came first). On the basis of BLS, different targets for daily fluid balance were set with the aim of avoiding or correcting moderate/severe EVLW increase. The primary outcome was 28-day mortality. Over 24 months, 166 ICU patients were enrolled in the trial and included in the final analysis. Trial results showed that daily BLS monitoring did not lead to a different cumulative fluid balance in surgical ICU patients as compared to standard care. Consecutively, no difference in 28-day mortality between groups was found (10.5% vs. 15.6%, p = 0.34). However, at least 400 patients would have been necessary for conclusive results.

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“…This is clinically associated with pulmonary edema. 2 The increase in lung water content further impairs lung function which is essential for oxygenation. 3 Studies have shown that the reduction of EVLW results in a favorable change in outcome.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit

Mustafi,

Talwar,

Krishna

et al. 2024

Indian Journal of Critical Care Medicine

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A bstract Background Lung ultrasound (LUS) is a simple bedside tool to assess overhydration. Our study aimed to assess extravascular lung water (EVLW) using B-lines and correlate it with weaning, duration of mechanical ventilation, and mortality in critically ill patients admitted to the intensive care unit (ICU). Patients and methods 150 mechanically ventilated ICU patients prospectively observed over 18 months, with their demographic and clinical data noted. Extravascular lung water was monitored using LUS in four intercostal spaces (ICS) from day 1 to day 5, day 7, day 10, and weekly thereafter. Pulmonary fluid burden was graded as low (1–10), moderate (11–20), and high (21–32). Weaning outcome, duration of weaning, mechanical ventilation, ICU stay, and mortality were compared in patients with and without EVLW. Results Out of 150, 54 patients (36.0%) had EVLW. The mean lung score amongst our patients was 8.57 ± 6.0. The mean time for detection of EVLW was 1.43 ± 2.24 days. Lung score was low in 40 (26.67%) patients, moderate in 9 (6.00%) patients, and high in 5 (3.33%) patients. Incidence of weaning failure ( p -value = 0.006), duration of weaning, mechanical ventilation, ICU stay ( p -value < 0.0001 each), and overall mortality were significantly higher in patients with EVLW ( p -value = 0.006). Conclusion We conclude that a good proportion of critically ill patients have EVLW. Extravascular lung water significantly increases the duration of weaning, mechanical ventilation days, ICU stay, and overall mortality in critically ill patients. How to cite this article Rajpal M, Talwar V, Krishna B, Mustafi SM. Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2024;28(2):165–169.

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Evaluating Extravascular Lung Water in Sepsis: Three Lung-Ultrasound Techniques Compared against Transpulmonary Thermodilution

Cited by 13 publications

References 36 publications

B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients

B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients

Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial

Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit

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