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

Abstract

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.

Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE): protocol for a multicentre randomised controlled trial

“…One recently published small RCT of LUS-guided deresuscitation in 176 surgical ICU patients found no differences in CFB nor an effect on 28-day or 90-day mortality when daily LUS was compared to routine care [ 29 ]. However, this study had several limitations.…”

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

“…[14][15][16][17][18] Ultrasound has also been used to guide fluid resuscitation in patients with septic shock (eg, using lung ultrasound B-line scores) and fluid management in patients with extravascular pulmonary water. [19] Cardiac function and fluid responsiveness of patients can be assessed by monitoring cardiac structure size, left ventricular ejection fraction, and left ventricular outflow tract velocity time integral (LVOT-VTI). [15,20,21] Furthermore, fluid responsiveness can be more accurately assessed by the diameter of the inferior vena cava (IVC) and the degree of morphological variability.…”