Role of lung ultrasound in assessment of endpoint of fluid therapy in patients with hypovolemic shock

Abstract

Background: Different techniques are employed to assess the endpoint of fluid therapy in hypovolemic patients. Lung ultrasound (US) is increasingly becoming a diagnostic tool in the critical care setting, providing standardized data. The present study aimed to evaluate the role of lung US in comparison to central venous pressure (CVP) in assessment of endpoint of fluid therapy in patients with hypovolemic shock. Patients and methods: Observational cross-sectional study carried in 60 adult patients with hypovolemic shock admitted to the intensive care unit received lactated Ringer's solution. CVP, blood pressure (BP), urine output (UOP), and lung US score were recorded on admission and during the period of resuscitation. Lung US score was correlated with CVP, BP, and UOP and evaluated in assessment of endpoint fluid therapy in comparison to CVP as a gold standard. Results: There was a significant increase in CVP, BP, UOP,and lung US score during fluid resuscitation. Lung US showed a significant positive correlation with CVP, BP, and UOP at different stages of fluid resuscitation. Lung US score showed a sensitivity of 95.7%, specificity of 92.9% with a positive predictive value of 97.8% negative predictive value of 86.7%, and the total accuracy was 95%. Conclusion:Lung US provides a simple noninvasive approach in assessment of endpoint (score ≥16) of fluid therapy in patients with hypovolemic shock with high sensitivity and specificity.

American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma: Clinical protocol for damage-control resuscitation for the adult trauma patient

“…are well studied in shock. 118,119 Although there is strong physiologic rationale for these in addition to other resuscitation endpoints (e.g., urine output), validating reports in trauma patients are limited.…”

“…Capillary refill and cardiac/lung ultrasound (pulmonary edema, ventricular filling, inferior vena cava respiratory variability, cardiac function, etc.) are well studied in shock 118,119 . Although there is strong physiologic rationale for these in addition to other resuscitation endpoints (e.g., urine output), validating reports in trauma patients are limited.…”