The Promising Role of Lung Ultrasound in Assessment of Volume Status for Patients Receiving Maintenance Renal Replacement Therapy

Koratala, Abhilash; Ronco, Claudio; Kazory, Amir

doi:10.1159/000505529

Cited by 19 publications

(21 citation statements)

References 21 publications

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“…In this study, only six zones were investigated. Other groups have recommended up to 28 zones for LUS examination [ 12 , 20 , 26 ]. However, with a six zone LUS, an overall impression of the lung status was achieved.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

et al. 2020

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The COVID-19 pandemic has increased the need for an accessible, point-of-care and accurate imaging modality for pulmonary assessment. COVID-19 pneumonia is mainly monitored with chest X-ray, however, lung ultrasound (LUS) is an emerging tool for pulmonary evaluation. In this study, patients with verified COVID-19 disease hospitalized at the intensive care unit and treated with ventilator and extracorporal membrane oxygenation (ECMO) were evaluated with LUS for pulmonary changes. LUS findings were compared to C-reactive protein (CRP) and ventilator settings. Ten patients were included and scanned the day after initiation of ECMO and thereafter every second day until, if possible, weaned from ECMO. In total 38 scans adding up to 228 cineloops were recorded and analyzed off-line with the use of a constructed LUS score. The study indicated that patients with a trend of lower LUS scores over time were capable of being weaned from ECMO. LUS score was associated to CRP (R = 0.34; p < 0.03) and compliance (R = 0.60; p < 0.0001), with the strongest correlation to compliance. LUS may be used as a primary imaging modality for pulmonary assessment reducing the use of chest X-ray in COVID-19 patients treated with ventilator and ECMO.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

et al. 2020

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“…Lung POCUS can detect extravascular lung water before the onset of symptoms, even outperforming chest radiography in diagnosing cardiogenic pulmonary edema [59,106]. In normal state, the lung tissue is not visualized on ultrasound as the underlying air scatters the ultrasound beam.…”

Section: Lung Pocusmentioning

confidence: 99%

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Koratala¹,

Ronco²,

Kazory³

2022

Cardiorenal Med

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Fluid overload has been associated with morbidity and mortality in various clinical scenarios including heart failure and critical illness. It exerts pathologic sequelae in almost all the organ systems. Proper management of patients with fluid overload requires knowledge of the underlying pathophysiology, objective evaluation of volume status, selection of appropriate therapeutic options, and maintenance and modulation of tissue perfusion. There are several methods to appraise volume status but none without limitations. In this review, we discuss the diagnostic utility, prognostic significance, and shortcomings of various bedside tools in the detection of fluid overload and evaluation of hemodynamic status. These include clinical examination, biomarkers, blood volume assessment, bioimpedance analysis, point-of-care ultrasound, and remote pulmonary pressure monitoring. In our opinion, clinicians must adopt a multiparametric approach offsetting the limitations of individual methods to formulate a management plan tailored to patients’ needs.

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“…Lung ultrasound (LUS) can detect extravascular lung water even before the congestion is clinically apparent and is increasingly used by nephrologists [57]. In fact, it outperforms a chest radiograph in ruling out interstitial edema and pleural effusion [58].…”

Section: The Leaksmentioning

confidence: 99%

Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

Koratala

Kazory

2021

Cardiorenal Med

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Background: Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. Summary: Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. Key Messages: Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.

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The Promising Role of Lung Ultrasound in Assessment of Volume Status for Patients Receiving Maintenance Renal Replacement Therapy

Cited by 19 publications

References 21 publications

COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

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