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VOLUME 18 , ISSUE 4 ( April, 2014 ) > List of Articles

RESEARCH ARTICLE

Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation

Pongdhep Theerawit, Nutchanart Touman, Yuda Sutherasan, Sumalee Kiatboonsri

Keywords : extravascular lung water, lung comet, lung leakage, lung ultrasound, sonographic B-line

Citation Information : Theerawit P, Touman N, Sutherasan Y, Kiatboonsri S. Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation. Indian J Crit Care Med 2014; 18 (4):195-199.

DOI: 10.4103/0972-5229.130569

License: CC BY-ND 3.0

Published Online: 01-04-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Several studies have shown that the number of B-lines was related to the amount of extravascular lung water (EVLW). In our study, we aimed to demonstrate the magnitude of the incremental B-lines in shock patients with positive net fluid balance and the association with gas exchange impairment. Materials and Methods: We performed trans-thoracic ultrasound at admission (T 0) and at follow-up period (T FL) to demonstrate the change of B lines (ΔB-lines) after fluid therapy. We compared the total B-line score (TBS) at T 0 and T FL and calculated the Pearson′s correlation coefficient between the ΔB-lines and PaO 2 /FiO 2 ratio. Results: A total of 20 patients were analyzed. All patients had septic shock. Net fluid balance was + 2228.05 ± 1982.15 ml. The TBS at T 0 and T FL were 36.6 ± 23.73 and 63.80 ± 29.25 (P < 0.01). The ΔB-lines along anterior axillary line (AAL) correlated to the TBS (r = 0.90, P < 0.01). The ΔB-lines along AAL had inverse correlation to PaO 2 /FiO 2 ratio (r = −0.704, P < 0.05). The increase of B-lines ≥ 10 was related to the decrease of PaO 2 /FiO 2 ratio. The inter-observer reliability between two ultrasound readers was high (r = 0.92, P < 0.01). Discussion: The number of B-lines increased in shock patients with positive net fluid balance and correlated to impaired oxygenation. These data supported the benefit of ultrasound for assessing the EVLW.


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