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.
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.
Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest 2002;122:2080-6.
Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, et al. Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med 2010;38:114-20.
Maddison B, Giudici R, Calzia E, Wolff C, Hinds C, Radermacher P, et al. Extravascular lung water volume measurement by a novel lithium-thermal indicator dilution method: Comparison of three techniques to post-mortem gravimetry. Intensive Care Med 2008;34:2106-11.
Katzenelson R, Perel A, Berkenstadt H, Preisman S, Kogan S, Sternik L, et al. Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med 2004;32:1550-4.
Kirov MY, Kuzkov VV, Kuklin VN, Waerhaug K, Bjertnaes LJ. Extravascular lung water assessed by transpulmonary single thermodilution and postmortem gravimetry in sheep. Crit Care 2004;8:R451-8.
Michard F. Bedside assessment of extravascular lung water by dilution methods: Temptations and pitfalls. Crit Care Med 2007;35:1186-92.
Michard F, Schachtrupp A, Toens C. Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients. Crit Care Med 2005;33:1243-7.
Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: Bedside lung ultrasound in critical care practice. Crit Care 2007;11:205.
Soldati G, Copetti R, Sher S. Sonographic interstitial syndrome: The sound of lung water. J Ultrasound Med 2009;28:163-74.
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol. Chest 2008;134:117-25.
Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF. Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. Am J Emerg Med 2008;26:585-91.
Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Thomas SH, Harris NS. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest 2007;131:1013-8.
Noble VE, Murray AF, Capp R, Sylvia-Reardon MH, Steele DJ, Liteplo A. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution. Chest 2009;135:1433-9.
Pistolesi M, Giuntini C. Assessment of extravascular lung water. Radiol Clin North Am 1978;16:551-74.
Giuntini C, Pistolesi M, Miniati M, Fazio F. Theoretical and practical considerations of measuring extravascular lung water. J Thorac Imaging 1988;3:36-43.
Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 1997;156:1640-6.
Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE. Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 1985;88:649-52.