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VOLUME 23 , ISSUE 3 ( March, 2019 ) > List of Articles

ORIGINAL ARTICLE

Lung Ultrasound as a Bedside Tool for Assessment of Extravascular Lung Water in Critically Ill Head Injured Patients: An Observational Study

Vasavi Gattupalli, Kajal Jain, Tanvir Samra

Keywords : Critical care, imaging, ultrasonography, extravascular lung water

Citation Information : Gattupalli V, Jain K, Samra T. Lung Ultrasound as a Bedside Tool for Assessment of Extravascular Lung Water in Critically Ill Head Injured Patients: An Observational Study. Indian J Crit Care Med 2019; 23 (3):131-134.

DOI: 10.5005/jp-journals-10071-23135

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Extra Vascular Lung Water (EVLW) is defined as the amount of fluid in the interstitial and alveolar spaces. Primary aim of this study was to assess EVLW using lung USG (B lines >3 per lung field) in critically ill head injured patients. Methods: Intubated adult patients admitted in Trauma ICU with head injury (GCS 4-15) were assessed by daily chest x ray and lung ultrasonography. Lung water content was graded based on the number of B lines per ICS with score ranging from 0-32 and categorized as low pulmonary fluid burden (0-10), moderate fluid burden (11-20) and high fluid burden (21-32). Results: 140 critically ill head injured patients were assessed for eligibility and 20 excluded. Incidence of increased EVLW using lung USG was 61.66% (74/120) and the incidence reported using chest x ray was 40.83%(49/120) and the difference was statistically significant (p value <0.001). Increased EVLW significantly increased the duration of weaning, mechanical ventilation and ICU stay (p value <0.05). Significant association was observed between APACHE II, SAPS II and GCS at admission to ICU with presence of EVLW (p value ≤0.001). Mean delay in identification of EVLW by chest x ray compared to lung ultrasound was 1.42±0.76 days. Conclusion: Lung ultrasound is better than CXR for early detection of increased EVLW in critically ill head injured patients and has prognostic relevance as increased EVLW prolongs duration of mechanical ventilation and ICU stay.


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  1. Bongard FS, Matthay M, Mackersie RC, Lewis FR: Morphologic and physiologic correlates of increased extravascular lung water. Surgery 1984; 96: 395–403.
  2. Yu CM, Wang L, Chau E. Intrathoracic impedance monitoring in patients with heart failure: Correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 2005; 112: 841-8.
  3. Soldati G, Copetti R, Sher S. Sonographic interstitial syndrome: the sound of lung water. J Ultrasound Med. 2009; 28: 163–74.
  4. Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA Patel R et al. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003; 55: 106-11
  5. Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jorres A, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care 2015; 6: 1-8
  6. Simmons RL, Martin AM, Heisterkamp CA, Ducker TB. Respiratory insufficiency in combat casualities: II-pulmonary edema following head injury. Ann Surg. 1969; 170: 39-44.
  7. Weisman SJ. Edema and congestion of the lungs resulting from intracranial hemorrhage. Surgery 1939; 6: 722-9.
  8. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008; 134: 117-25.
  9. Theodore J, Robin ED. Speculations on neurogenic pulmonary edema (NPE). Am Rev Respir Dis. 1976; 113: 405-11.
  10. Ott L, McClain CJ, Gillespie M, Young B. Cytokines and metabolic dysfunction after severe head injury. J Neurotrauma. 1994; 11: 447-72.
  11. Bratton SL, Davis RL. Acute lung injury in isolated traumatic brain injury. Neurosurgery. 1997; 40: 707-12.
  12. Bilotta F, Giudici LD, Zeppa IO, Guerra C, Stazi E, Rosa G et al. Ultrasound imaging and use of B-lines for functional lung evaluation in neurocritical care:a prospective, observational study. Eur J Anaesthesiol 2013; 30: 464–8.
  13. Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic value of extravascular lung water in critically ill patients. Chest 2002; 122: 2080–6.
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