A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients

Antonio Anile, Jole Russo, Giacomo Castiglione, Giovanni Volpicelli, Antonio Anile, Jole Russo, Giacomo Castiglione, Giovanni Volpicelli

Abstract

Background: The quantification of B-lines at lung ultrasonography is a valid tool to estimate the extravascular lung water (EVLW) in patients after major cardiac surgery. However, there is still uncertainty about the correlation between B-lines and EVLW in a general population of critically ill.

Aim: To evaluate a simplified lung ultrasonographic assessment as a tool to estimate the EVLW in critically ill patients admitted to a polyvalent intensive care unit (ICU).

Methods: Nineteen consecutive critically ill patients requiring mechanical ventilation and hemodynamic monitoring were enrolled. Lung ultrasonography and the thermodilution methodology (PiCCO system) were performed by two independent operators. The positive scan at lung ultrasound was defined by visualization of at least 3 B-lines. We then compared the number of chest areas positive for B-lines with the EVLW index obtained by the invasive procedure.

Results: A significant correlation was found between the number of lung quadrants positive for B-lines and EVLW indexed using both actual body weight (rho = 0.612 p = 0.0053) and predicted body weight (rho = 0.493 p = 0.032). Presence of more than 3 positive lung quadrants showed a good performance in identifying an EVLW index value >10 ml/kg of actual body weight(area under the ROC 0.894; 95% CI 0.668-0.987 p < 0.0001). Presence of of more than 4 positive lung quadrants indentified an EVLW index value >10 ml/kg of predicted body weight (area under the ROC 0.8; 95% CI 0.556-0.945 p = 0.0048).

Conclusion: A simplified lung ultrasound approach can by used as a reliable noninvasive bedside tool to predict EVLW in emergency and critically ill patients.

Figures

Fig. 1
Fig. 1
Correlation between the number of chest quadrants positive for B-lines at lung ultrasound and the values of EVLW/kg ABW. Spearman (rho) rank correlation test: sample size—19; Spearman’s coefficient of rank correlation (rho)—0.162; significance level—p = 0.0053; 95% confidence interval for rho—0.219 to 0.834
Fig. 2
Fig. 2
Correlation between the number of chest quadrants positive for B-lines at lung ultrasound and the values of EVLW/kg PBW. Spearman (rho) rank correlation test: sample size—19; Spearman’s coefficient of rank correlation (rho)—0.493; significance level—p = 0.032; 95% confidence interval for rho—0.499 to 0.774
Fig. 3
Fig. 3
Receiver operative characteristic (ROC) curve for EVLW/kg ABW
Fig. 4
Fig. 4
Receiver operative characteristic (ROC) curve for EVLW/kg PBW

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