MO737EVALUATION OF EXTRAVASCULAR FLUID IN HEMODIALYSIS PATIENTS BY LUNG ULTRASOUND IN COMPARISON WITH BIOIMPEDANCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anastasiia Putintceva ◽  
Irina Zdanova ◽  
Ekaterina Tsukanova ◽  
Julia Fadeeva ◽  
Ashot Esayan
Keyword(s):  
Lung Ultrasound ◽  
Statistical Significance ◽  
The Body ◽  
Water Volume ◽  
Maintenance Hemodialysis ◽  
Hydration Status ◽  
Lung Water ◽  
Cardiac Pacemakers ◽  
Fluid Status ◽  
B Lines

Abstract Background and Aims The aim of study was to compare the lung ultrasound (LUS) and bioimpedance analysis (BIA) as methods to assess the hydration (fluid) status in maintenance hemodialysis (MHD) patients. Method The comparative analysis was performed in 87 MHD patients aged 24 to 82 years (43 women, and 44 men). Patients with cardiac pacemakers and permanent catheters as vascular access were excluded from the study. Extravascular lung water (EVLW) in MHD patients was assessed simultaneously by LUS (Acuson X150 ultrasound system with a CH5-2 curvilinear transducer, Siemens) and by the bioimpedance spectroscopy (BIS) (Bodystat Multiscan 5000) with frequency range of 5-1000K Hz. Both LUS and BIS were performed before and 30 minutes after the hemodialysis (HD) session in the second and third sessions of the week. Ultrasonic measurements were performed by summing LUS comets or B-lines along four anatomical lines (parasternal, mid-clavicular, anterior, middle, and posterior axillary lines) from II to V intercostal spaces on the right and from the II to IV intercostal spaces on the left. The quantitative assessment of B-lines (B-lines score, BLS) was performed according to Picano E. et al. [2006]: normohydration – zero degree (<4 B lines) with the absence of EVLW, overhydration (OH) – 1st degree (5-14 BLS), 2nd degree OH (15-30 BLS), and 3d degree OH – >30 BLS with an insignificant, moderate and severe amount of EVLW, respectively. The body hydration status assessment technique by BIS was based on the overhydration (OH) index, the total body water volume, extra- and intracellular water, and the body composition. Patient's fluid status classified as normohydration (1.0-1.0 L), moderate OH (>1.0-<2.5 L), and severeOH (>2.5 L), and dehydration (<1.0 L) [Henry C. Lukaski et al., 2019]. The LUS do not allow assessing the state of dehydration, therefore, the normohydration by LUS was the sum of normo- and dehydration by BIS. We used SPSS Statistics 21.0 software for statistical processing of the data. To assess the correlation between BLS and OH indicators, we used Spearman's rank correlation coefficient. The statistical significance level was assumed to be 0.05. Results Data of the body fluid status using LUS and BIS before and after HD-session fully coincided in 33 of 87 MHD patients, partially coincided in 20 patients before and in 25 patients after HD-session. LUS and BIS didn’t coincide completely in only 9 patients. Statistically significant correlation was revealed between BLS and OH before (Rs=0.336; p<0.01), and after (Rs=0,317, p<0,01) HD session. A positive correlation between BLS and OH data was revealed in 53 patients, whose results were almost identical before (Rs=0,488, p<0.01), and in 58 patients after (Rs=0,658, p<0.01) HD session. Conclusion BIS remains the gold standard for the assessment of over-, normo- and dehydration in MHD patients. LUS is a simple and adequate technique for assessing the hydration status in MHD patients, and it is comparable to BIS in assessing over-, as well as normohydration. However, the LUS doesn’t allow diagnosing the body dehydration.

scholarly journals Optic nerve ultrasound for fluid status assessment in patients with severe preeclampsia

2018 ◽  
Vol 52 (4) ◽  
pp. 377-382 ◽  
Author(s):  
Gabrijela Brzan Simenc ◽  
Jana Ambrozic ◽  
Katja Prokselj ◽  
Natasa Tul ◽  
Marta Cvijic ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Lung Ultrasound ◽  
Optic Nerve Sheath Diameter ◽  
Severe Preeclampsia ◽  
Nerve Ultrasound ◽  
Lung Water ◽  
Fluid Status ◽  
Status Assessment ◽  
The Relationship ◽  
B Lines

AbstractBackgroundThere are no data on usefulness of optic nerve sheath diameter (ONSD) as a marker of patient’s fluid status in preeclampsia. The objective was to examine potential correlation between ONSD and lung ultrasound estimates of extravascular lung water in severe preeclampsia.Patients and methodsThirty patients with severe preeclampsia were included. Optic and lung ultrasound were performed within 24 hours from delivery. ONSD was measured 3 mm behind the globe. Lung ultrasound Echo Comet Score (ECS) was obtained summing B-lines (“comet tails”) in parasternal intercostal spaces bilaterally. Pearson’s correlation analysis was used to assess the relationship between ONSD and ECS (p < 0.05 significant).ResultsMedian ONSD was 5.7 mm (range 3.8–7.5 mm). Median ECS value was 19 (range 0-24). Statistically significant correlation was found between ONSD and ECS (r2= 0.464; p < 0.001).ConclusionsSignificant correlation between ONSD and ECS suggests optic ultrasound could be used for assessing fluid status and guiding peripartum fluid therapy in patients with severe preeclampsia.

scholarly journals Lung Ultrasound B-lines Occurrence in Relation to Left Ventricular Function and Hydration Status in Hemodialysis Patients

Medicina ◽  
2019 ◽  
Vol 55 (2) ◽  
pp. 45
Author(s):  
Agnieszka Pardała ◽  
Mariusz Lupa ◽  
Jerzy Chudek ◽  
Aureliusz Kolonko
Keyword(s):  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hydration Status ◽  
Multivariate Linear Regression Analysis ◽  
Ventricular Ejection Fraction ◽  
Fluid Status ◽  
B Lines

Background and objective: Reliable assessment of the fluid status in hemodialysis (HD) patients is often difficult. A lung ultrasound with an assessment of the B-lines (“lung comets” (LCs)) number is a novel hydration status measure. However, the occurrence of left ventricular dysfunction may have a significant effect on pulmonary congestion and further modulate the LC number. The aim of this study was to analyze to what extent left ventricular dysfunction, pulmonary hypertension, and hypervolemia affect the occurrence of LC in a cohort of prevalent HD patients. Material and methods: This cross-sectional study included 108 assessments performed in 54 patients who attended thrice weekly outpatient HD. Each patient’s fluid status was evaluated twice, prior to HD sessions, using echocardiography, LC number assessment, measurement of inferior vena cava (IVC) diameters, and bioelectric impedance analysis (BIA). Patients were stratified into three subgroups according to their LC number. Results: There were 76 separate assessments with mild (<14), 16 with moderate (14–30), and 16 with severe (>30) LC occurrence. There was a negative correlation between the LC number and left ventricular ejection fraction (LVEF), and positive correlations between the LC number and mitral gradient, and the left and right atrium area and volume, but not with the BIA-derived relative fluid overload. Multivariate linear regression analysis revealed that the LC number was proportionally related to the mitral gradient (β = 0.407 (0.247–0.567), p < 0.001) and IVC max diameter (β = 0.219 (0.060–0.378), p < 0.01), and was inversely related to LVEF (β = −0.431 (−0.580 to −0.282), p < 0.001). Conclusions: The number of LCs appears to reflect both overhydration and left ventricular dysfunction in our HD patients cohort. Therefore, heart failure must be considered as an important factor limiting the usefulness of LCs number assessment in this population.

FC 104CARDIAC GEOMETRY, FUNCTION, AND REMODELING PATTENRS AND LUNG WATER CONTENT IN PATIENTS UNDER MAINTENANCE HEMODIALYSIS AND PERITONEAL DIALYSIS TREATMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Charalampos Loutradis ◽  
Maria Eleni Alexandrou ◽  
Vassilios Sachpekidis ◽  
Christodoulos Papadopoulos ◽  
Vasileios Kamperidis ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Linear Regression ◽  
Diastolic Function ◽  
Lung Ultrasound ◽  
Systolic Function ◽  
Hemodialysis Patients ◽  
Right Atrial ◽  
Lung Water ◽  
Lung Water Content ◽  
B Lines

Abstract Background and Aims Cardiovascular disease is the leading cause of mortality in patients with end-stage kidney disease (ESKD). Evidence on the possible echocardiographic differences between patients undergoing different dialysis modalities is scarce. This study aimed to evaluate differences in left (LA) and right atrial (RA) and left (LV) and right ventricular (RV) geometry, systolic and diastolic function, as well as lung water content in hemodialysis and peritoneal dialysis (PD) patients. Method A total of 38 hemodialysis and 38 PD patients receiving treatment for ≥3 months, matched in a 1:1 ratio for age, sex and dialysis vintage were included in this study. Lung ultrasound, two-dimensional and tissue-Doppler echocardiography were performed during an interdialytic day in hemodialysis and before a programmed follow-up visit in PD patients. To identify factors possible associated with LVH (left ventricular hypertrophy), we performed univariate and multivariate linear regression analyses in the total population studied. Results No significant differences were evidenced in ultrasound B-lines (4.00 [6.00] vs 3.00 [4.25]; p=0.623) between the two groups. Vena cava diameter (11.09±4.53 vs 14.91±4.30 mm; P&lt;0.001) was significantly lower in hemodialysis patients. Indices of LA, RA, LV and RV dimensions were similar between the two groups. LVMi (116.91 [38.56] vs 122.83 [52.33] g/m2; P=0.767) was similar, but relative wall thickness (RWT) was marginally (0.40 [0.14] vs 0.45 [0.15] cm; P=0.055) lower in hemodialysis patients. LV hypertrophy prevalence, defined as LVMi values &gt;95 or &gt;115 g/m2 for female and male patients, was similar between groups (73.7% vs 71.1%; p=0.798), but relative wall thickness (RWT) was numerically lower (0.40 [0.14] vs 0.45 [0.15] cm; P=0.055) and fractional shortening (29.12±7.07% vs 23.37±8.84%; P=0.003) was significantly higher in patients under hemodialysis compared to those under PD. Hemodialysis patients presented mainly eccentric (normal RWT and increased LVMi), while PD patients presented mainly concentric LVH (increased RWT and increased LVMi). Left atrial (LA), right atrial (RA) and ventricular (RV) echocardiographic indices were again similar between the two study groups. Ventricular systolic function was similar between-groups, except for stroke volume (78.97 [24.24] vs 64.66 [27.35] ml; P=0.030) and cardiac output (5.75 [2.29] vs 4.93 [2.10] L/min; P=0.036) which were higher in hemodialysis. With regards to RV systolic function indices, RV systolic pressure (RVSP) was significantly lower in the hemodialysis compared to the PD group (20.37 [22.54] vs 27.68 [14.32] mmHg; P=0.009). All diastolic function indices were similar between the two groups. Prevalence of mitral valve (MV) regurgitation was significantly lower in the hemodialysis group (10.5% vs 39.5%; p=0.004). According to the results of multivariate linear regression analysis, only male gender (β=20.677, 95%CI: 3.479 to 37.874; P=0.019) and number of US-B lines (β=0.892, 95%CI:0.071 to 1.713; P=0.034) were independently associated with LVMi. Conclusion Hemodialysis and PD patients present similar volume overload, evaluated with lung ultrasound, and no significant differences in echocardiographic indices reflecting cardiac geometry, but different patterns of abnormal LV remodeling was evident in each dialysis modality, with hemodialysis presenting eccentric and PD concentric LVH. These results clearly support that PD is no better than HD with regards to cardiovascular stress, despite the fact that they experience a more stable volume status.

P1185LUNG COMETS AND EVALUATION OF HYDRATION STATUS IN PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Robert Ekart ◽  
Lucijan Lucic Srajer ◽  
Katharina Marko ◽  
Nina Hojs ◽  
Sebastjan Bevc ◽  
...  
Keyword(s):  
Body Composition ◽  
Peritoneal Dialysis ◽  
The Body ◽  
Whole Body ◽  
Fluid Distribution ◽  
Hydration Status ◽  
Non Invasive ◽  
Fluid Status ◽  
Multifrequency Bioimpedance ◽  
Dialysis Vintage

Abstract Background and Aims Assessment of optimal hydration status in patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD) is a challenge. Multiple diagnostic options to determine hydration status in PD patients are available. Multifrequency bioimpedance spectroscopy (MBIS) is a cheap, simple and non-invasive method of estimating body composition, including estimates of total body water (TBW), extracellular water (ECW), intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Lung ultrasonography (LUS) and lung B-lines (lung comets) can be used for the evaluation of extravascular lung water. Ultrasound evaluation of inferior vena cava (UIVC) provides rapid, non-invasive assessment of a patient's hemodynamic and volume status. N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of our study was to assess fluid status in PD patients comparing four different methods: MBIS, LUS, UIVC and NT-proBNP. Method We performed a single-centre cohort study in 19 PD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany), LUS with portable US device (VScan, General Electrics Corporate), UIVC index with SonoSite US device. NT-proBNP was measured in a one-step sandwich chemiluminescent immunoassay (Dimension Vista® System 1500, Siemens Healthcare Diagnostics Inc., Newark, NJ, USA). Results The mean age of patients was 54 ± 10 years, mean dialysis vintage 53 (10-194) months, 63% were men. Thirteen (68.4%) patients had fluid overload (FO) &gt; 1.1 L. Data of patients are presented in table 1. We found a statistically significant correlation between the number of lung comets and ECW/ICW ratio (r = 0.496, P = 0.031) and NT-proBNP (r = 0.759, P &lt; 0.0001). In contrast, there was no significant correlation between the number of lung comets and UIVC (r = 0.221, P &lt; 0.364). Conclusion According to our results, LUS with lung comets, MBIS with ECW/ICW ratio and NT-proBNP are useful and complementary methods for evaluation of fluid status in PD patients.

scholarly journals A Pilot Study of Wet Lung Using Lung Ultrasound Surface Wave Elastography in an Ex Vivo Swine Lung Model

2019 ◽  
Vol 9 (18) ◽  
pp. 3923 ◽  
Author(s):  
Xiaoming Zhang ◽  
Boran Zhou ◽  
Alex X. Zhang
Keyword(s):  
Surface Wave ◽  
Pilot Study ◽  
Wave Speed ◽  
Lung Ultrasound ◽  
Ex Vivo ◽  
Lung Model ◽  
Water Volume ◽  
Lung Water ◽  
Wave Speeds ◽  
Lung Sample

Extravascular lung water (EVLW) is a basic symptom of congestive heart failure and other conditions. Computed tomography (CT) is standard method used to assess EVLW, but it requires ionizing radiation and radiology facilities. Lung ultrasound reverberation artifacts called B-lines have been used to assess EVLW. However, analysis of B-line artifacts depends on expert interpretation and is subjective. Lung ultrasound surface wave elastography (LUSWE) was developed to measure lung surface wave speed. This pilot study aimed at measureing lung surface wave speed due to lung water in an ex vivo swine lung model. The surface wave speeds of a fresh ex vivo swine lung were measured at 100 Hz, 200 Hz, 300 Hz, and 400 Hz. An amount of water was then filled into the lung through its trachea. Ultrasound imaging was used to guide the water filling until significant changes were visible on the imaging. The lung surface wave speeds were measured again. It was found that the lung surface wave speed increases with frequency and decreases with water volume. These findings are confirmed by experimental results on an additional ex vivo swine lung sample.

scholarly journals Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Huan Ma ◽  
Daozheng Huang ◽  
Minzhou Zhang ◽  
Xin Huang ◽  
Shiyu Ma ◽  
...  
Keyword(s):  
Extravascular Lung Water ◽  
Reliable Method ◽  
Lung Ultrasound ◽  
Water Volume ◽  
Lung Water

scholarly journals P659 Patterns of diastolic dysfunction and correlation with lung ultrasound B-lines among patients with end-stage renal disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C G Ureche ◽  
R Sascau ◽  
S Ailoaei ◽  
L Tapoi ◽  
C Statescu ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
End Stage Renal Disease ◽  
Lung Ultrasound ◽  
Doppler Imaging ◽  
Volume Index ◽  
Hydration Status ◽  
Stage Renal Disease ◽  
End Stage ◽  
B Lines

Abstract Background Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). The degree of diastolic dysfunction (DD) as assessed by the E/e’ ratio correlates with worsening eGFR and the presence of diastolic dysfunction is an independent predictor of mortality for these patients. Purpose This study aimed to evaluate the patterns of DD in patients with end-stage renal disease not on renal replacement therapy (RRT) and investigate the correlation with lung ultrasound B-lines as an indicator of the hydration status. Methods Population: CKD patients with eGFR &lt;15 ml/min/1.73 m2 referred for echocardiography. According to the ESC recommendations for DD assessment, the following parameters derived from conventional 2D echocardiography, tissue and conventional doppler imaging were used: average E/e’, septal and lateral e’ velocities, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVi), E/A, E wave velocity, EF. Lung B-lines were assessed at the same time by scanning 28 intercostal spaces (IS) on the antero-lateral chest, 2nd-5thIS along with the midaxillary, anterior axillary, midclavicular and parasternal lines. In each IS, the B-lines were counted from 0 = black lung to 10 = white lung. Results 60 patients (41 males) with an eGFR &lt; 15 ml/min/1.73 m2(CKD-EPI) were included (mean eGFR = 8.3 ml/min/1.73 m2). The mean age was 61 (range 19-83) years old and 28.9% were diabetic. The number of B-lines varied between 0 and 80, with a median of 21. Of the 60 patients enrolled, 19 patients (31.6%) had an EF of &lt;50%. All of them had at least grade I DD and an increased LAVi. 41 patients (68.3%) had a preserved EF (pEF) and among these, 33 had diastolic dysfunction (80.4%). Overall, 52 of the 60 patients enrolled (86.6%) had DD (54.5 % grade I, 42.4 % grade II, 3 % grade III). Mean E/e’, lateral and septal e’, LAVi, TR velocity and the grade of DD were independently correlated with the number of B-lines - as assessed by lung ultrasound (p = 0.03, r = 0.34; p = 0.005, r = 0.43; p = 0.01, r = 0.40; p = 0.04, r = 0.32; p = 0.04; r = 0.32 and p = 0.02; r = 0.37 respectively). Additionally, the number of B-lines correlated with eGFR (p = 0.0008; r = 0.51), hemoglobin (Hb) levels (p = 0.03: r = 0.33) and EF (p = 0.0002; r = 0.56). In multiple regression analysis of a model consisting of E/e’, eGFR, Hb and B-lines, the number of B-lines counted for 18% of the variance of E/e’ (R2= .118, p = 0.03, F = 4.833). Conclusions Our study confirms that DD is extremely common among patients with ESRD even in the presence of a pEF. Additionally, we proved for the first time the independent correlation between the number of B-lines as assessed by lung ultrasound and the grade of DD in ESRD patients not yet on RRT. As it correlates with worse prognosis and mortality, further studies are needed to determine whether improving DD in patients with ESRD translates into better outcomes.

scholarly journals P0612UTILITY OF BODY COMPOSITION MONITORING (BCM) TO CORRELATE FLUID STATUS AND AKI IN PATIENTS UNDERGOING MAJOR CARDIAC SURGERY AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rajeevalochana Parthasarathy ◽  
Madhusri Babu ◽  
Merina Alex ◽  
Preethi Nagesh ◽  
Milly Mathew ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Body Composition ◽  
Cardiac Surgery ◽  
Informed Consent ◽  
Fluid Overload ◽  
Statistical Significance ◽  
Extracellular Volume ◽  
Kidney Injury ◽  
The Body ◽  
Fluid Status

Abstract Background and Aims Technically assisted assessment of volume status before cardiac surgery may be useful to direct intraoperative fluid administration. Using a three-compartment physiologic tissue model, the body composition monitor (BCM, In Body) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. Fluid overload is a risk factor for infection, increased re intubation rates, pneumonia and acute kidney injury in these high risk patients. This study is planned to use BCM to assess fluid status in patients undergoing cardiac surgery and correlating it with the risk of AKI AIMS: To do BCM analysis of patients undergoing major cardiac surgery to assess fluid status and renal outcomes Primary Objective To use BCM to assess fluid status in patients undergoing cardiac surgery and correlate it with the risk of acute kidney injury Secondary Objectives To assess the correlation of fluid status obtained by BCM to assess 1. In hospital mortality in patients with and without AKI Method The studyis being conducted at Madras Medical Mission, Chennai. Time period : 1 year ( June 1 2019- May 31 2020) Inclusion criteria All consecutive patients above 18 years of age undergoing cardiac surgery Exclusion criteria 1. No informed consent 2. Patients having metal implants, pace makers 3. Pregnant and lactating mothers After informed consent, all adult patients undergoing cardiac surgery will have a BCM analysis done by the dietician .( Free of Charge) The BCM analysisInbody S10) will be done on Day 0( preoperative), Day 2 and Day 5 . Data will be collected according to a set proforma ( Attached) . Analysis will be performed using the SPSS platform. Results In this pilot study, 134 patients who underwent major cardiac surgery were enrolled. Of these 44 patients developed AKI as defined by KDIGO criteria( 22 Stage 1, 15 stage 2, and 7 stage 3). There was no statistical significance in the baseline characteristics when compared to age, gender, htn, ckd between patients with and without aki. Overhydration as measured by ECW/TBW ration of &gt; 0.38 was significantly higher on day 2 and 5 in patients who developed AKI .(P&lt;0.00, All 44 patients in aki versus 40 in the non aki group). The PBF, ICW, BMI nad overall BCM score was higher in patient with AKI ( p&lt;0.00). 7 patients required RRT( 6 SLED and 1 Acute PD). There was 1 death in theAKI group. The mean duration of hospital stay was longer ( 14 +/- 5 vs 7 +/- 3.5 ) in the AKI grroup Conclusion There is not much data on BCM and fluid assessment in cardiac surgery patients. These patients have many risk factors and a failing heart and associated renal dysfunction in many makes it very difficult to guide volume therapy in these patients. Many of the so called standard objective measures in assessing volume are not fool- proof . This study will be one of the firsts from India to assess fluid status in these patients and help in guiding therapy and also knowing the outcomes of such an objective measurement

Lung Ultrasound Predicts Well Extravascular Lung Water but Is of Limited Usefulness in the Prediction of Wedge Pressure

2014 ◽  
Vol 121 (2) ◽  
pp. 320-327 ◽  
Author(s):  
Giovanni Volpicelli ◽  
Stefano Skurzak ◽  
Enrico Boero ◽  
Giuseppe Carpinteri ◽  
Marco Tengattini ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Congestion ◽  
Lung Water ◽  
Ventricular Ejection Fraction ◽  
B Lines ◽  
Limited Usefulness

Abstract Background: Pulmonary congestion is indicated at lung ultrasound by detection of B-lines, but correlation of these ultrasound signs with pulmonary artery occlusion pressure (PAOP) and extravascular lung water (EVLW) still remains to be further explored. The aim of the study was to assess whether B-lines, and eventually a combination with left ventricular ejection fraction (LVEF) assessment, are useful to differentiate low/high PAOP and EVLW in critically ill patients. Methods: The authors enrolled 73 patients requiring invasive monitoring from the intensive care unit of four university-affiliated hospitals. Forty-one patients underwent PAOP measurement by pulmonary artery catheterization and 32 patients had EVLW measured by transpulmonary thermodilution method. Lung and cardiac ultrasound examinations focused to the evaluation of B-lines and gross estimation of LVEF were performed. The absence of diffuse B-lines (A-pattern) versus the pattern showing prevalent B-lines (B-pattern) and the combination with normal or impaired LVEF were correlated with cutoff levels of PAOP and EVLW. Results: PAOP of 18 mmHg or less was predicted by the A-pattern with 85.7% sensitivity (95% CI, 70.5 to 94.1%) and 40.0% specificity (CI, 25.4 to 56.4%), whereas EVLW 10 ml/kg or less with 81.0% sensitivity (CI, 62.6 to 91.9%) and 90.9% specificity (CI, 74.2 to 97.7%). The combination of A-pattern with normal LVEF increased sensitivity to 100% (CI, 84.5 to 100%) and specificity to 72.7% (CI, 52.0 to 87.2%) for the prediction of PAOP 18 mmHg or less. Conclusions: B-lines allow good prediction of pulmonary congestion indicated by EVLW, whereas are of limited usefulness for the prediction of hemodynamic congestion indicated by PAOP. Combining B-lines with estimation of LVEF at transthoracic ultrasound may improve the prediction of PAOP.

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