scholarly journals Lung Ultrasound to Quantitatively Evaluate Extravascular Lung Water Content and its Clinical Significance

2020 ◽  
Author(s):  
Guo Guo ◽  
Xue-Feng Zhang ◽  
Jing Liu ◽  
Hai-Feng Zong
Keyword(s):  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Rabbit Model ◽  
Dry Weight ◽  
Type I ◽  
Lung Water ◽  
Arterial Blood Gas ◽  
Injection Volume ◽  
Arterial Blood ◽  
B Lines

Abstract Background:B-line assessment with lung ultrasound (LUS) has recently been proposed as a reliable, noninvasive semiquantitative tool for evaluating extravascular lung water (EVLW). Currently, there has been no easy quantitative method to evaluate EVLW by LUS. To establish a simple, accurate and clinically operable method for quantitative assessment of EVLW using LUS. Methods:Forty-five New Zealand rabbits were randomized into 9 groups (n=5). After anesthesia, each group of rabbits was injected with different amounts of warm sterile NS (0 ml/kg, 2 ml/kg, 4 ml/kg, 6 ml/kg, 8 ml/kg, 10 ml/kg, 15 ml/kg, 20 ml/kg, 30 ml/kg) via the endotracheal tube. Each rabbit was examined by LUS before and after NS injection. At the same time, the spontaneous respiratory rate (RR, breaths per minute), heart rate (HR, bpm) and arterial blood gas (ABG) of the rabbits were recorded. Then, both lungs were dissected to obtain the wet and dry weight and conduct a complete histological examination.Results:Injecting NS into the lungs through a tracheal tube can successfully establish a rabbit model with increased EVLW. When theNS injection volume is 2~6 ml/kg, comet-tail artifacts and B-lines are the main patterns found on LUS; as additional NS is injected into the lungs, the rabbits' RR gradually increases, while their HR gradually decreases. Confluent B-lines grow gradually but significantly, reaching a dominant position when the NS injection volume reaches 6~8 ml/kg and predominating almost entirely when the NS injection volume is 8~15 ml/kg; at that time, rabbits' RRs and HRs decrease sharply, and the ABG indicated type I respiratory failure (RF). Compact B-lines occur and predominate almost entirely when the NS injection volume reaches 10 ml/kg and 15~20 ml/kg, respectively. At that time, rabbits begin to enter cardiac and respiratory arrest, and ABG shows type II RF and metabolic acidosis (MA).Conclusion: LUS can estimate EVLW content based on the type of B-line.We can give clinical treatment depending on the type of LUS B-line.

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.

scholarly journals Extravascular Lung Water and Acute Lung Injury

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ritesh Maharaj
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Extravascular Lung Water ◽  
Response To Treatment ◽  
Dilution Method ◽  
Lung Water ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Chest Auscultation

Acute lung injury carries a high burden of morbidity and mortality and is characterised by nonhydrostatic pulmonary oedema. The aim of this paper is to highlight the role of accurate quantification of extravascular lung water in diagnosis, management, and prognosis in “acute lung injury” and “acute respiratory distress syndrome”. Several studies have verified the accuracy of both the single and the double transpulmonary thermal indicator techniques. Both experimental and clinical studies were searched in PUBMED using the term “extravascular lung water” and “acute lung injury”. Extravascular lung water measurement offers information not otherwise available by other methods such as chest radiography, arterial blood gas, and chest auscultation at the bedside. Recent data have highlighted the role of extravascular lung water in response to treatment to guide fluid therapy and ventilator strategies. The quantification of extravascular lung water may predict mortality and multiorgan dysfunction. The limitations of the dilution method are also discussed.

scholarly journals B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients

2020 ◽  
pp. 088506662096765 ◽  
Author(s):  
Ulrich Mayr ◽  
Marina Lukas ◽  
Livia Habenicht ◽  
Johannes Wiessner ◽  
Markus Heilmaier ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Lung Water ◽  
Extravascular Lung Water Index ◽  
Water Index ◽  
Non Invasive ◽  
B Lines

Introduction: Visualization of B-lines via lung ultrasound provides a non-invasive estimation of pulmonary hydration. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) assessed by transpulmonary thermodilution (TPTD) represent the most validated parameters of lung water and alveolocapillary permeability, but measurement is invasive and expensive. This study aimed to compare the correlations of B-lines scores from extensive 28-sector and simplified 4-sector chest scan with EVLWI and PVPI derived from TPTD in the setting of intensive care unit (primary endpoint). Methods: We performed scoring of 28-sector and 4-sector B-Lines in 50 critically ill patients. TPTD was carried out with the PiCCO-2-device (Pulsion Medical Systems SE, Maquet Getinge Group). Median time exposure for ultrasound procedure was 12 minutes for 28-sector and 4 minutes for 4-sector scan. Results: Primarily, we found close correlations of 28-sector as well as 4-sector B-Lines scores with EVLWI (R2 = 0.895 vs. R2 = 0.880) and PVPI (R2 = 0.760 vs. R2 = 0.742). Both B-lines scores showed high accuracy to identify patients with specific levels of EVLWI and PVPI. The extensive 28-sector B-lines score revealed a moderate advantage compared to simplified 4-sector scan in detecting a normal EVLWI ≤ 7 (28-sector scan: sensitivity = 81.8%, specificity = 94.9%, AUC = 0.939 versus 4-sector scan: sensitivity = 81.8%, specificity = 82.1%, AUC = 0.902). Both protocols were approximately equivalent in prediction of lung edema with EVLWI ≥ 10 (28-sector scan: sensitivity = 88.9%, specificity = 95.7%, AUC = 0.977 versus 4-sector scan: sensitivity = 81.5%, specificity = 91.3%, AUC = 0.958) or severe pulmonary edema with EVLWI ≥ 15 (28-sector scan: sensitivity = 91.7%, specificity = 97.4%, AUC = 0.995 versus 4-sector scan: sensitivity = 91.7%, specificity = 92.1%, AUC = 0.978). As secondary endpoints, our evaluations resulted in significant associations of 28-sector as well as simplified 4-sector B-Lines score with parameters of respiratory function. Conclusion: Both B-line protocols provide accurate non-invasive evaluation of lung water in critically ill patients. The 28-sector scan offers a marginal advantage in prediction of pulmonary edema, but needs substantially more time than 4-sector scan.

scholarly journals Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0003972021
Author(s):  
Nathaniel Reisinger ◽  
Abhilash Koratala
Keyword(s):  
Heart Failure ◽  
Acute Care ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Volume Overload ◽  
Care Utilization ◽  
Lung Ultrasonography ◽  
Lung Water ◽  
Acute Care Utilization ◽  
B Lines

Volume overload and its attendant increase in acute care utilization and cardiovascular morbidity and mortality represents a critical challenge for the practicing nephrologist. This is particularly true among patients with ESKD on HD where pre-dialysis volume overload and intradialytic and postdialytic hypovolemia account for almost a third of all cost for the Medicare dialysis benefit. Quantitative lung ultrasound is a tool for assessing the extent of extravascular lung water which outperforms physical exam and plain chest radiography. B-lines are vertical hyperechoic artifacts present in patients with increased extravascular lung water. B-lines have been shown to decrease dynamically during the hemodialysis treatment in proportion to ultrafiltration volume. Among patients with chronic heart failure, titration of diuretics based on the extent of pulmonary congestion noted on lung ultrasonography has been shown to decrease recurrent acute care utilization. Early data from randomized-controlled trials of lung ultrasound-guided ultrafiltration therapy among patients with ESKD on HD have shown promise for potential reduction in recurrent episodes of decompensated heart failure and cardiovascular events. Ultimately lung ultrasound may predict those who are ultrafiltration tolerant and could be used to decreased acute care utilization and thus cost in this population.

scholarly journals Can Alveolar-Arterial Difference and Lung Ultrasound Help the Clinical Decision Making in Patients with COVID-19?

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 761
Author(s):  
Gianmarco Secco ◽  
Francesco Salinaro ◽  
Carlo Bellazzi ◽  
Marco La Salvia ◽  
Marzia Delorenzo ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Signs And Symptoms ◽  
Clinical Decision ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Lung Dysfunction ◽  
Close Relationship

Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure − H2O pressure) − (PaCO2/R)) − PaO2. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). Conclusions: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

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.

DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs

2019 ◽  
Vol 38 (7) ◽  
pp. 757-766 ◽  
Author(s):  
Kamal S. Ayyat ◽  
Toshihiro Okamoto ◽  
Hiromichi Niikawa ◽  
Yoshifumi Itoda ◽  
Siddharth Dugar ◽  
...  
Keyword(s):  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Lung Water ◽  
Novel Technique ◽  
Ultrasound Evaluation

Permeability of barriers to albumin flux in lungs of sheep resuscitated from hemorrhagic shock

1986 ◽  
Vol 61 (6) ◽  
pp. 2156-2161 ◽  
Author(s):  
A. B. Gorin ◽  
G. Mendiondo
Keyword(s):  
Hemorrhagic Shock ◽  
Extravascular Lung Water ◽  
Weight Ratio ◽  
Equilibrium Concentration ◽  
Dry Weight ◽  
Lymph Flow ◽  
Base Line ◽  
Lung Water ◽  
Lung Lymph ◽  
Lung Lymph Flow

We assessed pulmonary endothelial and epithelial permeability and lung lymph flow in nine adult sheep under base-line conditions and after resuscitation from profound hemorrhagic shock. Animals were mechanically ventilated and maintained on 1% halothane anesthesia while aortic pressure was held at 40 Torr for 3 h. Systemic heparin was not used. After reinfusion of shed blood, sheep recovered from anesthesia and we measured lung lymph flow (QL), lymph-to-plasma concentration ratio for proteins, and time taken to reach half-equilibrium concentration of intravenous tracer albumin in lymph (t1/2). Twenty-four hours after bolus injection of radio-albumin we lavaged subsegments of the right upper lobe and determined fractional equilibration of the tracer in the alveolar luminal-lining layer. In each sheep we had measured these parameters 7 days earlier under base-line conditions. Animals were killed, and the lungs were used for gravimetric determination of extravascular lung water (gravimetric extravascular lung water-to-dry weight ratio) 24 h after resuscitation from shock. Pulmonary endothelial injury after resuscitation was evidenced by marked increase in QL, without fall in lymph-to-plasma ratio. Time taken to reach half-equilibrium concentration fell from 169 +/- 47 (SD) min in base-line studies to 53 +/- 33 min after shock. There was no evidence of lung epithelial injury. Gravimetric extravascular lung water-to-dry weight ratio was significantly increased in these animals killed 24 h after resuscitation (4.94 +/- 0.29) compared with values in our laboratory controls (4.13 +/- 0.09, mean +/- SD). These data demonstrate a loss of lung endothelial integrity in sheep after resuscitation from profound hemorrhagic shock.

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