Detecting Extravascular Lung Water in Septic Critical Care Patients: Lung Ultrasound versus Transpulmonary Thermodilution
CCCF ePoster library. Nasim N. 10/04/17; 198127; 115
Nasir Nasim
Nasir Nasim
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Detecting Extravascular Lung Water in Septic Critical Care Patients: Lung Ultrasound versus Transpulmonary Thermodilution

East, James M.1; Hawryluck, Laura2; Downar, James3

1 Adult Critical Care, University of Toronto, Toronto, Canada; 2 Adult Critical Care, University of Toronto, Toronto, Canada; 3 Adult Critical Care, University of Toronto, Toronto, Canada

Background: Excessive extravascular lung water (EVLW) is predictive of 28-day mortality in intensive care unit (ICU) patients with sepsis.While lung ultrasound (L-US) has been previously validated against transpulmonary thermodilution (TPTD), data are still limited in the aforementioned patients.  We compared three L-US techniques versus the gold-standard TPTD technique. Our goal was to study the feasibility and practicality of bedside L-US in determining excessive EVLW in ICU septic patients.

Methods: We prospectively enrolled 44 septic patients in our polyvalent 140 beds ICU. EVLW was measured by the TPTD method[EV1000 (VolumeView Set, EV1000, Edwards Lifesciences, Irvine, CA, USA]that measures cardiac output (CO), preload and lung water, and an index of >10mL/kg was considered diagnostic of pulmonary edema. EVLW was then compared to three established bedside L-US protocols that evaluate sonographic B-lines: i) a 28 zone protocol ii) a scanning 8-region examination and iii) a 4-point examination.

Results: Eighty-nine comparisons were obtained. A statistically significant positive correlation was found between L-US total B-line score (TBS) and an EVLW index ≥10mL/kg (r=0.668, p<0.001; Fig.1). The 28-zone protocol score ≥39 has sensitivity of 81.6% and specificity of 76.5% to define EVLWI ≥10mL/kg. In contrast, the positive 4-point examination and scanning 8-regions showed low sensitivity (23.7% and 50.0%, respectively) but high specificity (96.1% and 88.2%, respectively; Fig.2).

Conclusions: Despite various limitations, our preliminary data revealed that performing L-US for EVLW assessment is feasible in ICU septic patients. TBS is significantly correlated to EVLW measured by the TPTD method, while the 28-zone L-US protocol exhibited high sensitivity and specificity in defining EVLWI ≥10mL/kg. 

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