Detecting Extravascular Lung Water in Septic Critical Care Patients: Lung Ultrasound versus Transpulmonary Thermodilution
CCCF ePoster library. Nasim N. Oct 4, 2017; 198127; 115
Nasir Nasim
Nasir Nasim
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
#115



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. 
 

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings