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Zhang Q, Song R, Hang J, Wei S, Zhu Y, Zhang G, Ding B, Ye X, Guo X, Zhang D, Wu P, Lin H, Tu J. A lung disease diagnosis algorithm based on 2D spectral features of ultrasound RF signals. ULTRASONICS 2024; 140:107315. [PMID: 38603903 DOI: 10.1016/j.ultras.2024.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
Lung diseases are commonly diagnosed based on clinical pathological indications criteria and radiological imaging tools (e.g., X-rays and CT). During a pandemic like COVID-19, the use of ultrasound imaging devices has broadened for emergency examinations by taking their unique advantages such as portability, real-time detection, easy operation and no radiation. This provides a rapid, safe, and cost-effective imaging modality for screening lung diseases. However, the current pulmonary ultrasound diagnosis mainly relies on the subjective assessments of sonographers, which has high requirements for the operator's professional ability and clinical experience. In this study, we proposed an objective and quantifiable algorithm for the diagnosis of lung diseases that utilizes two-dimensional (2D) spectral features of ultrasound radiofrequency (RF) signals. The ultrasound data samples consisted of a set of RF signal frames, which were collected by professional sonographers. In each case, a region of interest of uniform size was delineated along the pleural line. The standard deviation curve of the 2D spatial spectrum was calculated and smoothed. A linear fit was applied to the high-frequency segment of the processed data curve, and the slope of the fitted line was defined as the frequency spectrum standard deviation slope (FSSDS). Based on the current data, the method exhibited a superior diagnostic sensitivity of 98% and an accuracy of 91% for the identification of lung diseases. The area under the curve obtained by the current method exceeded the results obtained that interpreted by professional sonographers, which indicated that the current method could provide strong support for the clinical ultrasound diagnosis of lung diseases.
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Affiliation(s)
- Qi Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Jing Hang
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Siqi Wei
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yifei Zhu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Guofeng Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Bo Ding
- Zhuhai Ecare Electronics Science & Technology Co., Ltd., Zhuhai 519041, China
| | - Xinhua Ye
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiasheng Guo
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Pingping Wu
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China
| | - Han Lin
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China.
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China.
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Song J, Luo Q, Lai X, Hu W, Yu Y, Wang M, Yang K, Chen G, Chen W, Li Q, Hu C, Gong S. Combined cardiac, lung, and diaphragm ultrasound for predicting weaning failure during spontaneous breathing trial. Ann Intensive Care 2024; 14:60. [PMID: 38641687 PMCID: PMC11031537 DOI: 10.1186/s13613-024-01294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Weaning from invasive mechanical ventilation (MV) is a complex and challenging process that involves multiple pathophysiological mechanisms. A combined ultrasound evaluation of the heart, lungs, and diaphragm during the weaning phase can help to identify risk factors and underlying mechanisms for weaning failure. This study aimed to investigate the accuracy of lung ultrasound (LUS), transthoracic echocardiography (TTE), and diaphragm ultrasound for predicting weaning failure in critically ill patients. METHODS Patients undergoing invasive MV for > 48 h and who were readied for their first spontaneous breathing trial (SBT) were studied. Patients were scheduled for a 2-h SBT using low-level pressure support ventilation. LUS and TTE were performed prospectively before and 30 min after starting the SBT, and diaphragm ultrasound was only performed 30 min after starting the SBT. Weaning failure was defined as failure of SBT, re-intubation, or non-invasive ventilation within 48 h. RESULTS Fifty-one patients were included, of whom 15 experienced weaning failure. During the SBT, the global, anterior, and antero-lateral LUS scores were higher in the failed group than in the successful group. Receiver operating characteristic curve analysis showed that the areas under the curves for diaphragm thickening fraction (DTF) and global and antero-lateral LUS scores during the SBT to predict weaning failure were 0.678, 0.719, and 0.721, respectively. There was no correlation between the LUS scores and the average E/e' ratio during the SBT. Multivariate analysis identified antero-lateral LUS score > 7 and DTF < 31% during the SBT as independent predictors of weaning failure. CONCLUSION LUS and diaphragm ultrasound can help to predict weaning failure in patients undergoing an SBT with low-level pressure support. An antero-lateral LUS score > 7 and DTF < 31% during the SBT were associated with weaning failure.
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Affiliation(s)
- Jia Song
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Qiancheng Luo
- Department of Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, No. 219, Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Xinle Lai
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Weihang Hu
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Yihua Yu
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Minjia Wang
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China
| | - Kai Yang
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Gongze Chen
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Wenwei Chen
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Qian Li
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, China
| | - Caibao Hu
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China.
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, Zhejiang, 310013, China.
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Muñoz F, Born P, Bruna M, Ulloa R, González C, Philp V, Mondaca R, Blanco JP, Valenzuela ED, Retamal J, Miralles F, Wendel-Garcia PD, Ospina-Tascón GA, Castro R, Rola P, Bakker J, Hernández G, Kattan E. Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study. Crit Care 2024; 28:52. [PMID: 38374167 PMCID: PMC10877871 DOI: 10.1186/s13054-024-04834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This study aims to compare the prevalence of venous congestion in fluid responsive and fluid unresponsive critically ill patients after intensive care (ICU) admission. METHODS Multicenter, prospective cross-sectional observational study conducted in three medical-surgical ICUs in Chile. Consecutive mechanically ventilated patients that required vasopressors and admitted < 24 h to ICU were included between November 2022 and June 2023. Patients were assessed simultaneously for fluid responsiveness and VC at a single timepoint. Fluid responsiveness status, VC signals such as central venous pressure, estimation of left ventricular filling pressures, lung, and abdominal ultrasound congestion indexes and relevant clinical data were collected. RESULTS Ninety patients were included. Median age was 63 [45-71] years old, and median SOFA score was 9 [7-11]. Thirty-eight percent of the patients were fluid responsive (FR+), while 62% were fluid unresponsive (FR-). The most prevalent diagnosis was sepsis (41%) followed by respiratory failure (22%). The prevalence of at least one VC signal was not significantly different between FR+ and FR- groups (53% vs. 57%, p = 0.69), as well as the proportion of patients with 2 or 3 VC signals (15% vs. 21%, p = 0.4). We found no association between fluid balance, CRT status, or diagnostic group and the presence of VC signals. CONCLUSIONS Venous congestion signals were prevalent in both fluid responsive and unresponsive critically ill patients. The presence of venous congestion was not associated with fluid balance or diagnostic group. Further studies should assess the clinical relevance of these results and their potential impact on resuscitation and monitoring practices.
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Affiliation(s)
- Felipe Muñoz
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Pablo Born
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Mario Bruna
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
| | - Rodrigo Ulloa
- Unidad de Cuidados Intensivos, Hospital Las Higueras, Talcahuano, Chile
| | - Cecilia González
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Valerie Philp
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Roberto Mondaca
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Juan Pablo Blanco
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Emilio Daniel Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | | | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gustavo A Ospina-Tascón
- Department of Intensive Care Medicine, Fundación Valle del Lili, Cali, Colombia
- Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Philippe Rola
- Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, USA
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile.
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Rajpal M, Talwar V, Krishna B, Mustafi SM. Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2024; 28:165-169. [PMID: 38323257 PMCID: PMC10839938 DOI: 10.5005/jp-journals-10071-24635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/19/2023] [Indexed: 02/08/2024] Open
Abstract
Background Lung ultrasound (LUS) is a simple bedside tool to assess overhydration. Our study aimed to assess extravascular lung water (EVLW) using B-lines and correlate it with weaning, duration of mechanical ventilation, and mortality in critically ill patients admitted to the intensive care unit (ICU). Patients and methods 150 mechanically ventilated ICU patients prospectively observed over 18 months, with their demographic and clinical data noted. Extravascular lung water was monitored using LUS in four intercostal spaces (ICS) from day 1 to day 5, day 7, day 10, and weekly thereafter. Pulmonary fluid burden was graded as low (1-10), moderate (11-20), and high (21-32). Weaning outcome, duration of weaning, mechanical ventilation, ICU stay, and mortality were compared in patients with and without EVLW. Results Out of 150, 54 patients (36.0%) had EVLW. The mean lung score amongst our patients was 8.57 ± 6.0. The mean time for detection of EVLW was 1.43 ± 2.24 days. Lung score was low in 40 (26.67%) patients, moderate in 9 (6.00%) patients, and high in 5 (3.33%) patients. Incidence of weaning failure (p-value = 0.006), duration of weaning, mechanical ventilation, ICU stay (p-value < 0.0001 each), and overall mortality were significantly higher in patients with EVLW (p-value = 0.006). Conclusion We conclude that a good proportion of critically ill patients have EVLW. Extravascular lung water significantly increases the duration of weaning, mechanical ventilation days, ICU stay, and overall mortality in critically ill patients. How to cite this article Rajpal M, Talwar V, Krishna B, Mustafi SM. Assessment of Extravascular Lung Water Using Lung Ultrasound in Critically Ill Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2024;28(2):165-169.
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Affiliation(s)
- Mayank Rajpal
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Vandana Talwar
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Bhavya Krishna
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Saurav Mitra Mustafi
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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Catena E, Volontè A, Rizzuto C, Bergomi P, Gambarini M, Fossali T, Ottolina D, Perotti A, Veronese A, Colombo R. The value of a dynamic echocardiographic approach to diastolic dysfunction in intensive care medicine. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:95-102. [PMID: 37962285 DOI: 10.1002/jcu.23610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
Diastolic dysfunction is an underestimated feature in the context of the critically ill setting and perioperative medicine. Advances in echocardiography, its noninvasive, safe and easy use, have allowed Doppler echocardiography to become a cornerstone for diagnosing diastolic dysfunction in clinical practice. The diagnosis of diastolic dysfunction and increased filling pressures is nevertheless complex. Using an echocardiographic assessment and the routine application of preload stress maneuvers during echocardiographic examination can help identify early stages of diastolic dysfunction leading to better management of patients at risk of acute heart decompensation in the perioperative period or during ICU stay.
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Affiliation(s)
- Emanuele Catena
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Alessandra Volontè
- Anesthesia and Intensive Care Unit, "Papa Giovanni XXIII" Hospital of Bergamo, University of Milan, Milan, Italy
| | - Chiara Rizzuto
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Paola Bergomi
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Matteo Gambarini
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Tommaso Fossali
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Davide Ottolina
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Andrea Perotti
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Alice Veronese
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
| | - Riccardo Colombo
- Anesthesia and Intensive Care Unit, "Luigi Sacco" Hospital of Milan, University of Milan, Milan, Italy
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Ortner CM, Lucovnik M, Zieleskiewicz L. Will Point-of-Care Ultrasound Be the New Standard of Care in the Management of Women Diagnosed With Preeclampsia? Anesth Analg 2023; 137:1154-1157. [PMID: 37973130 DOI: 10.1213/ane.0000000000006551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Clemens M Ortner
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Miha Lucovnik
- Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRA, Marseille, France
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Atmowihardjo LN, Schippers JR, Haaksma ME, Smit MR, Bogaard HJ, Heunks L, Juffermans NP, Schultz MJ, Endeman H, van Velzen P, Tuinman PR, Aman J, Bos LDJ. The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS. Ultrasound J 2023; 15:40. [PMID: 37782370 PMCID: PMC10545605 DOI: 10.1186/s13089-023-00340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS. OBJECTIVES This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS. METHODS In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS-ARDS), an 8-region anterior-lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated. RESULTS 26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS-ARDS (r = 0.58) and anterior-lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior-lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior-lateral and 0.85 for the LUS-ARDS score. CONCLUSIONS Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate-to-severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020-005447-23.
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Affiliation(s)
- Leila N Atmowihardjo
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands.
| | - Job R Schippers
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark E Haaksma
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marry R Smit
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Harm J Bogaard
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole P Juffermans
- Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus University, Rotterdam, the Netherlands
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Henrik Endeman
- Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Patricia van Velzen
- Dijklander Hospital Location Purmerend, Intensive Care, Waterlandlaan 250, Purmerend, The Netherlands
| | - Pieter R Tuinman
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography, Amsterdam, The Netherlands
| | - Jurjan Aman
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Schroeder I, Scharf C, Schneider J, Weggesser P, Hübner L, Kneidinger N, Michel S, Schneider C, Clevert DA, Sabel B, Irlbeck M, Scheiermann P. Lung Ultrasound as a Promising Diagnostic Tool for Primary Graft Dysfunction after Lung Transplantation. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:537-543. [PMID: 36854384 DOI: 10.1055/a-2011-5944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE The aim of the study was to evaluate whether the quantification of B-lines via lung ultrasound after lung transplantation is feasible and correlates with the diagnosis of primary graft dysfunction. METHODS Following lung transplantation, patients underwent daily lung ultrasound on postoperative days 1-3. B-lines were quantified by an ultrasound score based on the number of single and confluent B-lines per intercostal space, using a four-region protocol. The ultrasound score was correlated with the diagnosis of primary graft dysfunction. Furthermore, correlation analyses and receiver operating characteristics analyses taking into account ultrasound score, chest radiographs, and PaO2/FiO2 ratio were performed. RESULTS A total of 32 patients (91 ultrasound measurements) were included, whereby 10 were diagnosed with primary graft dysfunction. The median B-line score was 5 [IQR: 4, 8]. There was a significant correlation between B-line score and the diagnosis of primary graft dysfunction (r = 0.59, p < 0.001). A significant correlation could also be seen between chest X-rays and primary graft dysfunction (r = 0.34, p = 0.008), but the B-line score showed superiority over chest X-rays with respect to diagnosing primary graft dysfunction in the receiver operating characteristics curves with an area under the curve value of 0.921 versus 0.708. There was a significant negative correlation between B-line score and PaO2/FiO2 ratio (r = -0.41, p < 0.001), but not between chest X-rays and PaO2/FiO2 ratio (r = -0.14, p = 0.279). CONCLUSION The appearance of B-lines correlated well with primary graft dysfunction and outperformed chest radiographs.
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Affiliation(s)
- Ines Schroeder
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Schneider
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Patricia Weggesser
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Lucas Hübner
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Michel
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schneider
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Dirk-Andre Clevert
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Bastian Sabel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Scheiermann
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
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9
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Leote J, Muxagata T, Guerreiro D, Francisco C, Dias H, Loução R, Bacariza J, Gonzalez F. Influence of Ultrasound Settings on Laboratory Vertical Artifacts. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1901-1908. [PMID: 37150622 DOI: 10.1016/j.ultrasmedbio.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The aim of the work described here was to analyze the relationship between the change in ultrasound (US) settings and the vertical artifacts' number, visual rating and signal intensity METHODS: An in vitro phantom consisting of a damp sponge and gelatin mix was created to simulate vertical artifacts. Furthermore, several US parameters were changed sequentially (i.e., frequency, dynamic range, line density, gain, power and image enhancement) and after image acquisition. Five US experts rated the artifacts for number and quality. In addition, a vertical artifact visual score was created to determine the higher artifact rating ("optimal") and the lower artifact rating ("suboptimal"). Comparisons were made between the tested US parameters and baseline recordings. RESULTS The expert intraclass correlation coefficient for the number of vertical artifacts was 0.694. The parameters had little effect on the "optimal" vertical artifacts but changed their number. Dynamic range increased the number of discernible vertical artifacts to 3 from 36 to 102 dB. CONCLUSION The intensity did not correlate with the visual rating score. Most of the available US parameters did not influence vertical artifacts.
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Affiliation(s)
- Joao Leote
- Critical Care Department, Hospital Garcia de Orta EPE, Almada, Portugal; Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal.
| | - Tiago Muxagata
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Diana Guerreiro
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Cláudia Francisco
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Hermínia Dias
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Ricardo Loução
- Center of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Jacobo Bacariza
- Critical Care Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Filipe Gonzalez
- Critical Care Department, Hospital Garcia de Orta EPE, Almada, Portugal
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10
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Response to: A randomized-controlled trial comparing 20% albumin to plasmalyte in patients with cirrhosis and sepsis-induced hypotension [ALPS trial]. J Hepatol 2022; 77:1731-1732. [PMID: 35810928 DOI: 10.1016/j.jhep.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022]
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11
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Kulkarni AP, Govil D, Samavedam S, Srinivasan S, Ramasubban S, Venkataraman R, Pichamuthu K, Jog SA, Divatia JV, Myatra SN. ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill. Indian J Crit Care Med 2022; 26:S66-S76. [PMID: 36896359 PMCID: PMC9989872 DOI: 10.5005/jp-journals-10071-24301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Hemodynamic assessment along with continuous monitoring and appropriate therapy forms an integral part of management of critically ill patients with acute circulatory failure. In India, the infrastructure in ICUs varies from very basic facilities in smaller towns and semi-urban areas, to world-class, cutting-edge technology in corporate hospitals, in metropolitan cities. Surveys and studies from India suggest a wide variation in clinical practices due to possible lack of awareness, expertise, high costs, and lack of availability of advanced hemodynamic monitoring devices. We, therefore, on behalf of the Indian Society of Critical Care Medicine (ISCCM), formulated these evidence-based guidelines for optimal use of various hemodynamic monitoring modalities keeping in mind the resource-limited settings and the specific needs of our patients. When enough evidence was not forthcoming, we have made recommendations after achieving consensus amongst members. Careful integration of clinical assessment and critical information obtained from laboratory data and monitoring devices should help in improving outcomes of our patients. How to cite this article Kulkarni AP, Govil D, Samavedam S, Srinivasan S, Ramasubban S, Venkataraman R, et al. ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill. Indian J Crit Care Med 2022;26(S2):S66-S76.
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Affiliation(s)
- Atul Prabhakar Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurugram, Haryana, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | | | | | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Kishore Pichamuthu
- Department of Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sameer Arvind Jog
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Sheila Nainan Myatra
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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12
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Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. The emerging concept of fluid tolerance: A position paper. J Crit Care 2022; 71:154070. [PMID: 35660844 DOI: 10.1016/j.jcrc.2022.154070] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022]
Abstract
Fluid resuscitation is a core component of emergency and critical care medicine. While the focus of clinicians has largely been on detecting patients who would respond to fluid therapy, relatively little work has been done on assessing patients' tolerance to this therapy. In this article we seek to review the concept of fluid tolerance, propose a working definition, and introduce relevant clinical signals by which physicians can assess fluid tolerance, hopefully becoming a starting point for further research.
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Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | | | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Philippe Rola
- Chief of Service, Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada.
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13
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Bowcock EM, Mclean A. Bedside assessment of left atrial pressure in critical care: a multifaceted gem. Crit Care 2022; 26:247. [PMID: 35964098 PMCID: PMC9375940 DOI: 10.1186/s13054-022-04115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
Evaluating left atrial pressure (LAP) solely from the left ventricular preload perspective is a restrained approach. Accurate assessment of LAP is particularly relevant when pulmonary congestion and/or right heart dysfunction are present since it is the pressure most closely related to pulmonary venous pressure and thus pulmonary haemodynamic load. Amalgamation of LAP measurement into assessment of the ‘transpulmonary circuit’ may have a particular role in differentiating cardiac failure phenotypes in critical care. Most of the literature in this area involves cardiology patients, and gaps of knowledge in application to the bedside of the critically ill patient remain significant. Explored in this review is an overview of left atrial physiology, invasive and non-invasive methods of LAP measurement and their potential clinical application.
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14
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Research Progress on the Mechanism of Right Heart-Related Pulmonary Edema. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8947780. [PMID: 35966729 PMCID: PMC9365571 DOI: 10.1155/2022/8947780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
Objective. To investigate the mechanisms underlying the development of right heart-associated PE. Background. Right heart-related pulmonary edema (PE) refers to PE resulting from impaired right heart function caused by primary or secondary factors, which is common in critically ill patients. Although the clinical manifestations of different types of right heart-related PE are similar, the pathophysiological changes and treatment methods are significantly different. According to the hemodynamic mechanism, right heart-related PE is primarily classified into two types. One is the increase of right heart flow, including extravascular compression, intravascular compression, cardiac compression, and cardiac decompression. The other type is the abnormal distribution of pulmonary circulation, including obstruction, resistance, pleural decompression, or negative pressure. With the development of hemodynamic monitoring, hemodynamic data not only help us understand the specific pathogenesis of right heart-related PE but also assist us in determining the direction of therapy and enabling individualized treatment. Summary. This article presents a review on right heart-associated PE, with a perspective of hemodynamic analysis, and emphasizes the importance of right heart function in the management of circulation. Understanding the mechanism of right heart-associated PE will not only aid in better monitoring right heart function but also help intensivists make a more accurate identification of various types of PE in the clinic.
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15
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Voigt I, Mighali M, Manda D, Aurich P, Bruder O. Radiographic assessment of lung edema (RALE) score is associated with clinical outcomes in patients with refractory cardiogenic shock and refractory cardiac arrest after percutaneous implantation of extracorporeal life support. Intern Emerg Med 2022; 17:1463-1470. [PMID: 35169942 DOI: 10.1007/s11739-022-02937-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/19/2022] [Indexed: 01/27/2023]
Abstract
VA-ECMO is a promising therapeutic option in refractory cardiogenic shock (RCS) and refractory cardiac arrest (RCA). However, increase in left ventricular afterload enhances further reduction of LV contractility and pulmonary edema. The aim of this study was to evaluate pulmonary edema based on the RALE score and the prognostic value of the score on ECLS weaning and mortality. In this retrospective study, data from 40 patients (16 RCAs and 24 RCSs) were analyzed. Demographic, clinical data and the RALE score for evaluating pulmonary edema were assessed. Descriptive statistics, intraclass correlation, and receiver operating characteristic (ROC) curves were computed. Weaning from ECLS was successful in 30 (75%) patients, 16 patients (40%) were discharged alive. Overall, the survivors were younger, presenting with a higher left ventricular ejection fraction (30 ± 2% vs.23 ± 9%;p < 0.01) and a lower initial serum lactate concentration 7.7 ± 4.5 mmol/l vs. 11.5 ± 4.9 mmol/l; p = 0.017). Survivors had lower RALE scores than non-survivors (16.3 ± 9.4 vs. 26.4 ± 10.4; p = 0.0034). The interobserver variability of the RALE score was good (0.832). The AUC predicting mortality and weaning from ECLS presented comparable results to the established parameters (SAVE, serum lactate). Implementation of the RALE score could support prediction of outcome parameters during VA-ECMO therapy.
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Affiliation(s)
- Ingo Voigt
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany.
- Ruhr-University, Bochum, Germany.
| | - Marco Mighali
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Daniela Manda
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Phillip Aurich
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany
- Ruhr-University, Bochum, Germany
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16
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Licker M, Hagerman A, Bedat B, Ellenberger C, Triponez F, Schorer R, Karenovics W. Restricted, optimized or liberal fluid strategy in thoracic surgery: A narrative review. Saudi J Anaesth 2021; 15:324-334. [PMID: 34764839 PMCID: PMC8579501 DOI: 10.4103/sja.sja_1155_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 11/16/2022] Open
Abstract
Perioperative fluid balance has a major impact on clinical and functional outcome, regardless of the type of interventions. In thoracic surgery, patients are more vulnerable to intravenous fluid overload and to develop acute respiratory distress syndrome and other complications. New insight has been gained on the mechanisms causing pulmonary complications and the role of the endothelial glycocalix layer to control fluid transfer from the intravascular to the interstitial spaces and to promote tissue blood flow. With the implementation of standardized processes of care, the preoperative fasting period has become shorter, surgical approaches are less invasive and patients are allowed to resume oral intake shortly after surgery. Intraoperatively, body fluid homeostasis and adequate tissue oxygen delivery can be achieved using a normovolemic therapy targeting a “near-zero fluid balance” or a goal-directed hemodynamic therapy to maximize stroke volume and oxygen delivery according to the Franck–Starling relationship. In both fluid strategies, the use of cardiovascular drugs is advocated to counteract the anesthetic-induced vasorelaxation and maintain arterial pressure whereas fluid intake is limited to avoid cumulative fluid balance exceeding 1 liter and body weight gain (~1-1.5 kg). Modern hemodynamic monitors provide valuable physiological parameters to assess patient volume responsiveness and circulatory flow while guiding fluid administration and cardiovascular drug therapy. Given the lack of randomized clinical trials, controversial debate still surrounds the issues of the optimal fluid strategy and the type of fluids (crystalloids versus colloids). To avoid the risk of lung hydrostatic or inflammatory edema and to enhance the postoperative recovery process, fluid administration should be prescribed as any drug, adapted to the patient's requirement and the context of thoracic intervention.
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Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andres Hagerman
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Benoit Bedat
- Division of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frederic Triponez
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Raoul Schorer
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
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17
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Rusu DM, Grigoraș I, Blaj M, Siriopol I, Ciumanghel AI, Sandu G, Onofriescu M, Lungu O, Covic AC. Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial. Diagnostics (Basel) 2021; 11:diagnostics11081444. [PMID: 34441378 PMCID: PMC8394150 DOI: 10.3390/diagnostics11081444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022] Open
Abstract
The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose of this trial was to evaluate if a BLS-guided fluid management strategy could improve fluid balance and short-term mortality in surgical intensive care unit (ICU) patients. We conducted a randomised, controlled trial within the ICUs of two university hospitals. Critically ill patients were randomised upon ICU admission in a 1:1 ratio to BLS-guided fluid management (active group) or standard care (control group). In the active group, BLS was monitored daily until ICU discharge or day 28 (whichever came first). On the basis of BLS, different targets for daily fluid balance were set with the aim of avoiding or correcting moderate/severe EVLW increase. The primary outcome was 28-day mortality. Over 24 months, 166 ICU patients were enrolled in the trial and included in the final analysis. Trial results showed that daily BLS monitoring did not lead to a different cumulative fluid balance in surgical ICU patients as compared to standard care. Consecutively, no difference in 28-day mortality between groups was found (10.5% vs. 15.6%, p = 0.34). However, at least 400 patients would have been necessary for conclusive results.
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Affiliation(s)
- Daniel-Mihai Rusu
- Anaesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-M.R.); (M.B.); (I.S.); (O.L.)
- Anaesthesia and Intensive Care Department, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Ioana Grigoraș
- Anaesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-M.R.); (M.B.); (I.S.); (O.L.)
- Anaesthesia and Intensive Care Department, Regional Institute of Oncology, 700483 Iasi, Romania
- Correspondence: ; Tel.: +40-7-4530-7196
| | - Mihaela Blaj
- Anaesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-M.R.); (M.B.); (I.S.); (O.L.)
- Anaesthesia and Intensive Care Department, Sf. Spiridon University Hospital, 700111 Iasi, Romania; (A.-I.C.); (G.S.)
| | - Ianis Siriopol
- Anaesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-M.R.); (M.B.); (I.S.); (O.L.)
- Anaesthesia and Intensive Care Department, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Adi-Ionut Ciumanghel
- Anaesthesia and Intensive Care Department, Sf. Spiridon University Hospital, 700111 Iasi, Romania; (A.-I.C.); (G.S.)
| | - Gigel Sandu
- Anaesthesia and Intensive Care Department, Sf. Spiridon University Hospital, 700111 Iasi, Romania; (A.-I.C.); (G.S.)
| | - Mihai Onofriescu
- Nephrology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.O.); (A.C.C.)
- Nephrology Department, Dr. C.I. Parhon University Hospital, 700503 Iasi, Romania
| | - Olguta Lungu
- Anaesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.-M.R.); (M.B.); (I.S.); (O.L.)
- Anaesthesia and Intensive Care Department, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Adrian Constantin Covic
- Nephrology Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.O.); (A.C.C.)
- Nephrology Department, Dr. C.I. Parhon University Hospital, 700503 Iasi, Romania
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18
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Donal E, Galli E, Paven E, Sade LE. Haemodynamic evaluation: a key tool for heart failure management. Ultrasounds forever! Eur J Heart Fail 2020; 23:713-715. [PMID: 33215841 DOI: 10.1002/ejhf.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Erwan Donal
- CHU Rennes, Inserm, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Elena Galli
- CHU Rennes, Inserm, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Elise Paven
- CHU Rennes, Inserm, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Leyla Elif Sade
- Department of Cardiology, University of Baskent, Ankara, Turkey
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19
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Lee J. Lung Ultrasound as a Monitoring Tool. Tuberc Respir Dis (Seoul) 2020; 83:S12-S16. [PMID: 33261244 PMCID: PMC7837375 DOI: 10.4046/trd.2020.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022] Open
Abstract
Lung ultrasound has proven to be useful in detecting pneumothorax, interstitial syndrome, and lung consolidation. It is easily applied at the bedside, in real-time, and free of radiation hazards. Recently, the use of lung ultrasound has moved from a diagnostic tool to a monitoring tool for lung aeration quantification. This article reviewed the use of lung ultrasound in monitoring acute pulmonary edema, acute respiratory distress syndrome, and pneumonia, and how it could be used to monitor changes during the application of mechanical ventilation or other treatments for respiratory failure.
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Affiliation(s)
- Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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