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B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients
| Content Provider | SAGE Publishing |
|---|---|
| Author | Mayr, Ulrich Lukas, Marina Habenicht, Livia Wiessner, Johannes Heilmaier, Markus Ulrich, Jörg Rasch, Sebastian Schmid, Roland M. Lahmer, Tobias Huber, Wolfgang Herner, Alexander |
| Copyright Year | 2020 |
| Abstract | 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. |
| Related Links | https://journals.sagepub.com/doi/pdf/10.1177/0885066620967655?download=true |
| Starting Page | 21 |
| Ending Page | 31 |
| Page Count | 11 |
| ISSN | 08850666 |
| Issue Number | 1 |
| Volume Number | 37 |
| Journal | Journal of Intensive Care Medicine (JIC) |
| e-ISSN | 15251489 |
| DOI | 10.1177/0885066620967655 |
| Language | English |
| Publisher | Sage Publications CA |
| Publisher Date | 2020-11-05 |
| Publisher Place | Los Angeles |
| Access Restriction | Open |
| Rights Holder | © The Author(s) 2020 |
| Subject Keyword | pulmonary edema lung ultrasound pulmonary vascular permeability index (PVPI) acute respiratory distress syndrome (ARDS) intensive care unit (ICU) B-lines extravascular lung water index (EVLWI) transpulmonary thermodilution (TPTD) |
| Content Type | Text |
| Resource Type | Article |
| Subject | Critical Care and Intensive Care Medicine |
