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Reliability of lung ultrasound and inferior vena cava collapsibility index in volume sta¬tus estimation in ICU patients during early postoperative period 16. World Congress of Anesthesiologists, Hong Kong (2016)

A liberal approach to volume replacement therapy is commonly seen during surgical procedures .An excess of administrated fluid may result in an increase of Extra Vascular Lung Water (EVLW) and can cause gas exchange deterioration. The aim of this study was to investigate whether Lung Ultrasound, a noninvasive bedside method, can be used in volume status estimation. A liberal approach to volume replacement therapy is commonly seen during surgical procedures. An excess of administrated fluid may result in an increase of Extra Vascular Lung Water (EVLW) and can cause gas exchange deterioration. The aim of this study was to investigate whether Lung Ultrasound, a noninvasive bedside method, can be used in volume status estimation. One hundred patients were admitted to ICU after elective abdominal or vascular surgical procedure. Patients without known cardiac or lung diseases were included in the study. Overall 60 patients met the inclusion criteria. Inferior Vena Cava collapsibility index (IVC cl) and PaO2/FiO2 ratio were measured and the occurrence of B-lines was monitored at the patients’ admission to the ICU (0 time), and after six, twelve and twenty-four hours. The appearance of B-lines≤7mm together with IVC cl ≤ of 40% was taken as a sign of fluid overload and the rise of Extra Vascular Lung Water (EVLW). The value of the PaO2/FiO2 ratio lower than 200 was a sign of tissue oxygenation impairment. In 18/60(30%) of patients there were no signs of fluid overload. In 42/60(70%) of patients fluid overload was detected. The comparison of the appearance of B-lines≤ 7mm coupled with IVCcl≤40% to PaO2/FiO2<200 showed no difference in the time when fluid overload was detected (Wilcoxon test, P=0.0113). Relations between individual measures (B-Lines vs PaO2/FiO2 and IVCcl vs PaO2/FiO2) that were tested at the given times, showed a statistically significant association between B lines and PaO2/FiO2( Chi-square test, P<0.001 for all four times of measurement). The relation between IVCcl and PaO2/FiO2 was not statistically significant (Chi-square test, P=0, 071 or higher for all). Our study showed that Lung Ultrasound had the same sensitivity as the PaO2/FiO2 ratio in the detection of fluid overload, and that Lung Ultrasound could be used for volume status assessment in the ICU patients. These findings should be further verified in studies involving larger samples.

ultrasound, Extra Vascular Lung Water

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