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Lung ultrasonography as a marker of pulmonary edema in cardiac surgery patients: visual versus quantitative evaluation
Critical Care volume 19, Article number: P221 (2015)
Introduction
Lung ultrasonography (LUS) has been used for noninvasive detection of pulmonary edema. LUS visual scores (V-LUS) based on B-lines are poorly correlated with either pulmonary capillary wedge pressure (PCWP) or extravascular lung water (EVLW). A new quantitative LUS analysis (Q-LUS) has been recently proposed [1, 2]. The aim of the study was to investigate whether Q-LUS is better correlated with PCWP and EVLW than V-LUS, and to what extent positive end-expiratory pressure (PEEP) affects the assessment of pulmonary edema by Q-LUS and V-LUS.
Methods
Thirty-nine patients mechanically ventilated with PEEP of 5 cmH2O (n = 47) or 10 cmH2O (n = 30) and PCWP (n = 77) or EVLW (n = 38) monitored were studied.
Results
PCWP was significantly and strongly correlated with Q-LUS Grey Unit value (r2 = 0.64) but weakly with V-LUS B-line score (r2 = 0.19). EVLW was significantly and strongly correlated with QLUS Grey Unit mean value (r2 = 0.65) more than with V-LUS B-line score (r2 = 0.42). Q-LUS showed a better diagnostic accuracy than V-LUS for the detection of PCWP >15 mmHg or EVLW >10 ml/kg. With a PEEP of 5 cmH2O, the correlations with PCWP or EVLW were stronger with Q-LUS than V-LUS. With a PEEP of 10 cmH2O, the correlations with PCWP or EVLW were still significant for Q-LUS but insignificant for V-LUS. Intraobserver repeatability and interobserver reproducibility were much better for Q-LUS than V-LUS.
Conclusion
Both V-LUS and Q-LUS are acceptable indicators of pulmonary edema in patients mechanically ventilated with low PEEP but at high PEEP only Q-LUS provides data that are significantly correlated with. Computer-aided Q-LUS has the advantages of being not only independent of operator perception but also of PEEP.
References
Corradi F, Ball L, Brusasco C, Riccio AM, Baroffio M, Bovio G, et al: Assessment of extravascular lung water by quantitative ultrasound and CT in isolated bovine lung. Respir Physiol Neurobiol. 2013, 187: 244-9. 10.1016/j.resp.2013.04.002.
Quanta Imaging Technology. [http://www.quanta.camelotbio.com]
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Corradi, F., Brusasco, C., Manca, T. et al. Lung ultrasonography as a marker of pulmonary edema in cardiac surgery patients: visual versus quantitative evaluation. Crit Care 19 (Suppl 1), P221 (2015). https://doi.org/10.1186/cc14301
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DOI: https://doi.org/10.1186/cc14301
Keywords
- Diagnostic Accuracy
- Emergency Medicine
- Pulmonary Edema
- Quantitative Evaluation
- Pulmonary Capillary Wedge Pressure