Erschienen in:
01.02.2015 | Original Research
Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome
verfasst von:
Benoît Bataille, Guillaume Rao, Pierre Cocquet, Michel Mora, Bruno Masson, Jean Ginot, Stein Silva, Pierre-Etienne Moussot
Erschienen in:
Journal of Clinical Monitoring and Computing
|
Ausgabe 1/2015
Einloggen, um Zugang zu erhalten
Abstract
Extravascular lung water (EVLW) could increase by permeability pulmonary oedema, cardiogenic oedema, or both. Transthoracic echocardiography examination of a patient allows quantifying B-lines, originating from water-thickened interlobular septa, and the E/Ea ratio, related to pulmonary capillary wedge pressure. The aim of our study was to assess the correlation and the trending ability between EVLW measured by transpulmonary thermodilution and the B-lines score or the E/Ea ratio in patients with ARDS. Twenty-six intensive care unit patients were prospectively included. B-lines score was obtained from four ultrasound zones (anterior and lateral chest on left and right hemithorax). E/Ea was measured from the apical four-chamber view. EVLW was compared with the B-lines score and the E/Ea ratio. A linear mixed effect model was used to take account the repeated measurements. A p value <0.05 was considered significant. A total of 73 measurements were collected. The correlation coefficient between EVLW and B-lines score was 0.66 (EVLW = 0.71 B-lines + 7.64, R2 = 0.44, p = 0.001), versus 0.31 for E/Ea (p = 0.06). The correlation between EVLW changes and B-lines variations was significant (R2 = 0.26, p < 0.01), with a concordance rate of 74 %. A B-lines score ≥6 had a sensitivity of 82 % and a specificity of 77 % to predict EVLW >10 ml/kg, with an AUC equal to 0.86 (0.76–0.93). The gray zone approach identified a range of B-lines between four and seven for which EVLW >10 ml/kg could not be predicted reliably. The correlation between ultrasound B-lines and EVLW was significant, but the B-lines score was not able to track EVLW changes reliably.