A Simplified Approach to Extravascular Lung Water Assessment Using Point-of-Care Ultrasound in Patients with End-Stage Chronic Renal Failure Undergoing Hemodialysis

Abstract

Background: Fluid overload leading to pulmonary congestion is an important issue in patients undergoing hemodialysis. This study aimed to determine if a simplified method of extravascular lung water assessment using ultrasound provided clinically relevant information. Methods: This prospective study recruited 47 patients from a single hemodialysis center. Pulmonary ultrasound was performed before and after 2 hemodialysis sessions in 28 regions on the thorax. The B-line score was defined as the percentage regions where B-lines were present. Results: When B-lines were detected before hemodialysis, a significant relationship was found between fluid removal and the change in B-line score. Patients with a B-line score of ≥21.4% (4th quartile) after the second hemodialysis session were more likely to be hospitalized for pulmonary edema or acute coronary syndrome. Conclusions: A simplified pulmonary assessment using ultrasound provides relevant information about pulmonary congestion in hemodialysis patients and identifies patients at risk of hospitalization for heart-related problems.

Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

“…Although many studies and opinion articles focus on assessment of lung aeration using transthoracic lung US in scenarios other than ARDS, such as anesthesia, hemodialysis, pneumonia, postextubation distress, and cardiogenic pulmonary edema, evidence for using lung US in ARDS is limited to date, and extrapolation of data should be cautious, given the unique characteristics of the lungs in ARDS.…”

The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury

“…123 Extravascular lung water (EVLW) can be assessed semiquantitatively by recording the number of B-lines that are present at several positions on the thorax (5) or, more simply, by counting the number of regions with visible B-lines. 124,125 The presence of B-lines has been shown to be representative of invasively measured EVLW. 126À128 Considering EVLW has been associated with adverse outcomes in critically ill patients, 129 normalization of pulmonary ultrasound could be considered as a potential treatment target.…”

Whole body ultrasound in the operating room and intensive care unit

“…Hypovolemia can be absolute (as described above) or relative, for example an acute reduction in preload in the setting of chron-ically raised venous pressure from cardiac failure. Hence, a complete cardiac ultrasound is required to discriminate these two conditions before attempting treatment with intravascular volume replacement, as this could worsen renal venous congestion [46,47]. The use of color Doppler after appropriate scale adjustment offers a simple method to identify kidney hypoperfusion or venous congestion [48][49][50].…”