Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study

Abstract

IntroductionThe study was designed to assess the impact of fluid loading on lung aeration, oxygenation and hemodynamics in patients with septic shock and acute respiratory distress syndrome (ARDS).MethodsDuring a 1-year period, a prospective observational study was performed in 32 patients with septic shock and ARDS. Cardiorespiratory parameters were measured using Swan Ganz (n = 29) or PiCCO catheters (n = 3). Lung aeration and regional pulmonary blood flows were measured using bedside transthoracic ultrasound. Measurements were performed before (T0), at the end of volume expansion (T1) and 40 minutes later (T2), consisting of 1-L of saline over 30 minutes during the first 48 h following onset of septic shock and ARDS.ResultsLung ultrasound score increased by 23% at T2, from 13 at baseline to 16 (P < 0.001). Cardiac index and cardiac filling pressures increased significantly at T1 (P < 0.001) and returned to control values at T2. The increase in lung ultrasound score was statistically correlated with fluid loading-induced increase in cardiac index and was not associated with increase in pulmonary shunt or regional pulmonary blood flow. At T1, PaO2/FiO2 significantly increased (P < 0.005) from 144 (123 to 198) to 165 (128 to 226) and returned to control values at T2, whereas lung ultrasound score continued to increase.ConclusionsEarly fluid loading transitorily improves hemodynamics and oxygenation and worsens lung aeration. Aeration changes can be detected at the bedside by transthoracic lung ultrasound, which may serve as a safeguard against excessive fluid loading.

Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients

“…Neovascularization is a characteristic feature of tumor consolidation, which accounts for the low-impedance flow. However, other researchers also have found that pulmonary blood flow persists within the consolidations caused by ARDS or a diffuse alveolar hemorrhage [55, 56]. These results indicate that the hemodynamic changes observed in the regional pulmonary artery during lung consolidation are complex.…”

“…Lastly, LUS scoring systems based on the A line, B line, and lung consolidation have been applied for the quantitative monitoring of lung aeration and aeration changes [28, 55, 60, 61]. All these scoring systems divide lung aeration into four ultrasound patterns for the assessment of aeration and re-aeration observed on LUS.…”

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

“…In conclusion, while providing unessential or dangerous statements, this Commentary seems to overlook the strong evidence behind the use of semiquantitative LUS in critically ill patients of any age. In fact, several US scores, carrying all of the intrinsic characteristics due to their semiquantitative nature and being even simpler than the neonatal one, have been validated against a multitude of techniques (Table ), confirming their usefulness despite their intrinsic limitations . Table is not comprehensive, but it is out of the scope of this article to list all LUS validation studies.…”

Volumenersatztherapie – ist weniger mehr?

“…Der bisher nicht geklärten Frage, welche Folgen eine Albumin-Gabe bei schwerer Sepsis hat, ging eine kürzlich publizierte italienische randomi sierte, offene und multizentrische Studie nach [5] anzupassen und nicht in die Gefahr einer prog nostisch ungünstigen Hypervolämie zu kommen [25,26].…”