Thoracic fluid content: a novel parameter for detection of pulmonary edema in parturients with preeclampsia

Abstract

Acute pulmonary oedema is a serious complication of preeclampsia. Early detection of pulmonary edema in preeclampsia would improve fluid management and would also allow earlier detection of severe cases. The aim of this work is to evaluate the ability of thoracic fluid content measured by electrical cardiometry for early detection of pulmonary edema in parturients with preeclampsia. A prospective observational study included a cohort of preeclamptic parturients. On admission, lung ultrasound score was calculated, and thoracic fluid content was recorded using electrical cardiometry ICON device. Area under receiver operating characteristic (AUROC) curve was calculated for lung ultrasound score, thoracic fluid content for detection of pulmonary edema. Spearman correlation coefficient was calculated for correlation between lung ultrasound score and thoracic fluid content. Sixty patients were included in the study; of them, 6 patients (10%) required diuretics for pulmonary edema. Patients with pulmonary edema had higher lung ultrasound score and thoracic fluid content compared to other patients. Good correlation was reported between Lung ultrasound score and thoracic fluid content (r = 0.82). Thoracic fluid content and lung ultrasound score showed excellent diagnostic properties for pulmonary edema {AUROC: 0.941 (0.849-0.986), best cut-off value: 40 k ohm}, and {AUROC: 0.961 (0.887-0.994), best cut-off value of 15.7}. In parturients with preeclampsia, both lung ultrasound score and thoracic fluid content showed excellent properties for detection pulmonary edema. The high negative predictive value of both tests makes them useful screening tests to rule out pulmonary edema. The excellent correlation between both measures suggests that electrical cardiometry could be a promising surrogate to ultrasound for assessment of extravascular lung water.

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation

“…In late preterm and term newborn, TFC correlated with the occurrence of respiratory distress in the first 24 h after birth [19]. Our group had recently evaluated TFC in pre-eclamptic mothers and reported that TFC could detect mothers with high risk for pulmonary edema [10]. In the current study, we evaluated TFC in another population, the critically ill patients, and found that the TFC could be a useful tool for detection of weaning failure in cardiac patients.…”

“…Thoracic fluid content represents the whole (extravascular, intravascular, and intrapleural) fluid component in the thorax; thus, TFC was postulated to provide an estimation of the extravascular lung water. Our group had recently reported that TFC could detect pulmonary edema in parturients with pre-eclampsia [10]. We had also found that TFC correlated perfectly with extravascular lung water in pre-eclamptic patients [10].…”

“…Lung congestion may also be triggered by the SBT due to the increase in the left ventricular afterload [13], as well as the increase in the venous return and the subsequent increase in the cardiac preload [14]. The TFC is an index for both extra and intra-vascular thoracic fluid; however, the TFC showed good correlation with ultrasound in estimation of extravascular lung water [10]. Therefore, high TFC value could be an indirect measure of lung congestion and/or hypervolemia which is a known risk factor for failed weaning.…”

“…Our group had recently reported that TFC could detect pulmonary edema in parturients with pre-eclampsia [10]. We had also found that TFC correlated perfectly with extravascular lung water in pre-eclamptic patients [10]. In this study, we aimed to evaluate the accuracy of TFC, as an estimate of lung congestion, in predicting weaning outcome in critically ill patients.…”

The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

“…Lung ultrasound was performed by a skilled operator who was blinded to the study group. A Mindray device (DC-N6, with a phased array transducer, model P4-2, 3-6 megahertz) was used for 12-region lung ultrasound examination according to the following protocol [16]. We used the following definitions: 1) B-line: “laser-like vertical hyperechoic artefact which extends between the pleural line and the bottom of the screen, and moves with respiration”.…”