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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2013

01-01-2013 | Original

Lung water assessment by lung ultrasonography in intensive care: a pilot study

Authors: Giacomo Baldi, Luna Gargani, Antonio Abramo, Luigia D’Errico, Davide Caramella, Eugenio Picano, Francesco Giunta, Francesco Forfori

Published in: Intensive Care Medicine | Issue 1/2013

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Abstract

Objective

To investigate the accuracy of lung ultrasonography (LUS) in the quantification of lung water in critically ill patients by using quantitative computed tomography (CT) as the gold standard for the determination of lung weight.

Methods

Twenty consecutive patients admitted to an intensive care unit who underwent chest CT as a step in their clinical management were evaluated within 4 h by LUS. Lung weight, lung volume, and physical lung density were calculated from the CT scans using ad hoc software. Semiquantitative ultrasound assessment of lung water was performed by determining the ultrasound B-line score, defined as the total number of B-lines detectable in an anterolateral LUS examination.

Results

Good correlations were found between the B-line score and lung weight (r = 0.75, p < 0.05) and density (r = 0.82, p < 0.01), that only marginally increased when the lung density of the first 10 mm of subpleural lung tissue was evaluated (r = 0.83, p < 0.01). Moreover, values of subpleural lung density were not significantly different from values of the whole lung density (0.34 ± 0.11 vs. 0.37 ± 0.16 g/ml, p = ns). Very good correlations were found between the B-line score and both the weight (r = 0.85, p < 0.01) and the density (r = 0.88, p < 0.01) of the upper lobes. The weight of the lower lobes was not correlated with the B-line score (r = 0.14, p = ns).

Conclusions

Lung ultrasound B-lines are correlated with lung weight and density determined by CT. LUS may provide a reliable, simple and radiation-free lung densitometry in the intensive care setting.
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Literature
1.
Sakka SG, Klein M, Reinhart K, Meier-Hellmann A (2002) Prognostic value of extravascular lung water in critically ill patients. Chest 122:2080–2086PubMedCrossRef
2.
Martin GS, Eaton S, Mealer M, Moss M (2005) Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care 9:R74–R82PubMedCrossRef
3.
Isakow W, Schuster DP (2006) Extravascular lung water measurements and hemodynamic monitoring in the critically ill: bedside alternatives to the pulmonary artery catheter. Am J Physiol Lung Cell Mol Physiol 291:L1118–L1131PubMedCrossRef
4.
Tatsushi M, Kazumata K, Ajiki M, Ushikoshi S, Terasaka S (2007) Goal-directed fluid management by bedside transpulmonary hemodynamic monitoring after subarachnoid hemorrhage. Stroke 38:3218–3224CrossRef
5.
Pistolesi M, Giuntini C (1978) Assessment of extravascular lung water. Radiol Clin North Am 15:551–574
6.
Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q, Grenier P (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS severity score: CT scan ARDS study group. Intensive Care Med 26:1046–1056PubMedCrossRef
7.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:9–15PubMedCrossRef
8.
Roch A, Michelet P, Lambert D, Delliaux S, Saby C, Perrin G, Ghez O, Bregeon F, Thomas P, Carpentier JP, Papazian L, Auffray JP (2004) Accuracy of the double indicator method for measurement of extravascular lung water depends on the type of acute lung injury. Crit Care Med 32:811–817PubMedCrossRef
9.
Sakka SG, Reinhart K, Meier-Hellmann A (1999) Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med 25:843–846PubMedCrossRef
10.
Rossi P, Wanecek M, Rudehill A, Konrad D, Weitzberg E, Oldner A (2006) Comparison of a single indicator and gravimetric technique for estimation of extravascular lung water in endotoxemic pigs. Crit Care Med 34:1437PubMedCrossRef
11.
12.
Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O (1997) The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646PubMed
13.
Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G (2006) Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 19:356–363PubMedCrossRef
14.
Copetti R, Soldati G, Copetti P (2008) Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 6:16PubMedCrossRef
15.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T; International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591PubMedCrossRef
16.
17.
Lichtenstein D, Meziere G, Biderman P, Gepner A (2000) The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 26:1434–1440PubMedCrossRef
18.
Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S (2002) Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT – initial experience. Radiology 225:210–214PubMedCrossRef
19.
Lichtenstein D, Pinsky MR, Jardin F (2007) General ultrasound in the critically ill. Springer, Berlin
20.
Gryminski J, Krakowka P, Lypacewicz G (1976) The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 70:33PubMedCrossRef
21.
Yang P, Luh K, Chang D, Wu H, Yu C, Kuo S (1992) Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR Am J Roentgenol 159:29PubMed
22.
Mathis G, Blank W, Reissig A, Lechleitner P, Reuss J, Schuler A, Beckh S (2005) Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest 128:1531–1538PubMedCrossRef
23.
Reissig AK (2007) Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration 74:537–547PubMedCrossRef
24.
Gargani L, Frassi F, Soldati G, Tesorio P, Gheorghiade M, Picano E (2008) Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail 10:70–77PubMedCrossRef
25.
Soldati G, Copetti R, Sher S (2009) Sonographic interstitial syndrome: the sound of lung water. J Ultrasound Med 28:163–174PubMed
26.
Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF (2008) Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. Am J Emerg Med 26:585–591PubMedCrossRef
27.
Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M, Picano E (2004) Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 15:1265–1270CrossRef
28.
Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, Picano E (2005) “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 127:1690–1695PubMedCrossRef
29.
Gargani L, Lionetti V, Di Cristofano C, Bevilacqua G, Recchia FA, Picano E (2007) Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med 35:2769–2774PubMedCrossRef
30.
Lichtenstein D (2012) Fluid administration limited by lung sonography: the place of lung ultrasound in assessment of acute circulatory failure (the FALLS-protocol). Expert Rev Respir Med 6:155–162PubMedCrossRef
31.
Martin K, Ibáñez L, Avila L, Barré S, Kaspersen J (2005) Integrating segmentation methods from the insight toolkit into a visualization application. Med Image Anal 9:579–593PubMedCrossRef
32.
33.
Malbouisson LM, Preteux F, Puybasset L, Grenier P, Coriat P, Rouby JJ (2001) Validation of a software designed for computed tomographic (CT) measurement of lung water. Intensive Care Med 27:602–608PubMedCrossRef
34.
Pelosi P, Goldner M, McKibben A, Adams A, Eccher G, Caironi P, Losappio S, Gattinoni L, Marini JJ (2001) Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med 164:122–130PubMed
35.
Patroniti N, Bellani G, Manfio A, Maggioni E, Giuffrida A, Foti G, Pesenti A (2004) Lung volume in mechanically ventilated patients: measurement by simplified helium dilution compared to quantitative CT scan. Intensive Care Med 30:282–289PubMedCrossRef
36.
Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT scan ARDS study group. Intensive Care Med 26:857–869PubMedCrossRef
37.
Gargani L, Doveri M, D’Errico L, Frassi F, Bazzichi ML, Delle Sedie A, Scali MC, Monti S, Mondillo S, Bombardieri S, Caramella D, Picano E (2009) Ultrasound lung comets in systemic sclerosis: a chest sonography hallmark of pulmonary interstitial fibrosis. Rheumatology (Oxford) 48:1382–1387CrossRef
38.
Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ (2011) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 183:341–347PubMedCrossRef
39.
Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, Girard M, Lu Q, Rouby JJ (2010) Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med 38:84PubMedCrossRef
40.
Bellani G, Messa C, Guerra L, Spagnolli E, Foti G, Patroniti N, Fumagalli R, Musch G, Fazio F, Pesenti A (2009) Lungs of patients with acute respiratory distress syndrome show diffuse inflammation in normally aerated regions: a [18F]-fluoro-2-deoxy-d-glucose PET/CT study. Crit Care Med 37:2216PubMedCrossRef
41.
Mallamaci F, Benedetto F, Tripepi R, Rastelli S, Castellino P, Tripepi G, Picano E, Zoccali C (2010) Detection of pulmonary congestion by chest ultrasound in dialysis patients. JACC Cardiovasc Imaging 3:586–594PubMedCrossRef
42.
Bedetti G, Gargani L, Corbisiero A, Frassi F, Poggianti E, Mottola G (2006) Evaluation of ultrasound lung comets by hand-held echocardiography. Cardiovasc Ultrasound 4:34PubMedCrossRef
43.
Shah S, Noble VE, Umulisa I, Dushimiyimana JM, Bukhman G, Mukherjee J, Rich M, Epino H (2008) Development of an ultrasound training curriculum in a limited resource international setting: successes and challenges of ultrasound training in rural Rwanda. Int J Emerg Med 1(3):193–196
44.
Jambrik Z, Gargani L, Adamicza A, Kaszaki J, Varga A, Forster T, Boros M, Picano E (2010) B-lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury. Ultrasound Med Biol 36:2004–2010PubMedCrossRef
45.
Delle Sedie A, Doveri M, Frassi F, Gargani L, D’Errico G, Pepe P, Bazzichi L, Riente L, Caramella D, Bombardieri S (2010) Ultrasound lung comets in systemic sclerosis: a useful tool to detect lung interstitial fibrosis. Clin Exp Rheumatol 28(5 Suppl 62):S54PubMed
Metadata
Title
Lung water assessment by lung ultrasonography in intensive care: a pilot study
Authors
Giacomo Baldi
Luna Gargani
Antonio Abramo
Luigia D’Errico
Davide Caramella
Eugenio Picano
Francesco Giunta
Francesco Forfori
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2694-x

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