Lung ultrasound as an evolving tool in the detection of extravascular lung water following goal-directed fluid therapy in septic cancer patients

Abstract

Background: Severe sepsis can result in septic shock with a high mortality rate. This study aimed to assess the correlation between B-lines detected by lung ultrasound (LUS) and thoracic fluid content (TFC) and to compare their sensitivity and specificity to predict lung congestion on conventional chest radiograph following early goal-directed fluid therapy in septic cancer patients. Methods: This study included 30 patients suffering from sepsis admitted to the intensive care unit. They received resuscitation according to the surviving sepsis campaign 2018 guidelines. Lung ultrasonography, TFC, central venous pressure (CVP), and inferior vena cava (IVC) scanning were done upon admission then after 3, 6, and 12 h. Chest X-ray was done after 6 h then at the study end (12 h) and CT chest at 12 h. Results: B-lines showed a moderate-to-strong positive correlation with TFC, a moderate and positive correlation with CVP, and a negative and weak-to-moderate correlation with IVC collapsibility index. The performance of LUS was good at 6 h (AUC = 0.872, 95% CI = 0.700 to 0.965, P < 0.001), and the optimal cut-off value was 7 with a sensitivity and specificity of 75% and 95.5%, respectively. The sensitivity and specificity increased to reach 100% at 12 h using a cut-off value of 9. Meanwhile TFC had lower AUCs compared to B-lines at the two-time points though the difference was statistically non-significant. Conclusion: Lung ultrasound can be considered a useful non-invasive bedside tool for early detection of extravascular lung water during the early resuscitation phase of goal-directed fluid therapy in sepsis patients. Abbreviations: LUS: Lung ultrasound; EVLW: Extravascular Lung Water; TFC: Thoracic fluid content; CVP: Central venous pressure; IVC: Inferior vena cava; AUC: Area under the curve; PAOP: Pulmonary artery occlusion pressure; IVC-CI: Inferior vena cava collapsibility index Citation: Elsabeeny WY, Ibrahim MA, El Desouky ED, Hamed M, Shaker EH. Lung ultrasound as an evolving tool in the detection of extravascular lung water following goal-directed fluid therapy in septic cancer patients. Anaesth. pain intensive care 2022;26(5):623-632; DOI: 10.35975/apic.v26i5.1987