Gattupalli Vasavi, Jain Kajal, Samra Tanvir
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Indian J Crit Care Med. 2019 Mar;23(3):131-134. doi: 10.5005/jp-journals-10071-23135.
Extra vascular lung water (EVLW) is defined as the amount of fluid in the interstitial and alveolar spaces. Primary aim of this study was to assess EVLW using lung USG (B lines >3 per lung field) in critically ill head injured patients.
Intubated adult patients admitted in Trauma ICU with head injury (GCS 4-15) were assessed by daily chest X-ray and lung ultrasonography. Lung water content was graded based on the number of B lines per ICS with score ranging from 0-32 and categorized as low pulmonary fluid burden (0-10), moderate fluid burden (11-20) and high fluid burden (21-32).
140 critically ill head injured patients were assessed for eligibility and 20 excluded. Incidence of increased EVLW using lung USG was 61.66% (74/120) and the incidence reported using chest x ray was 40.83%(49/120) and the difference was statistically significant ( value <0.001). Increased EVLW significantly increased the duration of weaning, mechanical ventilation and ICU stay (p value <0.05). Significant association was observed between APACHE II, SAPS II and GCS at admission to ICU with presence of EVLW ( value ≤0.001). Mean delay in identification of EVLW by chest X-ray (CXR) compared to lung ultrasound was 1.42±0.76 days.
Lung ultrasound is better than CXR for early detection of increased EVLW in critically ill head injured patients and has prognostic relevance as increased EVLW prolongs duration of mechanical ventilation and ICU stay.
Gattupalli V, Jain K, . Lung Ultrasound as a Bedside Tool for Assessment of Extravascular Lung Water in Critically Ill Head Injured Patients: An Observational Study. Indian J Crit Care Med 2019;23(3):131-134.
血管外肺水（EVLW）被定义为间质和肺泡间隙中的液体量。本研究的主要目的是使用肺部超声（每个肺野B线>3条）评估重症颅脑损伤患者的EVLW。
对入住创伤重症监护病房（ICU）的成年颅脑损伤患者（格拉斯哥昏迷评分4-15分）进行每日胸部X线和肺部超声检查。根据每个肋间的B线数量对肺含水量进行分级，评分范围为0-32分，并分为低肺液负荷（0-10）、中度液负荷（11-20）和高液负荷（21-32）。
对140例重症颅脑损伤患者进行了资格评估，20例被排除。使用肺部超声检查发现EVLW增加的发生率为61.66%（74/120），使用胸部X线报告的发生率为40.83%（49/120），差异具有统计学意义（P值<0.001）。EVLW增加显著延长了脱机、机械通气和ICU住院时间（P值<0.05）。在入住ICU时，急性生理与慢性健康状况评分系统II（APACHE II）、简化急性生理学评分II（SAPS II）和格拉斯哥昏迷评分与EVLW的存在之间存在显著相关性（P值≤0.001）。与肺部超声相比，胸部X线（CXR）识别EVLW的平均延迟时间为1.42±0.76天。
对于早期检测重症颅脑损伤患者EVLW增加，肺部超声优于胸部X线，并且具有预后相关性，因为EVLW增加会延长机械通气时间和ICU住院时间。
Gattupalli V, Jain K, 。肺部超声作为评估重症颅脑损伤患者血管外肺水的床边工具：一项观察性研究。《印度重症监护医学杂志》2019年；23(3):131-134。
