Department of Anesthesia, Operation and Intensive Care, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Ultrasound Med. 2023 Sep;42(9):2013-2021. doi: 10.1002/jum.16219. Epub 2023 Mar 16.
Pulmonary edema is a common clinical problem and lung ultrasound (LUS) presents an efficient method for evaluating this pathology. This study aims to investigate if a clinically efficient LUS protocol can quantify the level of extravascular lung fluid in patients receiving hemodialysis, and to develop a simplified B-line scoring system based on this protocol.
A simple 8-area LUS approach was used for the assessment of the extravascular fluid status in patients before, during, and after receiving hemodialysis. The LUS assessments were compared to the amount of removed fluid over time. To determine the best B-line score system, different scorings for each zone were tested in a linear mixed model with pseudo R-square model fit against removed fluid. The B-line score was further validated through correlations with changes in oxygen saturation, grade of dyspnea, and body weight over time.
A total of 53 patients were included and examined on 108 hemodialysis occasions. Median fluid removal was 2.3 L. The B-line score model with best fit was a score of 0 points in a zone with 0 or 1 B-lines, 1 point with 2 or 3 B-lines, 2 points with 3 or more B-lines, and 3 points with any interstitial confluence. Using this B-line score, we found a significant association with amount of removed fluid, oxygen saturation, grade of dyspnea, and change in body weight.
A straightforward protocol for LUS and B-line score system was shown valid for quantification of pulmonary edema and fluid removal in hemodialysis patients. The scoring system developed here can be useful also in other patient groups, but this requires further validation.
肺水肿是一种常见的临床问题，肺部超声（LUS）为评估该病理提供了一种有效的方法。本研究旨在探讨一种临床有效的 LUS 方案是否可以量化接受血液透析患者的肺外血管内液体水平，并基于该方案开发简化的 B 线评分系统。
采用简单的 8 区 LUS 方法评估接受血液透析前后的患者的血管外液体状态。将 LUS 评估与随时间推移去除的液体量进行比较。为了确定最佳的 B 线评分系统，在具有伪 R 平方模型拟合的线性混合模型中，对每个区域的不同评分进行了测试，以对抗去除的液体。通过与随时间推移的血氧饱和度、呼吸困难程度和体重变化的相关性进一步验证了 B 线评分。
共纳入 53 例患者，共 108 次血液透析。中位液体清除量为 2.3 L。拟合最佳的 B 线评分模型是在 0 或 1 条 B 线的区域得分为 0 分，2 或 3 条 B 线得分为 1 分，3 或更多 B 线得分为 2 分，任何间质融合的区域得分为 3 分。使用该 B 线评分，我们发现其与清除量、血氧饱和度、呼吸困难程度和体重变化显著相关。
LUS 与 B 线评分系统的简单方案已被证明可有效量化血液透析患者的肺水肿和液体清除。这里开发的评分系统也可用于其他患者群体，但需要进一步验证。
