Chest
Original ResearchCritical Care MedicineA-Lines and B-Lines: Lung Ultrasound as a Bedside Tool for Predicting Pulmonary Artery Occlusion Pressure in the Critically Ill
Section snippets
Methods
A prospective 5-year study evaluated 103 critically ill patients receiving a PAC in medicosurgical ICUs. These patients required hemodynamic measurements at the discretion of the managing team faced with instability or complex hemodynamic situations (Table 1). Patients were consecutive in the context of the part-time presence of the ultrasound operators (DL and GM), who were blinded to the hemodynamic measurements made by other members of the managing team. Hindrances to an examination
Results
Of 103 patients, 1 patient experienced a pneumothorax and was excluded. The study enrolled 102 patients (Table 1), resulting in 102 comparisons of PAOP and lung ultrasound.
Discussion
Until now, lung ultrasound has been used for diagnosing the lung disorders: pneumothorax, pneumonia, COPD, asthma, and pulmonary embolism,7, 9, 10, 11, 12 for which it showed high accuracy, as has been confirmed by other studies.13, 14, 15, 16, 17, 18, 19 In particular, ultrasound proved to be an accurate test for diagnosing interstitial syndrome.6 Pulmonary edema combines respiratory and hemodynamic phenomena. The present study extends the potential of lung ultrasound to the hemodynamic
Conclusions
Lung ultrasound provides a new approach for interstitial edema detection. A-predominance indicates dry anterior interlobular septa. Specific to predicting a low PAOP value, A-predominance suggests that fluid may be given without initial concern for the development of hydrostatic pulmonary edema. B-predominance indicates interstitial syndrome, possibly related to interstitial edema. B-predominance is observed in a wide range of PAOP values, precluding firm conclusions for the need for fluid
Acknowledgments
Author contributions: Dr. Lichtenstein collected the data and wrote the article. Dr. Mezière collected the data and cowrote the article. Dr. Lagoueyte reviewed the article. Dr. Biderman was the advisor. Dr. Goldstein collected data. Dr. Gepner was the advisor and collected data.
Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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