Abstract
A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Our objective was to evaluate the appearance of B-lines as a diagnostic marker of preload unresponsiveness and postoperative complications in the operating theater. We conducted a prospective, bicentric, observational study. Adult patients undergoing abdominal surgery were included. Stroke volume (SV) was determined before and after a fluid challenge with 250 mL crystalloids (Delta-SV) using esophageal Doppler monitoring. Responders were defined by an increase of Delta-SV > 10% after fluid challenge. B-lines were collected at four bilateral predefined zones (right and left anterior and lateral). Delta-B-line was defined as the number of newly appearing B-lines after a fluid challenge. Postoperative pulmonary complications were prospectively recorded according to European guidelines. In total, 197 patients were analyzed. After a first fluid challenge, 67% of patients were responders and 33% were non-responders. Delta-B-line was significantly higher in non-responders than responders [4 (2–7) vs 1 (0–3), p < 0.0001]. Delta-B-line was able to diagnose fluid non-responders with an area under the curve of 0.74 (95% CI 0.67–0.80, p < 0.0001). The best threshold was two B-lines with a sensitivity of 80% and a specificity of 57%. The final Delta-B-line could predict postoperative pulmonary complications with an area under the curve of 0.74 (95% CI 0.67–0.80, p = 0.0004). Delta-B-line of two or more detected in four lung ultrasound zones can be considered to be a marker of preload unresponsiveness after a fluid challenge in abdominal surgery.The objectives and procedures of the study were registered at Clinicaltrials.gov (NCT03502460; Principal investigator: Stéphane BAR, date of registration: April 18, 2018).
Highlights
Stéphane Bar1*, Céline Yee1, Daniel Lichtenstein2, Magali Sellier1, Florent Leviel1, Osama Abou Arab1, Julien Marc3, Matthieu Miclo1, Hervé Dupont1 & Emmanuel Lorne1
Based on the study of artifacts over the last 25 years, lung ultrasound has been increasingly used in intensive care units (ICUs)5 emergency rooms6, cardiology7 and nephrology8
There were 190 patients included in the University Hospital Center and 10 patients included in the General Hospital Center
Summary
Stéphane Bar1*, Céline Yee, Daniel Lichtenstein, Magali Sellier, Florent Leviel, Osama Abou Arab, Julien Marc, Matthieu Miclo, Hervé Dupont1 & Emmanuel Lorne. A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Delta-B-line of two or more detected in four lung ultrasound zones can be considered to be a marker of preload unresponsiveness after a fluid challenge in abdominal surgery. Current guidelines recommend guiding fluid titration by measuring stroke volume (SV) in high-risk surgical patients to obtain an unresponsiveness state, which corresponds to the absence of an increase in SV of more than 10% after a fluid challenge. Current guidelines recommend guiding fluid titration by measuring stroke volume (SV) in high-risk surgical patients to obtain an unresponsiveness state, which corresponds to the absence of an increase in SV of more than 10% after a fluid challenge3,4 Application of such recommendations has reduced post-operative morbidity and the length of hospitalization. As lung ultrasound is a simple and real-time tool, could it be potentially used in the operative setting to guide fluid titration and avoid fluid overload?
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