Monitorización de las líneas B con ultrasonido pulmonar en pacientes mayores de 65 años durante cirugía de fractura de cadera

Abstract

BackgroundAnaesthetic management in elderly patients scheduled for hip fracture surgery is a challenge for anaesthesiologist. Ultrasound performed at the bedside (point-of-care) has a great potential for the non-invasive evaluation of extravascular lung water and cardiac function.We assessed B-lines using lung ultrasound (LUS) and their correlation with cardiac disfunction by transthoracic echocardiography (TTE) in patients undergoing hip fracture surgery with spinal anesthesia. Materials and methodsA multicentre prospective observational study was conducted that included 42 patients, ASA III, older than 65 year-old, and scheduled for hip fracture surgery under spinal anaesthesia. LUS and transthoracic echocardiography were performed before and 24hours after surgery. B-lines were determined using two scores: Echo Comet Score and B pattern score. Diastolic/systolic cardiac function and inferior vena cava collapsibility index were evaluated by transthoracic echocardiography. Restrictive fluid therapy was applied. ResultsDiastolic dysfunction was found in 80% of patients. B-pattern was found in 24 (57%) and 26 (61%) patients during pre/postoperative periods respectively. We found a linear correlation between the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/e′) and Echo Comet Score (P<.0001). The Echo Comet Score and B-pattern did not increase during the postoperative period (P<.63, P<.77, respectively). A statistically significant reduction was observed in inferior vena cava collapsibility index before and after surgery (P<.0001). DiscussionLUS detected asymptomatic lung congestion at a pre-clinical stage in a substantial proportion of elderly patients. B-lines did not increase during the postoperative period in these patients in whom restrictive fluid therapy was applied. ConclusionLUS may be a useful bedside tool to assess extravascular lung water in elderly patients during the peri-operative period, and can therefore help anaesthesiologists to optimise fluid therapy.