Role of lung ultrasound in assessment of endpoint of fluid therapy in patients with hypovolemic shock

Figures & data

Table 1. Ultrasound-scoring system [4]

Ultrasound finding	Score
No B-line/ICS^a	0
One B-line/ICS^a	1
Two B-line/ICS^a	2
Three B-line/ICS^a	3
Four B-line/ICS^a	4
Five B-line/ICS^a	5
Confluent B-lines > 50% ICS^a	6
Confluent B-lines > 75% ICS^a	7
Confluent B-lines 100% ICS^a	8

^aICS, intercostal space.

Figure 1. Scheme of the four parasternal points corresponding to the intercostal spaces between the third and fourth ribs and between the sixth and seventh ribs used to calculate the ultrasound score [4]

Table 2. Descriptive statistics for CVP values, lung US score, and UOP values over the period of resuscitation

		On admission (n = 60)	After 15 min (1st 1000 ml) (n = 60)	Within 1 h (2nd 1000 ml)				After 10 min (200 ml) (n = 14)	In 10 min (Additional 200 ml) (n = 4)
				After 15 min (n = 60)	After 30 min (n = 60)	After 45 min (n = 60)	After 60 min (n = 48)
CVP (cmH2O)	Min.	−3	0	2	4	6	8	10	12
	Max.	5	8	10	11	13	14	13	13
	Median	2.0	5.0	6.5	8.0	10.0	12.0	12.0	12.5
	IQR	0–3	3–6	5–8	7–9	9–11	10.25–12.75	10–13	12–13
Lung US score	Min.	0	0	2	6	8	12	12	16
	Max.	3	7	9	12	16	17	18	17
	Median	0.0	4.0	7.0	9.0	12.0	16.0	16.0	17.0
	IQR	0–2	0–6	5–8	8–12	11–14	14–16	14–18	16–17
UOP (ml)	Min.	0	0	0	0	0	10.0	20.0	20.0
	Max.	0	0	40	30	50	50.0	50.0	40.0
	Median	0.0	0.0	0.0	10.0	20.0	30.0	40.0	30.0
	IQR	0–0	0–0	0–10	0–20	10–30	20–30	20–50	20–40

Table 3. Descriptive statistics for blood pressure values over the period of resuscitation

Blood pressure (mmHg)		On admission (n = 46)^a	After 15 min (1st 1000 ml) (n = 58)^b	Within 1 h (2nd 1000 ml)				After 10 min (200 ml) (n = 14)	After 10 min (Additional 200 ml) (n = 4)
				After 15 min (n = 60)	After 30 min (n = 60)	After 45 min (n = 60)	After 60 min (n = 48)
SBP	Min.	40	50	50	60	80	90	100	110
	Max.	80	90	100	110	130	130	130	120
	Mean	61.7	71.3	81.3	92.6	106.7	117.5	112.8	115.0
	±SD	12.1	11.4	11.5	10.0	12.0	12.8	9.1	5.77
DBP	Min.	30	30	30	40	50	60	70	80
	Max.	50	60	60	70	90	90	90	90
	Mean	38.7	47.6	54.3	62.0	70.7	81.3	74.3	85.0
	±SD	6.9	11.2	8.9	8.8	9.4	11.0	7.5	5.8
MAP	Min.	33	37	37	47	60	70	80	90
	Max.	60	70	73	83	103	103	100	100
	Mean	46.4	55.7	63.4	72.2	82.4	93.1	87	95
	±SD	8.0	11.0	9.4	8.8	9.98	11.3	7.7	5.7

aValues of 14 cases were not detectable..

^bValues of two cases were not detectable.

Table 4. Correlation of lung US with CVP, blood pressure, and UOP

With	Lung US score
	At admission (n = 60)		After 1st 1000 ml (n = 60)		After 15 min (2nd 1000 ml) (n = 60)		After 30 min (2nd 1000 ml) (n = 60)		After 45 min (2nd 1000 ml) (n = 60)		After 60 min (2nd 1000 ml) (n = 48)		After 1st additional 200 ml (n = 14)		After 2nd additional 200 ml (n = 4)
	Rho	P	Rho	P	rho	P	Rho	P	Rho	P	Rho	P	Rho	P	Rho
CVP	0.502	<0.001 (HS)	0.643	<0.001 (HS)	0.695	<0.001 (HS)	0.690	<0.001 (HS)	0.809	<0.001 (HS)	0.734	<0.001 (HS)	0.495	0.072	1.0	<0.001 (HS)
SBP	0.235	0.26	0.553	<0.001 (HS)	0.664	<0.001 (HS)	0.640	<0.001 (HS)	0.843	<0.001 (HS)	0.712	<0.001 (HS)	0.671	0.009 (S)	1.0	<0.001 (HS)
DBP	0.267	0.072	0.507	<0.001 (HS)	0.590	<0.001 (HS)	0.569	<0.001 (HS)	0.725	<0.001 (HS)	0.757	<0.001 (HS)	0.350	0.22	1.0	<0.001 (HS)
MAP	0.249	0.095	0.555	<0.001 (HS)	0.667	<0.001 (HS)	0.655	<0.001 (HS)	0.823	<0.001 (HS)	0.731	<0.001 (HS)	0.568	0.034 (S)	1.0	<0.001 (HS)
UOP	0	0	0	0	0.530	<0.001 (HS)	0.518	<0.001 (HS)	0.517	<0.001 (HS)	0.120	0.41	0.198	0.49	1.0	<0.001 (HS)

Figure 2. Receiver operating characteristic (ROC) curve analysis for assessment of endpoint fluid therapy

Enghard P, Rademacher S, Nee J, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care. 2015;19(36):1–8.

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