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A Startling Conclusion: The Presence of B Lung Ultrasonography Performed by Medical Residents Did Not Lead to Less Fluid Administration
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A6805 - A Startling Conclusion: The Presence of B Lung Ultrasonography Performed by Medical Residents Did Not Lead to Less Fluid Administration
Author Block: C. Iskandir1, V. Viswanathan2, H. Bhatt3, R. C. Rajmane4; 1Internal Medicine, NYU Langone - Brooklyn, Brooklyn, NY, United States, 2NYU Langone - Brooklyn, Brooklyn, NY, United States, 3School of Medicine, St. George's University, St. George's, Grenada, 4NYU Langone - Brooklyn, New York, NY, United States.
Rationale
Fluid administration in critically ill patients is often determined by clinical impression without dynamic assessment. This retrospective study evaluates fluid administered after daily cardiac and lung ultrasonography performed in morning ICU rounds. The goal was to determine if a conservative or fluid resuscitation strategy could be predicted by lung ultrasonography.
Objective
The study aim is to determine whether fluid responsiveness on ultrasonography can impact the amount of fluid administered in critically ill patients. Lung ultrasonography was performed by medical residents and the images were interpreted during morning rounds.
Methods
8 patients underwent ultrasonography for a full 5-day work week. Patients without septic shock were excluded from the study. The patients were enrolled on day one of the study period regardless of the number of ICU days. Patients admitted with septic shock were also enrolled if they entered the ICU during the 5-day study. 27 ultrasound readings were analyzed to assess correlation with total daily fluid amount.
Results
The most common findings in this heterogeneous group of patients are A lines (74.1%) at six chest sites - right and left PLAPs and anterior upper and lower lobes - and preserved LV function (85%) in the parasternal short axis. Patients with B lines received a mean daily infusion of 2000 ± 3464 ml in contrast to 350 ± 558 ml of fluid without B.
Conclusion
There is correlation between higher fluid delivery and presence of B lines. However, data are heavily skewed by a B line patient who received the largest one-day amount of fluid – 6 liters. This patient received the bulk of fluid before B lines were appreciated during morning rounds. Nonetheless, patients with B lines received significantly less fluid than those with only A lines on subsequent days in the ICU.
Increasing the sample size will better validate this study. Another limitation is that most patients were enrolled on a fixed day at the beginning of the study week. This captured patients who had already been fluid resuscitated and were convalescing. Furthermore, IVC variability was excluded in this study, as this assessment is less validated in non-intubated patients.
Author Block: C. Iskandir1, V. Viswanathan2, H. Bhatt3, R. C. Rajmane4; 1Internal Medicine, NYU Langone - Brooklyn, Brooklyn, NY, United States, 2NYU Langone - Brooklyn, Brooklyn, NY, United States, 3School of Medicine, St. George's University, St. George's, Grenada, 4NYU Langone - Brooklyn, New York, NY, United States.
Rationale
Fluid administration in critically ill patients is often determined by clinical impression without dynamic assessment. This retrospective study evaluates fluid administered after daily cardiac and lung ultrasonography performed in morning ICU rounds. The goal was to determine if a conservative or fluid resuscitation strategy could be predicted by lung ultrasonography.
Objective
The study aim is to determine whether fluid responsiveness on ultrasonography can impact the amount of fluid administered in critically ill patients. Lung ultrasonography was performed by medical residents and the images were interpreted during morning rounds.
Methods
8 patients underwent ultrasonography for a full 5-day work week. Patients without septic shock were excluded from the study. The patients were enrolled on day one of the study period regardless of the number of ICU days. Patients admitted with septic shock were also enrolled if they entered the ICU during the 5-day study. 27 ultrasound readings were analyzed to assess correlation with total daily fluid amount.
Results
The most common findings in this heterogeneous group of patients are A lines (74.1%) at six chest sites - right and left PLAPs and anterior upper and lower lobes - and preserved LV function (85%) in the parasternal short axis. Patients with B lines received a mean daily infusion of 2000 ± 3464 ml in contrast to 350 ± 558 ml of fluid without B.
Conclusion
There is correlation between higher fluid delivery and presence of B lines. However, data are heavily skewed by a B line patient who received the largest one-day amount of fluid – 6 liters. This patient received the bulk of fluid before B lines were appreciated during morning rounds. Nonetheless, patients with B lines received significantly less fluid than those with only A lines on subsequent days in the ICU.
Increasing the sample size will better validate this study. Another limitation is that most patients were enrolled on a fixed day at the beginning of the study week. This captured patients who had already been fluid resuscitated and were convalescing. Furthermore, IVC variability was excluded in this study, as this assessment is less validated in non-intubated patients.
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