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Miao J, Sy-Go JPT, Issa M, Jenad H, Manohar S, Zoghby Z, Kashani KB, Gregoire JR: Ultrasonographic Assessment of Extravascular Lung Water in Hospitalized Patients Requiring Hemodialysis: A Prospective Observational Study. Cardiorenal Medicine DOI 10.1159/000516474
Evaluation of fluid overload in patients requiring hemodialysis for ESKD or AKI can be unreliable. Bedside assessment of lung water (B lines, TBLN) or inferior vena cava diameter (IVCD) with ultrasound are both of growing interest, especially as point-of-care handheld ultrasound devices are now readily available.
Miao and colleagues compared handheld ultrasound devices to standard portable ultrasound for the assessment of TBLN and IVCD in 54 hospitalized patients requiring hemodialysis (35 with ESKD and 19 with AKI). These measurements were made before and after each dialysis session.
The two methods were not different for measuring TBLN or IVCD, but the correlations were higher for TBLN (r = 0.92) than for IVCD (r = 0.51). Evaluation of fluid volume by physical examination was unreliable. The value for TBLN decreased post-dialysis, whereas the value for IVCD did not.
This study has significant value as it suggests that handheld ultrasound devices are as reliable as standard portable ultrasound devices in evaluating extracellular lung water in hospitalized subjects undergoing hemodialysis for ESKD or AKI. Assessing IVCD seems less reliable. This is a small study and relatively few subjects had severe volume overload. It needs to be confirmed in a larger cohort, including both in- and outpatients, with a broader range of fluid volume expansion.
