The Value Of Lung Ultrasonography In Differential Diagnosis Of Pulmonary Edema

Background and Objective:Pulmonary edema is the most common clinical syndrome in emergency and ICU department with dangerous course of disease and high mortality.Although hydrostatic pulmonary edema has the similar clinical signs,symptoms and laboratory examinations as the pulmonary edema caused by ARDS,the etiology,treatment and prognosis are difference.PICCO and chest CT have high value in differential diagnosis of two types of pulmonary edema,but PICCO is a invasive examination with catheters kept in central vein and femoral artery,and It must be calibrated every 8 hours for influences of chest pressure and compliance of heart.Patients must be sent to radiology department for CT examination,and this course will take a long time and increase the risk of patients.This is why clinical is looking for an invasive,reliable,fast and repeatable method for diagnosis of pulmonary edema.Recently there are more and more reports on lung ultrasound examinations.In this paper,a further evaluation of lung ultrasound in differential diagnosis between hydrostatic pulmonary edema and ARDS pulmonary edema,and the second part will discuss the usefulness of lung ultrasonography "B" line for quantity assessment of pulmonary edema.Material and methods: 35 patients with pulmonary edema in ICU department were included from October 23,2015 to November 22,2016,and were distributed to hydrostatic pulmonary edema group and ARDS group.ARDS diagnostic criteria is in accordance with the 2012 Berlin definition of ARDS made by European society of intensive medical.ARDS group enrolled 18patients(11 men,7 women;mean age,60±10.31years),Hydrostatic pulmonary edema group enroll 17 patients(7 men,10 women;mean age,54±15.45years).All Patients of two groups were assessed by LUS and PICCO."B" line distribution characteristic,quantity of "B" lines,"B" line separation,Subpleural consolidation,pleural thickening and pleural effusion were observed by LUS.EVLW,EVLWI,PVPI,CI and CVP were measured by PICCO.A SPSS ver17.0 statistic software was used for statistic analysis.In univariate analysis t-test and Pearson chi-square test were used to compare difference between two groups among the above factors,and then,a logistics regression analysis was used among the valuable factors.The differences were statistic significant when p<0.05.Results: 1.In the univariate analysis,the distribution of "B" line in patients with pulmonary edema of ARDS was wider,pleural thickening,subpleural consolidation and "B" line separation were higher(p<0.05)while the proportion of pleural effusion with hydrostatic pulmonary edema was higher(p <0.05).2.In the multivariate analysis,"B" line distribution characteristic,pleural thickening,subpleural consolidation,"B" line separation are risk factors for ARDS,while pleural effusion is the protective factor of ARDS,and OR of B" line distribution characteristic and subpleural consolidation were 44.32 and 40.43 respectively,which were the high risk factors of ARDS.3.The quantity of B lines is height positively correlated with EVLW(R = 0.68,p <0.05),and moderate positively correlated with EVLWI and PVPI(r = 0.76,r = 0.68,p <0.05).Conclusions: 1.There were significant differences between patients with hydrostatic pulmonary edema and ARDS pulmonary edema in the LUS characteristic(Including distribution range of "B" line,subpleural consolidation,pleural thickening,"B" line separation and pleural effusion,especially the first two of the differential diagnosis.).2.LUS quantity of "B" lines is height positively correlated with PICCO EVLW,which can be used to semi-quantitative assess pulmonary edema.