Accuracy of Daily Lung Ultrasound for the Detection of Pulmonary Edema Following Subarachnoid Hemorrhage

Craig A Williamson, Ivan Co, Aditya S Pandey, B Gregory Thompson, Venkatakrishna Rajajee
Neurocritical Care 2016, 24 (2): 189-96

BACKGROUND: Early detection of pulmonary edema is vital to appropriate fluid management following subarachnoid hemorrhage (SAH). Lung ultrasound (LUS) has been shown to accurately identify pulmonary edema in patients with acute respiratory failure (ARF). Our objective was to determine the accuracy of daily screening LUS for the detection of pulmonary edema following SAH.

METHODS: Screening LUS was performed in conjunction with daily transcranial doppler for SAH patients within the delayed cerebral ischemia (DCI) risk period in our neuroICU. We reviewed records of SAH patients admitted 7/2012-5/2014 who underwent bilateral LUS on at least 5 consecutive days. Ultrasound videos were reviewed by an investigator blinded to the final diagnosis. "B+ lines" were defined as ≥3 B-lines on LUS. Two other investigators blinded to ultrasound results determined whether pulmonary edema with ARF (PE-ARF) was present during the period of evaluation on the basis of independent chart review, with a fourth investigator performing adjudication in the event of disagreement. The diagnostic accuracy of B+ lines for the detection of PE-ARF and RPE was determined.

RESULTS: Of 59 patients meeting criteria for inclusion, 21 (36%) had PE-ARF and 26 (44%) had B+ lines. Kappa for inter-rater agreement was 0.821 (p < 0.0001) for clinical diagnosis of PE-ARF between the two investigators. B+ lines demonstrated sensitivity 90% (95% CI 70-99%) and specificity 82% (66-92%), for PE-ARF. Median days from B+ lines onset to PE-ARF was 1 (IQR 0-1).

CONCLUSION: Screening LUS was a sensitive test for the detection of symptomatic pulmonary edema following SAH and may assist with fluid titration during the risk period for DCI.

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