The ideal profile (increase in B-lines/delta B-lines) on lung ultrasound for diagnosing weaning induced pulmonary edema in ventilated patients | [Pakistan Armed Forces Medical Journal • 2021]

Author(s):

1. Ghulam Rasheed: Tabba Heart Institute, Karachi, Pakistan

2. Zahid Siddique Shad: Indus Hospital, Muzaffargarh, Pakistan

3. Tooba Mehreen: Shifa International Hospital, Islamabad, Pakistan

4. Nusrat Kharadi: Shifa International Hospital, Islamabad, Pakistan

5. Moazma Ramzan: Shifa International Hospital, Islamabad, Pakistan

6. Azmat Abdullah: Shifa International Hospital, Islamabad, Pakistan

7. Kiran Abbas: Jinnah Post Graduate Medical Center, Karachi, Pakistan

Abstract:

Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020. Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound. Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines =6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines =6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%. Conclusion: The study indicates that Delta-B-lines =6 diagnosed the weaning induced pulmonary edema with the best accuracy.

Page(s): 2220-2223

DOI: 10.51253/pafmj.v71i6.5691

Published: Journal: Pakistan Armed Forces Medical Journal, Volume: 71, Issue: 6, Year: 2021

Keywords:

Mechanical ventilation , Spontaneous breathing trials , Ideal profile , Weaning induced pulmonary edema , Heart failure

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