Abstract: TH-PO193
Lung Ultrasonography in the Assessment of Volume Overload: An Extra Tool to Improve Patient Care and Clinical Skills in Nephrology Fellows
Session Information
- Hemodialysis and Frequent Dialysis - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Carias martinez, Karla G., Jackson Health System, Miami, Florida, United States
- Zablah, Gerardo, University of Miami, Miami, Florida, United States
- Gonzalez Montalvo, Saul N., Jackson Memorial Hospital, Miami, Florida, United States
- Punchayil narayanankutty, Naveen, Jackson Memorial Hospital, Miami, Florida, United States
- Venkat, Vasuki N., Bruce W. Carter VA Medical Center, Hialeah, Florida, United States
- Soberon, Daniel J., Bruce W. Carter VA Medical Center, Hialeah, Florida, United States
- LadinoAvellaneda, Marco A., Miami VA Medical Center/University of Miami/ Jackson Memorial Hospital, Plantation, Florida, United States
Background
Estimating euvolemia in patients with end stage renal disease (ESRD) is critical in their management. Nephrologists use their clinical judgment and skills to estimate the volume status. Lung ultrasonography (LU) is a tool that allows clinicians to have an objective evaluation of volume status. B-lines on lung ultrasound have been validated as a sign of pulmonary congestion and volume overload. This study evaluates the use of LU in the clinical assessment of volume status in the patient that is admitted to the hospital with ESRD.
Methods
Twenty patients with ESRD, admitted with volume overload were evaluated on admission with LU. Physical exam on all the patients didn’t show physical signs of volume overload, on 9 patients the chest X-ray was clear, on 8 patients the CXR showed signs of congestion and on 3 patients the CXR showed mild-moderate pulmonary edema. A LU using a GE VScan portable ultrasound was done on all the patients.
Results
B-lines were found in the 20 patients, LU was suggestive of volume overload (B-lines present). Hemodialysis/Ultrafiltration was provided for all the patients, 10 patients needed extra ultrafiltration sessions in the following days for a complete resolution of the B-lines which was evidenced with subsequent use of LU.
Conclusion
LU guided fluid management protocol improves the clinical evaluation in ESRD patients. Clinical judgment and integrated lung ultrasonography for management of volume in hemodialysis patients improves outcomes and facilities the clinical management of hypervolemia. LU is an objective tool to assess volume overload in this patient population.