title: [Clinical value of lung ultrasound in the late goal-directed fluid removal in critically ill patients underwent fluid resuscitation].
abstract: OBJECTIVE
  To investigate the clinical value of lung ultrasound in the late goal -directed fluid removal in critically ill patients underwent fluid resuscitation.
  
  
  METHODS
  A prospective study was conducted. Forty patients underwent fluid resuscitation were enrolled in the Department of Surgical Intensive Care Unit of The First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to June 2015. Lung and heart ultrasound were conducted for lung B-lines and left ventricular ejection fraction (EF). Serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), central venous pressure (CVP) and serum creatinine were also measured and fluid balance was recorded in all patients enrolled.
  
  
  RESULTS
  Among the 40 patients enrolled, 35 patients survived and 5 died. In patients survived, B-lines reached its peak at 12(30)h after admitted to ICU. It started to decrease instantly after the peak and reached zero at (39±34) h. A higher peak was followed with more fluids to be removed later and longer ICU stay (P<0.01). Moreover, when compared with the survivors, B-lines in death reached a higher peak[7(8) vs 3(4), P<0.01]and without the tendency to drop down. EF was lower in death than in survivor (44.5%±3.5% vs 69.2%±11.0%, P<0.05). A lower EF was found to be followed with a higher peak of B-lines. The peak time of NT-proBNP and clinical dehydration treatment were later than the peak time of B-lines in survivors.
  
  
  CONCLUSIONS
  Fluid overloading occurs in late stage after resuscitation in critically ill patients. Lung ultrasound B-lines, which is more sensitive than the NT-proBNP and CVP, could help to monitor the patient's fluid status and guide the late goal-directed fluid removal.
authors.affiliation: Department of Surgical Intensive Care Unit, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Luhao
authors.initials: L
authors.lastname: Wang
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Guan
authors.forename: Minying
authors.initials: M
authors.lastname: Chen
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
authors.forename: Xiang
authors.initials: X
authors.lastname: Si
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Jiang
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Liu
authors.forename: Zimeng
authors.initials: Z
authors.lastname: Liu
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Wu
authors.forename: Bin
authors.initials: B
authors.lastname: Ouyang
mesh_terms: D002496:Central Venous Pressure; D016638:Critical Illness; D004452:Echocardiography; D005440:Fluid Therapy; D006040:Goals; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008168:Lung; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011446:Prospective Studies; D012151:Resuscitation; D014465:Ultrasonics; D014882:Water-Electrolyte Balance
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain