Your new device- the lung ultrasound has made its way in Europe. A recent trail in CJASN discusses the value of using lung ultrasound in assessing volume status of a patient. Lung water can be used in a way in clinical practice as it is being used in critical care and cardiology to assess volume in ESRD patients. Few prior studies that have looked at the role of ESRD and lung ultrasound in clinical practice and training of fellows/faculty are here:
This new study in CJASN looked at >1000 patients pre and post HD via lung ultrasound simultaneous to standardized lung exams ( crackles ) and peripheral edema. What the investigators found was that the lung congestion by crackles, edema or a combination was inferior to ultrasound B lines in various analysis. Using the knowledge of B lines might guide us in better managing volume status in our ESRD patients.
In the editorial with it in CJASN, Dr. Rich Sherman writes “I believe that lung US will prove to be of value in improving the care of patients on dialysis . From a practical standpoint, I hope that this technique can provide us with at least one simple benefit. If a routine lung US on the previous Friday before dialysis might make these events less likely, then sign me up!”
I concur with Dr Sherman! I think Nephrologists should get familiar with the science and technology and embrace this change to help their patients. Dialysis units ( large and small) should consider carrying US machines to help guide volume exam and make clinical decisions. It will decrease hospitalizations, less radiation exposure( X rays) and hopefully less ER visits.
Image courtesy: coreem.net