Lung Ultrasound Predicts Interstitial Syndrome and Hemodynamic Profile in Parturients with Severe Preeclampsia

• Published in: Anesthesiology (Philadelphia) Vol. 120; no. 4; pp. 906 - 914
• Main Authors: ZIELESKIEWICZ, Laurent, CONTARGYRIS, Claire, BRUN, Clément, TOURET, Maxime, VELLIN, Armand, ANTONINI, François, MULLER, Laurent, BRETELLE, Florence, MARTIN, Claude, LEONE, Marc
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-04-2014
• Subjects: Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; Comorbidity; Diastole; Diseases of mother, fetus and pregnancy; Echocardiography - methods; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Hemodynamics; Humans; Lung - diagnostic imaging; Lung - physiopathology; Medical sciences; Observer Variation; Pre-Eclampsia - diagnostic imaging; Pre-Eclampsia - epidemiology; Pre-Eclampsia - physiopathology; Predictive Value of Tests; Pregnancy; Pregnancy. Fetus. Placenta; Prospective Studies; Pulmonary Edema - diagnostic imaging; Pulmonary Edema - epidemiology; Pulmonary Edema - physiopathology; Sensitivity and Specificity; Severity of Illness Index; Syndrome; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology; Pregnancy disorders; Lung; Prediction; Respiratory system; Pregnancy toxemia; Syndrome; Preeclampsia; Anesthesia; Interstitial; Hemodynamics; Predictive factor; Severe; Ultrasound
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000000102

The role of lung ultrasound has never been evaluated in parturients with severe preeclampsia. The authors' first aim was to assess the ability of lung ultrasound to detect pulmonary edema in severe preeclampsia. The second aim was to highlight the relation between B-lines and increased left ventricular end-diastolic pressures.
This prospective cohort study was conducted in a level-3 maternity during a 12-month period. Twenty parturients with severe preeclampsia were consecutively enrolled. Both lung and cardiac ultrasound examinations were performed before (n = 20) and after delivery (n = 20). Each parturient with severe preeclampsia was compared with a control healthy parturient. Pulmonary edema was determined using two scores: the B-pattern and the Echo Comet Score. Left ventricular end-diastolic pressures were assessed by transthoracic echocardiography.
Lung ultrasound detected interstitial edema in five parturients (25%) with severe preeclampsia. A B-pattern was associated to increased mitral valve early diastolic peak E (116 vs. 90 cm/s; P = 0.05) and to increased E/E' ratio (9.9 vs. 6.6; P < 0.001). An Echo Comet Score of greater than 25 predicted an increase in filling pressures (E/E' ratio >9.5) with a sensitivity and specificity of 1.00 (95% CI, 0.69 to 1.00) and 0.82 (95% CI, 0.66 to 0.92), respectively.
In parturients with severe preeclampsia, lung ultrasound detects both pulmonary edema and increased left ventricular end-diastolic pressures. The finding of a B-pattern should restrict the use of fluid. However, these preliminary results are associations from a single sample. They need to be replicated in a larger, definitive study.