Role of Chest Ultrasound in Early Prediction of Volume Overload in Trauma Patients with Pulmonary Contusions (Cohort Study)

Abstract

Background: The lungs are frequently injured in blasts, with the edematous phase causing worsening interstitial edema and infiltration within the first 1-2 hours after injury. Point-of-care ultrasound (POCUS) and B-lines can detect fluid accumulation. The study evaluated the effectiveness of POCUS in monitoring fluid resuscitation in chest trauma patients with lung contusions to prevent volume overload.Aim of the Study: The study aimed to assess the efficacy of ultrasound in predicting volume overload in trauma patients with lung contusions.Patients and Methods: A cohort study included a total of 100 patients with chest trauma with a lung contusion. It was conducted at Assiut and Alexandria Main University Hospitals. After a thorough clinical evaluation and resuscitation, all patients were subjected to POCUS.Results: 80 (80%) patients improved without manifestations of volume overload (improved group), and 20 (20%) patients showed manifestations of volume overload (non-improved group). The mean B-line score among all patients was 24.16 ± 7.65, with a significantly higher score among the non-improved group (34.50 ± 6.24 vs. 21.58 ± 5.49). Based on volume overload severity, 12 (12%), 67 (67%), and 21 (21%) patients had mild, moderate, and severe volume overload, respectively. At a cut-off point > 27, B-line scoring has 90% sensitivity, 87.5% specificity, and 88% overall accuracy in predicting volume overload in patients with chest trauma, with an area under the curve of 0.928.Conclusion: Lung ultrasound plays a crucial role in monitoring patients with chest trauma and lung contusions. A B-line score could be utilized to predict volume overload in these patients.