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Soattin, Marta (2013) Valutazione dello stato volemico nel paziente emodializzato. [Ph.D. thesis]

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Abstract (english)

Introduction: Fluid balance is important in patients undergoing haemodialysis because both fluid excess and excessive fluid removal increase mortality. “Dry” weight is usually estimated from clinical measurement or by bioimpedance spectroscopy (BIS). Ultrasonography (US) of inferior vena cava is used to estimate central venous pressure, while lung US, by counting B-lines artefact, is used to assess extravascular lung water. Aim of this study was to clarify the respective merit of these US techniques in assessing volume status during haemodialysis
Patients and Methods: In 130 consecutive patients undergoing haemodialysis we estimated dry weight, performed BIS, counted B lines by chest ultrasound and measured inferior vena cava (IVC) diameters by ultrasound. Measurements were done before and immediately after haemodialysis.
Results: after dialysis body weight decreased 2,30±0,9 (SD) Kg, the total number of B-lines decreased from 3,3 to 1,6 (p<0,000), the diameter of the inferior vena cava decreased from 1,67 to 1,30 cm at end-expirium (p<0,000) and from 1,12 to 0,87 cm at end-inspirium (p<0,000). The reduction of B lines correlated with weight loss (p <0,000). On the opposite vena cava measurements did not correlate with fluid removal. At end dialysis both the total number of B lines and vena cava measurements correlated significantly with bioimpedance residual weight.
Conclusions: The reduction of B line number correlated with fluid loss due to haemodialysis, despite the small pre-dialysis number of B lines in the population studied, confirming that lung ultrasound can identify small changes in extra-vascular lung water. On the opposite inferior vena cava diameter measured by ultrasound, does not appear to reflect the extent of fluid removal at early times after dialysis. Clinically estimated dry weight had a poor correlation with both bioimpedance and ultrasound techniques. These data indicate that lung echography may have a role in managing patients undergoing hemodialysis, but more work is needed to clarify its impact on patient care and to better define the population of patients most likely to benefit from it.

Abstract (italian)

Introduzione: Il bilancio dei fluidi è di fondamentale importanza nei pazienti sottoposti ad emodialisi poichè sia l’eccessiva rimozione di liquidi che il loro eccesso è causa di aumentata mortalità in questi pazienti. Il peso secco è generalmente stimato tramite parametri clinici o tecniche bioimpedenziometriche (BIS). L’ecografia della cava inferiore è utilizzata per stimare la pressione venosa centrale mentre l’ecografia polmonare, tramite l’individuazione delle linee B polmonari, per valutare l’acqua libera extravascolare polmonare. Il nostro studio ha lo scopo di chiarire l’utilità delle tecniche ecografiche nel valutare lo stato d’idratazione del paziente durante la seduta di emodialisi.
Pazienti e metodi: di 130 pazienti consecutivi in trattamento emodialitico trisettimanale è stato stimato il peso secco, eseguita una bioimpedenziometria spettroscopica (BIS), contate le linee B mediante ecografia polmonare e misurati i diametri della vena cava mediante ultrasonografia. Le misurazioni sono state eseguite immediatamente prima e dopo la seduta dialitica.
Risultati: dopo la dialisi il calo ponderale è stato pari a 2.3±0.9 (SD) kg. Il numero di linee B è diminuito da 3,3 a 1,6 (p<0,000), i diametri cavali sono diminuiti da 1,67 a 1,30 (p<0,000) alla fine dell’espirio e da 1,12 a 0,87 (p<0,000) alla fine dell’inspirio. La riduzione delle linee B correla con la riduzione di peso (p<0,000). Al contrario, le misurazioni della vena cava non correlavano con la rimozione di liquidi. Alla fine della dialisi il numero totale di linee B correlava con il peso residuo stimato con la bioimpedenza (p <0,000) cosi come correlavano i diametri cavali post-dialisi in espirio (p 0,008) ed in inspirio (p 0,05).
Conclusioni: la riduzione del numero di linee B correla con la perdita di liquidi ottenuta con l’emodialisi, nonostante il loro numero esiguo alla rilevazione pre-dialisi nella popolazione valutata, confermando che l’ecografia polmonare può identificare anche piccole variazioni dell’acqua libera extravascolare polmonare. Al contrario, la misurazione ecografia dei diametri della vena cava inferiore non sembra riflettere l'entità dei fluidi rimossi nelle fasi immediatamente successive alla dialisi. La stima del peso secco ricavata dai parametri clinici sembra avere scarsa correlazione sia con i dati impedenziometrici che con le tecniche ecografiche. Questi dati indicano che l’ecografia polmonare possa avere un ruolo nella gestione del paziente sottoposto ad emodialisi, ma ulteriori studi sono necessari per chiarire il suo impatto sulla cura del paziente e per meglio definire la tipologia dei pazienti che più ne possano beneficiare.

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EPrint type:Ph.D. thesis
Tutor:Baritussio, Aldo
Ph.D. course:Ciclo 25 > Scuole 25 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > FISIOPATOLOGIA CLINICA E SCIENZE NEFROLOGICHE
Data di deposito della tesi:24 January 2013
Anno di Pubblicazione:January 2013
Key Words:ecografia polmonare/lung ultrasound; dialisi/dialysis
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/09 Medicina interna
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari
Codice ID:5483
Depositato il:11 Oct 2013 15:05
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