PULMONARY EDEMA and ULTRASOUND

Ultrasound Can identify Pregnant Woman with Preeclampsia at Risk for Respiratory Failure

By Medimaging International staff writers
Posted on 31 Mar 2014

Image: Ultrasound image of a lung (Photo courtesy of JP Rathmell).
Ultrasound imaging of the lungs could help clinicians rapidly determine if a pregnant woman with preeclampsia is at risk for respiratory failure.

The study’s findings were published in the April 2014 issue of the journal Anesthesiology. About 60,000 women worldwide die as a result of preeclampsia, which causes severely high blood pressure. Potential complications include stroke, bleeding and excess fluid in the lungs—called pulmonary edema—which can lead to respiratory failure. The study suggests that taking a lung ultrasound can help physicians easily determine whether a woman with preeclampsia is suffering from pulmonary edema and ensure she receives the appropriate treatment.

“Lung ultrasound is fast, safe, noninvasive, and easy to use,” said Marc Leone, MD, PhD, lead author of the study and vice chair of the department of anesthesiology and critical care medicine, Hopital Nord-Marseille (France). “We found it allowed us to quickly assess whether a woman with preeclampsia had pulmonary edema and confirm the severity of the condition.”

Clinicians frequently gauge urine output to determine if a woman needs fluid administration, but the results are wrong about half of the time. “Lung ultrasound enables the medical team to identify which women really need the fluid treatment,” noted Dr. Zieleskiewicz, the study's first author.

Pulmonary edema is typically caused by heart failure, but also can be caused by lung inflammation. Researchers analyzed the use of lung ultrasound imaging, which can evaluate lung edema, is easier to use than cardiac ultrasound, and can be performed with technology typically found in maternity wards. Lung ultrasound highlights white lines mimicking comet tails, irradiating from the border of the lungs. These lines represent water in the lungs. The detection of three or more lines strongly suggests the diagnosis of pulmonary edema.

Researchers performed both cardiac and lung ultrasound scans before and after delivery in 20 women with severe preeclampsia. Five of the 20 women (25%) had pulmonary edema prior to delivery according to lung ultrasound findings, whereas 4 (20%) had the disorder according to the cardiac ultrasound. The lung ultrasound identified a patient with noncardiac pulmonary edema, which the cardiac ultrasound did not detect.

These findings, according to the researchers, could help safeguard that pregnant women with pulmonary edema not be given intravenous or excess fluids, which worsens the disorder and can lead to respiratory failure. Typically, women with pulmonary edema are treated with oxygen and drugs to lower the blood pressure or rid the body of excess fluid. In real time, lung ultrasound scanning also serves to observe improvement or worsening of pulmonary edema.