Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: an observational study.

BACKGROUND AND OBJECTIVES: The harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyse the association between the variation in TFC values (TFCd0%) at 24 h postoperatively, postoperative fluid balance, and postoperative pulmonary complications. MATERIAL AND METHODS: Prospective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and fluid balance. RESULTS: 50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3-37.5] and was correlated at r = 0.44 with the postoperative balance of 677 ml [IQR: 125.5-1,412]. Increased TFC was related to a higher risk of atelectasis (OR = 1.24) and pulmonary congestion (OR = 1.3). CONCLUSIONS: TFCd0% measured 24 h after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications.

Uso del contenido de fluido torácico para la predicción del balance hídrico y las complicaciones pulmonares postoperatorias tras cirugía abdominal mayor / Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: An observational study

Antecedentes y objetivos: Los efectos nocivos del exceso de líquidos se manifiestan frecuentemente en los pulmones. El contenido de fluido torácico (thoracic fluid content [TFC]) es una variable que proporciona el monitor por biorreactancia STARLING™, que representa el volumen total de líquido en el tórax. El objetivo es analizar la asociación entre la variación de los valores del TFC (TFCd0%) a las 24horas postoperatorias, el balance hídrico postoperatorio y las complicaciones pulmonares postoperatorias. Material y métodos: Estudio observacional prospectivo y analítico. Se incluyeron pacientes programados para cirugía abdominal mayor en un hospital universitario de tercer nivel. Fueron monitorizados durante la intervención y las 24 primeras horas postoperatorias con el monitor STARLING™, midiendo el TFC y su variación en distintas etapas del perioperatorio. Se realizaron ecografías pulmonares seriadas y se recogieron las complicaciones pulmonares postoperatorias. Se realizó una regresión logística para predecir la aparición de atelectasias y congestión pulmonar. Se calculó el coeficiente de correlación de Pearson para comprobar la asociación entre TFC y balance hídrico. Resultados: Se analizaron 50 pacientes. El TFCd0% medido en la mañana del primer día postoperatorio aumentó una mediana del 27,1% [IQR: 20,3-37,5] y se correlacionó con una r=0,44 con el balance postoperatorio de 677ml [IQR: 125,5-1.412]. El aumento del TFC se relacionó con un mayor riesgo de sufrir atelectasias (OR=1,24) y congestión pulmonar (OR=1,3). Conclusiones: El TFCd0% medido a las 24horas de la cirugía presenta una correlación moderada con el balance hídrico postoperatorio. Su incremento es un factor de riesgo para la aparición de complicaciones pulmonares postoperatorias.(AU)

Background and objectives: The harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyze the association between the variation in TFC values (TFCd0%) at 24 hours postoperatively, postoperative fluid balance, and postoperative pulmonary complications. Material and methods: Prospective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and water balance. Results: 50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3-37.5] and was correlated at r=0.44 with the postoperative balance of 677 ml [IQR: 125.5-1,412]. Increased TFC was related to a higher risk of atelectasis (OR=1.24) and pulmonary congestion (OR=1.3). Conclusions: TFCd0% measured 24 hours after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications.(AU)

Lung ultrasound in heart failure. / Ecografía pulmonar en la insuficiencia cardiaca.

The present article reviews the usefulness of lung ultrasound in the diagnosis, prognostic stratification and treatment of patients with heart failure. The article addresses the technical aspects when performing lung ultrasonography, as well as the importance of the presence of B-lines in the diagnosis and the prognostic value of pulmonary congestion. Moreover, the article reviews the most recently published evidence on the use of lung ultrasound in heart failure. Lastly, the article references the new clinical trials currently underway, including the EPICC study conducted jointly by the Heart Failure and Clinical Ultrasonography Workgroups of the Spanish Society of Internal Medicine.

Tratamiento de la cardiopatía pulmonar crónica / Treatment of the chronic pulmonary cardiopathy

La cardiopatía pulmonar crónica constituye una complicación frecuente de las neumopatías crónicas y es consecuencia, fundamentalmente, de las enfermedades respiratorias obstructivas crónicas. El tratamiento de esta afección está encaminado a disminuir la hipertensión y congestión pulmonares, así como prevenir la ocurrencia de procesos embólicos, frecuentes en quienes la padecen. A pesar de los numerosos avances de las ciencias médicas, resulta difícil establecer una terapéutica para controlar la hipertensión pulmonar. Se ofrece una información actualizada acerca del tratamiento de la cardiopatía pulmonar crónica, válida para todos los profesionales de la salud interesados en el tema(AU)

The chronic pulmonary cardiopathy constitutes a frequent complication of the chronic neumonopathies and it is fundamentally a consequence of the chronic obstructive breathing diseases. The treatment of this affection is aimed at diminishing the lung hypertension and congestion, as well as preventing the occurrence of embolic processes, frequent in those who suffered from it. In spite of the numerous advances of the medical sciences, it is difficult to establish a therapy to control the lung hypertension. An up-to-date information about the treatment of the chronic pulmonary cardiopathy, valid for all health professionals interested in the topic is provided(AU)

Tratamiento de la cardiopatía pulmonar crónica / Treatment of the chronic pulmonary cardiopathy

La cardiopatía pulmonar crónica constituye una complicación frecuente de las neumopatías crónicas y es consecuencia, fundamentalmente, de las enfermedades respiratorias obstructivas crónicas. El tratamiento de esta afección está encaminado a disminuir la hipertensión y congestión pulmonares, así como prevenir la ocurrencia de procesos embólicos, frecuentes en quienes la padecen. A pesar de los numerosos avances de las ciencias médicas, resulta difícil establecer una terapéutica para controlar la hipertensión pulmonar. Se ofrece una información actualizada acerca del tratamiento de la cardiopatía pulmonar crónica, válida para todos los profesionales de la salud interesados en el tema.

The chronic pulmonary cardiopathy constitutes a frequent complication of the chronic neumonopathies and it is fundamentally a consequence of the chronic obstructive breathing diseases. The treatment of this affection is aimed at diminishing the lung hypertension and congestion, as well as preventing the occurrence of embolic processes, frequent in those who suffered from it. In spite of the numerous advances of the medical sciences, it is difficult to establish a therapy to control the lung hypertension. An up-to-date information about the treatment of the chronic pulmonary cardiopathy, valid for all health professionals interested in the topic is provided.