RT Journal Article SR Electronic T1 100 Serial lung ultrasonography in Malawian patients with suspected sepsis and haemodynamic compromise: findings change with intravenous fluid treatment and predict hypoxia JF Emergency Medicine Journal JO Emerg Med J FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine SP 829 OP 830 DO 10.1136/emj-2020-rcemabstracts.8 VO 37 IS 12 A1 Philip Delbridge A1 Richard Wang A1 Jamie Rylance A1 Grace Katha A1 Miriam Phiri A1 Stephen Gordon A1 Carolyn Calfee A1 Laurence Huang YR 2020 UL http://emj.bmj.com/content/37/12/829.abstract AB Aims/Objectives/Background Studies from sub-Saharan Africa have challenged conventional fluid-liberal strategies for patients with sepsis. Extravascular lung water, associated with increased mortality in sepsis, may be an important factor in these findings. The role of lung ultrasonography in guiding intravenous fluid treatment of sepsis is not yet clear, however sonographic B-lines have been shown to correlate with measures of extravascular lung water.The aim of this study was to assess, in Malawian patients with clinically suspected sepsis and haemodynamic compromise, how intravenous fluid treatment influences lung ultrasonography findings. In addition, we examined whether these findings predict the onset of hypoxia or are associated with decreased survival.Methods/Design A prospective observational cohort study was carried out of 70 patients presenting with suspected sepsis to a Malawian hospital. Eight-zone lung ultrasonography was performed at enrolment and again at 3, 6, 24, 48 and 72 hours with a B-line score calculated at each timepoint.View this table:Abstract 100 Table 1 Participant characteristicsAbstract 100 Figure 1 Box plots of cumulative intravenous fluid at each time point during the first 72 hours after enrollmentAbstract 100 Figure 2 Treatment with more IV fluid is associated with an increase in B-lines. A scatter plot of the change in B-line score by the amount of intravenous fluid given between enrollment and 3 hours after, with linear regression line and 95% confidence interval (β = 2.6, 95% CI 1.5 to 3.7, p < 0.001)Abstract 100 Figure 3 The baseline B-line score predicts the development of hypoxemia during the first 72 hours of hospitalization. A receiver operater characteristic curve illustrating how the sonographic B-line score predicts future hypoxemiaAbstract 100 Figure 4 A higher B-line score may be associated with decreased survival. Kaplan-Meier survival estimates for participants with a baseline sonographic B-line score from 0–5 compared to participants with scores > 5 (estimated hazard ratio 2.1, 95% CI 0.86 to 5.1, p = 0.11)Results/Conclusions Participants who received more intravenous fluid had more B-lines detected on lung ultrasonography. A mixed effects regression model estimated that there was approximately one additional B-line (1.01, 95% CI 0.59 – 1.43 p < 0.001) for every litre of intravenous fluid treatment. Moreover, in participants who were not hypoxic at presentation, a B-line score of greater than five was 86% sensitive and 74% specific for predicting impending hypoxia during the first 72 hours of admission. Analysis of mortality did not reach statistical significance (p = 0.11), but suggested a higher B-line score may be associated with increased risk of death.In summary, this study establishes important relationships between intravenous fluid treatment and extravascular lung water as assessed by a novel use of lung ultrasonography in a resource-limited setting.Funding U.S. National Institutes of HealthU.K. Medical Research CouncilU.K. National Institute for Health ResearchReferenceWang RJ, Katha G, Phiri M, Delbridge P, Gordon SB, Calfee CS, Huang L, Rylance J. Sonographic B-lines, fluid resuscitation, and hypoxemia in malawian patients with suspected sepsis. Am J Respir Crit Care Med 2020 Apr. doi: 10.1164/rccm.202003-0640LE.