الفهرس 
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Abstract
High incidence of ARDS is recorded among Burn patients reaching 24% with mortality incidence as high as 31% as conducted by Wang et al.’s study on 2021.
More than one pathophysiology can lead to lung injury and increase in extra vascular lung water in Burn patients including burn inflammatory pathway in the lungs, inhalational injury, systemic sepsis and cardiovascular failure. In addition, fluid creep as a complication of fluid management overload can occur leading to an increased extra vascular lung water.
Many tools were used to investigate extra vascular lung water. Transpulmonary thermodilution (TPTD) is now considered the gold standard quantitative tool to calculate the amount of extra vascular lung water. However, chest CT is still used as the gold standard for detection and estimation of extra vascular lung water.
Lung ultrasound as an imaging tool of radiation-free, easy to be trained on, simple to be used and no need to transfer the patient features in comparison with chest CT and chest x-ray, makes it an important tool to be studied as a lung imaging tool among burn patients in ICU who are at high risk of lung injury.
Mayr et al. conducted a study on 2022 to find the sensitivity of lung ultrasound in comparison with pulmonary vascular permeability index (PVPI) derived from transpulmonary thermodilution (TPTD) in the setting of intensive care unit. This study concluded a high sensitivity of lung Ultrasound in detection of extra vascular lung water.
In another study conducted by Baldi et al. on 2013 to investigate the accuracy of lung ultrasonography (LUS) in the quantification of lung water in critically ill patients by using quantitative computed tomography (CT) as the gold standard for the determination of lung weight, Good correlations were found between the b-line score and lung weight (p < 0.05) and density (p < 0.01).
The study was conducted in Burn ICU in Ain Shams University Hospitals after approval of the ethics committee and written patients’ consent.
It included 24 patients aged 24 – 64 years, of both Genders, suffering from severe burn upon admission to Burn ICU in Ain Shams University Hospitals with burn extent equal to or more than 20%, stayed in burn ICU for 14 days or more and showed at least once Lung ultrasound findings related to lung water capable of elevating LUS score more than zero.
Sampling Method: All critically ill severe burn patients in Burn ICU in Ain Shams University Hospitals after applying exclusion criteria were studied. 53 patients were studied until sample size was reached fulfilling inclusion and exclusion criteria.
Study procedure:
For all studied patients: demographic data (name, age, sex, weight and medical history), burn data (type of burn, burn surface area, burn to admission delay and suspicion of inhalational injury) were documented on admission. Lung ultrasound was performed every 12 hours in the first 2 days of the study and then every 24 hours during the study. Lung ultrasound was performed using 12 zone method and was determined based on four lung ultra sonographs: N = 0, B1 = 1, B2 = 2 and C = 3. The final LUS score of the patient on each time of imaging was the sum of each regional ultrasound score (ranging from 0 to 36). Chest CT was performed on admission and was repeated once lung ultrasound score is equal to or more than one. Positive chest CT for increased EVLW was documented if one or more of the following findings was observed in it (Broncho vascular bundle thickening, Interlobular septal thickening, Ground glass opacification). Chest x-ray was performed on admission and was repeated on every third day for non-intubated patients and on every day for intubated patients. Positive chest x-ray for increased EVLW was documented if one or more of the following findings was observed in it (Septal Kerley lines, Thickening of interlobar fissures, Air space opacification, Air bronchograms, Peri bronchial cuffing and perihilar haze). Clinical and Laboratory data were collected for all patients on every day of the study period and documentation was done on every third day of the study and on first day of positive LUS (PaO2/FiO2 ratio, Oxygen saturation, Respiratory rate, Body temperature). Positive clinical and laboratory data for increased EVLW was documented if one of the following changes was observed (PaO2/FiO2 ratio < 300, Oxygen saturation < 94%, Respiratory rate > 20/min). Bronchoscopy was performed once to patients with suspected inhalational injury and findings were documented and among those patients with suspected inhalational injury, administration of solumedrol as a part of medication regimen was documented. Cumulative fluid balance of the preceding days to the first day of positive lung ultrasound was calculated for every patient.
Outcomes was recorded:
The main finding is that the lung ultrasound is a sensitive tool in detection of extra vascular lung water in Burn patients with severe burn of burn surface area 20% or more of the total body surface area in intensive care unit when compared by chest CT and chest x-ray. And, by daily lung ultrasound follow up, early sensitivity of lung ultrasound in detection of extra vascular lung water in comparison with chest x-ray and clinical data is concluded.
Conclusion, our study showed that lung ultrasound is an early sensitive tool in detection of extra vascular lung water in burn patients with severe burn of burn surface area 20% or more of the total body surface area in intensive care unit.