Lung and Cardiac Ultrasound for Fluid Management in Acute Kidney Injury Patients In ICU: A Prospective Randomized Controlled Study

INTRODUCTION: Acute Kidney Injury(AKI) is a common and serious condition that affects kidney function and other organs. AKI can be caused by various factors, such as low blood flow, infection, or direct damage to the kidneys. AKI can lead to multi-organ dysfunction and high mortality. One of the challenges in treating AKI is to balance the fluid status of the patients, as both fluid overload and fluid depletion can be harmful. Ultrasound can be a useful tool to assess the fluid status and guide fluid therapy in AKI patients. AKI is a very common condition in critically ill patients admitted to ICU and it independently increases morbidity and mortality of the the patients. OBJECTIVES: Primary objective is to compare the 28 days all-cause mortality rates in control and study groups. Secondary objectives are to compare the fluid balance, P/F ratios, diuretics, length of ICU stay. MATERIALS AND METHODS: The study was carried out in the ICU of a tertiary care hospital and compared two groups of patients with acute kidney injury (AKI), who received different fluid and vasopressor management strategies. One group (control group) received standard care, while the other group (study group) received lung and cardiac ultrasound guided care. The ultrasound parameters, such as B-line score, IVC diameter, and IVC collapsibility index, were used to assess fluid status and guide fluid removal or administration. RESULTS: 22 out of 50 (44%) patients survived in study group, 15 out of 50 (30%) patients survived in the control group. Differences in mortality in study and control group were statistically not significant (p=0.147). There was a significant difference in fluid intake between the control group (Mean fluid intake of 2038ml) and in study group (mean fluid intake of 1782ml) (p= 0.02), with positive fluid balance in control group mean of 1448ml and in study group had mean 1046ml (p=0.006). There was a significant decrease in respiratory support (p=0.005), and a significant improvement in P/F ratios (p=0.01). CONCLUSION: The use of lung and cardiac ultrasound for fluid management in AKI in ICU patients shows improved outcomes in terms of mortality, fluid balance, and P/F ratios. DISCUSSION: The results of the study, such as mortality, creatinine level, p/f ratio, fluid balance, respiratory support, Glasgow Coma Scale (GCS), renal replacement therapy (RRT), and ICU length of stay. There was no significant difference in mortality between the two groups, but group 2 had better outcomes in terms of creatinine level, p/f ratio, fluid balance, respiratory support, and GCS. There was no significant difference in RRT and ICU length of stay between the two groups.